Datasets:

Jingmei

/

Pandemic_Wiki

like 0

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Paul_Allen/html

Paul Allen

Entrepreneur investor philanthropist programmer researcher film producer sports executive Paul Gardner Allen (January 21, 1953 – October 15, 2018) was an American businessman, computer programmer, researcher, investor, film producer, explorer, and philanthropist. He is best known for co-founding Microsoft Corporation with his childhood friend Bill Gates in 1975, which helped spark the microcomputer revolution of the 1970s and 1980s. Allen was ranked as the 44th-wealthiest person in the world by Forbes with an estimated net worth of $20.3 billion at the time of his death in October 2018. Allen quit from day-to-day work at Microsoft in early 1983 after a Hodgkin lymphoma diagnosis, remaining on its board as vice-chairman. He and his sister, Jody Allen , founded Vulcan Inc. in 1986, a privately held company that managed his business and philanthropic efforts. He had a multi-billion dollar investment portfolio, including technology and media companies, scientific research, real estate holdings, private space flight ventures, and stakes in other sectors. He owned the Seattle Seahawks of the National Football League and the Portland Trail Blazers of the National Basketball Association , and was part-owner of the Seattle Sounders FC of Major League Soccer . Under the helm of Allen, the Seahawks won Super Bowl XLVIII and made it to two other Super Bowls ( XL and XLIX ). In 2000 he resigned from his position on Microsoft's board and assumed the post of senior strategy advisor to the company's management team. Allen founded the Allen Institutes for Brain Science , Artificial Intelligence , and Cell Science , as well as companies like Stratolaunch Systems and Apex Learning . He gave more than $2 billion to causes such as education, wildlife and environmental conservation, the arts, healthcare, and community services. In 2004, he funded the first crewed private spaceplane with SpaceShipOne . He received numerous awards and honors, and was listed among the Time 100 Most Influential People in the World in 2007 and 2008. Allen was diagnosed with non-Hodgkin lymphoma in 2009. He died of septic shock related to cancer on October 15, 2018, at the age of 65. Shortly after his death, in April 2019, the Allen-funded Stratolaunch first flew and became the largest aircraft in history by wingspan . Allen was born on January 21, 1953, in Seattle , Washington, to Kenneth Sam Allen (a librarian) and Edna Faye (née Gardner) Allen (a fourth-grade teacher). From 1965 to 1971 he attended Lakeside School , a private school in Seattle where he befriended Bill Gates , with whom he shared an enthusiasm for computers. They used Lakeside's Teletype terminals to develop their programming skills on several time-sharing computer systems. They also used the laboratory of the Computer Science Department of the University of Washington for personal research and computer programming until they were banned in 1971 for abusing their privileges. Gates and Allen joined with Ric Weiland and Gates' childhood best friend and first collaborator, Kent Evans, to form the Lakeside Programming Club and find bugs in Computer Center Corporation 's software, in exchange for extra computer time. In 1972, after Evans' sudden death due to a mountain climbing accident, Gates turned to Allen for help finishing an automated class scheduling system for Lakeside. They then formed Traf-O-Data to make traffic counters based on the Intel 8008 processor. According to Allen, he and Gates would go dumpster diving during their teenage years for computer program code. Allen achieved a perfect SAT score of 1600 and went to Washington State University , where he joined the Phi Kappa Theta fraternity. He dropped out of college after two years to work as a programmer for Honeywell in Boston near Harvard University where Gates was enrolled. Allen convinced Gates to drop out of Harvard in order to found Microsoft . Allen and Gates formed Microsoft in 1975 in Albuquerque, New Mexico , and began marketing a BASIC programming language interpreter, with their first employee being high school friend and collaborator Ric Weiland . Allen came up with the name of "Micro-Soft", a combination of "microcomputer" and "software". Microsoft committed to delivering a disk operating system ( DOS ) to IBM for the original IBM PC in 1980, although they had not yet developed one, and Allen spearheaded a deal for Microsoft to purchase QDOS (Quick and Dirty Operating System) written by Tim Paterson who was employed at Seattle Computer Products . As a result of this transaction, Microsoft secured a contract to supply the DOS that ran on IBM's PC line, which opened the door to Allen's and Gates' wealth and success. The company restructured on June 25, 1981, to become an incorporated business in its home state of Washington (with a further change of its name to "Microsoft Corporation, Inc."). As part of the restructuring, Gates became president of the company and chairman of the board, and Allen became executive vice president and vice chairman. The relationship between Allen and Gates became strained as they argued even over small things. Allen effectively left Microsoft in 1982 after being diagnosed with Hodgkin's lymphoma , though he remained on the board of directors as vice chairman. Gates reportedly asked Allen to give him some of his shares to compensate for the higher amount of work that Gates was doing. According to Allen, Gates said that he "did almost everything on BASIC " and the company should be split 60–40 in his favor. Allen agreed to this arrangement, which Gates later renegotiated to 64–36. In 1983, Gates tried to buy Allen out at $5 per share, but Allen refused and left the company with his shares intact; this made him a billionaire when Microsoft went public. Gates later repaired his relationship with Allen, and the two men donated $2.2 million to their childhood school Lakeside in 1986. They remained friends for the rest of Allen's life. Allen resigned from his position on the Microsoft board of directors on November 9, 2000, but he remained as a senior strategy advisor to the company's executives. In January 2014, he still held 100 million shares of Microsoft. Allen confirmed that he was the sole investor behind aerospace engineer and entrepreneur Burt Rutan 's SpaceShipOne suborbital commercial spacecraft on October 4, 2004. The craft was developed and flown by Mojave Aerospace Ventures , which was a joint venture between Allen and Rutan's aviation company, Scaled Composites . SpaceShipOne climbed to an altitude of 367,442 feet (111,996 m) over the Mojave Air and Space Port and was the first privately funded effort to successfully put a civilian in suborbital space. It won the Ansari X Prize competition and received the $10 million prize. On December 13, 2011, Allen announced the creation of Stratolaunch Systems , based at the Mojave Air and Space Port . The Stratolaunch is a proposed orbital launch system consisting of a dual-bodied, 6-engine jet aircraft, capable of carrying a rocket to high altitude; the rocket would then separate from its carrier aircraft and fire its own engines to complete its climb into orbit. If successful, this project would be the first wholly privately funded space transport system. Stratolaunch, which is partnering with Orbital ATK and Scaled Composites, is intended to launch in inclement weather, fly without worrying about the availability of launch pads and to operate from different locations. Stratolaunch plans to ultimately host six to ten missions per year. On April 13, 2015, Vulcan Aerospace was announced. It is the company within Allen's Vulcan Inc. that plans and executes projects to shift how the world conceptualizes space travel through cost reduction and on-demand access. On April 13, 2019, the Stratolaunch aircraft made its maiden flight, reaching 15,000 ft (4,600 m) and 165 kn (305 km/h) in a 2 h 29 min flight. Stratolaunch CEO Jean Floyd offered this comment: "We dedicate this day to the man who inspired us all to strive for ways to empower the world's problem-solvers, Paul Allen. Without a doubt, he would have been exceptionally proud to see his aircraft take flight". Upon its flight, the airplane became the largest in history by wingspan . As of the end of May 2019, Stratolaunch Systems Corporation had ceased operations. Allen's Vulcan Real Estate division offers development and portfolio management services, and is known for the redevelopment of the South Lake Union neighborhood immediately north of downtown Seattle. Vulcan has developed 6.3 million square feet (590,000 m 2 ) of new residential, office, retail and biotechnology research space, and has a total development capacity of 10,000,000 sq ft (930,000 m 2 ) . Vulcan advocated for the Seattle Streetcar line known as South Lake Union Streetcar , which runs from Seattle's Westlake Center to the south end of Lake Union. In 2012, The Wall Street Journal called Allen's South Lake Union investment "unexpectedly lucrative" and one that led to his firm selling a 1,800,000-square-foot (170,000 m 2 ) office complex to Amazon.com for US$1.16 billion, one of the most expensive office deals ever in Seattle. "It's exceeded my expectations", Allen said of the South Lake Union development. Allen purchased the Portland Trail Blazers NBA team in 1988 from California real estate developer Larry Weinberg for $70 million. He was instrumental in the development and funding of the Moda Center (previously known as the Rose Garden), the arena where the Blazers play. He purchased the arena on April 2, 2007, and stated that this was a major milestone and a positive step for the franchise. The Allen-owned Trail Blazers reached the playoffs 19 times including the NBA Finals in 1990 and 1992 . According to Forbes , the Blazers were valued at $2.09 billion in 2021 and ranked No. 13 out of 30 NBA teams. Allen purchased the National Football League 's Seattle Seahawks in 1997 from owner Ken Behring , who had attempted to move the team to southern California the previous year . Herman Sarkowsky, a former Seahawks minority owner, told The Seattle Times about Allen's decision to buy the team, "I'm not sure anybody else in this community would have done what [Allen] did." In 2002, the team moved into Seahawks Stadium (now known as Lumen Field ), after Allen invested into the upgrade of the stadium. Acquired for US$200 million in 1997, the Seahawks were valued at $1.33 billion in August 2014 by Forbes , which says the team has "one of the most rabid fan bases in the NFL". Under the helm of Allen, the Seahawks made the Super Bowl three times following NFC Championship victories ( 2005 , 2013 , 2014 ), and won Super Bowl XLVIII in February 2014. Allen's Vulcan Sports & Entertainment is part of the ownership team of the Seattle Sounders FC, a Major League Soccer (MLS) franchise that began play in 2009 at CenturyLink Field , a stadium which was also controlled by Allen. The ownership team also includes film producer Joe Roth , businessman Adrian Hanauer , and comedian Drew Carey . The Sounders sold out every home game during its first season, setting a new MLS record for average match attendance. Allen and his sister, Jody Allen , together were the owners and executive producers of Vulcan Productions , a television and film production company headquartered in Seattle within the entertainment division of Vulcan Inc. Their films have received various recognition, ranging from a Peabody Award to Independent Spirit Awards , Grammys and Emmys . In 2014 alone, Allen's film, We The Economy, won 12 awards including a Webby award for best Online News & Politics Series. The films have also been nominated for Golden Globes and Academy Awards among many others. Vulcan Productions' films and documentary projects include Far from Heaven (2002), Hard Candy (2005), Rx for Survival: A Global Health Challenge (2005), Where God Left His Shoes (2006), Judgment Day: Intelligent Design on Trial (2007), This Emotional Life (2010), We The Economy (2014) Racing Extinction (2015) and Oscar-nominated Body Team 12 (2015). In 2013, Vulcan Productions co-produced the Richard E. Robbins-directed film Girl Rising which tells the stories of girls from different parts of the world who seek an education. Globally, over 205 million households watched Girl Rising during the CNN premier, and over 4 million people have engaged with Girl Rising through websites and social media. Through the associated 10×10 program, over $2.1 million has been donated to help girls receive an education worldwide. Also in 2013, Vulcan Productions signed on as a producing partner of Pandora's Promise , a documentary about nuclear power, directed by Oscar-nominated director Robert Stone . It was released on CNN in November 2013. A variety of college and private screenings as well as panel discussions have been hosted throughout the country. Allen confirmed that he was the sole investor behind aerospace engineer and entrepreneur Burt Rutan 's SpaceShipOne suborbital commercial spacecraft on October 4, 2004. The craft was developed and flown by Mojave Aerospace Ventures , which was a joint venture between Allen and Rutan's aviation company, Scaled Composites . SpaceShipOne climbed to an altitude of 367,442 feet (111,996 m) over the Mojave Air and Space Port and was the first privately funded effort to successfully put a civilian in suborbital space. It won the Ansari X Prize competition and received the $10 million prize. On December 13, 2011, Allen announced the creation of Stratolaunch Systems , based at the Mojave Air and Space Port . The Stratolaunch is a proposed orbital launch system consisting of a dual-bodied, 6-engine jet aircraft, capable of carrying a rocket to high altitude; the rocket would then separate from its carrier aircraft and fire its own engines to complete its climb into orbit. If successful, this project would be the first wholly privately funded space transport system. Stratolaunch, which is partnering with Orbital ATK and Scaled Composites, is intended to launch in inclement weather, fly without worrying about the availability of launch pads and to operate from different locations. Stratolaunch plans to ultimately host six to ten missions per year. On April 13, 2015, Vulcan Aerospace was announced. It is the company within Allen's Vulcan Inc. that plans and executes projects to shift how the world conceptualizes space travel through cost reduction and on-demand access. On April 13, 2019, the Stratolaunch aircraft made its maiden flight, reaching 15,000 ft (4,600 m) and 165 kn (305 km/h) in a 2 h 29 min flight. Stratolaunch CEO Jean Floyd offered this comment: "We dedicate this day to the man who inspired us all to strive for ways to empower the world's problem-solvers, Paul Allen. Without a doubt, he would have been exceptionally proud to see his aircraft take flight". Upon its flight, the airplane became the largest in history by wingspan . As of the end of May 2019, Stratolaunch Systems Corporation had ceased operations. Allen's Vulcan Real Estate division offers development and portfolio management services, and is known for the redevelopment of the South Lake Union neighborhood immediately north of downtown Seattle. Vulcan has developed 6.3 million square feet (590,000 m 2 ) of new residential, office, retail and biotechnology research space, and has a total development capacity of 10,000,000 sq ft (930,000 m 2 ) . Vulcan advocated for the Seattle Streetcar line known as South Lake Union Streetcar , which runs from Seattle's Westlake Center to the south end of Lake Union. In 2012, The Wall Street Journal called Allen's South Lake Union investment "unexpectedly lucrative" and one that led to his firm selling a 1,800,000-square-foot (170,000 m 2 ) office complex to Amazon.com for US$1.16 billion, one of the most expensive office deals ever in Seattle. "It's exceeded my expectations", Allen said of the South Lake Union development. Allen purchased the Portland Trail Blazers NBA team in 1988 from California real estate developer Larry Weinberg for $70 million. He was instrumental in the development and funding of the Moda Center (previously known as the Rose Garden), the arena where the Blazers play. He purchased the arena on April 2, 2007, and stated that this was a major milestone and a positive step for the franchise. The Allen-owned Trail Blazers reached the playoffs 19 times including the NBA Finals in 1990 and 1992 . According to Forbes , the Blazers were valued at $2.09 billion in 2021 and ranked No. 13 out of 30 NBA teams. Allen purchased the National Football League 's Seattle Seahawks in 1997 from owner Ken Behring , who had attempted to move the team to southern California the previous year . Herman Sarkowsky, a former Seahawks minority owner, told The Seattle Times about Allen's decision to buy the team, "I'm not sure anybody else in this community would have done what [Allen] did." In 2002, the team moved into Seahawks Stadium (now known as Lumen Field ), after Allen invested into the upgrade of the stadium. Acquired for US$200 million in 1997, the Seahawks were valued at $1.33 billion in August 2014 by Forbes , which says the team has "one of the most rabid fan bases in the NFL". Under the helm of Allen, the Seahawks made the Super Bowl three times following NFC Championship victories ( 2005 , 2013 , 2014 ), and won Super Bowl XLVIII in February 2014. Allen's Vulcan Sports & Entertainment is part of the ownership team of the Seattle Sounders FC, a Major League Soccer (MLS) franchise that began play in 2009 at CenturyLink Field , a stadium which was also controlled by Allen. The ownership team also includes film producer Joe Roth , businessman Adrian Hanauer , and comedian Drew Carey . The Sounders sold out every home game during its first season, setting a new MLS record for average match attendance. Allen purchased the Portland Trail Blazers NBA team in 1988 from California real estate developer Larry Weinberg for $70 million. He was instrumental in the development and funding of the Moda Center (previously known as the Rose Garden), the arena where the Blazers play. He purchased the arena on April 2, 2007, and stated that this was a major milestone and a positive step for the franchise. The Allen-owned Trail Blazers reached the playoffs 19 times including the NBA Finals in 1990 and 1992 . According to Forbes , the Blazers were valued at $2.09 billion in 2021 and ranked No. 13 out of 30 NBA teams. Allen purchased the National Football League 's Seattle Seahawks in 1997 from owner Ken Behring , who had attempted to move the team to southern California the previous year . Herman Sarkowsky, a former Seahawks minority owner, told The Seattle Times about Allen's decision to buy the team, "I'm not sure anybody else in this community would have done what [Allen] did." In 2002, the team moved into Seahawks Stadium (now known as Lumen Field ), after Allen invested into the upgrade of the stadium. Acquired for US$200 million in 1997, the Seahawks were valued at $1.33 billion in August 2014 by Forbes , which says the team has "one of the most rabid fan bases in the NFL". Under the helm of Allen, the Seahawks made the Super Bowl three times following NFC Championship victories ( 2005 , 2013 , 2014 ), and won Super Bowl XLVIII in February 2014. Allen's Vulcan Sports & Entertainment is part of the ownership team of the Seattle Sounders FC, a Major League Soccer (MLS) franchise that began play in 2009 at CenturyLink Field , a stadium which was also controlled by Allen. The ownership team also includes film producer Joe Roth , businessman Adrian Hanauer , and comedian Drew Carey . The Sounders sold out every home game during its first season, setting a new MLS record for average match attendance. Allen and his sister, Jody Allen , together were the owners and executive producers of Vulcan Productions , a television and film production company headquartered in Seattle within the entertainment division of Vulcan Inc. Their films have received various recognition, ranging from a Peabody Award to Independent Spirit Awards , Grammys and Emmys . In 2014 alone, Allen's film, We The Economy, won 12 awards including a Webby award for best Online News & Politics Series. The films have also been nominated for Golden Globes and Academy Awards among many others. Vulcan Productions' films and documentary projects include Far from Heaven (2002), Hard Candy (2005), Rx for Survival: A Global Health Challenge (2005), Where God Left His Shoes (2006), Judgment Day: Intelligent Design on Trial (2007), This Emotional Life (2010), We The Economy (2014) Racing Extinction (2015) and Oscar-nominated Body Team 12 (2015). In 2013, Vulcan Productions co-produced the Richard E. Robbins-directed film Girl Rising which tells the stories of girls from different parts of the world who seek an education. Globally, over 205 million households watched Girl Rising during the CNN premier, and over 4 million people have engaged with Girl Rising through websites and social media. Through the associated 10×10 program, over $2.1 million has been donated to help girls receive an education worldwide. Also in 2013, Vulcan Productions signed on as a producing partner of Pandora's Promise , a documentary about nuclear power, directed by Oscar-nominated director Robert Stone . It was released on CNN in November 2013. A variety of college and private screenings as well as panel discussions have been hosted throughout the country. Allen gave more than $2 billion towards the advancement of science, technology, education, wildlife conservation, the arts, and community services in his lifetime. The Paul G. Allen Family Foundation, which he founded with his sister Jody, was established to administer a portion of Allen's philanthropic contributions. Since its formation, the foundation has given more than $494 million to over 1,500 nonprofits; and, in 2010, Allen became a signatory of The Giving Pledge , promising to give at least half of his fortune to philanthropic causes. Allen received commendations for his philanthropic commitments including the Andrew Carnegie Medal of Philanthropy and Inside Philanthropy ' s "Philanthropist of the Year". In September 2003, Allen launched the Allen Institute for Brain Science with a $100 million contribution dedicated to understanding how the human brain works. In total, Allen donated $500 million to the institute, making it his single largest philanthropic recipient. Since its launch, the Allen Institute for Brain Science has taken a Big Science and open science approach to tackle projects. The institute makes research tools available to the scientific community using an open data model. Some of the institute's projects include the Allen Mouse Brain Atlas , Allen Human Brain Atlas and the Allen Mouse Brain Connectivity Atlas. The Allen Institute is also helping to advance and shape the White House 's BRAIN Initiative as well as the Human Brain Project . Founded in 2014, the Allen Institute for Artificial Intelligence (AI2)'s main focus is to research and engineer artificial intelligence . The institute is modeled after the Allen Institute for Brain Science and led by researcher and professor, Dr. Oren Etzioni . AI2 has undertaken four main projects, Aristo, Semantic Scholar , Euclid, and Plato. As of 2015 [ update ] Project Aristo is working to build an AI system capable of passing an 8th-grade science exam. In December 2014, Allen committed $100 million to create the Allen Institute for Cell Science in Seattle. The institute is investigating and creating a virtual model of cells in the hope of bringing forth treatment of different diseases. Like the institutes before it, all data generated and tools developed will be made publicly available online. Launched in 2016 with a $100 million commitment, The Paul G. Allen Frontiers Group aims to discover and support ideas at the frontier of bioscience in an effort to accelerate the pace of discovery. The group will target scientists and research areas that "some might consider out-of-the-box at the very edges of knowledge". Allen launched the Allen Distinguished Investigators Awards (ADI) in 2010 to support scientists pursuing early-stage research projects who often have difficulty securing funding from traditional sources. Allen donated the seed money to build SETI 's Allen Telescope Array , eventually contributing $30 million to the project. The Paul Allen's flower fly was named in recognition of his contributions to Dipterology . Allen provided more than $7 million to fund a census of elephant populations in Africa, the largest such endeavour since the 1970s. The Great Elephant Census team flew over 20 countries to survey African savannah elephants. The survey results were published in 2015 and showed rapid rates of decline which were accelerating. He began supporting the University of British Columbia 's Sea Around Us Project in 2014 to improve data on global fisheries as a way to fight illegal fishing . Part of his $2.6 million in funding went towards the creation of FishBase , an online database about adult finfish. Allen funded the Global FinPrint initiative, launched in July 2015, a three-year survey of sharks and rays in coral reef areas. The survey is the largest of its kind and designed to provide data to help conservation programs. Allen backed Washington state initiative 1401 to prohibit the purchase, sale and distribution of products made from 10 endangered species including elephants, rhinos, lions, tigers, leopards, cheetahs, marine turtles, pangolins, sharks and rays. The initiative gained enough signatures to be on the state's ballot on November 3, 2015, and passed. Alongside the United States Department of Transportation (USDOT), Allen and Vulcan Inc. launched the Smart City Challenge, a contest inviting American cities to transform their transportation systems. Created in 2015 with the USDOT's $40 million commitment as well as $10 million from Allen's Vulcan Inc., the challenge aims to create a first-of-its-kind modern city that will demonstrate how cities can improve quality of life while lowering greenhouse gas emissions. The winning city was Columbus, Ohio . As a member of the International SeaKeepers Society , Allen hosted its proprietary SeaKeeper 1000TM oceanographic and atmospheric monitoring system on all three of his megayachts. Allen funded the building of microgrids , which are small-scale power grids that can operate independently, in Kenya, to help promote reusable energy and empower its businesses and residents. He was an early investor in the Mawingu Networks, a wireless and solar-powered Internet provider which aims to connect rural Africa with the world, and Off Grid Electric, a company focused on providing solar energy to people in emerging nations. In 2014, Allen pledged at least $100 million toward the fight to end the Ebola virus epidemic in West Africa , making him the largest private donor in the Ebola crisis. He also created a website called TackleEbola.org as a way to spread awareness and serve as a vehicle for donors to fund projects in need. The site highlighted organizations working to stop Ebola that Allen supported, such as International Red Cross and Red Crescent Movement , Médecins Sans Frontières , Partners in Health , UNICEF and World Food Program USA . On April 21, 2015, Allen brought together key leaders in the Ebola fight at the Ebola Innovation Summit in San Francisco. The summit aimed to share key learnings and reinforce the need for continued action and support to reduce the number of Ebola cases to zero, which was achieved in January 2016. In October 2015, the Paul G. Allen Family Foundation announced it would award seven new grants totaling $11 million to prevent future widespread outbreaks of the virus. In 2012, along with his research team and the Royal Navy , Allen attempted to retrieve the ship's bell from HMS Hood , which sank in the Denmark Strait during World War II, but the attempt failed due to poor weather. On August 7, 2015, they tried again and recovered the bell in very good condition. It was restored and put on display in May 2016 in the National Museum of the Royal Navy, Portsmouth , in remembrance of the 1,415 crewmen lost. Since 2015, Allen funded the research ship RV Petrel , which he purchased in 2016. The project team aboard Petrel was responsible for locating the Japanese battleship Musashi in 2015. In 2017, at Allen's direction, Petrel found USS Indianapolis , USS Ward , the wrecks of the Battle of Surigao Strait and the Battle of Ormoc Bay . In 2018, Petrel found a lost US Navy C-2A Greyhound aircraft in the Philippine Sea, USS Lexington in the Coral Sea and the USS Juneau off the coast of the Solomon Islands . Allen established non-profit community institutions to display his collections of historic artifacts. These include: An active art collector, Allen gifted more than $100 million to support the arts. On October 15, 2012, the Americans for the Arts gave Allen the Eli and Edythe Broad Award for Philanthropy in the Arts. Allen loaned out more than 300 pieces from his private art collection to 47 different venues. The original 541-page typescript of Bram Stoker 's novel Dracula was in his collection at one point. In 2013, Allen sold Barnett Newman 's Onement VI (1953) at Sotheby's in New York for $43.8 million, then the record for a work by the abstract artist. In 2015, Allen founded the Seattle Art Fair, a four-day event with 60-plus galleries from around the world including the participation of the Gagosian Gallery , David Zwirner . The event drew thousands and inspired other satellite fairs throughout the city. In August 2016, Allen announced the launch of Upstream Music Fest + Summit, an annual festival fashioned after South by Southwest . Held in Pioneer Square , the first festival took place in May 2017. It was cancelled in 2019 following Allen's death in 2018. In November 2022, Allen's art collection was auctioned at Christie's New York . It was the biggest sale in art auction history, surpassing $1.5 billion in sales. Six works sold for more than $100 million: Seurat 's Les Poseuses Ensemble (Petite version) , ($149 million, with fees); Paul Cézanne 's 1888-90 La Montagne Sainte-Victoire ($138 million); van Gogh's Verger avec cyprès ($117 million); and Gustav Klimt 's 1903 Birch Forest ($105 million). The auction also included paintings by Botticelli , David Hockney , Roy Lichtenstein , Edward Hopper , Andy Warhol , Jasper Johns and Jan Brueghel the Younger . Proceeds from the auction benefitted undisclosed philanthropies. In 1989, Allen donated $2 million to the University of Washington to construct the Allen Library, which was named after his father Kenneth S. Allen, a former associate director of the University of Washington library system. In the same year, Allen donated an additional $8 million to establish the Kenneth S. Allen Library Endowment. In 2012, the endowment was renamed the Kenneth S. and Faye G. Allen Library Endowment after Allen's mother (a noted bibliophile) died. In 2002, Allen donated $14 million to the University of Washington to construct the Paul G. Allen Center for Computer Science and Engineering. The building was dedicated in October 2003. In 2010, Allen announced a gift of $26 million to build the Paul G. Allen School of Global Animal Health at Washington State University , his alma mater. The gift was the largest private donation in the university's history. In 2016, Allen pledged a $10 million donation over four years for the creation of the Allen Discovery Centers at Tufts University and Stanford University . The centers would fund research that would read and write the morphogenetic code. Over eight years the donation could be as much as $20 million. In 2017, Allen donated $40 million (with an additional $10 million from Microsoft) to reorganize the University of Washington's Computer Science and Engineering department into the Paul G. Allen School of Computer Science and Engineering. In September 2003, Allen launched the Allen Institute for Brain Science with a $100 million contribution dedicated to understanding how the human brain works. In total, Allen donated $500 million to the institute, making it his single largest philanthropic recipient. Since its launch, the Allen Institute for Brain Science has taken a Big Science and open science approach to tackle projects. The institute makes research tools available to the scientific community using an open data model. Some of the institute's projects include the Allen Mouse Brain Atlas , Allen Human Brain Atlas and the Allen Mouse Brain Connectivity Atlas. The Allen Institute is also helping to advance and shape the White House 's BRAIN Initiative as well as the Human Brain Project . Founded in 2014, the Allen Institute for Artificial Intelligence (AI2)'s main focus is to research and engineer artificial intelligence . The institute is modeled after the Allen Institute for Brain Science and led by researcher and professor, Dr. Oren Etzioni . AI2 has undertaken four main projects, Aristo, Semantic Scholar , Euclid, and Plato. As of 2015 [ update ] Project Aristo is working to build an AI system capable of passing an 8th-grade science exam. In December 2014, Allen committed $100 million to create the Allen Institute for Cell Science in Seattle. The institute is investigating and creating a virtual model of cells in the hope of bringing forth treatment of different diseases. Like the institutes before it, all data generated and tools developed will be made publicly available online. Launched in 2016 with a $100 million commitment, The Paul G. Allen Frontiers Group aims to discover and support ideas at the frontier of bioscience in an effort to accelerate the pace of discovery. The group will target scientists and research areas that "some might consider out-of-the-box at the very edges of knowledge". Allen launched the Allen Distinguished Investigators Awards (ADI) in 2010 to support scientists pursuing early-stage research projects who often have difficulty securing funding from traditional sources. Allen donated the seed money to build SETI 's Allen Telescope Array , eventually contributing $30 million to the project. The Paul Allen's flower fly was named in recognition of his contributions to Dipterology . Allen provided more than $7 million to fund a census of elephant populations in Africa, the largest such endeavour since the 1970s. The Great Elephant Census team flew over 20 countries to survey African savannah elephants. The survey results were published in 2015 and showed rapid rates of decline which were accelerating. He began supporting the University of British Columbia 's Sea Around Us Project in 2014 to improve data on global fisheries as a way to fight illegal fishing . Part of his $2.6 million in funding went towards the creation of FishBase , an online database about adult finfish. Allen funded the Global FinPrint initiative, launched in July 2015, a three-year survey of sharks and rays in coral reef areas. The survey is the largest of its kind and designed to provide data to help conservation programs. Allen backed Washington state initiative 1401 to prohibit the purchase, sale and distribution of products made from 10 endangered species including elephants, rhinos, lions, tigers, leopards, cheetahs, marine turtles, pangolins, sharks and rays. The initiative gained enough signatures to be on the state's ballot on November 3, 2015, and passed. Alongside the United States Department of Transportation (USDOT), Allen and Vulcan Inc. launched the Smart City Challenge, a contest inviting American cities to transform their transportation systems. Created in 2015 with the USDOT's $40 million commitment as well as $10 million from Allen's Vulcan Inc., the challenge aims to create a first-of-its-kind modern city that will demonstrate how cities can improve quality of life while lowering greenhouse gas emissions. The winning city was Columbus, Ohio . As a member of the International SeaKeepers Society , Allen hosted its proprietary SeaKeeper 1000TM oceanographic and atmospheric monitoring system on all three of his megayachts. Allen funded the building of microgrids , which are small-scale power grids that can operate independently, in Kenya, to help promote reusable energy and empower its businesses and residents. He was an early investor in the Mawingu Networks, a wireless and solar-powered Internet provider which aims to connect rural Africa with the world, and Off Grid Electric, a company focused on providing solar energy to people in emerging nations. In 2014, Allen pledged at least $100 million toward the fight to end the Ebola virus epidemic in West Africa , making him the largest private donor in the Ebola crisis. He also created a website called TackleEbola.org as a way to spread awareness and serve as a vehicle for donors to fund projects in need. The site highlighted organizations working to stop Ebola that Allen supported, such as International Red Cross and Red Crescent Movement , Médecins Sans Frontières , Partners in Health , UNICEF and World Food Program USA . On April 21, 2015, Allen brought together key leaders in the Ebola fight at the Ebola Innovation Summit in San Francisco. The summit aimed to share key learnings and reinforce the need for continued action and support to reduce the number of Ebola cases to zero, which was achieved in January 2016. In October 2015, the Paul G. Allen Family Foundation announced it would award seven new grants totaling $11 million to prevent future widespread outbreaks of the virus. In 2012, along with his research team and the Royal Navy , Allen attempted to retrieve the ship's bell from HMS Hood , which sank in the Denmark Strait during World War II, but the attempt failed due to poor weather. On August 7, 2015, they tried again and recovered the bell in very good condition. It was restored and put on display in May 2016 in the National Museum of the Royal Navy, Portsmouth , in remembrance of the 1,415 crewmen lost. Since 2015, Allen funded the research ship RV Petrel , which he purchased in 2016. The project team aboard Petrel was responsible for locating the Japanese battleship Musashi in 2015. In 2017, at Allen's direction, Petrel found USS Indianapolis , USS Ward , the wrecks of the Battle of Surigao Strait and the Battle of Ormoc Bay . In 2018, Petrel found a lost US Navy C-2A Greyhound aircraft in the Philippine Sea, USS Lexington in the Coral Sea and the USS Juneau off the coast of the Solomon Islands . Allen established non-profit community institutions to display his collections of historic artifacts. These include:An active art collector, Allen gifted more than $100 million to support the arts. On October 15, 2012, the Americans for the Arts gave Allen the Eli and Edythe Broad Award for Philanthropy in the Arts. Allen loaned out more than 300 pieces from his private art collection to 47 different venues. The original 541-page typescript of Bram Stoker 's novel Dracula was in his collection at one point. In 2013, Allen sold Barnett Newman 's Onement VI (1953) at Sotheby's in New York for $43.8 million, then the record for a work by the abstract artist. In 2015, Allen founded the Seattle Art Fair, a four-day event with 60-plus galleries from around the world including the participation of the Gagosian Gallery , David Zwirner . The event drew thousands and inspired other satellite fairs throughout the city. In August 2016, Allen announced the launch of Upstream Music Fest + Summit, an annual festival fashioned after South by Southwest . Held in Pioneer Square , the first festival took place in May 2017. It was cancelled in 2019 following Allen's death in 2018. In November 2022, Allen's art collection was auctioned at Christie's New York . It was the biggest sale in art auction history, surpassing $1.5 billion in sales. Six works sold for more than $100 million: Seurat 's Les Poseuses Ensemble (Petite version) , ($149 million, with fees); Paul Cézanne 's 1888-90 La Montagne Sainte-Victoire ($138 million); van Gogh's Verger avec cyprès ($117 million); and Gustav Klimt 's 1903 Birch Forest ($105 million). The auction also included paintings by Botticelli , David Hockney , Roy Lichtenstein , Edward Hopper , Andy Warhol , Jasper Johns and Jan Brueghel the Younger . Proceeds from the auction benefitted undisclosed philanthropies. In 1989, Allen donated $2 million to the University of Washington to construct the Allen Library, which was named after his father Kenneth S. Allen, a former associate director of the University of Washington library system. In the same year, Allen donated an additional $8 million to establish the Kenneth S. Allen Library Endowment. In 2012, the endowment was renamed the Kenneth S. and Faye G. Allen Library Endowment after Allen's mother (a noted bibliophile) died. In 2002, Allen donated $14 million to the University of Washington to construct the Paul G. Allen Center for Computer Science and Engineering. The building was dedicated in October 2003. In 2010, Allen announced a gift of $26 million to build the Paul G. Allen School of Global Animal Health at Washington State University , his alma mater. The gift was the largest private donation in the university's history. In 2016, Allen pledged a $10 million donation over four years for the creation of the Allen Discovery Centers at Tufts University and Stanford University . The centers would fund research that would read and write the morphogenetic code. Over eight years the donation could be as much as $20 million. In 2017, Allen donated $40 million (with an additional $10 million from Microsoft) to reorganize the University of Washington's Computer Science and Engineering department into the Paul G. Allen School of Computer Science and Engineering. While Allen expressed interest in romantic love and one day having a family, he never married and had no children. His marriage plans with his first girlfriend were cancelled as he felt he "was not ready to marry at 23". He was sometimes considered reclusive . In the 1990s, he purchased Rock Hudson 's Los Angeles estate from film director John Landis and added the Neptune Valley recording studio to the property. Allen's family put the home on the market for $56 million after his death. Allen received his first electric guitar at the age of sixteen, and was inspired to play it by listening to Jimi Hendrix . In 2000, Allen played rhythm guitar on the independently produced album Grown Men . In 2013, he had a major label release on Sony's Legacy Recordings: Everywhere at Once by Paul Allen and the Underthinkers. PopMatters.com described Everywhere at Once as "a quality release of blues-rock that's enjoyable from start to finish". On February 7, 2018, an interview with Quincy Jones was released by the magazine New York on their Vulture website. In this interview, Jones said that he had extreme respect for Eric Clapton , his band Cream , and Allen. Referencing Allen's Hendrix-like play, the article mentioned a jam session on a yacht with Stevie Wonder . Allen's 414-foot (126 m) yacht, Octopus , was launched in 2003. As of 2019, it was 20th on the list of motor yachts by length . The yacht is equipped with two helicopters, a submarine, an ROV , a swimming pool, a music studio and a basketball court. Octopus is a member of AMVER , a voluntary group ship reporting system used worldwide by authorities to arrange assistance for those in distress at sea. The ship is also known for its annual celebrity-studded parties which Allen hosted at the Cannes film festival , where Allen and his band played for guests. These performances included musicians such as Usher and Dave Stewart . Octopus was also used in the search for a missing American pilot and two officers whose plane disappeared off Palau , and the study of a rare fish called a coelacanth , among many others. Following Allen's death in 2018, Octopus was refitted and put on the market for $325 million. Allen also owned Tatoosh , one of the world's 100 largest yachts. In January 2016, it was reported that Tatoosh severely damaged approximately 1300 square meters of coral reef in the West Bay replenishment zone, Cayman Islands . In April 2016, the Department of Environment (DoE) and Allen's Vulcan Inc. successfully completed a restoration plan to help speed recovery and protect the future of coral in this area. Allen received his first electric guitar at the age of sixteen, and was inspired to play it by listening to Jimi Hendrix . In 2000, Allen played rhythm guitar on the independently produced album Grown Men . In 2013, he had a major label release on Sony's Legacy Recordings: Everywhere at Once by Paul Allen and the Underthinkers. PopMatters.com described Everywhere at Once as "a quality release of blues-rock that's enjoyable from start to finish". On February 7, 2018, an interview with Quincy Jones was released by the magazine New York on their Vulture website. In this interview, Jones said that he had extreme respect for Eric Clapton , his band Cream , and Allen. Referencing Allen's Hendrix-like play, the article mentioned a jam session on a yacht with Stevie Wonder . Allen's 414-foot (126 m) yacht, Octopus , was launched in 2003. As of 2019, it was 20th on the list of motor yachts by length . The yacht is equipped with two helicopters, a submarine, an ROV , a swimming pool, a music studio and a basketball court. Octopus is a member of AMVER , a voluntary group ship reporting system used worldwide by authorities to arrange assistance for those in distress at sea. The ship is also known for its annual celebrity-studded parties which Allen hosted at the Cannes film festival , where Allen and his band played for guests. These performances included musicians such as Usher and Dave Stewart . Octopus was also used in the search for a missing American pilot and two officers whose plane disappeared off Palau , and the study of a rare fish called a coelacanth , among many others. Following Allen's death in 2018, Octopus was refitted and put on the market for $325 million. Allen also owned Tatoosh , one of the world's 100 largest yachts. In January 2016, it was reported that Tatoosh severely damaged approximately 1300 square meters of coral reef in the West Bay replenishment zone, Cayman Islands . In April 2016, the Department of Environment (DoE) and Allen's Vulcan Inc. successfully completed a restoration plan to help speed recovery and protect the future of coral in this area. In 2011, Allen's memoir, Idea Man: A Memoir by the Co-founder of Microsoft , was published by Portfolio, a Penguin Group imprint. The book recounts how Allen became enamored with computers and, at an early age, conceived the idea for Microsoft, recruited his friend Bill Gates to join him, and launched what would become the world's most successful software company. It also explores Allen's business and creative ventures following his 1983 departure from Microsoft, including his involvement in SpaceShipOne, his purchase of the Portland Trail Blazers and Seattle Seahawks, his passion for music, and his ongoing support for scientific research. The book made the New York Times Best Seller list . A paperback version, which included a new epilogue, was published on October 30, 2012. Allen was diagnosed with Stage 1-A Hodgkin's lymphoma in 1982. His cancer was successfully treated by several months of radiation therapy . Allen was diagnosed with non-Hodgkin lymphoma in 2009. Likewise, the cancer was successfully treated until it returned in 2018. It ultimately caused his death by septic shock on October 15, 2018. He was 65 years old. Following his death, Allen's sister Jody Allen was named executor and trustee of all of Paul Allen's estate, pursuant to his instructions. She had responsibility for overseeing the execution of his will and settling his affairs with tax authorities and parties with an interest in his projects. Several Seattle-area landmarks, including the Space Needle , Columbia Center and Lumen Field , as well as various Microsoft offices throughout the United States, were illuminated in blue on November 3, 2018, as a tribute to Allen. He was also honored by his early business partner and lifelong friend Bill Gates , who said in a statement: Paul loved life and those around him, and we all cherished him in return. He deserved much more time, but his contributions to the world of technology and philanthropy will live on for generations to come. We will miss him tremendously. Allen received numerous awards in many different areas, including sports, technology, philanthropy, and the arts:

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Black_Man_of_Steal/html

Black Man of Steal

"Ebola (La La)" Released: 2014 "In The Sun" Released: 2015 "1 Up" Released: 2019 "Ginger" Released: 2019 Black Man of Steal is the seventh studio album of Israeli-American parody rapper Rucka Rucka Ali . The album was released January 13, 2015, and distributed by Pinegrove Records. It peaked at number 7 on the Billboard Top Comedy Albums . The title of the album, "Black Man of Steal", is a reference to the stereotype that black people commit crime more often than other ethnicities of people . The name's also a parody of the nickname for the DC superhero Superman : "Man of Steel". The quote on the bottom of the album cover is a parody of a similar line from Uncle Ben in Marvel 's Spider-Man : " With great power comes great responsibility ".

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Viral_vector_vaccine/html

Viral vector vaccine

A viral vector vaccine is a vaccine that uses a viral vector to deliver genetic material ( DNA ) that can be transcribed by the recipient's host cells as mRNA coding for a desired protein , or antigen , to elicit an immune response. As of April 2021 [ update ] , six viral vector vaccines, four COVID-19 vaccines and two Ebola vaccines , have been authorized for use in humans. The first viral vector was introduced in 1972 through genetic engineering of the SV40 virus. A recombinant viral vector was first used when a hepatitis B surface antigen gene was inserted into a vaccinia virus . Subsequently, other viruses including adenovirus , adeno-associated virus , retrovirus , cytomegalovirus , sendai virus , and lentiviruses have been designed into vaccine vectors. Vaccinia virus and adenovirus are the most commonly used viral vectors because of robust immune response it induces. The incorporation of several viruses in vaccination schemes has been investigated since the vaccinia virus was created in 1984 as a vaccine vector. Human clinical trials were conducted for viral vector vaccines against several infectious diseases including Zika virus , influenza viruses, respiratory syncytial virus , HIV , and malaria , before the vaccines that target SARS-CoV-2 , which causes COVID-19 . Two Ebola vaccines that used viral vector technology were used to combat Ebola outbreaks in West Africa (2013–2016) , and in the Democratic Republic of the Congo (2018–2020) . The rVSV-ZEBOV vaccine was approved for medical use in the European Union in November 2019, and in December 2019 for the United States. Zabdeno/Mvabea was approved for medical use in the European Union in July 2020. Viral vector vaccines enable antigen expression within cells and induce a robust cytotoxic T cell response, unlike subunit vaccines which only confer humoral immunity . In order to transfer a nucleic acid coding for a specific protein to a cell, the vaccines employ a variant of a virus as its vector. This process helps to create immunity against the disease, which helps to protect people from contracting the infection. Viral vector vaccines do not cause infection with either the virus used as the vector or the source of the antigen. The genetic material it delivers does not integrate into a person's genome . The majority of viral vectors lack the required genes, making them unable to replicate. In order to be widely accepted and approved for medical use, the development of viral vector vaccines requires a high biological safety level. Consequently, non or low-pathogenic viruses are often selected. Viral vector vaccines have benefits over other forms of vaccinations depending on the virus which they produced thanks to their qualities of immunogenicity, immunogenic stability, and safety. Specific immunogenicity properties include highly efficient gene transduction, highly specific delivery of genes to target cells, and the ability to induce potent immune responses. The immunogenicity is further enhanced through intrinsic vector motifs that stimulate the innate immunity pathways, so the use of an adjuvant is unnecessary. Replicating vectors imitate natural infection, which stimulates the release of cytokines and co-stimulatory molecules that produce a strong adjuvant effect. The induction of innate immunity pathways is crucial to stimulating downstream pathways and adaptive immunity responses. Additionally, viral vectors can be produced in high quantities at relatively low costs, which enables use in low-income countries. The first viral vector was introduced in 1972 through genetic engineering of the SV40 virus. A recombinant viral vector was first used when a hepatitis B surface antigen gene was inserted into a vaccinia virus . Subsequently, other viruses including adenovirus , adeno-associated virus , retrovirus , cytomegalovirus , sendai virus , and lentiviruses have been designed into vaccine vectors. Vaccinia virus and adenovirus are the most commonly used viral vectors because of robust immune response it induces. The incorporation of several viruses in vaccination schemes has been investigated since the vaccinia virus was created in 1984 as a vaccine vector. Human clinical trials were conducted for viral vector vaccines against several infectious diseases including Zika virus , influenza viruses, respiratory syncytial virus , HIV , and malaria , before the vaccines that target SARS-CoV-2 , which causes COVID-19 . Two Ebola vaccines that used viral vector technology were used to combat Ebola outbreaks in West Africa (2013–2016) , and in the Democratic Republic of the Congo (2018–2020) . The rVSV-ZEBOV vaccine was approved for medical use in the European Union in November 2019, and in December 2019 for the United States. Zabdeno/Mvabea was approved for medical use in the European Union in July 2020. Viral vector vaccines enable antigen expression within cells and induce a robust cytotoxic T cell response, unlike subunit vaccines which only confer humoral immunity . In order to transfer a nucleic acid coding for a specific protein to a cell, the vaccines employ a variant of a virus as its vector. This process helps to create immunity against the disease, which helps to protect people from contracting the infection. Viral vector vaccines do not cause infection with either the virus used as the vector or the source of the antigen. The genetic material it delivers does not integrate into a person's genome . The majority of viral vectors lack the required genes, making them unable to replicate. In order to be widely accepted and approved for medical use, the development of viral vector vaccines requires a high biological safety level. Consequently, non or low-pathogenic viruses are often selected. Viral vector vaccines have benefits over other forms of vaccinations depending on the virus which they produced thanks to their qualities of immunogenicity, immunogenic stability, and safety. Specific immunogenicity properties include highly efficient gene transduction, highly specific delivery of genes to target cells, and the ability to induce potent immune responses. The immunogenicity is further enhanced through intrinsic vector motifs that stimulate the innate immunity pathways, so the use of an adjuvant is unnecessary. Replicating vectors imitate natural infection, which stimulates the release of cytokines and co-stimulatory molecules that produce a strong adjuvant effect. The induction of innate immunity pathways is crucial to stimulating downstream pathways and adaptive immunity responses. Additionally, viral vectors can be produced in high quantities at relatively low costs, which enables use in low-income countries. Adenovirus vectors have the advantage of high transduction efficiency, transgene expression, and broad viral tropism , and can infect both dividing and non-dividing cells. A disadvantage is that many people have preexisting immunity to adenoviruses from previous exposure. The seroprevalence against Ad5 in the US population is as high as 40%–45%. Most Adenovirus vectors are replication-defective because of the deletion of the E1A and E1B viral gene region. Currently, overcoming the effects of adenovirus-specific neutralizing antibodies is being explored by vaccinologists. These studies include numerous strategies such as designing alternative Adenovirus serotypes, diversifying routes of immunization, and using prime-boost procedures. Human adenovirus serotype 5 is often used because it can be easily produced in high titers . As of April 2021, four adenovirus vector vaccines for COVID-19 have been authorized in at least one country: Zabdeno, the first dose of the Zabdeno/Mvabea Ebola vaccine , is derived from human adenovirus serotype 26, expressing the glycoprotein of the Ebola virus Mayinga variant. Both doses are non-replicating vectors and carry the genetic code of several Ebola virus proteins. With the increasing prevalence of adenoviral vaccines, two vaccines, Ad26.COV2.S and ChadOx1-nCoV-19, have been linked to the rare clotting disorder, thrombosis with thrombocytopenia syndrome (TTS). The vaccinia virus is part of the poxvirus family. It is a large, complex, and enveloped virus that was previously used for the smallpox vaccine. The vaccinia virus's large size allows for a high potential for foreign gene insertion. Several vaccinia virus strains have been developed including replication-competent and replication-deficient strains. Modified vaccinia ankara (MVA) is a replication-deficient strain that has been safely used for a smallpox vaccine. The Ebola vaccine regimen approved by the European Commission was developed by Janssen Pharmaceutials and Bavarian Nordic , and utilizes MVA technology in its second vaccine dose of Mvabea (MVA-BN-Filo). Vesicular stomatitis virus (VSV) was introduced as a vaccine vector in the late 1990s. In most VSV vaccine vectors, attenuation provides safety against its virulence. VSV is an RNA virus and is part of the Rhabdoviridae family. The VSV genome encodes for nucleocapsid, phosphoprotein, matrix, glycoprotein, and an RNA-dependent RNA polymerase proteins. The rVSV-ZEBOV vaccine , known as Ervebo , was approved as a prophylactic Ebola vaccine for medical use by the FDA in 2019. The vaccine is a recombinant , replication-competent vaccine consisting of genetically engineered vesicular stomatitis virus. The gene for the natural VSV envelope glycoprotein is replaced with that from the Kikwit 1995 Zaire strain Ebola virus . Adenovirus vectors have the advantage of high transduction efficiency, transgene expression, and broad viral tropism , and can infect both dividing and non-dividing cells. A disadvantage is that many people have preexisting immunity to adenoviruses from previous exposure. The seroprevalence against Ad5 in the US population is as high as 40%–45%. Most Adenovirus vectors are replication-defective because of the deletion of the E1A and E1B viral gene region. Currently, overcoming the effects of adenovirus-specific neutralizing antibodies is being explored by vaccinologists. These studies include numerous strategies such as designing alternative Adenovirus serotypes, diversifying routes of immunization, and using prime-boost procedures. Human adenovirus serotype 5 is often used because it can be easily produced in high titers . As of April 2021, four adenovirus vector vaccines for COVID-19 have been authorized in at least one country: Zabdeno, the first dose of the Zabdeno/Mvabea Ebola vaccine , is derived from human adenovirus serotype 26, expressing the glycoprotein of the Ebola virus Mayinga variant. Both doses are non-replicating vectors and carry the genetic code of several Ebola virus proteins. With the increasing prevalence of adenoviral vaccines, two vaccines, Ad26.COV2.S and ChadOx1-nCoV-19, have been linked to the rare clotting disorder, thrombosis with thrombocytopenia syndrome (TTS). With the increasing prevalence of adenoviral vaccines, two vaccines, Ad26.COV2.S and ChadOx1-nCoV-19, have been linked to the rare clotting disorder, thrombosis with thrombocytopenia syndrome (TTS). The vaccinia virus is part of the poxvirus family. It is a large, complex, and enveloped virus that was previously used for the smallpox vaccine. The vaccinia virus's large size allows for a high potential for foreign gene insertion. Several vaccinia virus strains have been developed including replication-competent and replication-deficient strains. Modified vaccinia ankara (MVA) is a replication-deficient strain that has been safely used for a smallpox vaccine. The Ebola vaccine regimen approved by the European Commission was developed by Janssen Pharmaceutials and Bavarian Nordic , and utilizes MVA technology in its second vaccine dose of Mvabea (MVA-BN-Filo). Modified vaccinia ankara (MVA) is a replication-deficient strain that has been safely used for a smallpox vaccine. The Ebola vaccine regimen approved by the European Commission was developed by Janssen Pharmaceutials and Bavarian Nordic , and utilizes MVA technology in its second vaccine dose of Mvabea (MVA-BN-Filo). Vesicular stomatitis virus (VSV) was introduced as a vaccine vector in the late 1990s. In most VSV vaccine vectors, attenuation provides safety against its virulence. VSV is an RNA virus and is part of the Rhabdoviridae family. The VSV genome encodes for nucleocapsid, phosphoprotein, matrix, glycoprotein, and an RNA-dependent RNA polymerase proteins. The rVSV-ZEBOV vaccine , known as Ervebo , was approved as a prophylactic Ebola vaccine for medical use by the FDA in 2019. The vaccine is a recombinant , replication-competent vaccine consisting of genetically engineered vesicular stomatitis virus. The gene for the natural VSV envelope glycoprotein is replaced with that from the Kikwit 1995 Zaire strain Ebola virus . Intramuscular injection is the commonly used route for vaccine administration. The introduction of alternate routes for immunization of viral vector vaccines can induce mucosal immunology at the site of administration, thereby limiting respiratory or gastrointestinal infections. Also, studies are being done on how these diverse routes can be used to overcome the effects of specific neutralizing antibodies limiting the use of these vaccines. These routes include intranasal , oral, intradermal , and aerosol vaccination.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Ra's_al_Ghul/html

Ra's al Ghul

Ra's al Ghul [lower-alpha 1] is a supervillain appearing in American comic books published by DC Comics , commonly as an adversary of the superhero Batman . Created by editor Julius Schwartz , writer Dennis O'Neil and artist Neal Adams , the character first appeared in Batman #232's "Daughter of the Demon" (June 1971). Most notable as the leader of the League of Assassins , Ra's al Ghul's name in Arabic translates to "Head of the Demon ". He is the son of Sensei ; the father of Talia al Ghul , Nyssa Raatko and Dusan al Ghul; and the maternal grandfather of Damian Wayne . Stories featuring Ra's al Ghul often involve the Lazarus Pits, which restore life to the dying. The Lazarus Pits have considerably prolonged Ra's' life, making him particularly dangerous as he has honed his combat skills for centuries. Though primarily an enemy of Batman, Ra's has also come into conflict with Superman and other heroes in the DC Universe. Ra's al Ghul has been featured in various media adaptations. The character was portrayed by David Warner in the DC Animated Universe , Liam Neeson in the Dark Knight trilogy , Jason Isaacs in Batman: Under the Red Hood , Dee Bradley Baker in the Batman: Arkham video game series, Matt Nable in the Arrowverse television series, and Alexander Siddig in Gotham . IGN 's list of the Top 100 Comic Book Villains of All Time List ranked Ra's as No. 7. Created by editor Julius Schwartz , writer Dennis O'Neil and artist Neal Adams , he was introduced in Batman #232's "Daughter of the Demon" (June 1971). Adams discussed how he designed the character in a 2007 Wizard interview "First of all, Denny O'Neil started as a journalist, and so his experience with costume characters was always a forced experience. When the idea came to Julie Schwartz that "we're kind of reviving old characters. What do we want to do for a new character?" Denny's tendency - and I understood it totally - was not to go to a costumed character with superpowers, but to go to a Moriarty type. When Denny presented it, here I was as a comic book artist who was used to doing fairly realistic stuff having to deal with, "Hey, no costume." How do I make him unique? Because after all, we are pandering to our audience a little bit. How does he become unique? So I sort of went down the list of things that I could do that didn't offend my sensibilities as an artist and as a person that lived in the world. How do you make a person unique? And then I realized there are people that look unique, that present their personality with their physiognomy - like Jack Palance , for example. Jack Palance is incredible to look at." Ra's al Ghul is an international criminal mastermind whose ultimate goal is a world in perfect environmental balance. He believes that the best way to achieve this balance is to eliminate most of humanity . Ra's usually tries to assault the world's human populace with a biological weapon, such as a genetically-engineered virus. He is aided in this quest by the Lazarus Pits, reservoirs of rejuvenating chemicals that restore the dead and dying to life; these pits have granted him a lifespan of several centuries. He regards Batman as his worthiest opponent, addressing him as "Detective" out of respect for his intellectual brilliance, and has frequently sought to make the Dark Knight his successor. He is one of the few criminals in Batman's rogues gallery to have deduced his secret identity as Bruce Wayne , but keeps silent on the matter due to the same sense of respect for Batman. For his own part, Batman's opposition to Ra's is complicated by both his own respect for al Ghul's genius (if not his goals and methods) and his attraction to his daughter, Talia, which she reciprocates. Ra's al Ghul's real name, early life, and exact age have been described differently by various writers. His Post-Crisis origin story is told in the graphic novel Batman: Birth of the Demon (1992) by Dennis O'Neil and Norm Breyfogle . This origin story is later revisited and amended in Batman Annual #26 (2007) by Peter Milligan and David López as part of the Batman: The Resurrection of Ra's al Ghul story arc. Most recent retelling origin story, Batman and Robin (vol. 2) #23.3 (2013) by James Tynion IV and Jeremy Haun , references these prior iterations of al Ghul's origin while keeping common details that lead towards Ra's' adoption of the moniker (e.g. Ra's' occupation as a physician, his wife's death, and the annihilation of the Sultan's city). As told in Birth of the Demon , Ra's al Ghul (known only as The Physician prior to adopting the moniker) was born over 600 years before his first appearance in Batman comics, to a tribe of Chinese nomads settling in the desert in eastern North Africa , near a city governed by a Sultan . Developing an interest in the sciences at an early age, Ra's abandoned his tribe to live in the city, where he focused himself on learning and experimentation. He subsequently trained as a physician and married a woman named Sora. Upon discovering the healing properties of the Lazarus Pit, Ra's managed to save the Sultan's dying son by lowering him into it. However, he is unaware that use of the Lazarus Pit can induce insanity, and the prince (who is already sadistic and cruel), emerges as a mentally unstable sociopath. He proceeds to fatally strangle Sora, on whom he has already had his eye for some time. The Sultan, unwilling to admit to himself his son's culpability, accuses Ra's of poisoning his son's mind and sentences him to a slow, tortured death in a cage with Sora's corpse. Ra's is set free by the son of a dying elderly woman, who Ra's had earlier treated. The son feels that he owes Ra's a debt for easing his mother's suffering during her last few hours. Ra's and the son head into the desert to seek the tribe of Ra's' birth. Ra's convinces the head of his tribe, his uncle, to follow Ra's in his quest for revenge by promising the downfall of the Sultan. By understanding the germ theory of disease hundreds of years before anyone else, Ra's is able to infect the prince with a deadly virus by sending him contaminated fabrics. When the Sultan once again demands that Ra's save his son, both men are killed by the former physician. Ra's then leads his tribe to raze the city to the ground and kill all of its inhabitants. Subsequently, Ra's declares himself "Ra's al Ghul", the "Demon's Head". Batman: Birth of the Demon provides a rough figure of 500 years for Ra's al Ghul's age. Due to living so long and being so old, he is assumed to have lost track of how old he is. Azrael #6 (July 1995; written by Dennis O'Neil ) places Ra's age closer to 450 years. As he tells Jean Paul Valley , "I appear to be a vigorous fifty. I am actually a very vigorous four hundred and forty-eight...or is it four hundred and fifty-three? I lost count during the Black Plague . No matter". In Batman Annual #25 (published in 2006), Ra's al Ghul is described as a "700-Year Old International Terrorist". The 700 year plus mark is used again in Batman and Robin (vol. 2) #23.3 (2013), followed by Issue #30 of the same series where over a 1000-year time span is also described in Ra's' pursuit of Themyscira . Using the Lazarus Pits to extend his life, Ra's spends the next several centuries journeying the world. He fights in the French Revolution and the Napoleonic Wars and becomes a formidable warrior. As the world entered the modern age and industrialization began to cover much of the Earth, Ra's grew to despise the humans who he believed were destroying the world's natural beauty, thus setting him on a path of eco-terrorism. Also during this time, Ra's, his uncle, and Huwe, the son who freed Ra's from the Sultan's initial execution are all using the Lazarus Pits to prolong their lives until an incident in London . Ra's catches Huwe writing his own memoirs in their original Chinese language , despite Ra's having forbidden him to reveal the secret of their immortality. During a battle, Ra's kills Huwe and flees to a Lazarus Pit, which he uses. When he returns to their home in London, his uncle has vanished with the remnants of their historical records. Over time, he becomes a master of many forms of combat, notably fencing. He also builds up vast wealth and creates The Demon , a huge international organization. According to Justice League of America (1st series) #94: It has been whispered in the darkest places for 500 years that a cartel of criminals has slowly sucked its way into the rich veins of the Earth. Many are its names spit from the mouths of men, but most often it is cursed only as. The Demon. It has a leader. A Head. The League of Assassins , one of the many smaller organizations making up The Demon, is thus sometimes called "The Demon's Fang" or "Demonfang". Ra's al Ghul's ethnic origins may be described East Asian in accordance to Birth of the Demon and The Resurrection of Ra's al Ghul , and Byzantine/Eastern Roman as addressed by Talia al Ghul in Batman Annual #26. Ra's al Ghul's Eastern Roman background is further implied in Batman and Robin (vol. 2) #23.3. The significance of al Ghul's Eurasian profile is attributed to his known paternal heritage whilst his ambitions for world conquest is often compared and traced to the likes of Alexander the Great ; an influence too shared by other family members such as Sensei ( Batman #671 (2007) by Grant Morrison and Tony S. Daniel ), Talia al Ghul, and Damian Wayne ( Batman and Robin (vol. 2) #0 (2012) by Peter J. Tomasi and Patrick Gleason ) (the name "Damian" being derivative of "damianos", Greek for "to tame"). Most commonly depicted in source material with a dominant phenotype of fair complexion, Ra's has also been able to opportunistically be involved in Western world global exploits such as the Age of Exploration ( Year One: Batman/Ra's al Ghul #2 (2005) by Devin K. Grayson and Paul Gulacy ) and the Third Reich ( Batman: Death and the Maidens #5 (2004) by Greg Rucka and Klaus Janson ). Ra's al Ghul's adoptive use of Arabic monikers and the language itself is a result of al Ghul's settlement and cultured history both in erudition and regional pursuit of Lazarus Pit/longevity sources most commonly unearthed throughout the Greater Middle East (e.g. The Well of Sins in the Arabian Peninsula , Red Hood and the Outlaws #22 (2013) by James Tynion IV and Julius Gopez) to East Asia ( Peaches of Immortality , Year One: Batman/Ra's al Ghul #1). The use of Arabic monikers in particular (in regards to demons ) is used as a scare tactic in Ra's' history promoting both his influence, and reign of terror throughout the Greater Middle East—his first eradication of a sultanate as described in Birth of the Demon , the same actions insinuated to have been repeated in Batman and Robin (vol. 2) #23.3, and direct depiction in Death and the Maidens #4. Aligning with Ra's al Ghul's character overview as an international environmental terrorist, in conjunction with the character's background being subject to different renditions from multiple writers; co-creator of the character, Neal Adams, has stated that the character has no specific regional/ethnic representation of any kind, necessarily. "...we created an equal to Batman, and that's what Ra's al Ghul is all about. He's not necessarily Arabic. He's not necessarily Eastern. He's not necessarily Western. He's not necessarily anything! He's just a villain and he's equal to Batman." - Neal Adams, via SYFY WIRE Batman at 80: How To Craft The Perfect Batman Villain Ra's returns to prominence and comes dangerously close to realizing his dream of worldwide genocide in the " Contagion " story arc of the Batman titles. His organization unleashes a deadly virus known as Ebola Gulf A (a.k.a. "The Clench") in Gotham City , putting Batman in conflict with a force he seemingly cannot defeat. A cure is eventually located by Batman and his allies, though the mastermind behind the outbreak is not discovered until the follow-up story " Legacy " . Learning that the Demon's Head still lives, Batman and his team circle the globe, preventing further outbreaks of the virus. Ra's allies himself with Bane , the man who once crippled and nearly killed Batman. Ra's considers Bane a potential heir to his empire, despite his daughter Talia's distaste for the criminal mastermind. Eventually, Batman deduces a way to eliminate the Clench virus from an ancient "Wheel of Plagues" artifact whose knowledge has aided Ra's in the creation of the disease. The long-lived madman eludes justice again. In the " Tower of Babel " storyline, in JLA #43–46, Ra's discovers Batman's contingency plans for stopping the other members of the Justice League of America , should they turn or be turned evil, and uses them to try to destroy the group. Meanwhile, Ra's steals the bodies of Batman's parents. This theft prevents Batman from realizing Ra's is using his traps until it is too late, as he is distracted by the search for the corpses of his parents. Though defeated, Ra's does cause the temporary exit of Batman from the JLA, who now distrust the Caped Crusader. However, though some of the League resent Batman's plans, they eventually accept that the plans were created for the right reasons once Batman confirms that he trusts them by revealing his secret identity to the rest of the team. Talia, disillusioned with her father, leaves the League to run LexCorp for former U.S. President Lex Luthor , before selling the company to Bruce Wayne for his Wayne Foundation to aid Batman and Superman's victory over Luthor. Ra's blames Batman for his failed relationship with Talia, and stages a plot where he tries to separate Batman from his heir, Dick Grayson , shortly before Wayne officially adopts his former ward as his son. The plan fails, and Wayne and Grayson go ahead with the adoption. Ra's is also featured in Birds of Prey #31–35, where he has a romantic fling with the Black Canary . The superheroine is injured and healed in the Lazarus Pit, which also restores the Canary Cry she lost years earlier. In Death and the Maidens (2004), Ra's' other daughter, Nyssa Raatko , furious at her father for abandoning her in a Nazi concentration camp during World War II , begins plotting to destroy him, prompting Ra's to contact Batman to make a deal for access to a Lazarus Pit to give him the strength for a final confrontation with Nyssa; in exchange for the location of a Pit, Ra's provides Batman with a serum that will allow him to walk in the spirit world and speak with his parents. While Batman experiences his "vision", Nyssa befriends Talia and then kidnaps and brainwashes her. Nyssa plots to destroy all hope and optimism in the world by assassinating Superman with Kryptonite bullets she steals from the Batcave . While Batman stops Nyssa from killing Superman, he is unable to stop her from mortally injuring her father. A dying Ra's reveals that this is all part of his greater plan to ensure that his daughters will realize that he is correct in his perceptions about the world and what needs to be done to it, and that they would come to accept their destinies as his heirs. Ra's' plan works: both Nyssa and Talia become the heads of The Demon and the League of Assassins. Talia disavows her love for Bruce Wayne, and both sisters declare Batman their enemy. It is too late for Ra's, as Nyssa stabs her father through the heart, seemingly killing him for good. To ensure Ra's will not return, Batman oversees his nemesis' cremation . In Batman Annual #26, Talia is prompted to read the history of Ra's al Ghul to her son Damian by a mysterious figure from Ra's' past: the White Ghost. Unbeknownst to her, the White Ghost plans to use Damian as a vessel for Ra's' return. However, mother and son escape before the plan is completed. After the escape, Batman confronts the White Ghost; he fights Batman, but accidentally falls into a Lazarus Pit. As of Batman #670, Ra's al Ghul has returned, having evaded death by transferring his consciousness into the body of another. Because his host body is decaying from radiation poisoning, he needs to transfer his mind into another host body. His first choice is that of his grandson Damian Wayne , but Damian escapes to alert his father. Upon taking Ra's to a "Fountain of Essence", which contains the qualities of a Lazarus Pit, Batman is confronted with the sight of the Sensei , who is revealed to be Ra's' father. After defeating Ra's, Sensei fights and impales Batman with a cane. Determined to win, Batman drags the Sensei into the Fountain, where he is killed for not being a pure soul. Ra's, meanwhile, has taken over the body of a Nanda Parbat monk and departs. Healed by the Fountain, Batman emerges and yells for Ra's. Ra's attempts to make amends with Batman after his resurrection, but Batman responds by crushing his decaying fingers. Ra's accepts this latest rebuke and, with the help of his men, overpowers Batman and captures Damian, who has arrived to try to help his father. Ra's attempts to take over Damian, but Batman breaks free just as Robin , Talia, Alfred Pennyworth , and Nightwing arrive to save him. While the battle ensues at Nanda Parbat, the White Ghost takes Ra's to a secluded place, where he appears to accept the fact that his death is inevitable. The White Ghost is revealed as Ra's' estranged albino son Dusan, and offers up his own body instead. Ra's performs the transfer of souls , but the White Ghost apparently dies soon afterward. Ra's resumes the battle and attempts to kill Batman, but the monks at Nanda Parbat stop him and banish him from the temple. Following his resurrection, Ra's al Ghul, in his new body, moves his base of operations to Gotham City where it is revealed that a remnant of his son Dusan's consciousness still remains within him. Since the White Ghost was his son, Ra's was able to use the resemblance between them to modify his new body's appearance to be more like his own, though he remains an albino. This arrogance contributes to the brazen move to Gotham and a subsequent ninja attack on Batman, which indirectly leads to the discovery of a map of all the known Lazarus Pit locations across the globe. Batman then infiltrates Ra's al Ghul's new Gotham penthouse headquarters and easily defeats his horde of ninjas and Ra's himself. To ensure Ra's is not a constant threat within Gotham City, Batman comes up with the false identity of " Terry Gene Kase ", and plants it along with credible photos, medical records, and police records for both Blackgate Penitentiary and Arkham Asylum . Batman takes an unconscious Ra's directly to Arkham where it is believed he really is the prisoner "Terry Gene Kase", a criminal with multiple personality disorder who has just been transferred to Arkham to finish out multiple life sentences. Along with attaching false information and a false identity to Ra's al Ghul's file, Batman attaches a false prescription of potent medication that ensures slurred speech and next to zero mobility. Despite these precautions, Ra's eventually escapes when the orderlies miss his dosage once, which allows him to become conscious enough to escape from Arkham. Ra's realizes that Batman has apparently died after Darkseid 's invasion during Final Crisis . After confronting Nightwing with his knowledge, he and the hero eventually duel with swords. Nightwing defeats Ra's and earns the immortal's respect, signified by leaving his sword in the Batcave as a gift after their fight. Ra's refuses to believe his enemy's passing despite the evidence, leading him to be involved in the Red Robin's (Tim Drake) quest concerning the fate of the original Dark Knight. After Drake finds proof that Wayne is still alive but lost in time after his battle with Darkseid, the former Boy Wonder cripples Ra's' organization, the League of Assassins , from within. In response, Ra's returns to Gotham to begin his attack to destroy every legacy of the Wayne Family. While his men target everyone close to the Waynes, Ra's makes a pact with Hush as part of his plans. Unknown to both men, Lucius Fox has already given Tim power of attorney leaving him in control of the Wayne Family resources. Enraged, Ra's then engages Tim Drake in combat, which ends with Tim mocking Ra's by saying that there's nothing he can do to harm the Bat Family anymore; in response, Ra's smiles and says "Well done. Detective" (a name he has only ever reserved for Batman, Nightwing and Red Hood once before). He then proceeds to kick him out of a skyscraper window and retreats from the battle. Later, in seclusion, Ra's reveals everything which happened was a test for Tim Drake, from the league, the council, the Men of Death, and the plot against Bruce Wayne. Learning of Bruce Wayne's return, Ra's muses that his next confrontation with the detective will be particularly interesting as he believes that Batman has at last had a taste of the immortality that Ra's himself enjoys. He goes after Vicki Vale and almost kills her. He spares her life only after she refuses to publish the identity of Batman and gets rid of all of the evidence she has to that effect. He also realizes that Vale may be a descendant of a French opponent, Marcel du Valliere, from centuries before; therefore, his business with her may not be finished. In The New 52 (a 2011 reboot of the DC Comics universe), Ra's al Ghul appears in a hooded robe at the League of Assassins' city of 'Eth Alth'eban. He enters the Well of Sins after an encounter with Jason Todd . When he emerges, Ra's is consumed by the evil that corrupted the Untitled centuries before, and he feels compelled to rid himself of the machinations of his daughter and Ducra by killing Jason. At Ra's' command, the prisoners are brought to him, and he promises to use his newfound power to destroy them. Red Hood engages Ra's, as Essence joins the battle. She insists that he will allow Jason and his friends to leave his realm, or he will be forced to die a mortal death just as he always feared he would. Despite having destroyed the All-Caste, Ra's al Ghul's actions have led to their eventual rebirth. Defeated, he swears that he will visit great agony upon Red Hood if he ever sees him again. Batman and Aquaman head to an island, where the League of Assassins are located, after Ra's has the bodies of Damian Wayne and Talia exhumed. Ra's had ordered the hunt of whales , creating genetically altered super-humans in the wombs of sperm whales , part of a plan to rebuild the League of Assassins. Inside the compound, they find that Ra's is wiping the hard drives clean, preventing data recovery. As his parting gift, he has left Batman the Heretics to keep him entertained. Batman fights his way to Ra's escape aircraft. He sees Talia and Damian's bodies stored within it, and clings to the fuselage from outside as the plane takes off. Though Ra's plans to go to Paradise Island, he is nearly surprised to see Batman pounding on the cockpit's windshield. From outside, Batman screams for Ra's to give back his son, but Ra's responds that he is blood of Damian's blood and the boy is in good hands. He orders the plane to tilt its angle, causing the wind shear to rip Batman from his purchase and drop down into the sea, where he is caught by Aquaman. Batman and Ra's then encounter Glorious Godfrey . Glorious Godfrey's reason to come to Earth is to retrieve the Chaos Shard, a powerful crystal once belonged to Darkseid which Ra's al Ghul revealed was hidden inside the sarcophagus he crafted for Damian. During Batman Eternal , Bruce briefly speculates that Ra's is the mastermind behind most of the attacks against him that have left Wayne Enterprises bankrupt and Batman pushed to the limit. However, when he confronts Ra's, his foe reveals that, while he was invited to participate in the attack by the true mastermind , he rejected the offer as Ra's would prefer to destroy Batman when the Dark Knight believes that his legacy will be as eternal as Ra's, rather than tear him down in such a manner. During DC Rebirth , Ra's al Ghul is featured in Detective Comics issues #953-956 as part of the "League of Shadows" story arc, which runs from issue #951-956 (April–July 2017). Ra's al Ghul appears in Dark Nights: Metal issue #2 as a member of the Immortals, a group formed by the oldest beings in the multiverse. He participates in a discussion on how they will fight the Dark Multiverse invasion.Ra's al Ghul's real name, early life, and exact age have been described differently by various writers. His Post-Crisis origin story is told in the graphic novel Batman: Birth of the Demon (1992) by Dennis O'Neil and Norm Breyfogle . This origin story is later revisited and amended in Batman Annual #26 (2007) by Peter Milligan and David López as part of the Batman: The Resurrection of Ra's al Ghul story arc. Most recent retelling origin story, Batman and Robin (vol. 2) #23.3 (2013) by James Tynion IV and Jeremy Haun , references these prior iterations of al Ghul's origin while keeping common details that lead towards Ra's' adoption of the moniker (e.g. Ra's' occupation as a physician, his wife's death, and the annihilation of the Sultan's city). As told in Birth of the Demon , Ra's al Ghul (known only as The Physician prior to adopting the moniker) was born over 600 years before his first appearance in Batman comics, to a tribe of Chinese nomads settling in the desert in eastern North Africa , near a city governed by a Sultan . Developing an interest in the sciences at an early age, Ra's abandoned his tribe to live in the city, where he focused himself on learning and experimentation. He subsequently trained as a physician and married a woman named Sora. Upon discovering the healing properties of the Lazarus Pit, Ra's managed to save the Sultan's dying son by lowering him into it. However, he is unaware that use of the Lazarus Pit can induce insanity, and the prince (who is already sadistic and cruel), emerges as a mentally unstable sociopath. He proceeds to fatally strangle Sora, on whom he has already had his eye for some time. The Sultan, unwilling to admit to himself his son's culpability, accuses Ra's of poisoning his son's mind and sentences him to a slow, tortured death in a cage with Sora's corpse. Ra's is set free by the son of a dying elderly woman, who Ra's had earlier treated. The son feels that he owes Ra's a debt for easing his mother's suffering during her last few hours. Ra's and the son head into the desert to seek the tribe of Ra's' birth. Ra's convinces the head of his tribe, his uncle, to follow Ra's in his quest for revenge by promising the downfall of the Sultan. By understanding the germ theory of disease hundreds of years before anyone else, Ra's is able to infect the prince with a deadly virus by sending him contaminated fabrics. When the Sultan once again demands that Ra's save his son, both men are killed by the former physician. Ra's then leads his tribe to raze the city to the ground and kill all of its inhabitants. Subsequently, Ra's declares himself "Ra's al Ghul", the "Demon's Head". Batman: Birth of the Demon provides a rough figure of 500 years for Ra's al Ghul's age. Due to living so long and being so old, he is assumed to have lost track of how old he is. Azrael #6 (July 1995; written by Dennis O'Neil ) places Ra's age closer to 450 years. As he tells Jean Paul Valley , "I appear to be a vigorous fifty. I am actually a very vigorous four hundred and forty-eight...or is it four hundred and fifty-three? I lost count during the Black Plague . No matter". In Batman Annual #25 (published in 2006), Ra's al Ghul is described as a "700-Year Old International Terrorist". The 700 year plus mark is used again in Batman and Robin (vol. 2) #23.3 (2013), followed by Issue #30 of the same series where over a 1000-year time span is also described in Ra's' pursuit of Themyscira . Using the Lazarus Pits to extend his life, Ra's spends the next several centuries journeying the world. He fights in the French Revolution and the Napoleonic Wars and becomes a formidable warrior. As the world entered the modern age and industrialization began to cover much of the Earth, Ra's grew to despise the humans who he believed were destroying the world's natural beauty, thus setting him on a path of eco-terrorism. Also during this time, Ra's, his uncle, and Huwe, the son who freed Ra's from the Sultan's initial execution are all using the Lazarus Pits to prolong their lives until an incident in London . Ra's catches Huwe writing his own memoirs in their original Chinese language , despite Ra's having forbidden him to reveal the secret of their immortality. During a battle, Ra's kills Huwe and flees to a Lazarus Pit, which he uses. When he returns to their home in London, his uncle has vanished with the remnants of their historical records. Over time, he becomes a master of many forms of combat, notably fencing. He also builds up vast wealth and creates The Demon , a huge international organization. According to Justice League of America (1st series) #94: It has been whispered in the darkest places for 500 years that a cartel of criminals has slowly sucked its way into the rich veins of the Earth. Many are its names spit from the mouths of men, but most often it is cursed only as. The Demon. It has a leader. A Head. The League of Assassins , one of the many smaller organizations making up The Demon, is thus sometimes called "The Demon's Fang" or "Demonfang". Ra's al Ghul's ethnic origins may be described East Asian in accordance to Birth of the Demon and The Resurrection of Ra's al Ghul , and Byzantine/Eastern Roman as addressed by Talia al Ghul in Batman Annual #26. Ra's al Ghul's Eastern Roman background is further implied in Batman and Robin (vol. 2) #23.3. The significance of al Ghul's Eurasian profile is attributed to his known paternal heritage whilst his ambitions for world conquest is often compared and traced to the likes of Alexander the Great ; an influence too shared by other family members such as Sensei ( Batman #671 (2007) by Grant Morrison and Tony S. Daniel ), Talia al Ghul, and Damian Wayne ( Batman and Robin (vol. 2) #0 (2012) by Peter J. Tomasi and Patrick Gleason ) (the name "Damian" being derivative of "damianos", Greek for "to tame"). Most commonly depicted in source material with a dominant phenotype of fair complexion, Ra's has also been able to opportunistically be involved in Western world global exploits such as the Age of Exploration ( Year One: Batman/Ra's al Ghul #2 (2005) by Devin K. Grayson and Paul Gulacy ) and the Third Reich ( Batman: Death and the Maidens #5 (2004) by Greg Rucka and Klaus Janson ). Ra's al Ghul's adoptive use of Arabic monikers and the language itself is a result of al Ghul's settlement and cultured history both in erudition and regional pursuit of Lazarus Pit/longevity sources most commonly unearthed throughout the Greater Middle East (e.g. The Well of Sins in the Arabian Peninsula , Red Hood and the Outlaws #22 (2013) by James Tynion IV and Julius Gopez) to East Asia ( Peaches of Immortality , Year One: Batman/Ra's al Ghul #1). The use of Arabic monikers in particular (in regards to demons ) is used as a scare tactic in Ra's' history promoting both his influence, and reign of terror throughout the Greater Middle East—his first eradication of a sultanate as described in Birth of the Demon , the same actions insinuated to have been repeated in Batman and Robin (vol. 2) #23.3, and direct depiction in Death and the Maidens #4. Aligning with Ra's al Ghul's character overview as an international environmental terrorist, in conjunction with the character's background being subject to different renditions from multiple writers; co-creator of the character, Neal Adams, has stated that the character has no specific regional/ethnic representation of any kind, necessarily. "...we created an equal to Batman, and that's what Ra's al Ghul is all about. He's not necessarily Arabic. He's not necessarily Eastern. He's not necessarily Western. He's not necessarily anything! He's just a villain and he's equal to Batman." - Neal Adams, via SYFY WIRE Batman at 80: How To Craft The Perfect Batman VillainRa's returns to prominence and comes dangerously close to realizing his dream of worldwide genocide in the " Contagion " story arc of the Batman titles. His organization unleashes a deadly virus known as Ebola Gulf A (a.k.a. "The Clench") in Gotham City , putting Batman in conflict with a force he seemingly cannot defeat. A cure is eventually located by Batman and his allies, though the mastermind behind the outbreak is not discovered until the follow-up story " Legacy " . Learning that the Demon's Head still lives, Batman and his team circle the globe, preventing further outbreaks of the virus. Ra's allies himself with Bane , the man who once crippled and nearly killed Batman. Ra's considers Bane a potential heir to his empire, despite his daughter Talia's distaste for the criminal mastermind. Eventually, Batman deduces a way to eliminate the Clench virus from an ancient "Wheel of Plagues" artifact whose knowledge has aided Ra's in the creation of the disease. The long-lived madman eludes justice again.In the " Tower of Babel " storyline, in JLA #43–46, Ra's discovers Batman's contingency plans for stopping the other members of the Justice League of America , should they turn or be turned evil, and uses them to try to destroy the group. Meanwhile, Ra's steals the bodies of Batman's parents. This theft prevents Batman from realizing Ra's is using his traps until it is too late, as he is distracted by the search for the corpses of his parents. Though defeated, Ra's does cause the temporary exit of Batman from the JLA, who now distrust the Caped Crusader. However, though some of the League resent Batman's plans, they eventually accept that the plans were created for the right reasons once Batman confirms that he trusts them by revealing his secret identity to the rest of the team. Talia, disillusioned with her father, leaves the League to run LexCorp for former U.S. President Lex Luthor , before selling the company to Bruce Wayne for his Wayne Foundation to aid Batman and Superman's victory over Luthor. Ra's blames Batman for his failed relationship with Talia, and stages a plot where he tries to separate Batman from his heir, Dick Grayson , shortly before Wayne officially adopts his former ward as his son. The plan fails, and Wayne and Grayson go ahead with the adoption. Ra's is also featured in Birds of Prey #31–35, where he has a romantic fling with the Black Canary . The superheroine is injured and healed in the Lazarus Pit, which also restores the Canary Cry she lost years earlier.In Death and the Maidens (2004), Ra's' other daughter, Nyssa Raatko , furious at her father for abandoning her in a Nazi concentration camp during World War II , begins plotting to destroy him, prompting Ra's to contact Batman to make a deal for access to a Lazarus Pit to give him the strength for a final confrontation with Nyssa; in exchange for the location of a Pit, Ra's provides Batman with a serum that will allow him to walk in the spirit world and speak with his parents. While Batman experiences his "vision", Nyssa befriends Talia and then kidnaps and brainwashes her. Nyssa plots to destroy all hope and optimism in the world by assassinating Superman with Kryptonite bullets she steals from the Batcave . While Batman stops Nyssa from killing Superman, he is unable to stop her from mortally injuring her father. A dying Ra's reveals that this is all part of his greater plan to ensure that his daughters will realize that he is correct in his perceptions about the world and what needs to be done to it, and that they would come to accept their destinies as his heirs. Ra's' plan works: both Nyssa and Talia become the heads of The Demon and the League of Assassins. Talia disavows her love for Bruce Wayne, and both sisters declare Batman their enemy. It is too late for Ra's, as Nyssa stabs her father through the heart, seemingly killing him for good. To ensure Ra's will not return, Batman oversees his nemesis' cremation .In Batman Annual #26, Talia is prompted to read the history of Ra's al Ghul to her son Damian by a mysterious figure from Ra's' past: the White Ghost. Unbeknownst to her, the White Ghost plans to use Damian as a vessel for Ra's' return. However, mother and son escape before the plan is completed. After the escape, Batman confronts the White Ghost; he fights Batman, but accidentally falls into a Lazarus Pit. As of Batman #670, Ra's al Ghul has returned, having evaded death by transferring his consciousness into the body of another. Because his host body is decaying from radiation poisoning, he needs to transfer his mind into another host body. His first choice is that of his grandson Damian Wayne , but Damian escapes to alert his father. Upon taking Ra's to a "Fountain of Essence", which contains the qualities of a Lazarus Pit, Batman is confronted with the sight of the Sensei , who is revealed to be Ra's' father. After defeating Ra's, Sensei fights and impales Batman with a cane. Determined to win, Batman drags the Sensei into the Fountain, where he is killed for not being a pure soul. Ra's, meanwhile, has taken over the body of a Nanda Parbat monk and departs. Healed by the Fountain, Batman emerges and yells for Ra's. Ra's attempts to make amends with Batman after his resurrection, but Batman responds by crushing his decaying fingers. Ra's accepts this latest rebuke and, with the help of his men, overpowers Batman and captures Damian, who has arrived to try to help his father. Ra's attempts to take over Damian, but Batman breaks free just as Robin , Talia, Alfred Pennyworth , and Nightwing arrive to save him. While the battle ensues at Nanda Parbat, the White Ghost takes Ra's to a secluded place, where he appears to accept the fact that his death is inevitable. The White Ghost is revealed as Ra's' estranged albino son Dusan, and offers up his own body instead. Ra's performs the transfer of souls , but the White Ghost apparently dies soon afterward. Ra's resumes the battle and attempts to kill Batman, but the monks at Nanda Parbat stop him and banish him from the temple. Following his resurrection, Ra's al Ghul, in his new body, moves his base of operations to Gotham City where it is revealed that a remnant of his son Dusan's consciousness still remains within him. Since the White Ghost was his son, Ra's was able to use the resemblance between them to modify his new body's appearance to be more like his own, though he remains an albino. This arrogance contributes to the brazen move to Gotham and a subsequent ninja attack on Batman, which indirectly leads to the discovery of a map of all the known Lazarus Pit locations across the globe. Batman then infiltrates Ra's al Ghul's new Gotham penthouse headquarters and easily defeats his horde of ninjas and Ra's himself. To ensure Ra's is not a constant threat within Gotham City, Batman comes up with the false identity of " Terry Gene Kase ", and plants it along with credible photos, medical records, and police records for both Blackgate Penitentiary and Arkham Asylum . Batman takes an unconscious Ra's directly to Arkham where it is believed he really is the prisoner "Terry Gene Kase", a criminal with multiple personality disorder who has just been transferred to Arkham to finish out multiple life sentences. Along with attaching false information and a false identity to Ra's al Ghul's file, Batman attaches a false prescription of potent medication that ensures slurred speech and next to zero mobility. Despite these precautions, Ra's eventually escapes when the orderlies miss his dosage once, which allows him to become conscious enough to escape from Arkham. Ra's realizes that Batman has apparently died after Darkseid 's invasion during Final Crisis . After confronting Nightwing with his knowledge, he and the hero eventually duel with swords. Nightwing defeats Ra's and earns the immortal's respect, signified by leaving his sword in the Batcave as a gift after their fight. Ra's refuses to believe his enemy's passing despite the evidence, leading him to be involved in the Red Robin's (Tim Drake) quest concerning the fate of the original Dark Knight. After Drake finds proof that Wayne is still alive but lost in time after his battle with Darkseid, the former Boy Wonder cripples Ra's' organization, the League of Assassins , from within. In response, Ra's returns to Gotham to begin his attack to destroy every legacy of the Wayne Family. While his men target everyone close to the Waynes, Ra's makes a pact with Hush as part of his plans. Unknown to both men, Lucius Fox has already given Tim power of attorney leaving him in control of the Wayne Family resources. Enraged, Ra's then engages Tim Drake in combat, which ends with Tim mocking Ra's by saying that there's nothing he can do to harm the Bat Family anymore; in response, Ra's smiles and says "Well done. Detective" (a name he has only ever reserved for Batman, Nightwing and Red Hood once before). He then proceeds to kick him out of a skyscraper window and retreats from the battle. Later, in seclusion, Ra's reveals everything which happened was a test for Tim Drake, from the league, the council, the Men of Death, and the plot against Bruce Wayne. Learning of Bruce Wayne's return, Ra's muses that his next confrontation with the detective will be particularly interesting as he believes that Batman has at last had a taste of the immortality that Ra's himself enjoys. He goes after Vicki Vale and almost kills her. He spares her life only after she refuses to publish the identity of Batman and gets rid of all of the evidence she has to that effect. He also realizes that Vale may be a descendant of a French opponent, Marcel du Valliere, from centuries before; therefore, his business with her may not be finished.In The New 52 (a 2011 reboot of the DC Comics universe), Ra's al Ghul appears in a hooded robe at the League of Assassins' city of 'Eth Alth'eban. He enters the Well of Sins after an encounter with Jason Todd . When he emerges, Ra's is consumed by the evil that corrupted the Untitled centuries before, and he feels compelled to rid himself of the machinations of his daughter and Ducra by killing Jason. At Ra's' command, the prisoners are brought to him, and he promises to use his newfound power to destroy them. Red Hood engages Ra's, as Essence joins the battle. She insists that he will allow Jason and his friends to leave his realm, or he will be forced to die a mortal death just as he always feared he would. Despite having destroyed the All-Caste, Ra's al Ghul's actions have led to their eventual rebirth. Defeated, he swears that he will visit great agony upon Red Hood if he ever sees him again. Batman and Aquaman head to an island, where the League of Assassins are located, after Ra's has the bodies of Damian Wayne and Talia exhumed. Ra's had ordered the hunt of whales , creating genetically altered super-humans in the wombs of sperm whales , part of a plan to rebuild the League of Assassins. Inside the compound, they find that Ra's is wiping the hard drives clean, preventing data recovery. As his parting gift, he has left Batman the Heretics to keep him entertained. Batman fights his way to Ra's escape aircraft. He sees Talia and Damian's bodies stored within it, and clings to the fuselage from outside as the plane takes off. Though Ra's plans to go to Paradise Island, he is nearly surprised to see Batman pounding on the cockpit's windshield. From outside, Batman screams for Ra's to give back his son, but Ra's responds that he is blood of Damian's blood and the boy is in good hands. He orders the plane to tilt its angle, causing the wind shear to rip Batman from his purchase and drop down into the sea, where he is caught by Aquaman. Batman and Ra's then encounter Glorious Godfrey . Glorious Godfrey's reason to come to Earth is to retrieve the Chaos Shard, a powerful crystal once belonged to Darkseid which Ra's al Ghul revealed was hidden inside the sarcophagus he crafted for Damian. During Batman Eternal , Bruce briefly speculates that Ra's is the mastermind behind most of the attacks against him that have left Wayne Enterprises bankrupt and Batman pushed to the limit. However, when he confronts Ra's, his foe reveals that, while he was invited to participate in the attack by the true mastermind , he rejected the offer as Ra's would prefer to destroy Batman when the Dark Knight believes that his legacy will be as eternal as Ra's, rather than tear him down in such a manner. During DC Rebirth , Ra's al Ghul is featured in Detective Comics issues #953-956 as part of the "League of Shadows" story arc, which runs from issue #951-956 (April–July 2017). Ra's al Ghul appears in Dark Nights: Metal issue #2 as a member of the Immortals, a group formed by the oldest beings in the multiverse. He participates in a discussion on how they will fight the Dark Multiverse invasion.Due to his expanded life span and longevity, Ra's has accumulated vast knowledge and abilities which exceed those of Batman. These include detective skills, chemistry , physics , military tactics , economics , and martial arts , fully using his photographic memory to master all such skills. He has also gained many international contacts and an immense fortune over the course of centuries. When in combat, he favors more ancient weaponry (as he has had more time to master them than more modern weaponry) these weapons include scimitars , katanas , spears , staffs , bolas , shurikens , smoke pellets and miniaturized explosives . Ra's' greatest tools are his green Lazarus Pits, which heal any injury including recent death and restore the user to the prime of life, but cause temporary insanity (or for those already insane like the Joker , sanity). His constant exposure to the pits has granted him slightly enhanced endurance, strength, and healing but also comes with the price of a gradual onset of insanity if overused. Along with his physical abilities and resources, Ra's al Ghul has been shown to possess a certain degree of proficiency with mysticism. In an effort to guarantee his continued existence, he has on several occasions demonstrated the ability to transfer his soul into the bodies of others, giving him a way to live on in the event that his physical body is destroyed and unable to be transported into a Lazarus Pit. The exact details of this process have remained inconsistent; at times it appears as though a complicated ritual is required to achieve this effect, while on other occasions he is capable of performing this feat on a whim, merely by making physical contact with his intended host. In the New 52 , Ra's temporarily gained vast magical powers after bathing in the Well of Sins, the first Lazarus Pit. He claimed he was gifted with true immortality and displayed powers such as levitation, energy projection and construct creation and matter manipulation. However, he lost these abilities following his battle with Jason Todd.Due to his expanded life span and longevity, Ra's has accumulated vast knowledge and abilities which exceed those of Batman. These include detective skills, chemistry , physics , military tactics , economics , and martial arts , fully using his photographic memory to master all such skills. He has also gained many international contacts and an immense fortune over the course of centuries. When in combat, he favors more ancient weaponry (as he has had more time to master them than more modern weaponry) these weapons include scimitars , katanas , spears , staffs , bolas , shurikens , smoke pellets and miniaturized explosives . Ra's' greatest tools are his green Lazarus Pits, which heal any injury including recent death and restore the user to the prime of life, but cause temporary insanity (or for those already insane like the Joker , sanity). His constant exposure to the pits has granted him slightly enhanced endurance, strength, and healing but also comes with the price of a gradual onset of insanity if overused. Along with his physical abilities and resources, Ra's al Ghul has been shown to possess a certain degree of proficiency with mysticism. In an effort to guarantee his continued existence, he has on several occasions demonstrated the ability to transfer his soul into the bodies of others, giving him a way to live on in the event that his physical body is destroyed and unable to be transported into a Lazarus Pit. The exact details of this process have remained inconsistent; at times it appears as though a complicated ritual is required to achieve this effect, while on other occasions he is capable of performing this feat on a whim, merely by making physical contact with his intended host. In the New 52 , Ra's temporarily gained vast magical powers after bathing in the Well of Sins, the first Lazarus Pit. He claimed he was gifted with true immortality and displayed powers such as levitation, energy projection and construct creation and matter manipulation. However, he lost these abilities following his battle with Jason Todd.The following are members of Ra's al Ghul's family: Created by Neal Adams in 1968, the Sensei was originally introduced as high-ranking member of the League of Assassins . He was portrayed as an aged but highly skilled martial artist. During the Resurrection of Ra's al Ghul storyline, he was revealed to be Ra's al Ghul's centuries-old father. He dies during the same storyline. Created by Joshua Williamson and Gleb Melnikov in 2021, Mother Soul is the mysterious head of the "League of Lazarus". In Robin (vol. 3) #7, she is revealed to be Ruh al Ghul (Soul of the Demon), Ra's al Ghul's mother. Created by Peter Milligan and David Lopez in 2007, Dusan al Ghul ( Arabic : دوسان الغول ) was Ra's' only known son. He was also referred to as Ash'Shabah Al-Abyad ( Arabic : الشبح الأبيض ), meaning "the White Ghost". Though little is known about his past, it is stated that he was born out of a union meant to strengthen his father's hold over "some long-extinct people", suggesting that he was older than Ra's' other children. As an albino , he was never considered a potential heir to his father's empire. He ultimately sacrificed himself to ensure his father's survival during the Resurrection of Ra's al Ghul storyline. Created by Greg Rucka and Klaus Janson in 2003, Nyssa Raatko ( Arabic : نيسا رعتكو ) is Ra's al Ghul's oldest known daughter. She was born the only child to Ra's al Ghul's mistress Amina Raatko, also known as Lourdes in 18th century Russia . She would later become a Holocaust survivor. She is murdered by Cassandra Cain during the One Year Later storyline. Created by Dennis O'Neil and Bob Brown in 1971, Talia al Ghul ( Arabic : تاليه الغول ) is Ra's al Ghul's daughter. Talia's mother was a woman of mixed Chinese and Arab ancestry named Melisande, who met Ra's at the Woodstock festival. Originally appearing as an unnamed infant in the 1987 graphic novel Batman: Son of the Demon , the character was introduced as Damian Wayne or Damian al Ghul ( Arabic : د٠يان الغول) by Grant Morrison and Andy Kubert in 2006. Damian is the son of Bruce Wayne and Talia al Ghul , making him the grandson of Ra's al Ghul. He is an Heir to the Demon Head and expected to one day lead the League. Ra's raised him to be the new Alexander the Great. He is bred from birth to take and rule the world by his mother Talia al Ghul. He was very aggressive until he met his father, Batman. Batman taught him how to calm himself and trained him to be the new Robin. His genetic perfection and genetic makeup unfortunately marked him as the ideal host for his grandfather who wants to take over his body. Created by Benjamin Percy and Jonboy Meyers, the character debuted in Teen Titans (vol. 6) in December 2016. Mara al Ghul is a granddaughter of Ra's al Ghul, daughter to the late Dusan al Ghul and a cousin to Damian Wayne. Introduced as an enemy to Damian she was also raised by the League of Assassins. She and Damian were both members of the Demon's Fist , an elite group within in the League. Damian was supposed to lead the Demon's Fist but Mara now leads the group since Damian's choosing his father over the League. Mara hates Damian since he left her with a scar across her right eye during a training session when they were younger. Mara has not inherited her father's albinism; she has black hair with red bangs . Like the rest of her family, she is a skilled fighter and is also noted to be a talented artist. Athanasia al Ghul is a character featured in the Injustice 2 prequel comics and does not appear in the Prime Earth continuity. She is the daughter of Bruce Wayne and Talia al Ghul, sister of Damian Wayne and granddaughter of Ra's al Ghul. Athanasia is the secret daughter of Talia and Bruce and raised by Talia without Bruce or even Damian's knowledge. While Talia allowed Damian to become a hero and work with his father for a time, Talia kept Athanasia a secret from her father and raised her as a member of the League of Assassins. Athanasia is first seen beside her mother Talia breaking her brother Damian out of prison. She is insulted by Damian's apparent rudeness and wants him to say please before letting him out. When Warden Dan Turpin tries to arrest them she kills him and the guards. While exiting the building Damian tells his mother to control her 'servant', Athanasia, who then assaults him. It is only then that Talia reveals Athanasia is Damian's sister and the "Daughter of the Bat". After the fall of Superman 's regime Athanasia and the rest of the League come out of hiding. She works alongside her mother and grandfather in a scheme to reclaim the Earth from humans who were destroying it. During a fight with Batman in their secret base in the Amazon Rainforest Athanasia was seemingly killed when El Diablo exploded and Athanasia wasn't shielded from the blast. She later appeared again alongside her grandfather in Gorilla City as King Solovar 's guests. Although he fathered children with several women, Ra's al Ghul has only two confirmed marriages. The first was to Sora, whose death set Ra's on the path to becoming the "Demon's Head". The second was to Melisande, Talia's mother. Ra's also appears to have an unnamed sister or half-sister, a female assassin belonging to a group called the "Daughters of Acheron", whose members share the same father. Another member is a woman using the alias "Promise". It is unclear if their common father, "Acheron", is in fact the Sensei (making them all Ra's' half-sisters) or if Ra's only has one half-sister on his mother's side. In Batman and Robin #12, it is revealed that Talia has cloned her son, Damian who's known as " The Heretic " The clone is, therefore, a grandson of sorts of Ra's al Ghul. Additionally, Nyssa once stated that she has given birth twelve times (only two of her children, Daniel and Hannah, are named), opening the possibility of Ra's having many other descendants, although most of Nyssa's family are murdered by the Nazis and Nyssa believes that her great-grandson Vasily (a Russian soldier who is reported to have been killed in the Middle East) was the last of her line. The Birth of the Demon features Ra's' uncle, who helps him avenge his wife and found the League of Assassins before they go their separate ways.Created by Neal Adams in 1968, the Sensei was originally introduced as high-ranking member of the League of Assassins . He was portrayed as an aged but highly skilled martial artist. During the Resurrection of Ra's al Ghul storyline, he was revealed to be Ra's al Ghul's centuries-old father. He dies during the same storyline. Created by Joshua Williamson and Gleb Melnikov in 2021, Mother Soul is the mysterious head of the "League of Lazarus". In Robin (vol. 3) #7, she is revealed to be Ruh al Ghul (Soul of the Demon), Ra's al Ghul's mother. Created by Peter Milligan and David Lopez in 2007, Dusan al Ghul ( Arabic : دوسان الغول ) was Ra's' only known son. He was also referred to as Ash'Shabah Al-Abyad ( Arabic : الشبح الأبيض ), meaning "the White Ghost". Though little is known about his past, it is stated that he was born out of a union meant to strengthen his father's hold over "some long-extinct people", suggesting that he was older than Ra's' other children. As an albino , he was never considered a potential heir to his father's empire. He ultimately sacrificed himself to ensure his father's survival during the Resurrection of Ra's al Ghul storyline. Created by Greg Rucka and Klaus Janson in 2003, Nyssa Raatko ( Arabic : نيسا رعتكو ) is Ra's al Ghul's oldest known daughter. She was born the only child to Ra's al Ghul's mistress Amina Raatko, also known as Lourdes in 18th century Russia . She would later become a Holocaust survivor. She is murdered by Cassandra Cain during the One Year Later storyline. Created by Dennis O'Neil and Bob Brown in 1971, Talia al Ghul ( Arabic : تاليه الغول ) is Ra's al Ghul's daughter. Talia's mother was a woman of mixed Chinese and Arab ancestry named Melisande, who met Ra's at the Woodstock festival. Originally appearing as an unnamed infant in the 1987 graphic novel Batman: Son of the Demon , the character was introduced as Damian Wayne or Damian al Ghul ( Arabic : د٠يان الغول) by Grant Morrison and Andy Kubert in 2006. Damian is the son of Bruce Wayne and Talia al Ghul , making him the grandson of Ra's al Ghul. He is an Heir to the Demon Head and expected to one day lead the League. Ra's raised him to be the new Alexander the Great. He is bred from birth to take and rule the world by his mother Talia al Ghul. He was very aggressive until he met his father, Batman. Batman taught him how to calm himself and trained him to be the new Robin. His genetic perfection and genetic makeup unfortunately marked him as the ideal host for his grandfather who wants to take over his body.Created by Benjamin Percy and Jonboy Meyers, the character debuted in Teen Titans (vol. 6) in December 2016. Mara al Ghul is a granddaughter of Ra's al Ghul, daughter to the late Dusan al Ghul and a cousin to Damian Wayne. Introduced as an enemy to Damian she was also raised by the League of Assassins. She and Damian were both members of the Demon's Fist , an elite group within in the League. Damian was supposed to lead the Demon's Fist but Mara now leads the group since Damian's choosing his father over the League. Mara hates Damian since he left her with a scar across her right eye during a training session when they were younger. Mara has not inherited her father's albinism; she has black hair with red bangs . Like the rest of her family, she is a skilled fighter and is also noted to be a talented artist.Athanasia al Ghul is a character featured in the Injustice 2 prequel comics and does not appear in the Prime Earth continuity. She is the daughter of Bruce Wayne and Talia al Ghul, sister of Damian Wayne and granddaughter of Ra's al Ghul. Athanasia is the secret daughter of Talia and Bruce and raised by Talia without Bruce or even Damian's knowledge. While Talia allowed Damian to become a hero and work with his father for a time, Talia kept Athanasia a secret from her father and raised her as a member of the League of Assassins. Athanasia is first seen beside her mother Talia breaking her brother Damian out of prison. She is insulted by Damian's apparent rudeness and wants him to say please before letting him out. When Warden Dan Turpin tries to arrest them she kills him and the guards. While exiting the building Damian tells his mother to control her 'servant', Athanasia, who then assaults him. It is only then that Talia reveals Athanasia is Damian's sister and the "Daughter of the Bat". After the fall of Superman 's regime Athanasia and the rest of the League come out of hiding. She works alongside her mother and grandfather in a scheme to reclaim the Earth from humans who were destroying it. During a fight with Batman in their secret base in the Amazon Rainforest Athanasia was seemingly killed when El Diablo exploded and Athanasia wasn't shielded from the blast. She later appeared again alongside her grandfather in Gorilla City as King Solovar 's guests. Although he fathered children with several women, Ra's al Ghul has only two confirmed marriages. The first was to Sora, whose death set Ra's on the path to becoming the "Demon's Head". The second was to Melisande, Talia's mother. Ra's also appears to have an unnamed sister or half-sister, a female assassin belonging to a group called the "Daughters of Acheron", whose members share the same father. Another member is a woman using the alias "Promise". It is unclear if their common father, "Acheron", is in fact the Sensei (making them all Ra's' half-sisters) or if Ra's only has one half-sister on his mother's side. In Batman and Robin #12, it is revealed that Talia has cloned her son, Damian who's known as " The Heretic " The clone is, therefore, a grandson of sorts of Ra's al Ghul. Additionally, Nyssa once stated that she has given birth twelve times (only two of her children, Daniel and Hannah, are named), opening the possibility of Ra's having many other descendants, although most of Nyssa's family are murdered by the Nazis and Nyssa believes that her great-grandson Vasily (a Russian soldier who is reported to have been killed in the Middle East) was the last of her line. The Birth of the Demon features Ra's' uncle, who helps him avenge his wife and found the League of Assassins before they go their separate ways.After Talia encounters and falls in love with Batman in Detective Comics #411 (May 1971), Ra's begins to consider Batman as a possible heir. Ra's first deduces Batman's secret identity when he reasons the Dark Knight has to be rich, and learns only Bruce Wayne has bought the equipment a crime fighter would have; he is then ready to put Batman to a final test. Ra's surprises Batman in the Batcave , seemingly to enlist Batman's aid in rescuing both Talia and Dick Grayson , the first Robin , both of whom have apparently been kidnapped. Batman soon discovers the whole affair is a charade orchestrated by Ra's to test Batman, which he passes. Ra's asks Batman to become his heir, which Batman refuses, appalled by his genocidal plan to "cleanse" the world. This story was later adapted into a two-part story in Batman: The Animated Series during its first season under the title "The Demon's Quest". Despite being mortal enemies, Ra's al Ghul and Batman maintain some level of respect towards one another. Similar to The Riddler , Ra's admires Batman's intellectual prowess first and foremost, regularly referring to Batman as "Detective" or "The Detective" when speaking to or about him. Despite being aware of Batman's true identity as Bruce Wayne since their first meeting, Ra's has never exposed that information to the public or Batman's other foes; Batman once attributed this to Ra's' personal code of honor, though Ra's has repeatedly used that knowledge to his own advantage when fomenting plans and contingencies against Batman. In the story "Resurrection Night" in Batman #400, Ra's helps all of Batman's foes to escape from Arkham Asylum and the Gotham State Penitentiary, setting them on a plan to abduct certain individuals across Gotham City who are linked in one form or another to Batman. Ra's' true intent is to show Batman the folly of his efforts to protect a corrupt society which, to his mind, allows criminals to exist and flourish. Ra's eventually uses the Pit while still healthy, both increasing his strength and putting his life at risk, in an attempt to outmatch the Dark Knight. The plan backfires, as Ra's is left writhing in the pit, seemingly destroyed.In the graphic novel Son of the Demon , Ra's successfully enlists Batman's aid in defeating a rogue assassin and warlord, Qayin (a variation on the spelling of Cain ), who has murdered Ra's' then-wife Melisande (Talia's mother). During this storyline, Batman marries Talia and she becomes pregnant . Batman is nearly killed protecting Talia from the assassin's agents. In the end, Talia ends her relationship with Batman, unwilling to put him in danger. She claims to have miscarried and the marriage is dissolved. The child is eventually born and left at an orphanage (eventually taking the name Ibn al Xu'ffasch ). The only identification provided is Talia's jewel-encrusted necklace, which once belonged to Talia's mother. Two Elseworlds stories, Kingdom Come and Brotherhood of the Bat , feature two alternate versions of Ibn as an adult, coming to terms with his dual heritage. For a time, DC Comics' policy was that Son of the Demon was not canon and that Batman had no son. The recent appearance of the child (under the name Damian) in an issue of Batman implies that this policy may have changed. Ra's has previously been revealed as alive in the 31st-century setting of the post- Zero Hour reboot Legion of Super-Heroes , impersonating Leland McCauley . In the first Superman & Batman: Generations series, created by John Byrne , Bruce Wayne tracks down Ra's al Ghul after passing the Batman mantle on to his son. Ra's offers Bruce (whom he addresses as "Adversary") a chance at immortality . Ra's has determined that if two people enter the Lazarus Pit, the Pit will merge both life forces, destroying one soul in the process and imbuing the other with youth and immortality without the ensuing madness. With his only choices being a fifty-fifty chance at death in the Pit or being murdered by Ra's' men, Bruce agrees to the process. He survives exposure to the Pit and subsequently uses Ra's' criminal empire to clandestinely set up an international humanitarian network. He also becomes a near-immortal, aging one year for every century. In the Batman & Spider-Man: New Age Dawning crossover book (considered an Elseworlds story), Ra's begins plans for worldwide devastation. He manipulates the Kingpin to his side by infecting the crime lord's wife Vanessa with terminal disease and promising him the cure in return for his allegiance. Ra's then orders him to press the button on his machines which would send New York City under the ocean. Ultimately, Spider-Man and Batman interfere and the Kingpin reveals that he knows Ra's' plans and allows the two heroes to board his plane so they can assist him. Defeated, Ra's bows out of the plan gracefully but claims that there is no cure for the disease. Vanessa convinces her husband that she wishes no further violence, and they leave. Talia soon gives the cure to Batman, who then gives it to Spider-Man, who passes it on to the Kingpin. In The Batman Adventures #1, albeit Ra's didn't appear, he plays a larger role behind-the-scenes along the Society of Shadows and the Penguin . Ra's finally appears in issue #4, in which he fights Batman again only to be defeated by him one more time. Series writer Ty Templeton originally wanted to bring back Ra's in issue #5 depicting him at prison, but his script for the planned story was rejected because DC Comics told him and Dan Slott that they were 'done' with Ra's and it was time to move with other characters, resulting in issue #5 as a story of Black Mask 's False Face Society. In the Amalgam Comics alternate dimension, Ra's is fused with Marvel Comics supervillain Apocalypse to become " Ra's Al-Pocalypse ". Ra's' daughter Talia is fused with Lady Deathstrike to become "Lady Talia". In Captain Carrot and the Final Ark , Ra's is parodied as Rash Al Paca, an alpaca who plans to save the environment from "animalkind" by increasing global warming and flooding the planet. In Kingdom Come , a rogue superhuman claimed that Ra's al Ghul was killed. Ra's' grandson, Ibn al Xu'ffasch , is a member of Lex Luthor 's Mankind Liberation Front. When the appearance of Gog threatens this reality, Ibn uses a Lazarus Pit to restore Ra's to life to try to find a solution in collaboration with Lex Luthor and Brainiac , but they fail to find a solution. All three of them attempt to betray Ibn, and Lex and Brainiac die in their own trap for him. Ra's gets into a sword duel with his grandson in the Batcave and is killed by him. In the alternate timeline of the Flashpoint event, Ra's al Ghul is a young boy and member of the H.I.V.E. council. He voted against using nuclear weapons to end the war in Western Europe between Aquaman and Wonder Woman. In the Batman/Teenage Mutant Ninja Turtles crossover miniseries, when the Foot Clan initially arrive in Gotham, Batman considers the possibility that they are a branch of the League of Assassins, but dismisses the idea as the Foot's combat skills show a focus on a specific area of martial arts as opposed to the more varied skills of the League. After Shredder attempts to escape a confrontation with Batman and the Turtles, he is confronted by Ra's, who offers him an alliance. With a batch of fresh mutagen brought to the DC Universe by Casey Jones , Shredder and Ra's try to bring the world to its knees by unleashing their mutated monstrosities (starting with the inmates of Arkham Asylum ), but are defeated by the combined efforts of Batman, Ra's' own grandson Damian , the Teenage Mutant Ninja Turtles and Splinter , who force Ra's into flight. In the Arrow tie-in comic, Season 2.5 , when he hears about terrorist group Onslaught and his leader Khem-Adam , Ra's wishes to speak with him. He sends Nyssa al Ghul and Sara Lance to retrieve him from his base in the Amon-Shu caves of Kahndaq . They arrive back, with him and a girl named Mesi Natifah. Wishing to give Mesi vengeance, he gives her his sword to execute him. Ra's appears in a crossover story between Batman '66 and Wonder Woman '77 (taking place in the continuity of Adam West's portrayal of Batman and Lynda Carter's portrayal of Wonder Woman ). He and his daughter Talia first meet Bruce in the 40s at a Wayne Foundation auction to support the war effort, where The League of Shadows and the Nazis attempt to bid for a book detailing ancient treasures and locations. When they confront the book's auction winner Mr. Finlay, the young Bruce and Talia escape with both of the books to keep them safe. Ra's finds Bruce in the maze and threatens his life, but Bruce escapes as Ra's manages to obtain one of the books. Twenty-two years later, Talia hires Catwoman to steal the second book from Mr. Finlay. Batman, Robin and Catwoman travel to Paradise Island to warn Wonder Woman and her people that the League of Shadows will be invading one of the nearby areas, with Diana knowing that Ra's is after the island's Lazarus Pit. Ra's uses the pit to restore his youth and offers the four the chance to join the League of Shadows, but they refuse. Ra's tries to bury them alive, but they are saved thanks to the intervention of Wonder Girl and Talia rescuing them behind her father's back (still harboring feelings for Bruce). Talia is placed in prison by the Amazons while Ra's manages to escape. 11 years later, Catwoman aids Talia in escaping Paradise Island and the two Ghuls continue their search for Lazarus Pits. Thanks to spying on Wonder Woman and Batman, the League discovers there's a Pit in Gotham underneath Arkham Asylum. Ra's hires the Riddler, Mr. Freeze, Clayface, Killer Croc, and Cheetah to keep the heroes at bay. Batman follows Ra's near the Pit and tries to stop him, but Ra's uses his magical assassins to prevent them from interfering. Due to using the Pit sooner than the last time he used it, Ra's is de-aged into a ten year old. The two al Ghuls are taken by authorities, with Batman saddened that Talia chose to follow her father's influence. Ra's appears in the comic prequel series to the video game Injustice 2 . After the fall of the Regime, he takes control of the Suicide Squad , using them to break out Damian Wayne out of Stryker's Island and kidnap the heads of large companies for execution, including Ted Kord . He also organizes the kidnapping of the relatives of active superheroes as a deterrent to their involvement in his plans and resurrects Alfred Pennyworth with one of his Lazarus Pits. Ra's' plan is eventually stopped when Batman and the remnants of the Insurgency, including Ted's successor as Blue Beetle Jaime Reyes , break into his base, inadvertently killing all endangered life he was protecting. As he leaves, Ra's reveals that he had ordered Jackson Hyde to attack the US congress, causing the deaths of thousands and damage to Batman's plans of rebuilding society. It is also revealed that he has been working with Solovar and has possession of the android Amazo . The war between him and Batman continues until he and Solovar are usurped by Gorilla Grodd . During Grodd's coup, he attempts to warn Bruce about the coup before he was mind controlled. As his last request, he asks Bruce to protect his grandchildren. Soon, Ra's appeared before Grodd and was killed by the new ruler of Gorilla City . Despite Ra's apparent death in the prequel comic, he appears alive in the games itself where he is featured in Black Adam 's character ending. In the story Batman: The Doom That Came to Gotham , Ra's al Ghul is the main antagonist. This version is a deranged cultist bent on freeing the demon Iog-Sotha from its prison, creating monsters such as Poison Ivy to terrorize Gotham. In the finale, Batman confronted his enemy who had transformed into a monster, prompting Bruce Wayne to become a bat-like monster to defeat him. In the graphic novel Son of the Demon , Ra's successfully enlists Batman's aid in defeating a rogue assassin and warlord, Qayin (a variation on the spelling of Cain ), who has murdered Ra's' then-wife Melisande (Talia's mother). During this storyline, Batman marries Talia and she becomes pregnant . Batman is nearly killed protecting Talia from the assassin's agents. In the end, Talia ends her relationship with Batman, unwilling to put him in danger. She claims to have miscarried and the marriage is dissolved. The child is eventually born and left at an orphanage (eventually taking the name Ibn al Xu'ffasch ). The only identification provided is Talia's jewel-encrusted necklace, which once belonged to Talia's mother. Two Elseworlds stories, Kingdom Come and Brotherhood of the Bat , feature two alternate versions of Ibn as an adult, coming to terms with his dual heritage. For a time, DC Comics' policy was that Son of the Demon was not canon and that Batman had no son. The recent appearance of the child (under the name Damian) in an issue of Batman implies that this policy may have changed.Ra's has previously been revealed as alive in the 31st-century setting of the post- Zero Hour reboot Legion of Super-Heroes , impersonating Leland McCauley .In the first Superman & Batman: Generations series, created by John Byrne , Bruce Wayne tracks down Ra's al Ghul after passing the Batman mantle on to his son. Ra's offers Bruce (whom he addresses as "Adversary") a chance at immortality . Ra's has determined that if two people enter the Lazarus Pit, the Pit will merge both life forces, destroying one soul in the process and imbuing the other with youth and immortality without the ensuing madness. With his only choices being a fifty-fifty chance at death in the Pit or being murdered by Ra's' men, Bruce agrees to the process. He survives exposure to the Pit and subsequently uses Ra's' criminal empire to clandestinely set up an international humanitarian network. He also becomes a near-immortal, aging one year for every century.In the Batman & Spider-Man: New Age Dawning crossover book (considered an Elseworlds story), Ra's begins plans for worldwide devastation. He manipulates the Kingpin to his side by infecting the crime lord's wife Vanessa with terminal disease and promising him the cure in return for his allegiance. Ra's then orders him to press the button on his machines which would send New York City under the ocean. Ultimately, Spider-Man and Batman interfere and the Kingpin reveals that he knows Ra's' plans and allows the two heroes to board his plane so they can assist him. Defeated, Ra's bows out of the plan gracefully but claims that there is no cure for the disease. Vanessa convinces her husband that she wishes no further violence, and they leave. Talia soon gives the cure to Batman, who then gives it to Spider-Man, who passes it on to the Kingpin.In The Batman Adventures #1, albeit Ra's didn't appear, he plays a larger role behind-the-scenes along the Society of Shadows and the Penguin . Ra's finally appears in issue #4, in which he fights Batman again only to be defeated by him one more time. Series writer Ty Templeton originally wanted to bring back Ra's in issue #5 depicting him at prison, but his script for the planned story was rejected because DC Comics told him and Dan Slott that they were 'done' with Ra's and it was time to move with other characters, resulting in issue #5 as a story of Black Mask 's False Face Society. In the Amalgam Comics alternate dimension, Ra's is fused with Marvel Comics supervillain Apocalypse to become " Ra's Al-Pocalypse ". Ra's' daughter Talia is fused with Lady Deathstrike to become "Lady Talia".In Captain Carrot and the Final Ark , Ra's is parodied as Rash Al Paca, an alpaca who plans to save the environment from "animalkind" by increasing global warming and flooding the planet.In Kingdom Come , a rogue superhuman claimed that Ra's al Ghul was killed. Ra's' grandson, Ibn al Xu'ffasch , is a member of Lex Luthor 's Mankind Liberation Front. When the appearance of Gog threatens this reality, Ibn uses a Lazarus Pit to restore Ra's to life to try to find a solution in collaboration with Lex Luthor and Brainiac , but they fail to find a solution. All three of them attempt to betray Ibn, and Lex and Brainiac die in their own trap for him. Ra's gets into a sword duel with his grandson in the Batcave and is killed by him. In the alternate timeline of the Flashpoint event, Ra's al Ghul is a young boy and member of the H.I.V.E. council. He voted against using nuclear weapons to end the war in Western Europe between Aquaman and Wonder Woman. In the Batman/Teenage Mutant Ninja Turtles crossover miniseries, when the Foot Clan initially arrive in Gotham, Batman considers the possibility that they are a branch of the League of Assassins, but dismisses the idea as the Foot's combat skills show a focus on a specific area of martial arts as opposed to the more varied skills of the League. After Shredder attempts to escape a confrontation with Batman and the Turtles, he is confronted by Ra's, who offers him an alliance. With a batch of fresh mutagen brought to the DC Universe by Casey Jones , Shredder and Ra's try to bring the world to its knees by unleashing their mutated monstrosities (starting with the inmates of Arkham Asylum ), but are defeated by the combined efforts of Batman, Ra's' own grandson Damian , the Teenage Mutant Ninja Turtles and Splinter , who force Ra's into flight. In the Arrow tie-in comic, Season 2.5 , when he hears about terrorist group Onslaught and his leader Khem-Adam , Ra's wishes to speak with him. He sends Nyssa al Ghul and Sara Lance to retrieve him from his base in the Amon-Shu caves of Kahndaq . They arrive back, with him and a girl named Mesi Natifah. Wishing to give Mesi vengeance, he gives her his sword to execute him. Ra's appears in a crossover story between Batman '66 and Wonder Woman '77 (taking place in the continuity of Adam West's portrayal of Batman and Lynda Carter's portrayal of Wonder Woman ). He and his daughter Talia first meet Bruce in the 40s at a Wayne Foundation auction to support the war effort, where The League of Shadows and the Nazis attempt to bid for a book detailing ancient treasures and locations. When they confront the book's auction winner Mr. Finlay, the young Bruce and Talia escape with both of the books to keep them safe. Ra's finds Bruce in the maze and threatens his life, but Bruce escapes as Ra's manages to obtain one of the books. Twenty-two years later, Talia hires Catwoman to steal the second book from Mr. Finlay. Batman, Robin and Catwoman travel to Paradise Island to warn Wonder Woman and her people that the League of Shadows will be invading one of the nearby areas, with Diana knowing that Ra's is after the island's Lazarus Pit. Ra's uses the pit to restore his youth and offers the four the chance to join the League of Shadows, but they refuse. Ra's tries to bury them alive, but they are saved thanks to the intervention of Wonder Girl and Talia rescuing them behind her father's back (still harboring feelings for Bruce). Talia is placed in prison by the Amazons while Ra's manages to escape. 11 years later, Catwoman aids Talia in escaping Paradise Island and the two Ghuls continue their search for Lazarus Pits. Thanks to spying on Wonder Woman and Batman, the League discovers there's a Pit in Gotham underneath Arkham Asylum. Ra's hires the Riddler, Mr. Freeze, Clayface, Killer Croc, and Cheetah to keep the heroes at bay. Batman follows Ra's near the Pit and tries to stop him, but Ra's uses his magical assassins to prevent them from interfering. Due to using the Pit sooner than the last time he used it, Ra's is de-aged into a ten year old. The two al Ghuls are taken by authorities, with Batman saddened that Talia chose to follow her father's influence. Ra's appears in the comic prequel series to the video game Injustice 2 . After the fall of the Regime, he takes control of the Suicide Squad , using them to break out Damian Wayne out of Stryker's Island and kidnap the heads of large companies for execution, including Ted Kord . He also organizes the kidnapping of the relatives of active superheroes as a deterrent to their involvement in his plans and resurrects Alfred Pennyworth with one of his Lazarus Pits. Ra's' plan is eventually stopped when Batman and the remnants of the Insurgency, including Ted's successor as Blue Beetle Jaime Reyes , break into his base, inadvertently killing all endangered life he was protecting. As he leaves, Ra's reveals that he had ordered Jackson Hyde to attack the US congress, causing the deaths of thousands and damage to Batman's plans of rebuilding society. It is also revealed that he has been working with Solovar and has possession of the android Amazo . The war between him and Batman continues until he and Solovar are usurped by Gorilla Grodd . During Grodd's coup, he attempts to warn Bruce about the coup before he was mind controlled. As his last request, he asks Bruce to protect his grandchildren. Soon, Ra's appeared before Grodd and was killed by the new ruler of Gorilla City . Despite Ra's apparent death in the prequel comic, he appears alive in the games itself where he is featured in Black Adam 's character ending. In the story Batman: The Doom That Came to Gotham , Ra's al Ghul is the main antagonist. This version is a deranged cultist bent on freeing the demon Iog-Sotha from its prison, creating monsters such as Poison Ivy to terrorize Gotham. In the finale, Batman confronted his enemy who had transformed into a monster, prompting Bruce Wayne to become a bat-like monster to defeat him. Ra's al Ghul appears in the Batman: Arkham video games, voiced by Dee Bradley Baker . Batman gives the Lazarus Pit sample to Ra's, and is forced to fight Nyssa and her rebels. Not soon after, Ra's regains his former strength and fatally slashes Nyssa for her treachery. Batman tries to fight him, but Ra's steals one of his smoke bombs and disappears. Batman comforts Nyssa in her dying moments and closes her eyes before he leaves. Batman decides against giving the Lazarus Pit sample to Ra's, and destroys the equipment keeping him alive. After he takes care of his loyalists, Nyssa arrives to see what her father has ultimately become. As she is about to strike him down, Batman stops her and says that he will take him to the GCPD. Nyssa is satisfied and lives up to her word, recalling all her forces from Gotham while Batman takes Ra's to a special cell at GCPD and straps him to a gurney, with Ra's telling the Dark Knight that he is proud of him for apparently breaking his code.Ra's al Ghul appears in the Batman: Arkham video games, voiced by Dee Bradley Baker . Batman gives the Lazarus Pit sample to Ra's, and is forced to fight Nyssa and her rebels. Not soon after, Ra's regains his former strength and fatally slashes Nyssa for her treachery. Batman tries to fight him, but Ra's steals one of his smoke bombs and disappears. Batman comforts Nyssa in her dying moments and closes her eyes before he leaves. Batman decides against giving the Lazarus Pit sample to Ra's, and destroys the equipment keeping him alive. After he takes care of his loyalists, Nyssa arrives to see what her father has ultimately become. As she is about to strike him down, Batman stops her and says that he will take him to the GCPD. Nyssa is satisfied and lives up to her word, recalling all her forces from Gotham while Batman takes Ra's to a special cell at GCPD and straps him to a gurney, with Ra's telling the Dark Knight that he is proud of him for apparently breaking his code.Ra's al Ghul appears in the Batman: Arkham video games, voiced by Dee Bradley Baker . Batman gives the Lazarus Pit sample to Ra's, and is forced to fight Nyssa and her rebels. Not soon after, Ra's regains his former strength and fatally slashes Nyssa for her treachery. Batman tries to fight him, but Ra's steals one of his smoke bombs and disappears. Batman comforts Nyssa in her dying moments and closes her eyes before he leaves. Batman decides against giving the Lazarus Pit sample to Ra's, and destroys the equipment keeping him alive. After he takes care of his loyalists, Nyssa arrives to see what her father has ultimately become. As she is about to strike him down, Batman stops her and says that he will take him to the GCPD. Nyssa is satisfied and lives up to her word, recalling all her forces from Gotham while Batman takes Ra's to a special cell at GCPD and straps him to a gurney, with Ra's telling the Dark Knight that he is proud of him for apparently breaking his code.His stories have been collected into a number of volumes :

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/List_of_epidemics_and_pandemics/html

List of epidemics and pandemics

This is a list of the largest known epidemics and pandemics caused by an infectious disease . Widespread non-communicable diseases such as cardiovascular disease and cancer are not included. An epidemic is the rapid spread of disease to a large number of people in a given population within a short period of time; in meningococcal infections , an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic. Due to the long time spans, the first plague pandemic (6th century – 8th century) and the second plague pandemic (14th century – early 19th century) are shown by individual outbreaks, such as the Plague of Justinian (first pandemic) and the Black Death (second pandemic). Infectious diseases with high prevalence are listed separately (sometimes in addition to their epidemics), such as malaria , which may have killed 50–60 billion people throughout history, or about half of all humans that have ever lived. Ongoing epidemics and pandemics are in boldface . For a given epidemic or pandemic, the average of its estimated death toll range is used for ranking. If the death toll averages of two or more epidemics or pandemics are equal, then the smaller the range, the higher the rank. For the historical records of major changes in the world population, see world population . Not included in the above table are many waves of deadly diseases brought by Europeans to the Americas and Caribbean. Western Hemisphere populations were ravaged mostly by smallpox , but also typhus , measles , influenza , bubonic plague , cholera , malaria , tuberculosis , mumps , yellow fever , and pertussis . The lack of written records in many places and the destruction of many native societies by disease, war, and colonization make estimates uncertain. Deaths probably numbered in the tens or perhaps over a hundred million, with perhaps 90% of the population dead in the worst-hit areas. Lack of scientific knowledge about microorganisms and lack of surviving medical records for many areas makes attribution of specific numbers to specific diseases uncertain. There have been various major infectious diseases with high prevalence worldwide, but they are currently not listed in the above table as epidemics/pandemics due to the lack of definite data, such as time span and death toll.Ongoing epidemics and pandemics are in boldface . For a given epidemic or pandemic, the average of its estimated death toll range is used for ranking. If the death toll averages of two or more epidemics or pandemics are equal, then the smaller the range, the higher the rank. For the historical records of major changes in the world population, see world population . Not included in the above table are many waves of deadly diseases brought by Europeans to the Americas and Caribbean. Western Hemisphere populations were ravaged mostly by smallpox , but also typhus , measles , influenza , bubonic plague , cholera , malaria , tuberculosis , mumps , yellow fever , and pertussis . The lack of written records in many places and the destruction of many native societies by disease, war, and colonization make estimates uncertain. Deaths probably numbered in the tens or perhaps over a hundred million, with perhaps 90% of the population dead in the worst-hit areas. Lack of scientific knowledge about microorganisms and lack of surviving medical records for many areas makes attribution of specific numbers to specific diseases uncertain.There have been various major infectious diseases with high prevalence worldwide, but they are currently not listed in the above table as epidemics/pandemics due to the lack of definite data, such as time span and death toll.Events in boldface are ongoing.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Sierra_Leone_national_football_team/html

Sierra Leone national football team

The Sierra Leone national football team represents Sierra Leone in association football and is governed by the Sierra Leone Football Association . It has qualified for Africa Cup of Nations three times.Sierra Leone's first match was at home on 10 August 1949 against another British colony, Nigeria , and was lost 2–0. In 1954 it played another British colony and British administered U.N trust territory, Gold Coast and Trans-Volta Togoland , and lost 2–0 away. On 22 April 1961, it hosted Nigeria and lost 4–2. On 12 November 1966, it hosted Liberia in its first match against a non-British colony and earned its first draw, 1–1. A week later, it lost 2–0 in Liberia. On 13 January 1971, it played its first match against a non-African team, West Germany 's B-team. The match in Sierra Leone was won 1–0 by the Germans. Sierra Leone's first match outside Africa was its first against an Asian nation, China . It lost 4–1 in China on 5 April 1974. In August 2014, Sierra Leone FA cancelled all association football matches in an effort to stop the spread of the 2014 Ebola virus epidemic in Sierra Leone , a week after Liberian FA did the same. Sierra Leonean players playing outside Sierra Leone, such as Michael Lahoud playing in the United States , were discriminated against, with opposition players refusing to swap shirts, shake hands and allow them to certain places of the stadium because they fear that they could be carrying the disease. The Sierra Leonean national team wasn't allowed to play home games and all players had to be foreign-based. The following is a list of match results in the last 12 months, as well as any future matches that have been scheduled. Win Draw Loss FixtureThe following players were called up for the friendly matches against Ivory Coast and Morocco on 6 and 11 January 2024. Caps and goals are correct as of 6 January 2024, after the match against Ivory Coast . The following players had been called up in 12 months preceding the above draft. INJ Withdrew due to injury. PRE Preliminary squad / standby RET Had announced retirement from international association football. SUS Is serving a suspension. PRI Absent due to private circumstances. WD Withdrawn.The following players were called up for the friendly matches against Ivory Coast and Morocco on 6 and 11 January 2024. Caps and goals are correct as of 6 January 2024, after the match against Ivory Coast .The following players had been called up in 12 months preceding the above draft. INJ Withdrew due to injury. PRE Preliminary squad / standby RET Had announced retirement from international association football. SUS Is serving a suspension. PRI Absent due to private circumstances. WD Withdrawn.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Ebola_virus_disease_treatment_research/html

Ebola virus disease treatment research

There is a cure for the Ebola virus disease that is currently approved for market the US government has inventory in the Strategic National Stockpile. For past and current Ebola epidemics, treatment has been primarily supportive in nature. As of August 2023 [ update ] , treatment known as atoltivimab/maftivimab/odesivimab and experimental ansuvimab were found to be 90% effective. In October 2020, the U.S. Food and Drug Administration (FDA) approved atoltivimab/maftivimab/odesivimab with an indication for the treatment of infection caused by Zaire ebolavirus . In March 2014, the World Health Organization (WHO) reported a major Ebola outbreak in Guinea , a western African nation. The disease then rapidly spread to the neighboring countries of Liberia and Sierra Leone . The 2014 West African Ebola outbreak is the largest Ebola outbreak ever documented, and the first recorded in the region. The director of the US National Institute of Allergy and Infectious Diseases (NIAID) has stated that the scientific community is still in the early stages of understanding how infection with the Ebola virus can be treated and prevented. The unavailability of treatments in the most-affected regions has spurred controversy, with some calling for experimental drugs to be made more widely available in Africa on a humanitarian basis, and others warning that making unproven drugs widely available would be unethical, especially in light of past experimentation conducted in developing countries by Western drug companies. As a result of the controversy, on 12 August an expert panel of the WHO endorsed the use of interventions with as-yet-unknown effects for both treatment and prevention of Ebola, and also said that deciding which treatments should be used and how to distribute them equitably were matters that needed further discussion. Conventional trials to study efficacy by exposure of humans to the pathogen are obviously not feasible in this case. For such situations, the Food and Drug Administration (FDA) has established the " animal efficacy rule " allowing limited licensure to be approved on the basis of animal model studies that replicate human disease, combined with evidence of safety. A number of experimental treatments are being considered for use in the context of this outbreak, and are currently or will soon undergo clinical trials . A distributed computing project, Outsmart Ebola Together , has been launched by World Community Grid in collaboration with the Scripps Research Institute to help find chemical compounds to fight the disease. It uses the idle processing capacity of volunteers' computers and tablets. The centre for epidemic and microbiological research and treatment was constructed in the Guinean Kindia province. The centre was designed and created by RUSAL specialists with the assistance of Rospotrebnadzor scientists (RUSAL has invested $10 million). The World Health Organization (WHO) has stated that transfusion of whole blood or purified serum from Ebola survivors has the greatest potential to be implemented immediately, and has issued an interim guideline for this therapy. A study in Sierra Leone started in November 2014, and preliminary results show an 80 percent survival rate. Trials in Liberia and Guinea started in January 2015, with funding from the Gates Foundation . Blood transfusions were also used in a 1995 outbreak in the Democratic Republic of the Congo, and 7 out of 8 patients survived. Ribavirin is also known to be ineffective against ebolaviruses despite its effectiveness against other viral hemorrhagic fevers such as Lassa fever . Interferon therapies have been tried as a form of treatment for EVD, but were found to be ineffective. One issue which hinders control of Ebola is that diagnostic tests that are currently available require specialised equipment and highly trained personnel. Since there are few suitable testing centres in West Africa, this leads to delay in diagnosis. In December, a conference in Geneva will aim to work out which diagnostic tools could identify Ebola reliably and more quickly. The meeting, convened by the WHO and the non-profit Foundation for Innovative New Diagnostics , seeks to identify tests that can be used by untrained staff, do not require electricity or can run on batteries or solar power and use reagents that can withstand temperatures of 40 °C (104 °F) . As of February 2015 [ update ] , a number of diagnostic tests are under trial:The Hemopurifier is a single-use disposable biological cartridge designed for use with dialysis machines and other blood circulatory pumps. It is a method for removal of viruses from blood by lectin affinity hemodialysis which embodies reducing viral loads in the blood of individuals infected with a virus. During October 2014, the Hemopurifier was used as an adjunct in the treatment of a patient with Ebola , who then recovered. The FDA subsequently approved the device for testing in up to 20 infected Ebola cases in the United States.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/ZMapp/html

ZMapp

ZMapp is an experimental biopharmaceutical drug comprising three chimeric monoclonal antibodies under development as a treatment for Ebola virus disease . Two of the three components were originally developed at the Public Health Agency of Canada 's National Microbiology Laboratory (NML), and the third at the U.S. Army Medical Research Institute of Infectious Diseases ; the cocktail was optimized by Gary Kobinger , a research scientist at the NML and underwent further development under license by Mapp Biopharmaceutical . ZMapp was first used on humans during the Western African Ebola virus epidemic , having only been previously tested on animals and not yet subjected to a randomized controlled trial . The National Institutes of Health (NIH) ran a clinical trial starting in January 2015 with subjects from Sierra Leone, Guinea, and Liberia aiming to enroll 200 people, but the epidemic waned and the trial closed early, leaving it too statistically underpowered to give a meaningful result about whether ZMapp worked. In 2016, a clinical study comparing ZMapp to the current standard of care for Ebola was inconclusive. The drug is composed of three monoclonal antibodies (mAbs), initially harvested from mice exposed to Ebola virus proteins, that have been chimerized with human constant regions . The components are chimeric monoclonal antibody c13C6 from a previously existing antibody cocktail called "MB-003" and two chimeric mAbs from a different antibody cocktail called ZMab, c2G4, and c4G7. ZMapp is manufactured in the tobacco plant Nicotiana benthamiana in the bioproduction process known as " pharming " by Kentucky BioProcessing, a subsidiary of Reynolds American . Like intravenous immunoglobulin therapy, ZMapp contains a mixture of neutralizing antibodies that confer passive immunity to an individual, enhancing the normal immune response, and is designed to be administered after exposure to the Ebola virus. Such antibodies have been used in the treatment and prevention of various infectious diseases and are intended to attack the virus by interfering with its surface and neutralizing it to prevent further damage. Two of the drug's three components were originally developed at the Public Health Agency of Canada's National Microbiology Laboratory (NML), and a third at the U.S. Army Medical Research Institute of Infectious Diseases; the cocktail was optimized by Gary Kobinger, then branch chief of the NML, and is undergoing further development by Leaf Biopharmaceutical (LeafBio, Inc.), a San Diego-based arm of Mapp Biopharmaceutical. LeafBio created ZMapp in collaboration with its parent and Defyrus Inc., each of which had licensed its own cocktail of antibodies, called MB-003 and ZMab. [ citation needed ] MB-003 is a cocktail of three humanized or human–mouse chimeric mAbs: c13C6, h13F6, and c6D8. A study published in September 2012 found that rhesus macaques infected with Ebola virus (EBOV) survived when receiving MB-003 (mixture of 3 chimeric monoclonal antibodies) one hour after infection. When treated 24 or 48 hours after infection, four of six animals survived and had little to no viremia and few, if any, clinical symptoms. MB-003 was created by scientists at the U.S. Army Medical Research Institute of Infectious Diseases, Gene Olinger, and Jamie Pettitt in collaboration with Mapp Biopharmaceutical with years of funding from US government agencies including the National Institute of Allergy and Infectious Disease , Biomedical Advanced Research and Development Authority , and the Defense Threat Reduction Agency . ZMAb is a mixture of three mouse mAbs: m1H3, m2G4, and m4G7. A study published in November 2013 found that EBOV-infected macaque monkeys survived after being given a therapy with a combination of three EBOV surface glycoprotein (EBOV-GP)-specific monoclonal antibodies (ZMAb) within 24 hours of infection. The authors concluded that post-exposure treatment resulted in a robust immune response, with good protection for up to 10 weeks and some protection at 13 weeks. ZMab was created by the NML and licensed to Defyrus, a Toronto-based biodefense company, with further funding by the Public Health Agency of Canada . A 2014 paper described how Mapp and its collaborators, including investigators at Public Health Agency of Canada , Kentucky BioProcessing, and the National Institute of Allergy and Infectious Diseases , first chimerized the three antibodies comprising ZMAb, then tested combinations of MB-003 and the chimeric ZMAb antibodies in guinea pigs and then primates to determine the best combination, which turned out to be c13C6 from MB-003 and two chimeric mAbs from ZMAb, c2G4 and c4G7. This is ZMapp. In an experiment also published in the 2014 paper, 21 rhesus macaque primates were infected with the Kikwit Congolese variant of EBOV. Three primates in the control arm were given a non-functional antibody, and the 18 in the treatment arm were divided into three groups of six. All primates in the treatment arm received three doses of ZMapp, spaced 3 days apart. The first treatment group received its first dose on 3rd day after being infected; the second group on the 4th day after being infected, and the third group, on the 5th day after being infected. All three primates in the control group died; all 18 primates in the treatment arm survived. Mapp then went on to show that ZMapp inhibits replication of a Guinean strain of EBOV in cell cultures. Mapp remains involved in the production of the drug through its contracts with Kentucky BioProcessing, a subsidiary of Reynolds American . To produce the drug, genes coding for the chimeric mAbs were inserted into viral vectors , and tobacco plants are infected with the viral vector encoding for the antibodies, using Agrobacterium cultures. Subsequently, antibodies are extracted and purified from the plants. Once the genes encoding the chimeric mAbs are in hand, the entire tobacco production cycle is believed to take a few months. The development of these production methods was funded by the U.S. Defense Advanced Research Projects Agency as part of its bio-defense efforts following the 9/11 terrorist attacks. MB-003 is a cocktail of three humanized or human–mouse chimeric mAbs: c13C6, h13F6, and c6D8. A study published in September 2012 found that rhesus macaques infected with Ebola virus (EBOV) survived when receiving MB-003 (mixture of 3 chimeric monoclonal antibodies) one hour after infection. When treated 24 or 48 hours after infection, four of six animals survived and had little to no viremia and few, if any, clinical symptoms. MB-003 was created by scientists at the U.S. Army Medical Research Institute of Infectious Diseases, Gene Olinger, and Jamie Pettitt in collaboration with Mapp Biopharmaceutical with years of funding from US government agencies including the National Institute of Allergy and Infectious Disease , Biomedical Advanced Research and Development Authority , and the Defense Threat Reduction Agency . ZMAb is a mixture of three mouse mAbs: m1H3, m2G4, and m4G7. A study published in November 2013 found that EBOV-infected macaque monkeys survived after being given a therapy with a combination of three EBOV surface glycoprotein (EBOV-GP)-specific monoclonal antibodies (ZMAb) within 24 hours of infection. The authors concluded that post-exposure treatment resulted in a robust immune response, with good protection for up to 10 weeks and some protection at 13 weeks. ZMab was created by the NML and licensed to Defyrus, a Toronto-based biodefense company, with further funding by the Public Health Agency of Canada . A 2014 paper described how Mapp and its collaborators, including investigators at Public Health Agency of Canada , Kentucky BioProcessing, and the National Institute of Allergy and Infectious Diseases , first chimerized the three antibodies comprising ZMAb, then tested combinations of MB-003 and the chimeric ZMAb antibodies in guinea pigs and then primates to determine the best combination, which turned out to be c13C6 from MB-003 and two chimeric mAbs from ZMAb, c2G4 and c4G7. This is ZMapp. In an experiment also published in the 2014 paper, 21 rhesus macaque primates were infected with the Kikwit Congolese variant of EBOV. Three primates in the control arm were given a non-functional antibody, and the 18 in the treatment arm were divided into three groups of six. All primates in the treatment arm received three doses of ZMapp, spaced 3 days apart. The first treatment group received its first dose on 3rd day after being infected; the second group on the 4th day after being infected, and the third group, on the 5th day after being infected. All three primates in the control group died; all 18 primates in the treatment arm survived. Mapp then went on to show that ZMapp inhibits replication of a Guinean strain of EBOV in cell cultures. Mapp remains involved in the production of the drug through its contracts with Kentucky BioProcessing, a subsidiary of Reynolds American . To produce the drug, genes coding for the chimeric mAbs were inserted into viral vectors , and tobacco plants are infected with the viral vector encoding for the antibodies, using Agrobacterium cultures. Subsequently, antibodies are extracted and purified from the plants. Once the genes encoding the chimeric mAbs are in hand, the entire tobacco production cycle is believed to take a few months. The development of these production methods was funded by the U.S. Defense Advanced Research Projects Agency as part of its bio-defense efforts following the 9/11 terrorist attacks. ZMapp was first used during the 2014 West Africa Ebola Virus outbreak, having not previously undergone any human clinical trials to determine its efficacy or potential risks. By October 2014, the United States Food and Drug Administration had approved the use of several experimental drugs, including ZMapp, to be used on patients infected with Ebola virus. The use of such drugs during the epidemic was also deemed ethical by the World Health Organization . In 2014, a limited supply of ZMapp was used to treat 7 individuals infected with the Ebola virus; of these 2 died. The outcome is not considered to be statistically significant . Mapp announced in August 2014, that supplies of ZMapp had been exhausted. The lack of drugs and unavailability of experimental treatment in the most affected regions of the West African Ebola virus outbreak spurred some controversy. The fact that the drug was first given to Americans and a European and not to Africans, according to the Los Angeles Times , "provoked outrage, feeding into African perceptions of Western insensitivity and arrogance, with a deep sense of mistrust and betrayal still lingering over the exploitation and abuses of the colonial era". Salim S. Abdool Karim , the director of an AIDS research center in South Africa, placed the issue in the context of the history of exploitation and abuses. Responding to a question on how people might have reacted if ZMapp and other drugs had first been used on Africans, he said "It would have been the front-page screaming headline: 'Africans used as guinea pigs for American drug company's medicine ' " . In early August, the World Health Organization called for convening a panel of medical authorities "to consider whether experimental drugs should be more widely released." In a statement, Peter Piot (co-discoverer of the Ebola virus); Jeremy Farrar, the director of the Wellcome Trust ; and David Heymann of the Chatham House Center on Global Health Security, called for the release of experimental drugs for affected African nations . At an August 6, 2014 press conference, Barack Obama , the President of the United States , was questioned regarding whether the cocktail should be fast-tracked for approval or be made available to sick patients outside of the United States. He responded, "I think we've got to let the science guide us. I don't think all the information's in on whether this drug is helpful." The lack of drugs and unavailability of experimental treatment in the most affected regions of the West African Ebola virus outbreak spurred some controversy. The fact that the drug was first given to Americans and a European and not to Africans, according to the Los Angeles Times , "provoked outrage, feeding into African perceptions of Western insensitivity and arrogance, with a deep sense of mistrust and betrayal still lingering over the exploitation and abuses of the colonial era". Salim S. Abdool Karim , the director of an AIDS research center in South Africa, placed the issue in the context of the history of exploitation and abuses. Responding to a question on how people might have reacted if ZMapp and other drugs had first been used on Africans, he said "It would have been the front-page screaming headline: 'Africans used as guinea pigs for American drug company's medicine ' " . In early August, the World Health Organization called for convening a panel of medical authorities "to consider whether experimental drugs should be more widely released." In a statement, Peter Piot (co-discoverer of the Ebola virus); Jeremy Farrar, the director of the Wellcome Trust ; and David Heymann of the Chatham House Center on Global Health Security, called for the release of experimental drugs for affected African nations . At an August 6, 2014 press conference, Barack Obama , the President of the United States , was questioned regarding whether the cocktail should be fast-tracked for approval or be made available to sick patients outside of the United States. He responded, "I think we've got to let the science guide us. I don't think all the information's in on whether this drug is helpful." The National Institutes of Health announced on 27 February 2015 the commencement of a randomized controlled trial of ZMapp to be conducted in Liberia and the United States. From March 2015 through November 2015, 72 individuals infected with the Ebola virus were enrolled in the trial; investigators stopped enrolling new subjects in January 2016, having failed to reach its enrollment goal of 200 due to the waning of the Ebola outbreak . As a result, although a 40% lower risk of death was calculated for those who received ZMapp, the difference was not statistically significant and ultimately it could not be determined whether the use of ZMapp was superior to the optimized standard of care alone. However, ZMapp was found to be safe and well tolerated. The ZMapp cocktail was assessed by the World Health Organization for emergency use under the MEURI ethical protocol. The panel agreed that "the benefits of ZMapp outweigh its risks" while noting that it presented logistical challenges, particularly that of requiring a cold chain for distribution and storage. Four alternative therapies ( remdesivir , the Regeneron product atoltivimab/maftivimab/odesivimab , favipiravir , and ansuvimab ) were also considered for use, but they were at earlier stages of development. In August 2019, the Democratic Republic of the Congo's national health authorities, the World Health Organization, and the National Institutes of Health announced that they would stop using ZMapp, along with all other Ebola treatments except atoltivimab/maftivimab/odesivimab and ansuvimab, in their ongoing clinical trials, citing the higher mortality rates of patients not treated with atoltivimab/maftivimab/odesivimab and ansuvimab. In October 2020, the U.S. Food and Drug Administration (FDA) approved atoltivimab/maftivimab/odesivimab with an indication for the treatment of infection caused by Zaire ebolavirus .

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/1976_Zaire_Ebola_virus_outbreak/html

1976 Zaire Ebola virus outbreak

Cases / Deaths: (as at end of outbreak) Zaire : 318 / 280 In August–November 1976, an outbreak of Ebola virus disease occurred in Zaire (now the Democratic Republic of the Congo ). The first recorded case was from Yambuku , a small village in Mongala District , 1,098 kilometres (682 mi) northeast of the capital city of Kinshasa . The virus responsible for the initial outbreak, named after the nearby Ebola River , was first thought to be Marburg virus but was later identified as a new type of virus related to the genus Marburgvirus . A total of 318 cases and 280 deaths (an 88% fatality rate) resulted from this outbreak, which, along with an outbreak in Sudan that had begun a few weeks previously, were the first outbreaks of Ebola ever recorded. The people of north-central Zaire were most heavily affected by this specific epidemic . This area is located within the Bumba Zone in the Equator Region , which consists mostly of tropical rainforests in the biome . In 1976, there were approximately 275,000 people in the entire Bumba Zone, including 35,000 Zaireans. [ citation needed ] 75% of Zaire's population lived in forest villages at that time. Estimates suggest that each of the forest villages had a population of less than 5,000 people; the smallest villages had less than 500 inhabitants. Many of these villages bordered the Zaire River . The river runs along the border on the south side of the country, which was important in the context of the Ebola epidemic because it separated the areas geographically. [ citation needed ] Most of Zaire's people either hunted or had contact with hunters that were exposed to an array of wild animals. This was considered a possible cause of the epidemic for some time; however, it probably was not. Because the cause of the outbreak was initially unknown, many people with Ebola virus disease were misdiagnosed and/or treated for malaria , yellow fever , and typhoid fever . Mabalo Lokela, the headmaster of a local school in Yambuku, was the first case of the 1976 outbreak in Zaire. Lokela had toured with a Yambuku mission in August 1976 near the Central African Republic border and along the Ebola River. Initially, Lokela was diagnosed with malaria at the Yambuku Mission Hospital and was given quinine . However, Lokela returned to the mission hospital on 1 September with a high fever. Rest was recommended, and he returned home to his village of Yalikonde, about one kilometer from the mission complex. By 5 September, Lokela was in a critical condition with profuse bleeding from all orifices , vomiting, acute diarrhea, chest pains, headache, fever, agitation, and confusion. He died shortly afterwards on 8 September. On 28 August, another man presented symptoms, claiming he was from the nearby village of Yandongi. He left the hospital on 30 August, as no clear cause could be identified from his symptoms, and was not seen again. On the same day, Yombe Ngongo, a patient at the hospital receiving treatment for anemia , checked out of the hospital and returned to her village. She soon fell seriously ill, and was tended to by her younger sister Euza. Yombe Ngongo died on 7 September, and her sister Euza followed on 9 September. Soon after Lokela's visit, a number of other cases were presented at the Yambuku Mission Hospital. A report from the World Health Organization (WHO) noted that "almost all subsequent infections had either received injections at the hospital or had had close contact with another case." Shortly after family members had prepared his body for burial, in accordance with local customs, 21 of Lokela's friends and relatives all fell seriously ill and 18 later died. Yambuku Mission Hospital was a remote Catholic hospital and had no doctors or laboratory facilities to aid in diagnosis. This, as well as a lack of communication capabilities, contributed to the hospital's isolation from Kinshasa . After the initial Ebola virus disease cases, the hospital was unable get more resources until the Minister of Health sent out an International Commission to investigate further. Victims received treatment from four Belgian nuns , a priest, one female nurse from Zaire, and seven male Zaireians. Urgent pleas for assistance were sent out on 12 September. On 15 September, the first doctor to arrive, Mgoi Mushola, prepared a report in which he noted that none of the many treatments provided met with success. This was the first formal description of Ebola virus disease . The International Commission team worked with the nurses for interpreting and processing standardized pre-coded forms. These forms included clinical questionnaires, as well as, many epidemiological features such as: asking for the sex and age of the person and asking to list out relatives that would also fill out a form. Through this form, the team was able to construct a control group to compare with the Ebola patients, by matching similar traits, thus helping them construct their epidemiological study. The team needed to figure out how this disease was spreading in order to make a plan of attack against the virus.  Because of the uncertainty of the infection route, the team placed a quarantine over the region of the Bumba Zone that was most concerning within two days after the hospital's closure in October. The motivation for this quick quarantine was largely due to the intense nature of the symptoms and rapid progression of this disease. Unfortunately, there was a lot of resistance from people to help out the team and situation because of the fear associated with the unknown infection route of this disease. Since all of the infection route possibilities were in contention, they had to start narrowing down the potential infection pathways. The team noted that the cases had distinct patterns when drawn out into an epidemic curve that showed a clear correlation between the disease and women between the age of 18 and 25. The Mission Hospital had only 120 beds available and a staff of just 17 nurses that were directed by a paramedical assistant, not a doctor. This hospital primarily saw patients from the Yandongi sector, but they had also attracted patients from the outer Bumba Zone because this hospital was considered relatively well-stocked and supplied with a good amount of staff for the area. They were already very limited in disease containment abilities because of these factors, but they also generally saw anywhere between 6,000 and 12,000 patients a month for general care. This is another reason why the quarantine was so necessary during the time of the Ebola epidemic at this hospital. Peter Piot , a microbiologist and physician who investigated the ensuing epidemic, concluded that it was inadvertently caused by the Sisters of Yambuku Mission Hospital, who had given unnecessary vitamin injections to pregnant women in their prenatal clinic without sterilizing the needles and syringes. There were five total syringes and needles that were being used by this nursing staff for multiple days. These medical materials were rinsed between uses with the use of only warm water. Then, at the end of their shift, the nurses would boil the needles and syringes in water, and no other sterilization methods were utilized. This was not an effective enough sterilization process as the Ebola virus was able to be spread from an initial unidentified infected person and spread through this hospital. The International Commission team was able to back up this theory by their epidemiological study showing a correlation between injection history and Ebola cases and then consequently the spreading through person to person. In all, 318 cases of Ebola were identified in Zaire, and 280 resulted in death. An additional 284 cases and 151 deaths occurred in nearby South Sudan in an unrelated outbreak. Yambuku Mission Hospital was closed after 11 of its 17 staff members died. Belgian nuns serving the community were also infected, and two of them died, along with Mayinga N'Seka , a Zairean nurse, after the group was transported to Kinshasa. With assistance from the WHO, the outbreak was eventually contained by quarantining local villagers in their communities, sterilizing medical equipment, and providing protective clothing to medical personnel. The small Congolese Air Force provided helicopters to allow the outbreak team to visit 550 villages in the area. Cases were documented in 55 of the 550 villages surveyed. The majority of cases were detected in the first four weeks of September, and the last detected probable case died on 5 November 1976. The table below summarizes the eleven outbreaks that have occurred in the DRC since 1976:The International Commission team worked with the nurses for interpreting and processing standardized pre-coded forms. These forms included clinical questionnaires, as well as, many epidemiological features such as: asking for the sex and age of the person and asking to list out relatives that would also fill out a form. Through this form, the team was able to construct a control group to compare with the Ebola patients, by matching similar traits, thus helping them construct their epidemiological study. The team needed to figure out how this disease was spreading in order to make a plan of attack against the virus.  Because of the uncertainty of the infection route, the team placed a quarantine over the region of the Bumba Zone that was most concerning within two days after the hospital's closure in October. The motivation for this quick quarantine was largely due to the intense nature of the symptoms and rapid progression of this disease. Unfortunately, there was a lot of resistance from people to help out the team and situation because of the fear associated with the unknown infection route of this disease. Since all of the infection route possibilities were in contention, they had to start narrowing down the potential infection pathways. The team noted that the cases had distinct patterns when drawn out into an epidemic curve that showed a clear correlation between the disease and women between the age of 18 and 25. The Mission Hospital had only 120 beds available and a staff of just 17 nurses that were directed by a paramedical assistant, not a doctor. This hospital primarily saw patients from the Yandongi sector, but they had also attracted patients from the outer Bumba Zone because this hospital was considered relatively well-stocked and supplied with a good amount of staff for the area. They were already very limited in disease containment abilities because of these factors, but they also generally saw anywhere between 6,000 and 12,000 patients a month for general care. This is another reason why the quarantine was so necessary during the time of the Ebola epidemic at this hospital. Peter Piot , a microbiologist and physician who investigated the ensuing epidemic, concluded that it was inadvertently caused by the Sisters of Yambuku Mission Hospital, who had given unnecessary vitamin injections to pregnant women in their prenatal clinic without sterilizing the needles and syringes. There were five total syringes and needles that were being used by this nursing staff for multiple days. These medical materials were rinsed between uses with the use of only warm water. Then, at the end of their shift, the nurses would boil the needles and syringes in water, and no other sterilization methods were utilized. This was not an effective enough sterilization process as the Ebola virus was able to be spread from an initial unidentified infected person and spread through this hospital. The International Commission team was able to back up this theory by their epidemiological study showing a correlation between injection history and Ebola cases and then consequently the spreading through person to person. In all, 318 cases of Ebola were identified in Zaire, and 280 resulted in death. An additional 284 cases and 151 deaths occurred in nearby South Sudan in an unrelated outbreak. Yambuku Mission Hospital was closed after 11 of its 17 staff members died. Belgian nuns serving the community were also infected, and two of them died, along with Mayinga N'Seka , a Zairean nurse, after the group was transported to Kinshasa. With assistance from the WHO, the outbreak was eventually contained by quarantining local villagers in their communities, sterilizing medical equipment, and providing protective clothing to medical personnel. The small Congolese Air Force provided helicopters to allow the outbreak team to visit 550 villages in the area. Cases were documented in 55 of the 550 villages surveyed. The majority of cases were detected in the first four weeks of September, and the last detected probable case died on 5 November 1976. The table below summarizes the eleven outbreaks that have occurred in the DRC since 1976:

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Personal_protective_equipment/html

Personal protective equipment

Personal protective equipment ( PPE ) is protective clothing , helmets , goggles , or other garments or equipment designed to protect the wearer's body from injury or infection . The hazards addressed by protective equipment include physical, electrical, heat, chemical, biohazards , and airborne particulate matter . Protective equipment may be worn for job-related occupational safety and health purposes, as well as for sports and other recreational activities . Protective clothing is applied to traditional categories of clothing, and protective gear applies to items such as pads, guards, shields, or masks, and others. PPE suits can be similar in appearance to a cleanroom suit . The purpose of personal protective equipment is to reduce employee exposure to hazards when engineering controls and administrative controls are not feasible or effective to reduce these risks to acceptable levels. PPE is needed when there are hazards present. PPE has the serious limitation that it does not eliminate the hazard at the source and may result in employees being exposed to the hazard if the equipment fails. Any item of PPE imposes a barrier between the wearer/user and the working environment. This can create additional strains on the wearer, impair their ability to carry out their work and create significant levels of discomfort. Any of these can discourage wearers from using PPE correctly, therefore placing them at risk of injury, ill-health or, under extreme circumstances, death. Good ergonomic design can help to minimise these barriers and can therefore help to ensure safe and healthy working conditions through the correct use of PPE. Practices of occupational safety and health can use hazard controls and interventions to mitigate workplace hazards, which pose a threat to the safety and quality of life of workers. The hierarchy of hazard controls provides a policy framework which ranks the types of hazard controls in terms of absolute risk reduction. At the top of the hierarchy are elimination and substitution , which remove the hazard entirely or replace the hazard with a safer alternative. If elimination or substitution measures cannot be applied, engineering controls and administrative controls – which seek to design safer mechanisms and coach safer human behavior – are implemented. Personal protective equipment ranks last on the hierarchy of controls, as the workers are regularly exposed to the hazard, with a barrier of protection. The hierarchy of controls is important in acknowledging that, while personal protective equipment has tremendous utility, it is not the desired mechanism of control in terms of worker safety.Early PPE such as body armor , boots and gloves focused on protecting the wearer's body from physical injury . The plague doctors of sixteenth-century Europe also wore protective uniforms consisting of a full-length gown, helmet, glass eye coverings, gloves and boots (see Plague doctor costume ) to prevent contagion when dealing with plague victims. These were made of thick material which was then covered in wax to make it water-resistant . A mask with a beak-like structure was filled with pleasant-smelling flowers, herbs and spices to prevent the spread of miasma , the prescientific belief of bad smells which spread disease through the air. In more recent years, scientific personal protective equipment is generally believed to have begun with the cloth facemasks promoted by Wu Lien-teh in the 1910–11 Manchurian pneumonic plague outbreak, although many Western medics doubted the efficacy of facemasks in preventing the spread of disease. Personal protective equipment can be categorized by the area of the body protected, by the type of hazard, and by the type of garment or accessory. A single item – for example, boots – may provide multiple forms of protection: a steel toe cap and steel insoles for protection of the feet from crushing or puncture injuries, impervious rubber and lining for protection from water and chemicals, high reflectivity and heat resistance for protection from radiant heat, and high electrical resistivity for protection from electric shock. The protective attributes of each piece of equipment must be compared with the hazards expected to be found in the workplace. More breathable types of personal protective equipment may not lead to more contamination but do result in greater user satisfaction. Respirators are protective breathing equipment, which protect the user from inhaling contaminants in the air, thus preserving the health of their respiratory tract. There are two main types of respirators. One type of respirator functions by filtering out chemicals and gases, or airborne particles, from the air breathed by the user. The filtration may be either passive or active (powered) . Gas masks and particulate respirators (like N95 masks ) are examples of this type of respirator. A second type of respirator protects users by providing clean, respirable air from another source. This type includes airline respirators and self-contained breathing apparatus (SCBA). In work environments, respirators are relied upon when adequate ventilation is not available or other engineering control systems are not feasible or inadequate. In the United Kingdom, an organization that has extensive expertise in respiratory protective equipment is the Institute of Occupational Medicine . This expertise has been built on a long-standing and varied research programme that has included the setting of workplace protection factors to the assessment of efficacy of masks available through high street retail outlets. [ citation needed ] The Health and Safety Executive (HSE), NHS Health Scotland and Healthy Working Lives (HWL) have jointly developed the RPE (Respiratory Protective Equipment) Selector Tool, which is web-based. This interactive tool provides descriptions of different types of respirators and breathing apparatuses, as well as "dos and don'ts" for each type. In the United States, The National Institute for Occupational Safety and Health (NIOSH) provides recommendations on respirator use, in accordance to NIOSH federal respiratory regulations 42 CFR Part 84. The National Personal Protective Technology Laboratory (NPPTL) of NIOSH is tasked towards actively conducting studies on respirators and providing recommendations. Surgical masks are considered as PPE, but are not considered as respirators, being unable to stop submicron particles from passing through, and also having unrestricted air flow at the edges of the masks. Occupational skin diseases such as contact dermatitis , skin cancers , and other skin injuries and infections are the second-most common type of occupational disease and can be very costly. Skin hazards, which lead to occupational skin disease, can be classified into four groups. Chemical agents can come into contact with the skin through direct contact with contaminated surfaces, deposition of aerosols, immersion or splashes. Physical agents such as extreme temperatures and ultraviolet or solar radiation can be damaging to the skin over prolonged exposure. Mechanical trauma occurs in the form of friction, pressure, abrasions, lacerations and contusions. Biological agents such as parasites, microorganisms, plants and animals can have varied effects when exposed to the skin. Any form of PPE that acts as a barrier between the skin and the agent of exposure can be considered skin protection. Because much work is done with the hands, gloves are an essential item in providing skin protection. Some examples of gloves commonly used as PPE include rubber gloves , cut-resistant gloves , chainsaw gloves and heat-resistant gloves. For sports and other recreational activities, many different gloves are used for protection, generally against mechanical trauma. Other than gloves, any other article of clothing or protection worn for a purpose serve to protect the skin. Lab coats for example, are worn to protect against potential splashes of chemicals. Face shields serve to protect one's face from potential impact hazards, chemical splashes or possible infectious fluid. Many migrant workers need training in PPE for Heat Related Illnesses prevention (HRI). Based on study results, research identified some potential gaps in heat safety education. While some farm workers reported receiving limited training on pesticide safety, others did not. This could be remedied by incoming groups of farm workers receiving video and in-person training on HRI prevention. These educational programs for farm workers are most effective when they are based on health behavior theories, use adult learning principles and employ train-the-trainer approaches. Each day, about 2,000 US workers have a job-related eye injury that requires medical attention. Eye injuries can happen through a variety of means. Most eye injuries occur when solid particles such as metal slivers, wood chips, sand or cement chips get into the eye. Smaller particles in smokes and larger particles such as broken glass also account for particulate matter-causing eye injuries. Blunt force trauma can occur to the eye when excessive force comes into contact with the eye. Chemical burns, biological agents, and thermal agents, from sources such as welding torches and UV light , also contribute to occupational eye injury. While the required eye protection varies by occupation, the safety provided can be generalized. Safety glasses provide protection from external debris, and should provide side protection via a wrap-around design or side shields. Industrial noise is often overlooked as an occupational hazard, as it is not visible to the eye. Overall, about 22 million workers in the United States are exposed to potentially damaging noise levels each year. Occupational hearing loss accounted for 14% of all occupational illnesses in 2007, with about 23,000 cases significant enough to cause permanent hearing impairment. About 82% of occupational hearing loss cases occurred to workers in the manufacturing sector. In the US the Occupational Safety and Health Administration establishes occupational noise exposure standards. The National Institute for Occupational Safety and Health recommends that worker exposures to noise be reduced to a level equivalent to 85 dBA for eight hours to reduce occupational noise-induced hearing loss . PPE for hearing protection consists of earplugs and earmuffs . Workers who are regularly exposed to noise levels above the NIOSH recommendation should be provided with hearing protection by the employers, as they are a low-cost intervention. A personal attenuation rating can be objectively measured through a hearing protection fit-testing system. The effectiveness of hearing protection varies with the training offered on their use. This form of PPE is all-encompassing and refers to the various suits and uniforms worn to protect the user from harm. Lab coats worn by scientists and ballistic vests worn by law enforcement officials, which are worn on a regular basis, would fall into this category. Entire sets of PPE, worn together in a combined suit, are also in this category. Below are some examples of ensembles of personal protective equipment, worn together for a specific occupation or task, to provide maximum protection for the user: Participants in sports often wear protective equipment. Studies performed on the injuries of professional athletes, such as that on NFL players, question the effectiveness of existing personal protective equipment.Respirators are protective breathing equipment, which protect the user from inhaling contaminants in the air, thus preserving the health of their respiratory tract. There are two main types of respirators. One type of respirator functions by filtering out chemicals and gases, or airborne particles, from the air breathed by the user. The filtration may be either passive or active (powered) . Gas masks and particulate respirators (like N95 masks ) are examples of this type of respirator. A second type of respirator protects users by providing clean, respirable air from another source. This type includes airline respirators and self-contained breathing apparatus (SCBA). In work environments, respirators are relied upon when adequate ventilation is not available or other engineering control systems are not feasible or inadequate. In the United Kingdom, an organization that has extensive expertise in respiratory protective equipment is the Institute of Occupational Medicine . This expertise has been built on a long-standing and varied research programme that has included the setting of workplace protection factors to the assessment of efficacy of masks available through high street retail outlets. [ citation needed ] The Health and Safety Executive (HSE), NHS Health Scotland and Healthy Working Lives (HWL) have jointly developed the RPE (Respiratory Protective Equipment) Selector Tool, which is web-based. This interactive tool provides descriptions of different types of respirators and breathing apparatuses, as well as "dos and don'ts" for each type. In the United States, The National Institute for Occupational Safety and Health (NIOSH) provides recommendations on respirator use, in accordance to NIOSH federal respiratory regulations 42 CFR Part 84. The National Personal Protective Technology Laboratory (NPPTL) of NIOSH is tasked towards actively conducting studies on respirators and providing recommendations. Surgical masks are considered as PPE, but are not considered as respirators, being unable to stop submicron particles from passing through, and also having unrestricted air flow at the edges of the masks. Occupational skin diseases such as contact dermatitis , skin cancers , and other skin injuries and infections are the second-most common type of occupational disease and can be very costly. Skin hazards, which lead to occupational skin disease, can be classified into four groups. Chemical agents can come into contact with the skin through direct contact with contaminated surfaces, deposition of aerosols, immersion or splashes. Physical agents such as extreme temperatures and ultraviolet or solar radiation can be damaging to the skin over prolonged exposure. Mechanical trauma occurs in the form of friction, pressure, abrasions, lacerations and contusions. Biological agents such as parasites, microorganisms, plants and animals can have varied effects when exposed to the skin. Any form of PPE that acts as a barrier between the skin and the agent of exposure can be considered skin protection. Because much work is done with the hands, gloves are an essential item in providing skin protection. Some examples of gloves commonly used as PPE include rubber gloves , cut-resistant gloves , chainsaw gloves and heat-resistant gloves. For sports and other recreational activities, many different gloves are used for protection, generally against mechanical trauma. Other than gloves, any other article of clothing or protection worn for a purpose serve to protect the skin. Lab coats for example, are worn to protect against potential splashes of chemicals. Face shields serve to protect one's face from potential impact hazards, chemical splashes or possible infectious fluid. Many migrant workers need training in PPE for Heat Related Illnesses prevention (HRI). Based on study results, research identified some potential gaps in heat safety education. While some farm workers reported receiving limited training on pesticide safety, others did not. This could be remedied by incoming groups of farm workers receiving video and in-person training on HRI prevention. These educational programs for farm workers are most effective when they are based on health behavior theories, use adult learning principles and employ train-the-trainer approaches. Each day, about 2,000 US workers have a job-related eye injury that requires medical attention. Eye injuries can happen through a variety of means. Most eye injuries occur when solid particles such as metal slivers, wood chips, sand or cement chips get into the eye. Smaller particles in smokes and larger particles such as broken glass also account for particulate matter-causing eye injuries. Blunt force trauma can occur to the eye when excessive force comes into contact with the eye. Chemical burns, biological agents, and thermal agents, from sources such as welding torches and UV light , also contribute to occupational eye injury. While the required eye protection varies by occupation, the safety provided can be generalized. Safety glasses provide protection from external debris, and should provide side protection via a wrap-around design or side shields. Industrial noise is often overlooked as an occupational hazard, as it is not visible to the eye. Overall, about 22 million workers in the United States are exposed to potentially damaging noise levels each year. Occupational hearing loss accounted for 14% of all occupational illnesses in 2007, with about 23,000 cases significant enough to cause permanent hearing impairment. About 82% of occupational hearing loss cases occurred to workers in the manufacturing sector. In the US the Occupational Safety and Health Administration establishes occupational noise exposure standards. The National Institute for Occupational Safety and Health recommends that worker exposures to noise be reduced to a level equivalent to 85 dBA for eight hours to reduce occupational noise-induced hearing loss . PPE for hearing protection consists of earplugs and earmuffs . Workers who are regularly exposed to noise levels above the NIOSH recommendation should be provided with hearing protection by the employers, as they are a low-cost intervention. A personal attenuation rating can be objectively measured through a hearing protection fit-testing system. The effectiveness of hearing protection varies with the training offered on their use. This form of PPE is all-encompassing and refers to the various suits and uniforms worn to protect the user from harm. Lab coats worn by scientists and ballistic vests worn by law enforcement officials, which are worn on a regular basis, would fall into this category. Entire sets of PPE, worn together in a combined suit, are also in this category. Below are some examples of ensembles of personal protective equipment, worn together for a specific occupation or task, to provide maximum protection for the user: Participants in sports often wear protective equipment. Studies performed on the injuries of professional athletes, such as that on NFL players, question the effectiveness of existing personal protective equipment.Below are some examples of ensembles of personal protective equipment, worn together for a specific occupation or task, to provide maximum protection for the user:Participants in sports often wear protective equipment. Studies performed on the injuries of professional athletes, such as that on NFL players, question the effectiveness of existing personal protective equipment.The definition of what constitutes personal protective equipment varies by country. In the United States, the laws regarding PPE also vary by state. In 2011, workplace safety complaints were brought against Hustler and other adult film production companies by the AIDS Healthcare Foundation , leading to several citations brought by Cal/OSHA . The failure to use condoms by adult film stars was a violation of Cal/OSHA's Blood borne Pathogens Program, Personal Protective Equipment. This example shows that personal protective equipment can cover a variety of occupations in the United States, and has a wide-ranging definition.The National Defense Authorization Act for 2022 defines personal protective equipment as Equipment for use in preventing spread of disease, such as by exposure to infected individuals or contamination or infection by infectious material (including nitrile and vinyl gloves, surgical masks, respirator masks and powered air purifying respirators and required filters, face shields and protective eyewear, surgical and isolation gowns, and head and foot coverings) or clothing, and the materials and components thereof, other than sensors, electronics, or other items added to and not normally associated with such personal protective equipment or clothing. Under this Act, US military services are prohibited from purchasing PPE from suppliers in North Korea, China, Russia or Iran, unless there are problems with the supply or cost of PPE of "satisfactory quality and quantity". At the European Union level, personal protective equipment is governed by Directive 89/686/EEC on personal protective equipment (PPE). The Directive is designed to ensure that PPE meets common quality and safety standards by setting out basic safety requirements for personal protective equipment, as well as conditions for its placement on the market and free movement within the EU single market. It covers "any device or appliance designed to be worn or held by an individual for protection against one or more health and safety hazards". The directive was adopted on 21 January 1989 and came into force on 1 July 1992. The European Commission additionally allowed for a transition period until 30 June 1995 to give companies sufficient time to adapt to the legislation. After this date, all PPE placed on the market in EU Member States was required to comply with the requirements of Directive 89/686/EEC and carry the CE Marking . Article 1 of Directive 89/686/EEC defines personal protective equipment as any device or appliance designed to be worn or held by an individual for protection against one or more health and safety hazards. PPE which falls under the scope of the Directive is divided into three categories: Category I: simple design (e.g. gardening gloves, footwear, ski goggles) Category II: PPE not falling into category I or III (e.g. personal flotation devices, dry and wet suits, motorcycle personal protective equipment ) Category III: complex design (e.g. respiratory equipment, harnesses) Directive 89/686/EEC on personal protective equipment does not distinguish between PPE for professional use and PPE for leisure purposes. Personal protective equipment falling within the scope of the Directive must comply with the basic health and safety requirements set out in Annex II of the Directive. To facilitate conformity with these requirements, harmonized standards are developed at the European or international level by the European Committee for Standardization (CEN, CENELEC) and the International Organization for Standardization in relation to the design and manufacture of the product. Usage of the harmonized standards is voluntary and provides presumption of conformity. However, manufacturers may choose an alternative method of complying with the requirements of the Directive. Personal protective equipment excluded from the scope of the Directive includes: PPE designed for and used by the armed forces or in the maintenance of law and order; PPE for self-defence (e.g. aerosol canisters, personal deterrent weapons); PPE designed and manufactured for personal use against adverse atmospheric conditions (e.g. seasonal clothing, umbrellas), damp and water (e.g. dish-washing gloves) and heat; PPE used on vessels and aircraft but not worn at all times; helmets and visors intended for users of two- or three-wheeled motor vehicles. The European Commission is currently working to revise Directive 89/686/EEC. The revision will look at the scope of the Directive, the conformity assessment procedures and technical requirements regarding market surveillance. It will also align the Directive with the New Legislative Framework. The European Commission is likely to publish its proposal in 2013. It will then be discussed by the European Parliament and Council of the European Union under the ordinary legislative procedure before being published in the Official Journal of the European Union and becoming law.The National Defense Authorization Act for 2022 defines personal protective equipment as Equipment for use in preventing spread of disease, such as by exposure to infected individuals or contamination or infection by infectious material (including nitrile and vinyl gloves, surgical masks, respirator masks and powered air purifying respirators and required filters, face shields and protective eyewear, surgical and isolation gowns, and head and foot coverings) or clothing, and the materials and components thereof, other than sensors, electronics, or other items added to and not normally associated with such personal protective equipment or clothing. Under this Act, US military services are prohibited from purchasing PPE from suppliers in North Korea, China, Russia or Iran, unless there are problems with the supply or cost of PPE of "satisfactory quality and quantity". At the European Union level, personal protective equipment is governed by Directive 89/686/EEC on personal protective equipment (PPE). The Directive is designed to ensure that PPE meets common quality and safety standards by setting out basic safety requirements for personal protective equipment, as well as conditions for its placement on the market and free movement within the EU single market. It covers "any device or appliance designed to be worn or held by an individual for protection against one or more health and safety hazards". The directive was adopted on 21 January 1989 and came into force on 1 July 1992. The European Commission additionally allowed for a transition period until 30 June 1995 to give companies sufficient time to adapt to the legislation. After this date, all PPE placed on the market in EU Member States was required to comply with the requirements of Directive 89/686/EEC and carry the CE Marking . Article 1 of Directive 89/686/EEC defines personal protective equipment as any device or appliance designed to be worn or held by an individual for protection against one or more health and safety hazards. PPE which falls under the scope of the Directive is divided into three categories: Category I: simple design (e.g. gardening gloves, footwear, ski goggles) Category II: PPE not falling into category I or III (e.g. personal flotation devices, dry and wet suits, motorcycle personal protective equipment ) Category III: complex design (e.g. respiratory equipment, harnesses) Directive 89/686/EEC on personal protective equipment does not distinguish between PPE for professional use and PPE for leisure purposes. Personal protective equipment falling within the scope of the Directive must comply with the basic health and safety requirements set out in Annex II of the Directive. To facilitate conformity with these requirements, harmonized standards are developed at the European or international level by the European Committee for Standardization (CEN, CENELEC) and the International Organization for Standardization in relation to the design and manufacture of the product. Usage of the harmonized standards is voluntary and provides presumption of conformity. However, manufacturers may choose an alternative method of complying with the requirements of the Directive. Personal protective equipment excluded from the scope of the Directive includes: PPE designed for and used by the armed forces or in the maintenance of law and order; PPE for self-defence (e.g. aerosol canisters, personal deterrent weapons); PPE designed and manufactured for personal use against adverse atmospheric conditions (e.g. seasonal clothing, umbrellas), damp and water (e.g. dish-washing gloves) and heat; PPE used on vessels and aircraft but not worn at all times; helmets and visors intended for users of two- or three-wheeled motor vehicles. The European Commission is currently working to revise Directive 89/686/EEC. The revision will look at the scope of the Directive, the conformity assessment procedures and technical requirements regarding market surveillance. It will also align the Directive with the New Legislative Framework. The European Commission is likely to publish its proposal in 2013. It will then be discussed by the European Parliament and Council of the European Union under the ordinary legislative procedure before being published in the Official Journal of the European Union and becoming law.Research studies in the form of randomized controlled trials and simulation studies are needed to determine the most effective types of PPE for preventing the transmission of infectious diseases to healthcare workers. There is low certainty evidence that supports making improvements or modifications to PPE in order to help decrease contamination. Examples of modifications include adding tabs to masks or gloves to ease removal and designing protective gowns so that gloves are removed at the same time. In addition, there is low certainty evidence that the following PPE approaches or techniques may lead to reduced contamination and improved compliance with PPE protocols: Wearing double gloves, following specific doffing (removal) procedures such as those from the CDC, and providing people with spoken instructions while removing PPE.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Ebola_misinformation/html

Ebola misinformation

Multiple conspiracy theories, hoaxes, and quack cures have circulated about ebola viruses , regarding the origin of outbreaks , treatments for ebola virus disease , and preventative measures .During the Western African Ebola virus epidemic (2013-2016), a number of unproven and fake treatments were marketed online in the United States, including snake venom, vitamin C, " Nano Silver ", and various homeopathic and herbal remedies, including clove oil, garlic, and ewedu soup . Gary Coody, national health fraud coordinator for the FDA , described the purveyors of these unproven treatments as "like storm-chasing roofers, who go and try to defraud people after a big storm. Some of them may be making an honest mistake; other companies are trying to rip people off." Coody also said the problem with implausible and unproven remedies is not only that they are unlikely to work, but also that such treatments may lead to patients delaying effective and timely medical care in a hospital setting. During the 2014 and 2019 outbreaks, a number of hoax remedies for the prevention of Ebola were spread online. One such common thread was the frequent use of essential oils . There is no evidence that any of these treatments will decrease the risk of Ebola virus infection, and no known plausible mechanisms for such an effect. During the 2014 outbreak in Liberia , an article in the Liberian Observer alleged that the virus was a bioweapon designed by the US military as a form of population control . Other theories spreading online during the pandemic alleged that the New World Order had engineered the virus to impose quarantines and travel bans to soften an eventual descent into martial law. During a 2019 outbreak in the Democratic Republic of the Congo , rumors spread that the virus was imported to the country for financial gain, or as part of a plot to procure organs for the black market .

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/William_Close/html

William Close

William Taliaferro Close (June 7, 1924 – January 15, 2009) was an American surgeon who played a major role in stemming a 1976 outbreak of the Ebola virus in Zaire , the first major outbreak of the viral hemorrhagic fever in Central Africa , and preventing its further spread. He was also the father of actress Glenn Close and husband of Bettine Moore Close.William Close was born in Greenwich, Connecticut , on June 7, 1924, minutes after his twin brother Edward Jr. His parents were Elizabeth (née Taliaferro) and Edward Bennett Close, an attorney; his mother was a member of the Taliaferro family, one of the First Families of Virginia . William had two half-sisters, Adelaide Breevort (Close) Riggs and Eleanor Post Close ( Eleanor Post Hutton ), from his father's first marriage to Post Cereals heiress and General Foods owner Marjorie Merriweather Post . [ citation needed ] Raised in France , he attended Summer Fields School , Harrow School in England , and then St. Paul's School in Concord, New Hampshire . Close enrolled in Harvard College in 1941, leaving the school two years later to marry and to become a pilot in the U.S. Army Air Corps during World War II . He served as the personal pilot and interpreter for General Joseph Harper . Following his military service, he attended the Columbia University College of Physicians and Surgeons , and he trained in surgery at Roosevelt Hospital in Manhattan after receiving his medical degree. In 1960, he traveled to the Belgian Congo , where he practiced medicine, being the only surgeon in Leopoldville during the Belgian revolutions. He met and befriended a young Congolese soldier named Mobutu , and after Mobutu became president, he agreed to run the 1,500-bed Mama Yemo Hospital (now Kinshasa General Hospital ) named in honor of Mobutu's mother, in the capital city of Kinshasa, Zaire , with the goal of getting health care into rural areas of the country. He served President Mobutu Sese Seko as his personal physician, pilot, director of security, and was Surgeon General of the nation's army. He developed a hospital ship that traveled the Congo, bringing medical care, and, more importantly, medical education to remote village healers. Medical research at the Mama Yemo Hospital was very important to the understanding of the HIV-AIDS disease, and changed the worldwide practice of always repeating C-Section deliveries. [ citation needed ] In the mid-1970s, the Ebola virus broke out at a missionary hospital in rural Yambuku , near the Ebola River . The disease, which was characterized by severe sore throat, rash, abdominal pain, and bleeding from multiple sites, had killed 11 of the 17 medical staff at the hospital, forcing it to close. Panic was in the air, with roads blocked, river traffic stopped, and commercial air travel restricted. The army would not enter the area and President Mobutu was said to have left the country and fled to France, in the face of fears that the disease could spread to others, as those infected with the disease tried to escape the center of the outbreak. On his way back home to the United States for a home leave, Dr. Close returned to Kinshasa from Geneva , discussing the issue on the flight with two physicians from the Centers for Disease Control (CDC), Joel G. Breman and Peter Piot , who discovered the Ebola virus. Back in Zaire, Close obtained airplanes and pilots from the Ministry of Health to transport medical equipment to the affected area, using his personal connection to President Mobutu to obtain the access he needed. Close coordinated efforts in the area, ensuring that medical supplies were directed to where they were most needed. After providing protective equipment for hospital workers, sterilizing medical supplies, and quarantining patients, the team was able to break the chain of transmission of the virus, with almost 90% of the 318 people infected left dead. Blood samples that Close had collected in the 1970s were used to investigate the progress of the AIDS pandemic , showing that the rate of infection had been stable at 0.8% by comparing new samples to the older ones that had been collected in Zaire, one of the few sets of historical specimens available to perform this analysis. This showed that HIV infection rates could have been stable in rural Africa before it spread throughout the world. Disillusioned with Mobutu's policies, Close left Zaire in 1977. He moved to Big Piney, Wyoming , where he became a country doctor, making his final house call a month before his death. During the 1995 Ebola outbreak , he was a liaison between the CDC and the Zairian government. Close wrote four books, which included chronicles of his experiences as a doctor in Zaire and Wyoming . [ citation needed ]Disillusioned with Mobutu's policies, Close left Zaire in 1977. He moved to Big Piney, Wyoming , where he became a country doctor, making his final house call a month before his death. During the 1995 Ebola outbreak , he was a liaison between the CDC and the Zairian government. Close wrote four books, which included chronicles of his experiences as a doctor in Zaire and Wyoming . [ citation needed ]On February 6, 1943, Close married Bettine Moore in a ceremony held at the home of her parents in Greenwich. She was the daughter of Elizabeth Hyde (1897–1983) and Charles Arthur Moore, Jr. (1880–1949). Together they had: Tina, Glenn , Alexander, and Jessie. Close died at age 84 on January 15, 2009, in his home in Big Piney due to a heart attack . A Doctor's Life: Unique Stories (2001), Expanded, revised version, Marbleton, Wyoming: Meadowlarks Springs Productions.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Nigeria/html

Nigeria

Nigeria , [lower-alpha 1] officially the Federal Republic of Nigeria , is a country in West Africa . It is situated between the Sahel to the north and the Gulf of Guinea to the south in the Atlantic Ocean . It covers an area of 923,769 square kilometres (356,669 sq mi) , and with a population of over 230 million, it is the most populous country in Africa , and the world's sixth-most populous country . Nigeria borders Niger in the north , Chad in the northeast , Cameroon in the east , and Benin in the west . Nigeria is a federal republic comprising 36 states and the Federal Capital Territory , where the capital, Abuja , is located. The largest city in Nigeria is Lagos , one of the largest metropolitan areas in the world and the largest in Africa . Nigeria has been home to several indigenous pre-colonial states and kingdoms since the second millennium BC, with the Nok civilization in the 15th century BC marking the first internal unification. The modern state originated with British colonialization in the 19th century, taking its present territorial shape with the merging of the Southern Nigeria Protectorate and the Northern Nigeria Protectorate in 1914. The British set up administrative and legal structures while practising indirect rule through traditional chiefdoms . Nigeria became a formally independent federation on 1 October 1960. It experienced a civil war from 1967 to 1970 , followed by a succession of military dictatorships and democratically elected civilian governments until achieving a stable government in the 1999 Nigerian presidential election , with the election of Olusegun Obasanjo of the Peoples Democratic Party . However, the country frequently experiences electoral fraud , and corruption is significantly present in all levels of Nigerian politics. Nigeria is a multinational state inhabited by more than 250 ethnic groups speaking 500 distinct languages , all identifying with a wide variety of cultures. The three largest ethnic groups are the Hausa in the north , Yoruba in the west , and Igbo in the east , together constituting over 60% of the total population. The official language is English , chosen to facilitate linguistic unity at the national level. Nigeria's constitution ensures de jure freedom of religion , and it is home to some of the world's largest Muslim and Christian populations. Nigeria is divided roughly in half between Muslims , who live mostly in the north part of the country, and Christians , who live mostly in the south; indigenous religions , such as those native to the Igbo and Yoruba ethnicities, are in the minority. Nigeria is a regional power in Africa and a middle power in international affairs. Nigeria's economy is the second-largest in Africa , the 39th-largest in the world by nominal GDP , and 27th-largest by PPP . Nigeria is often referred to as the Giant of Africa owing to its large population and economy , and is considered to be an emerging market by the World Bank . Nigeria is a founding member of the African Union and a member of many international organizations, including the United Nations , the Commonwealth of Nations , NAM , the Economic Community of West African States , Organisation of Islamic Cooperation and OPEC . It is also a member of the informal MINT group of countries and is one of the Next Eleven economies.The name Nigeria derives from the Niger River running through the country. This name was coined on 8 January 1897, by the British journalist Flora Shaw . The neighbouring Republic of Niger takes its name from the same river. The origin of the name Niger , which originally applied to only the middle reaches of the Niger River, is uncertain. The word is likely an alteration of the Tuareg name egerew n-iger ewen used by inhabitants along the middle reaches of the river around Timbuktu before 19th-century European colonialism . Before Flora Shaw suggested the name Nigeria , other proposed names included Royal Niger Company Territories , Central Sudan , Niger Empire , Niger Sudan , and Hausa Territories . Kainji Dam excavations showed ironworking by the 2nd century BC. The transition from Neolithic times to the Iron Age was accomplished without intermediate bronze production. Some have suggested the technology moved west from the Nile Valley . But the Iron Age in the Niger River valley and the forest region appears to predate the introduction of metallurgy in the upper savanna by more than 800 years, as well as predating it in the Nile Valley. More recent research suggests that iron metallurgy was developed independently in sub-Saharan Africa . The Nok civilization thrived between 1,500 BC and AD 200. It produced life-sized terracotta figures that are some of the earliest known sculptures in sub-Saharan Africa and smelted iron by about 550 BC and possibly a few centuries earlier. Evidence of iron smelting has also been excavated at sites in the Nsukka region of southeast Nigeria: dating to 2000 BC at the site of Lejja and to 750 BC and at the site of Opi . The Kano Chronicle highlights an ancient history dating to around 999 AD of the Hausa Sahelian city-state of Kano , with other major Hausa cities (or Hausa Bakwai ) of Daura , Hadeija , Kano , Katsina , Zazzau , Rano , and Gobir all having recorded histories dating back to the 10th century. With the spread of Islam from the 7th century AD, the area became known as Sudan or as Bilad Al Sudan (English: Land of the Blacks). Since the populations were partially affiliated with the Arab Muslim culture of North Africa , they began trans-Saharan trade and were referred to by the Arabic speakers as Al-Sudan (meaning "The Blacks") as they were considered an extended part of the Muslim world . There are early historical references by medieval Arab and Muslim historians and geographers which refer to the Kanem–Bornu Empire as the region's major centre for Islamic civilization. [ citation needed ] The Kingdom of Nri of the Igbo people consolidated in the 10th century and continued until it lost its sovereignty to the British in 1911. Nri was ruled by the Eze Nri , and the city of Nri is considered to be the foundation of Igbo culture . Nri and Aguleri , where the Igbo creation myth originates, are in the territory of the Umeuri clan. Members of the clan trace their lineages back to the patriarchal king-figure Eri . In West Africa, the oldest bronzes made using the lost wax process were from Igbo-Ukwu , a city under Nri influence. The Yoruba kingdoms of Ife and Oyo in southwestern Nigeria became prominent in the 12th and 14th centuries, respectively. The oldest signs of human settlement at Ife's current site date back to the 9th century, and its material culture includes terracotta and bronze figures. In the 16th century, Portuguese explorers were the first Europeans to begin important, direct trade with the peoples of southern Nigeria, at the port they named Lagos (formerly Eko) and in Calabar along the region Slave Coast . Europeans traded goods with peoples at the coast; coastal trade with Europeans also marked the beginnings of the Atlantic slave trade . The port of Calabar on the historical Bight of Biafra (now commonly referred to as the Bight of Bonny) became one of the largest slave-trading posts in West Africa in this era. Other major slaving ports were located in Badagry , Lagos on the Bight of Benin , and Bonny Island on the Bight of Biafra. The majority of those taken to these ports were captured in raids and wars. Usually, the captives were taken back to the conquerors' territory as forced labour ; they were sometimes gradually acculturated and absorbed into the conquerors' society. Slave routes were established throughout Nigeria linking the hinterland areas with the major coastal ports. Some of the more prolific slave-trading kingdoms who participated in the Atlantic slave trade were linked with the Edo's Benin Empire in the south, Oyo Empire in the southwest, and the Aro Confederacy in the southeast. Benin's power lasted between the 15th and 19th centuries. Oyo, at its territorial zenith in the late 17th to early 18th centuries, extended its influence from western Nigeria to modern-day Togo . In the north, the incessant fighting amongst the Hausa city-states and the decline of the Bornu Empire allowed the Fulani people to gain headway into the region. Until this point, the Fulani, a nomadic ethnic group, primarily traversed the semi-desert Sahelian region north of Sudan with cattle and avoided trade and intermingling with the Sudanic peoples. At the beginning of the 19th century, Usman dan Fodio led a successful jihad against the Hausa Kingdoms , founding the centralised Sokoto Caliphate . This empire, with Arabic as its official language, grew rapidly under his rule and that of his descendants , who sent out invading armies in every direction. The vast landlocked empire connected the east with the western Sudan region and made inroads down south conquering parts of the Oyo Empire (modern-day Kwara ), and advanced towards the Yoruba heartland of Ibadan , to reach the Atlantic Ocean. The territory controlled by the empire included much of modern-day northern and central Nigeria. The sultan sent out emirs to establish suzerainty over the conquered territories and promote Islamic civilization; the emirs in turn became increasingly rich and powerful through trade and slavery. By the 1890s, the largest slave population in the world, about two million, was concentrated in the territories of the Sokoto Caliphate . The use of slave labour was extensive, especially in agriculture. By the time of its break-up in 1903 into various European colonies, the Sokoto Caliphate was one of the largest pre-colonial African states. A changing legal imperative (the outlawing of the Atlantic slave trade in 1807) and economic imperative (a desire for political and social stability) led most European powers to support the widespread cultivation of agricultural products, such as the palm, for use in European industry. The slave trade continued after the ban, as illegal smugglers purchased slaves along the coast from native slavers. Britain's West Africa Squadron sought to intercept the smugglers at sea. The rescued slaves were taken to Freetown , a colony in West Africa originally established by Lieutenant John Clarkson for the resettlement of slaves freed by Britain in North America after the American Revolutionary War . Britain intervened in the Lagos kingship power struggle by bombarding Lagos in 1851, deposing the slave-trade-friendly Oba Kosoko , helping to install the amenable Oba Akitoye and signing the Treaty between Great Britain and Lagos on 1 January 1852. Britain annexed Lagos as a crown colony in August 1861 with the Lagos Treaty of Cession . British missionaries expanded their operations and travelled further inland. In 1864, Samuel Ajayi Crowther became the first African bishop of the Anglican Church . In 1885, British claims to a West African sphere of influence received recognition from other European nations at the Berlin Conference . The following year, it chartered the Royal Niger Company under the leadership of Sir George Taubman Goldie . By the late 19th and early 20th centuries, the company had vastly succeeded in subjugating the independent southern kingdoms along the Niger River , the British conquered Benin in 1897, and, in the Anglo-Aro War (1901–1902), defeated other opponents. The defeat of these states opened up the Niger area to British rule. In 1900, the company's territory came under the direct control of the British government and established the Southern Nigeria Protectorate as a British protectorate and part of the British Empire . By 1902, the British had begun plans to move north into the Sokoto Caliphate. British General Lord Frederick Lugard was tasked by the Colonial Office to implement the agenda. Lugard used rivalries between many of the emirs in the southern reach of the caliphate and the central Sokoto administration to prevent any defence as he worked towards the capital. As the British approached the city of Sokoto , Sultan Muhammadu Attahiru I organized a quick defence of the city and fought the advancing British-led forces. The British force quickly won, sending Attahiru I and thousands of followers on a Mahdist hijra . In the northeast, the decline of the Bornu Empire gave rise to the British-controlled Borno Emirate which established Abubakar Garbai of Borno as ruler. In 1903, the British victory in the Battle of Kano gave them a logistical edge in pacifying the heartland of the Sokoto Caliphate and parts of the former Bornu Empire. On 13 March 1903, at the grand market square of Sokoto, the last vizier of the caliphate officially conceded to British rule. The British appointed Muhammadu Attahiru II as the new caliph. Lugard abolished the caliphate but retained the title sultan as a symbolic position in the newly organized Northern Nigeria Protectorate . This remnant became known as " Sokoto Sultanate Council ". In June 1903, the British defeated the remaining northern forces of Attahiru. By 1906, all resistance to British rule had ended. On 1 January 1914, the British formally united the Southern Nigeria Protectorate and the Northern Nigeria Protectorate into the Colony and Protectorate of Nigeria . Administratively, Nigeria remained divided into the Northern and Southern Protectorates and Lagos Colony . Inhabitants of the southern region sustained more interaction, economic and cultural, with the British and other Europeans owing to the coastal economy. Christian missions established Western educational institutions in the protectorates. Under Britain's policy of indirect rule and validation of Islamic legitimist tradition, the Crown did not encourage the operation of Christian missions in the northern, Islamic part of the country. By the mid-20th century following World War II , a wave for independence was sweeping across Africa, in response to the growth of Nigerian nationalism and demands for independence, successive constitutions legislated by the British government moved Nigeria toward self-government on a representative and increasingly federal basis. By the eve of independence in 1960, regional differences in modern educational access were marked. The legacy, though less pronounced, continues to the present day. Imbalances between north and south were expressed in Nigeria's political life as well. For instance, northern Nigeria did not outlaw slavery until 1936 whilst in other parts of Nigeria, slavery was abolished soon after colonialism. Nigeria gained a degree of self-rule in 1954, and full independence from the United Kingdom on 1 October 1960, as the Federation of Nigeria with Abubakar Tafawa Balewa as its prime minister , while retaining the British monarch , Elizabeth II , as nominal head of state and Queen of Nigeria . Azikiwe replaced the colonial governor-general in November 1960. At independence, the cultural and political differences were sharp among Nigeria's dominant ethnic groups: the Hausa in the north, Igbo in the east and Yoruba in the west. The Westminster system of government was retained, and thus the President 's powers were generally ceremonial. The parliamentary system of government had Abubakar Tafawa Balewa as Prime Minister and Nnamdi Azikiwe as the ceremonial president. The founding government was a coalition of conservative parties: the Northern People's Congress led by Sir Ahmadu Bello , a party dominated by Muslim northerners, and the Igbo and Christian-dominated National Council of Nigeria and the Cameroons led by Nnamdi Azikiwe . The opposition consisted of the comparatively liberal Action Group , which was largely dominated by the Yoruba and led by Obafemi Awolowo . An imbalance was created in the polity as the result of the 1961 plebiscite . Southern Cameroons opted to join the Republic of Cameroon while Northern Cameroons chose to join Nigeria. The northern part of the country became larger than the southern part. The disequilibrium and perceived corruption of the electoral and political process led to two military coups in 1966. The first coup was in January 1966 and was led mostly by soldiers under Majors Emmanuel Ifeajuna (of the Igbo tribe), Chukwuma Kaduna Nzeogwu ( Northerner of Eastern extraction) and Adewale Ademoyega (a Yoruba from the West). The coup plotters succeeded in assassinating Sir Ahmadu Bello and Sir Abubakar Tafawa Balewa alongside prominent leaders of the Northern Region and Premier Samuel Akintola of the Western Region , but the plotters struggled to form a central government. Senate President Nwafor Orizu handed over government control to the Army , under the command of another Igbo officer, Major General Johnson Aguiyi-Ironsi . Later, the counter-coup of 1966 , supported primarily by Northern military officers, facilitated the rise of Yakubu Gowon as military head of state. Tension rose between north and south; Igbos in northern cities suffered persecution and many fled to the Eastern Region . In May 1967, Governor of the Eastern Region Lt. Colonel Emeka Ojukwu declared the region independent from the federation as a state called the Republic of Biafra , as a result of the continuous and systematically planned attacks against Igbos and those of Eastern extraction popularly known as 1966 pogroms . This declaration precipitated the Nigerian Civil War , which began as the official Nigerian government side attacked Biafra on 6 July 1967, at Garkem. The 30-month war, with a long blockade of Biafra and its isolation from trade and international relief, ended in January 1970. Estimates of the number of dead in the former Eastern Region during the 30-month civil war range from one to three million. Britain and the Soviet Union were the main military backers of the Nigerian government, with Nigeria utilizing air support from Egyptian pilots provided by Gamal Abdel Nasser , while France and Israel aided the Biafrans. The Congolese government, under President Joseph-Désiré Mobutu , took an early stand on the Biafran secession, voicing strong support for the Nigerian federal government and deploying thousands of troops to fight against the secessionists . Following the war, Nigeria enjoyed an oil boom in the 1970s, during which the country joined OPEC and received huge oil revenues. Despite these revenues, the military government did little to improve the standard of living , help small and medium businesses, or invest in infrastructure. As oil revenues fuelled the rise of federal subsidies to states, the federal government became the centre of political struggle and the threshold of power in the country. As oil production and revenue rose, the Nigerian government became increasingly dependent on oil revenues and international commodity markets for budgetary and economic concerns. The coup in July 1975 , led by Generals Shehu Musa Yar'Adua and Joseph Garba , ousted Gowon, who fled to Britain. The coup plotters wanted to replace Gowon's autocratic rule with a triumvirate of three brigadier generals whose decisions could be vetoed by a Supreme Military Council . For this triumvirate, they convinced General Murtala Muhammed to become military head of state, with General Olusegun Obasanjo as his second-in-command, and General Theophilus Danjuma as the third. Together, the triumvirate introduced austerity measures to stem inflation, established a Corrupt Practices Investigation Bureau, replaced all military governors with new officers, and launched "Operation Deadwood" through which they fired 11,000 officials from the civil service. Colonel Buka Suka Dimka launched a February 1976 coup attempt , during which General Murtala Muhammed was assassinated. Dimka lacked widespread support among the military, and his coup failed, forcing him to flee. After the coup attempt, General Olusegun Obasanjo was appointed military head of state. Obasanjo vowed to continue Murtala's policies. Aware of the danger of alienating northern Nigerians, Obasanjo brought General Shehu Yar'Adua as his replacement and second-in-command as Chief of Staff, Supreme Headquarters completing the military triumvirate, with Obasanjo as head of state and General Theophilus Danjuma as Chief of Army Staff , the three went on to re-establish control over the military regime and organized the military's transfer of power programme: states creation and national delimitation , local government reforms and the constitutional drafting committee for a new republic. The military carefully planned the return to civilian rule putting in place measures to ensure that political parties had broader support than witnessed during the first republic. In 1979, five political parties competed in a series of elections in which Alhaji Shehu Shagari of the National Party of Nigeria (NPN) was elected president. All five parties won representation in the National Assembly. On 1 October 1979, Shehu Shagari was sworn in as the first President and Commander-in-Chief of the Federal Republic of Nigeria. Obasanjo peacefully transferred power to Shagari, becoming the first head of state in Nigerian history to willingly step down. The Shagari government became viewed as corrupt by virtually all sectors of Nigerian society. In 1983, the inspectors of the state-owned Nigerian National Petroleum Corporation began to notice "the slow poisoning of the waters of this country". In August 1983, Shagari and the NPN were returned to power in a landslide victory, with a majority of seats in the National Assembly and control of 12 state governments. But the elections were marred by violence, and allegations of widespread vote-rigging and electoral malfeasance led to legal battles over the results. There were also uncertainties, such as in the first republic, that political leaders may be unable to govern properly. The 1983 military coup d'état was coordinated by key officers of the Nigerian military and led to the overthrow of the government and the installation of Major General Muhammadu Buhari as head of state. The military coup of Muhammadu Buhari shortly after the regime's re-election in 1984 was generally viewed as a positive development. In 1985, Ibrahim Babangida overthrew Buhari in a coup d'état. In 1986, Babangida established the Nigerian Political Bureau which made recommendations for the transition to the Third Nigerian Republic. In 1989, Babangida started making plans for the transition to the Third Nigerian Republic. Babangida survived the 1990 Nigerian coup d'état attempt , then postponed a promised return to democracy to 1992. Babangida legalized the formation of political parties and formed the two-party system with the Social Democratic Party and National Republican Convention ahead of the 1992 general elections . He urged all Nigerians to join either of the parties, which Chief Bola Ige referred to as "two leper hands". The 1993 presidential election held on 12 June was the first since the military coup of 1983. The results, though not officially declared by the National Electoral Commission, showed the duo of Moshood Abiola and Baba Gana Kingibe of the Social Democratic Party defeated Bashir Tofa and Sylvester Ugoh of the National Republican Convention by over 2.3 million votes. However, Babangida annulled the elections, leading to massive civilian protests that effectively shut down the country for weeks. In August 1993, Babangida finally kept his promise to relinquish power to a civilian government but not before appointing Ernest Shonekan head of an interim national government . Babangida's regime has been considered the most corrupt and responsible for creating a culture of corruption in Nigeria. Shonekan's interim government, the shortest in the political history of the country, was overthrown in a coup d'état of 1993 led by General Sani Abacha , who used military force on a wide scale to suppress the continuing civilian unrest. In 1995, the government hanged environmentalist Ken Saro-Wiwa on trumped-up charges in the deaths of four Ogoni elders, which caused Nigerian's suspension from the Commonwealth . Lawsuits under the American Alien Tort Statute against Royal Dutch Shell and Brian Anderson, the head of Shell's Nigerian operation, settled out of court with Shell continuing to deny liability. Several hundred million dollars in accounts traced to Abacha were discovered in 1999. The regime came to an end in 1998 when the dictator died in the villa. He looted money to offshore accounts in western European banks and defeated coup plots by arresting and bribing generals and politicians. His successor, General Abdulsalami Abubakar , adopted a new constitution on 5 May 1999, which provided for multiparty elections. On 29 May 1999, Abubakar handed over power to the winner of the 1999 presidential election, former military ruler General Olusegun Obasanjo , as President of Nigeria. Obasanjo had been in prison under the dictatorship of Abacha. Obasanjo's inauguration heralded the beginning of the Fourth Nigerian Republic, ending a 39-year period of short-lived democracies, civil war and military dictatorship. Although the elections that brought Obasanjo to power and allowed him to run for a second term in the 2003 presidential elections were condemned as unfree and unfair, Nigeria made significant progress in democratisation under Obasanjo. In the 2007 general elections, Umaru Yar'Adua of the People's Democratic Party came to power. The international community, which had observed the Nigerian elections to promote a free and fair process, condemned these elections as seriously flawed. Yar'Adua died on 5 May 2010, and Vice President Goodluck Jonathan had been sworn in by the Senate three months earlier as acting president to succeed Yar'Adua. Jonathan won the 2011 presidential election; the polls went smoothly and with relatively little violence or electoral fraud. Jonathan's tenure saw an economic recovery that made Nigeria the leading economic power in Africa. The Jonathan administration also saw an increase in unparalleled corruption, with as many as 20 billion US dollars said to have been lost to the Nigerian state through the national oil company. Above all, however, Jonathan's tenure saw the emergence of a wave of terror by the Boko Haram insurgency , such as the Gwoza massacre and Chibok schoolgirls kidnapping in 2014. Ahead of the general election of 2015 , a merger of the biggest opposition parties in Nigeria – the Action Congress of Nigeria , the Congress for Progressive Change , the All Nigeria Peoples Party , a faction of the All Progressives Grand Alliance and the new PDP (a faction of serving governors of the ruling People's Democratic Party) – formed the All Progressives Congress led by current president Bola Ahmed Tinubu. At the time, it was the most expensive election ever to be held on the African continent (being surpassed only by the elections of 2019 and 2023 ). The new mega-opposition party chose as their candidate for the election former military dictator Muhammadu Buhari. Buhari's campaign in 2015 was popular and built around his image as a staunch anti-corruption fighter—he won the election by over two million votes. Observers generally praised the election as being fair. The election marked the first time an incumbent president had lost re-election in Nigeria. In the 2019 presidential election , Buhari was re-elected. Four candidates vied for the presidency in the 2023 presidential election ; for the first time since the return of democracy, no former military ruler ran for president, marking a strengthening of democracy and faith in the multiparty constitution . The election also saw the rise of metonymic supporters of the new candidates, the Obidient movement of Peter Obi , previously governor of Anambra State, widely appealed to young, urban voters and has his core base in the Southeast; and the Kwankwassiya of Rabiu Kwankwaso , former governor of Kano State in the Northwest. Bola Tinubu , of the ruling party, won the disputed election with 36.61% of the vote, but both runner-ups claimed victory and litigation is ongoing in an election tribunal. Bola Tinubu's inauguration was held on 29 May 2023. Problems with widespread kidnapping in Nigeria continued. Kainji Dam excavations showed ironworking by the 2nd century BC. The transition from Neolithic times to the Iron Age was accomplished without intermediate bronze production. Some have suggested the technology moved west from the Nile Valley . But the Iron Age in the Niger River valley and the forest region appears to predate the introduction of metallurgy in the upper savanna by more than 800 years, as well as predating it in the Nile Valley. More recent research suggests that iron metallurgy was developed independently in sub-Saharan Africa . The Nok civilization thrived between 1,500 BC and AD 200. It produced life-sized terracotta figures that are some of the earliest known sculptures in sub-Saharan Africa and smelted iron by about 550 BC and possibly a few centuries earlier. Evidence of iron smelting has also been excavated at sites in the Nsukka region of southeast Nigeria: dating to 2000 BC at the site of Lejja and to 750 BC and at the site of Opi .The Kano Chronicle highlights an ancient history dating to around 999 AD of the Hausa Sahelian city-state of Kano , with other major Hausa cities (or Hausa Bakwai ) of Daura , Hadeija , Kano , Katsina , Zazzau , Rano , and Gobir all having recorded histories dating back to the 10th century. With the spread of Islam from the 7th century AD, the area became known as Sudan or as Bilad Al Sudan (English: Land of the Blacks). Since the populations were partially affiliated with the Arab Muslim culture of North Africa , they began trans-Saharan trade and were referred to by the Arabic speakers as Al-Sudan (meaning "The Blacks") as they were considered an extended part of the Muslim world . There are early historical references by medieval Arab and Muslim historians and geographers which refer to the Kanem–Bornu Empire as the region's major centre for Islamic civilization. [ citation needed ] The Kingdom of Nri of the Igbo people consolidated in the 10th century and continued until it lost its sovereignty to the British in 1911. Nri was ruled by the Eze Nri , and the city of Nri is considered to be the foundation of Igbo culture . Nri and Aguleri , where the Igbo creation myth originates, are in the territory of the Umeuri clan. Members of the clan trace their lineages back to the patriarchal king-figure Eri . In West Africa, the oldest bronzes made using the lost wax process were from Igbo-Ukwu , a city under Nri influence. The Yoruba kingdoms of Ife and Oyo in southwestern Nigeria became prominent in the 12th and 14th centuries, respectively. The oldest signs of human settlement at Ife's current site date back to the 9th century, and its material culture includes terracotta and bronze figures.In the 16th century, Portuguese explorers were the first Europeans to begin important, direct trade with the peoples of southern Nigeria, at the port they named Lagos (formerly Eko) and in Calabar along the region Slave Coast . Europeans traded goods with peoples at the coast; coastal trade with Europeans also marked the beginnings of the Atlantic slave trade . The port of Calabar on the historical Bight of Biafra (now commonly referred to as the Bight of Bonny) became one of the largest slave-trading posts in West Africa in this era. Other major slaving ports were located in Badagry , Lagos on the Bight of Benin , and Bonny Island on the Bight of Biafra. The majority of those taken to these ports were captured in raids and wars. Usually, the captives were taken back to the conquerors' territory as forced labour ; they were sometimes gradually acculturated and absorbed into the conquerors' society. Slave routes were established throughout Nigeria linking the hinterland areas with the major coastal ports. Some of the more prolific slave-trading kingdoms who participated in the Atlantic slave trade were linked with the Edo's Benin Empire in the south, Oyo Empire in the southwest, and the Aro Confederacy in the southeast. Benin's power lasted between the 15th and 19th centuries. Oyo, at its territorial zenith in the late 17th to early 18th centuries, extended its influence from western Nigeria to modern-day Togo . In the north, the incessant fighting amongst the Hausa city-states and the decline of the Bornu Empire allowed the Fulani people to gain headway into the region. Until this point, the Fulani, a nomadic ethnic group, primarily traversed the semi-desert Sahelian region north of Sudan with cattle and avoided trade and intermingling with the Sudanic peoples. At the beginning of the 19th century, Usman dan Fodio led a successful jihad against the Hausa Kingdoms , founding the centralised Sokoto Caliphate . This empire, with Arabic as its official language, grew rapidly under his rule and that of his descendants , who sent out invading armies in every direction. The vast landlocked empire connected the east with the western Sudan region and made inroads down south conquering parts of the Oyo Empire (modern-day Kwara ), and advanced towards the Yoruba heartland of Ibadan , to reach the Atlantic Ocean. The territory controlled by the empire included much of modern-day northern and central Nigeria. The sultan sent out emirs to establish suzerainty over the conquered territories and promote Islamic civilization; the emirs in turn became increasingly rich and powerful through trade and slavery. By the 1890s, the largest slave population in the world, about two million, was concentrated in the territories of the Sokoto Caliphate . The use of slave labour was extensive, especially in agriculture. By the time of its break-up in 1903 into various European colonies, the Sokoto Caliphate was one of the largest pre-colonial African states. A changing legal imperative (the outlawing of the Atlantic slave trade in 1807) and economic imperative (a desire for political and social stability) led most European powers to support the widespread cultivation of agricultural products, such as the palm, for use in European industry. The slave trade continued after the ban, as illegal smugglers purchased slaves along the coast from native slavers. Britain's West Africa Squadron sought to intercept the smugglers at sea. The rescued slaves were taken to Freetown , a colony in West Africa originally established by Lieutenant John Clarkson for the resettlement of slaves freed by Britain in North America after the American Revolutionary War .Britain intervened in the Lagos kingship power struggle by bombarding Lagos in 1851, deposing the slave-trade-friendly Oba Kosoko , helping to install the amenable Oba Akitoye and signing the Treaty between Great Britain and Lagos on 1 January 1852. Britain annexed Lagos as a crown colony in August 1861 with the Lagos Treaty of Cession . British missionaries expanded their operations and travelled further inland. In 1864, Samuel Ajayi Crowther became the first African bishop of the Anglican Church . In 1885, British claims to a West African sphere of influence received recognition from other European nations at the Berlin Conference . The following year, it chartered the Royal Niger Company under the leadership of Sir George Taubman Goldie . By the late 19th and early 20th centuries, the company had vastly succeeded in subjugating the independent southern kingdoms along the Niger River , the British conquered Benin in 1897, and, in the Anglo-Aro War (1901–1902), defeated other opponents. The defeat of these states opened up the Niger area to British rule. In 1900, the company's territory came under the direct control of the British government and established the Southern Nigeria Protectorate as a British protectorate and part of the British Empire . By 1902, the British had begun plans to move north into the Sokoto Caliphate. British General Lord Frederick Lugard was tasked by the Colonial Office to implement the agenda. Lugard used rivalries between many of the emirs in the southern reach of the caliphate and the central Sokoto administration to prevent any defence as he worked towards the capital. As the British approached the city of Sokoto , Sultan Muhammadu Attahiru I organized a quick defence of the city and fought the advancing British-led forces. The British force quickly won, sending Attahiru I and thousands of followers on a Mahdist hijra . In the northeast, the decline of the Bornu Empire gave rise to the British-controlled Borno Emirate which established Abubakar Garbai of Borno as ruler. In 1903, the British victory in the Battle of Kano gave them a logistical edge in pacifying the heartland of the Sokoto Caliphate and parts of the former Bornu Empire. On 13 March 1903, at the grand market square of Sokoto, the last vizier of the caliphate officially conceded to British rule. The British appointed Muhammadu Attahiru II as the new caliph. Lugard abolished the caliphate but retained the title sultan as a symbolic position in the newly organized Northern Nigeria Protectorate . This remnant became known as " Sokoto Sultanate Council ". In June 1903, the British defeated the remaining northern forces of Attahiru. By 1906, all resistance to British rule had ended. On 1 January 1914, the British formally united the Southern Nigeria Protectorate and the Northern Nigeria Protectorate into the Colony and Protectorate of Nigeria . Administratively, Nigeria remained divided into the Northern and Southern Protectorates and Lagos Colony . Inhabitants of the southern region sustained more interaction, economic and cultural, with the British and other Europeans owing to the coastal economy. Christian missions established Western educational institutions in the protectorates. Under Britain's policy of indirect rule and validation of Islamic legitimist tradition, the Crown did not encourage the operation of Christian missions in the northern, Islamic part of the country. By the mid-20th century following World War II , a wave for independence was sweeping across Africa, in response to the growth of Nigerian nationalism and demands for independence, successive constitutions legislated by the British government moved Nigeria toward self-government on a representative and increasingly federal basis. By the eve of independence in 1960, regional differences in modern educational access were marked. The legacy, though less pronounced, continues to the present day. Imbalances between north and south were expressed in Nigeria's political life as well. For instance, northern Nigeria did not outlaw slavery until 1936 whilst in other parts of Nigeria, slavery was abolished soon after colonialism. Nigeria gained a degree of self-rule in 1954, and full independence from the United Kingdom on 1 October 1960, as the Federation of Nigeria with Abubakar Tafawa Balewa as its prime minister , while retaining the British monarch , Elizabeth II , as nominal head of state and Queen of Nigeria . Azikiwe replaced the colonial governor-general in November 1960. At independence, the cultural and political differences were sharp among Nigeria's dominant ethnic groups: the Hausa in the north, Igbo in the east and Yoruba in the west. The Westminster system of government was retained, and thus the President 's powers were generally ceremonial. The parliamentary system of government had Abubakar Tafawa Balewa as Prime Minister and Nnamdi Azikiwe as the ceremonial president. The founding government was a coalition of conservative parties: the Northern People's Congress led by Sir Ahmadu Bello , a party dominated by Muslim northerners, and the Igbo and Christian-dominated National Council of Nigeria and the Cameroons led by Nnamdi Azikiwe . The opposition consisted of the comparatively liberal Action Group , which was largely dominated by the Yoruba and led by Obafemi Awolowo . An imbalance was created in the polity as the result of the 1961 plebiscite . Southern Cameroons opted to join the Republic of Cameroon while Northern Cameroons chose to join Nigeria. The northern part of the country became larger than the southern part.The disequilibrium and perceived corruption of the electoral and political process led to two military coups in 1966. The first coup was in January 1966 and was led mostly by soldiers under Majors Emmanuel Ifeajuna (of the Igbo tribe), Chukwuma Kaduna Nzeogwu ( Northerner of Eastern extraction) and Adewale Ademoyega (a Yoruba from the West). The coup plotters succeeded in assassinating Sir Ahmadu Bello and Sir Abubakar Tafawa Balewa alongside prominent leaders of the Northern Region and Premier Samuel Akintola of the Western Region , but the plotters struggled to form a central government. Senate President Nwafor Orizu handed over government control to the Army , under the command of another Igbo officer, Major General Johnson Aguiyi-Ironsi . Later, the counter-coup of 1966 , supported primarily by Northern military officers, facilitated the rise of Yakubu Gowon as military head of state. Tension rose between north and south; Igbos in northern cities suffered persecution and many fled to the Eastern Region . In May 1967, Governor of the Eastern Region Lt. Colonel Emeka Ojukwu declared the region independent from the federation as a state called the Republic of Biafra , as a result of the continuous and systematically planned attacks against Igbos and those of Eastern extraction popularly known as 1966 pogroms . This declaration precipitated the Nigerian Civil War , which began as the official Nigerian government side attacked Biafra on 6 July 1967, at Garkem. The 30-month war, with a long blockade of Biafra and its isolation from trade and international relief, ended in January 1970. Estimates of the number of dead in the former Eastern Region during the 30-month civil war range from one to three million. Britain and the Soviet Union were the main military backers of the Nigerian government, with Nigeria utilizing air support from Egyptian pilots provided by Gamal Abdel Nasser , while France and Israel aided the Biafrans. The Congolese government, under President Joseph-Désiré Mobutu , took an early stand on the Biafran secession, voicing strong support for the Nigerian federal government and deploying thousands of troops to fight against the secessionists . Following the war, Nigeria enjoyed an oil boom in the 1970s, during which the country joined OPEC and received huge oil revenues. Despite these revenues, the military government did little to improve the standard of living , help small and medium businesses, or invest in infrastructure. As oil revenues fuelled the rise of federal subsidies to states, the federal government became the centre of political struggle and the threshold of power in the country. As oil production and revenue rose, the Nigerian government became increasingly dependent on oil revenues and international commodity markets for budgetary and economic concerns. The coup in July 1975 , led by Generals Shehu Musa Yar'Adua and Joseph Garba , ousted Gowon, who fled to Britain. The coup plotters wanted to replace Gowon's autocratic rule with a triumvirate of three brigadier generals whose decisions could be vetoed by a Supreme Military Council . For this triumvirate, they convinced General Murtala Muhammed to become military head of state, with General Olusegun Obasanjo as his second-in-command, and General Theophilus Danjuma as the third. Together, the triumvirate introduced austerity measures to stem inflation, established a Corrupt Practices Investigation Bureau, replaced all military governors with new officers, and launched "Operation Deadwood" through which they fired 11,000 officials from the civil service. Colonel Buka Suka Dimka launched a February 1976 coup attempt , during which General Murtala Muhammed was assassinated. Dimka lacked widespread support among the military, and his coup failed, forcing him to flee. After the coup attempt, General Olusegun Obasanjo was appointed military head of state. Obasanjo vowed to continue Murtala's policies. Aware of the danger of alienating northern Nigerians, Obasanjo brought General Shehu Yar'Adua as his replacement and second-in-command as Chief of Staff, Supreme Headquarters completing the military triumvirate, with Obasanjo as head of state and General Theophilus Danjuma as Chief of Army Staff , the three went on to re-establish control over the military regime and organized the military's transfer of power programme: states creation and national delimitation , local government reforms and the constitutional drafting committee for a new republic. The military carefully planned the return to civilian rule putting in place measures to ensure that political parties had broader support than witnessed during the first republic. In 1979, five political parties competed in a series of elections in which Alhaji Shehu Shagari of the National Party of Nigeria (NPN) was elected president. All five parties won representation in the National Assembly. On 1 October 1979, Shehu Shagari was sworn in as the first President and Commander-in-Chief of the Federal Republic of Nigeria. Obasanjo peacefully transferred power to Shagari, becoming the first head of state in Nigerian history to willingly step down. The Shagari government became viewed as corrupt by virtually all sectors of Nigerian society. In 1983, the inspectors of the state-owned Nigerian National Petroleum Corporation began to notice "the slow poisoning of the waters of this country". In August 1983, Shagari and the NPN were returned to power in a landslide victory, with a majority of seats in the National Assembly and control of 12 state governments. But the elections were marred by violence, and allegations of widespread vote-rigging and electoral malfeasance led to legal battles over the results. There were also uncertainties, such as in the first republic, that political leaders may be unable to govern properly. The 1983 military coup d'état was coordinated by key officers of the Nigerian military and led to the overthrow of the government and the installation of Major General Muhammadu Buhari as head of state. The military coup of Muhammadu Buhari shortly after the regime's re-election in 1984 was generally viewed as a positive development. In 1985, Ibrahim Babangida overthrew Buhari in a coup d'état. In 1986, Babangida established the Nigerian Political Bureau which made recommendations for the transition to the Third Nigerian Republic. In 1989, Babangida started making plans for the transition to the Third Nigerian Republic. Babangida survived the 1990 Nigerian coup d'état attempt , then postponed a promised return to democracy to 1992. Babangida legalized the formation of political parties and formed the two-party system with the Social Democratic Party and National Republican Convention ahead of the 1992 general elections . He urged all Nigerians to join either of the parties, which Chief Bola Ige referred to as "two leper hands". The 1993 presidential election held on 12 June was the first since the military coup of 1983. The results, though not officially declared by the National Electoral Commission, showed the duo of Moshood Abiola and Baba Gana Kingibe of the Social Democratic Party defeated Bashir Tofa and Sylvester Ugoh of the National Republican Convention by over 2.3 million votes. However, Babangida annulled the elections, leading to massive civilian protests that effectively shut down the country for weeks. In August 1993, Babangida finally kept his promise to relinquish power to a civilian government but not before appointing Ernest Shonekan head of an interim national government . Babangida's regime has been considered the most corrupt and responsible for creating a culture of corruption in Nigeria. Shonekan's interim government, the shortest in the political history of the country, was overthrown in a coup d'état of 1993 led by General Sani Abacha , who used military force on a wide scale to suppress the continuing civilian unrest. In 1995, the government hanged environmentalist Ken Saro-Wiwa on trumped-up charges in the deaths of four Ogoni elders, which caused Nigerian's suspension from the Commonwealth . Lawsuits under the American Alien Tort Statute against Royal Dutch Shell and Brian Anderson, the head of Shell's Nigerian operation, settled out of court with Shell continuing to deny liability. Several hundred million dollars in accounts traced to Abacha were discovered in 1999. The regime came to an end in 1998 when the dictator died in the villa. He looted money to offshore accounts in western European banks and defeated coup plots by arresting and bribing generals and politicians. His successor, General Abdulsalami Abubakar , adopted a new constitution on 5 May 1999, which provided for multiparty elections.On 29 May 1999, Abubakar handed over power to the winner of the 1999 presidential election, former military ruler General Olusegun Obasanjo , as President of Nigeria. Obasanjo had been in prison under the dictatorship of Abacha. Obasanjo's inauguration heralded the beginning of the Fourth Nigerian Republic, ending a 39-year period of short-lived democracies, civil war and military dictatorship. Although the elections that brought Obasanjo to power and allowed him to run for a second term in the 2003 presidential elections were condemned as unfree and unfair, Nigeria made significant progress in democratisation under Obasanjo. In the 2007 general elections, Umaru Yar'Adua of the People's Democratic Party came to power. The international community, which had observed the Nigerian elections to promote a free and fair process, condemned these elections as seriously flawed. Yar'Adua died on 5 May 2010, and Vice President Goodluck Jonathan had been sworn in by the Senate three months earlier as acting president to succeed Yar'Adua. Jonathan won the 2011 presidential election; the polls went smoothly and with relatively little violence or electoral fraud. Jonathan's tenure saw an economic recovery that made Nigeria the leading economic power in Africa. The Jonathan administration also saw an increase in unparalleled corruption, with as many as 20 billion US dollars said to have been lost to the Nigerian state through the national oil company. Above all, however, Jonathan's tenure saw the emergence of a wave of terror by the Boko Haram insurgency , such as the Gwoza massacre and Chibok schoolgirls kidnapping in 2014. Ahead of the general election of 2015 , a merger of the biggest opposition parties in Nigeria – the Action Congress of Nigeria , the Congress for Progressive Change , the All Nigeria Peoples Party , a faction of the All Progressives Grand Alliance and the new PDP (a faction of serving governors of the ruling People's Democratic Party) – formed the All Progressives Congress led by current president Bola Ahmed Tinubu. At the time, it was the most expensive election ever to be held on the African continent (being surpassed only by the elections of 2019 and 2023 ). The new mega-opposition party chose as their candidate for the election former military dictator Muhammadu Buhari. Buhari's campaign in 2015 was popular and built around his image as a staunch anti-corruption fighter—he won the election by over two million votes. Observers generally praised the election as being fair. The election marked the first time an incumbent president had lost re-election in Nigeria. In the 2019 presidential election , Buhari was re-elected. Four candidates vied for the presidency in the 2023 presidential election ; for the first time since the return of democracy, no former military ruler ran for president, marking a strengthening of democracy and faith in the multiparty constitution . The election also saw the rise of metonymic supporters of the new candidates, the Obidient movement of Peter Obi , previously governor of Anambra State, widely appealed to young, urban voters and has his core base in the Southeast; and the Kwankwassiya of Rabiu Kwankwaso , former governor of Kano State in the Northwest. Bola Tinubu , of the ruling party, won the disputed election with 36.61% of the vote, but both runner-ups claimed victory and litigation is ongoing in an election tribunal. Bola Tinubu's inauguration was held on 29 May 2023. Problems with widespread kidnapping in Nigeria continued. Nigeria is located in western Africa on the Gulf of Guinea and has a total area of 923,768 km 2 (356,669 sq mi) , making it the world's 32nd-largest country . Its borders span 4,047 kilometres (2,515 mi) , and it shares borders with Benin ( 773 km or 480 mi ), Niger ( 1,497 km or 930 mi ), Chad ( 87 km or 54 mi ), and Cameroon (including the separatist Ambazonia ) 1,690 km or 1,050 mi . Its coastline is at least 853 km (530 mi) . Nigeria lies between latitudes 4° and 14°N , and longitudes 2° and 15°E . The highest point in Nigeria is Chappal Waddi at 2,419 m (7,936 ft) . The main rivers are the Niger and the Benue , which converge and empty into the Niger Delta . This is one of the world's largest river deltas and the location of a large area of Central African mangroves . Nigeria's most expansive topographical region is that of the valleys of the Niger and Benue river valleys (which merge and form a Y-shape). To the southwest of the Niger is a "rugged" highland . To the southeast of the Benue are hills and mountains, which form the Mambilla Plateau , the highest plateau in Nigeria. This plateau extends through the border with Cameroon , where the montane land is part of the Bamenda Highlands of Cameroon. The far south is defined by its tropical rainforest climate , where annual rainfall is 1,500 to 2,000 millimetres (60 to 80 in) per year. In the southeast stands the Obudu Plateau . Coastal plains are found in both the southwest and the southeast. Mangrove swamps are found along the coast. The area near the border with Cameroon close to the coast is rich rainforest and part of the Cross-Sanaga-Bioko coastal forests ecoregion , an important centre for biodiversity . It is a habitat for the drill primate , which is found in the wild only in this area and across the border in Cameroon. The areas surrounding Calabar , Cross River State, also in this forest, are believed to contain the world's largest diversity of butterflies. The area of southern Nigeria between the Niger and the Cross Rivers has lost most of its forest because of development and harvesting by increased population, and has been replaced by grassland . Everything in between the far south and the far north is savannah (insignificant tree cover, with grasses and flowers located between trees). Rainfall is more limited to between 500 and 1,500 millimetres (20 and 60 in) per year. The savannah zone's three categories are Guinean forest-savanna mosaic , Sudan savannah, and Sahel savannah. Guinean forest-savanna mosaic is plains of tall grass interrupted by trees. Sudan savannah is similar but with shorter grasses and shorter trees. Sahel savannah consists of patches of grass and sand, found in the northeast. Nigeria is divided into two main catchment areas - that of Lake Chad and that of the Niger. The Niger catchment area covers about 63% of the country. The main tributary of the Niger is the Benue, whose tributaries extend beyond Cameroon into Cameroon into Chad and the Sharie catchment area. In the Sahel region, rain is less than 500 millimetres (20 in) per year, and the Sahara Desert is encroaching. In the dry northeast corner of the country lies Lake Chad , on a shared water boundary delimitation with Niger, Chad and Cameroon. The Chad Basin is fed from the north-eastern quarter of Nigeria. The Bauchi Plateau forms the watershed between the Niger/Benue and Komadugu Yobe river systems. The flat plains of north-eastern Nigeria are geographically part of the Chad Basin, where the course of the El Beid River forms the border with Cameroon, from the Mandara Mountains to Lake Chad. The Komadugu Yobe river system gives rise to the internationally important Hadejia-Nguru wetlands and Ox-bow lakes around Lake Nguru in the rainy season. Other rivers of the northeast include the Ngadda and the Yedseram, both of which flow through the Sambisa swamps, thus forming a river system. The river system of the northeast is also a major river system. In addition, Nigeria has numerous coastal rivers. Over the last million years, Lake Chad in the far north-east of Nigeria has dried up several times for a few thousand years and just as often growing to many times its current size. In recent decades its surface area has been reduced considerably, which may also be due to humans taking water from the inlets to irrigate agricultural land. Nigeria is covered by three types of vegetation: forests (where there is significant tree cover), savannahs (insignificant tree cover, with grasses and flowers located between trees), and montane land (least common and mainly found in the mountains near the Cameroon border). Both the forest zone and the savannah zone are divided into three parts. Some of the forest zone's most southerly portion, especially around the Niger River and Cross River deltas, is mangrove swamp . North of this is fresh water swamp, containing different vegetation from the salt water mangrove swamps, and north of that is rain forest. The savannah zone's three categories are divided into Guinean forest-savanna mosaic , made up of plains of tall grass which are interrupted by trees, the most common across the country; Sudan savannah, with short grasses and short trees; and Sahel savannah patches of grass and sand, found in the northeast. Waste management including sewage treatment , the linked processes of deforestation and soil degradation , and climate change or global warming are the major environmental problems in Nigeria. Waste management presents problems in a megacity like Lagos and other major Nigerian cities which are linked with economic development, population growth and the inability of municipal councils to manage the resulting rise in industrial and domestic waste. This waste management problem is also attributable to unsustainable environmental management lifestyles of Kubwa community in the Federal Capital Territory, where there are habits of indiscriminate disposal of waste, dumping of waste along or into the canals, sewerage systems that are channels for water flows, and the like. Haphazard industrial planning, increased urbanisation, poverty and lack of competence of the municipal government are seen as the major reasons for high levels of waste pollution in major cities of the country. Some of the solutions have been disastrous to the environment, resulting in untreated waste being dumped in places where it can pollute waterways and groundwater . In 2005, Nigeria had the highest rate of deforestation in the world, according to the Food and Agriculture Organization of the United Nations . That year, 12.2%, the equivalent of 11,089,000 hectares, had been forested in the country. Between 1990 and 2000, Nigeria lost an average of 409,700 hectares of forest every year equal to an average annual deforestation rate of 2.4%. Between 1990 and 2005, in total Nigeria lost 35.7% of its forest cover or around 6,145,000 hectares. Nigeria had a 2019 Forest Landscape Integrity Index mean score of 6.2/10, ranking it 82nd globally out of 172 countries. In the year 2010, thousands of people were inadvertently exposed to lead-containing soil from informal gold mining within the northern state of Zamfara. While estimates vary, it is thought that upwards of 400 children died of acute lead poisoning , making this perhaps the largest lead poisoning fatality outbreak ever encountered. Nigeria's Delta region is one of the most polluted regions in the world due to serious oil spills and other environmental problems caused by its oil industry. The heavy contamination of the air, ground and water with toxic pollutants is often used as an example of ecocide . In additional to the environmental damage it has caused conflict in the Delta region . Illegal oil refineries, in which local operators convert stolen crude oil into petrol and diesel, are considered particularly "dirty, dangerous and lucrative". Safety and environmental aspects are usually ignored. Refining petroleum also inevitably produces heavy oil, which is "cracked" into lighter fuel components in regular plants at great technical expense. Illegal refineries do not have these technical possibilities and "dispose" of the heavy oil where it accumulates. The lighter components of crude oil ( methane to butane , isobutane ) create a certain risk of explosion, which often leads to disasters at illegal plants. In 2022, Nigeria suffered 125 deaths from explosions at local, illegal refineries. Nigeria is divided into two main catchment areas - that of Lake Chad and that of the Niger. The Niger catchment area covers about 63% of the country. The main tributary of the Niger is the Benue, whose tributaries extend beyond Cameroon into Cameroon into Chad and the Sharie catchment area. In the Sahel region, rain is less than 500 millimetres (20 in) per year, and the Sahara Desert is encroaching. In the dry northeast corner of the country lies Lake Chad , on a shared water boundary delimitation with Niger, Chad and Cameroon. The Chad Basin is fed from the north-eastern quarter of Nigeria. The Bauchi Plateau forms the watershed between the Niger/Benue and Komadugu Yobe river systems. The flat plains of north-eastern Nigeria are geographically part of the Chad Basin, where the course of the El Beid River forms the border with Cameroon, from the Mandara Mountains to Lake Chad. The Komadugu Yobe river system gives rise to the internationally important Hadejia-Nguru wetlands and Ox-bow lakes around Lake Nguru in the rainy season. Other rivers of the northeast include the Ngadda and the Yedseram, both of which flow through the Sambisa swamps, thus forming a river system. The river system of the northeast is also a major river system. In addition, Nigeria has numerous coastal rivers. Over the last million years, Lake Chad in the far north-east of Nigeria has dried up several times for a few thousand years and just as often growing to many times its current size. In recent decades its surface area has been reduced considerably, which may also be due to humans taking water from the inlets to irrigate agricultural land.Nigeria is covered by three types of vegetation: forests (where there is significant tree cover), savannahs (insignificant tree cover, with grasses and flowers located between trees), and montane land (least common and mainly found in the mountains near the Cameroon border). Both the forest zone and the savannah zone are divided into three parts. Some of the forest zone's most southerly portion, especially around the Niger River and Cross River deltas, is mangrove swamp . North of this is fresh water swamp, containing different vegetation from the salt water mangrove swamps, and north of that is rain forest. The savannah zone's three categories are divided into Guinean forest-savanna mosaic , made up of plains of tall grass which are interrupted by trees, the most common across the country; Sudan savannah, with short grasses and short trees; and Sahel savannah patches of grass and sand, found in the northeast. Waste management including sewage treatment , the linked processes of deforestation and soil degradation , and climate change or global warming are the major environmental problems in Nigeria. Waste management presents problems in a megacity like Lagos and other major Nigerian cities which are linked with economic development, population growth and the inability of municipal councils to manage the resulting rise in industrial and domestic waste. This waste management problem is also attributable to unsustainable environmental management lifestyles of Kubwa community in the Federal Capital Territory, where there are habits of indiscriminate disposal of waste, dumping of waste along or into the canals, sewerage systems that are channels for water flows, and the like. Haphazard industrial planning, increased urbanisation, poverty and lack of competence of the municipal government are seen as the major reasons for high levels of waste pollution in major cities of the country. Some of the solutions have been disastrous to the environment, resulting in untreated waste being dumped in places where it can pollute waterways and groundwater . In 2005, Nigeria had the highest rate of deforestation in the world, according to the Food and Agriculture Organization of the United Nations . That year, 12.2%, the equivalent of 11,089,000 hectares, had been forested in the country. Between 1990 and 2000, Nigeria lost an average of 409,700 hectares of forest every year equal to an average annual deforestation rate of 2.4%. Between 1990 and 2005, in total Nigeria lost 35.7% of its forest cover or around 6,145,000 hectares. Nigeria had a 2019 Forest Landscape Integrity Index mean score of 6.2/10, ranking it 82nd globally out of 172 countries. In the year 2010, thousands of people were inadvertently exposed to lead-containing soil from informal gold mining within the northern state of Zamfara. While estimates vary, it is thought that upwards of 400 children died of acute lead poisoning , making this perhaps the largest lead poisoning fatality outbreak ever encountered. Nigeria's Delta region is one of the most polluted regions in the world due to serious oil spills and other environmental problems caused by its oil industry. The heavy contamination of the air, ground and water with toxic pollutants is often used as an example of ecocide . In additional to the environmental damage it has caused conflict in the Delta region . Illegal oil refineries, in which local operators convert stolen crude oil into petrol and diesel, are considered particularly "dirty, dangerous and lucrative". Safety and environmental aspects are usually ignored. Refining petroleum also inevitably produces heavy oil, which is "cracked" into lighter fuel components in regular plants at great technical expense. Illegal refineries do not have these technical possibilities and "dispose" of the heavy oil where it accumulates. The lighter components of crude oil ( methane to butane , isobutane ) create a certain risk of explosion, which often leads to disasters at illegal plants. In 2022, Nigeria suffered 125 deaths from explosions at local, illegal refineries. Nigeria is a federal republic modelled after the United States , with 36 states and capital Abuja as an independent unit. The executive power is exercised by the President . The president is both head of state and head of the federal government ; the president is elected by popular vote to a maximum of two four-year terms. State governors , like the president, are elected for four years and may serve a maximum of two terms. The president's power is checked by a Senate and a House of Representatives , which are combined in a bicameral body called the National Assembly . The Senate is a 109-seat body with three members from each state and one from the capital region of Abuja; members are elected by popular vote to four-year terms. The House contains 360 seats, with the number of seats per state determined by population. The Nigerian president is elected in a modified two-round system. To be elected in the first round, a candidate must receive a relative majority of the votes and more than 25% of the votes in at least 24 of the 36 states. If no candidate reaches this hurdle, a second round of voting takes place between the leading candidate and the next candidate who received the majority of votes in the highest number of states. By convention, presidential candidates take a running mate (candidate for the vice-presidency) who is both ethnically and religiously the opposite of themselves. There is no law prescribing this, yet all presidential candidates since the existence of the Fourth Republic until 2023 adhered to this rule. However, this principle of religious and ethnic diversity in leadership was ignored in the 2023 General Elections, where the candidate for the All Progressives Congress , Bola Ahmed Tinubu , a Muslim, selected another Muslim, Senator Kashim Shettima , as running mate. Nigeria is divided into thirty-six states and one Federal Capital Territory , which are further sub-divided into 774 local government areas . In some contexts, the states are aggregated into six geopolitical zones : North West , North East , North Central , South West , South East , and South South . Nigeria has five cities with a population of over a million (from largest to smallest): Lagos , Kano , Ibadan , Benin City and Port Harcourt . Lagos is the largest city in Africa , with a population of over 12 million in its urban area . The south of the country in particular is characterised by very strong urbanisation and a relatively large number of cities. According to an estimate from 2015, there are 20 cities in Nigeria with more than 500,000 inhabitants, including ten cities with a population of one million. The Constitution of Nigeria is the supreme law of the country. There are four distinct legal systems in Nigeria, which include English law , common law , customary law , and Sharia law : The country has a judicial branch , the highest court of which is the Supreme Court of Nigeria . Upon gaining independence in 1960, Nigeria made African unity the centrepiece of its foreign policy. One exception to the African focus was Nigeria's close relationship developed with Israel throughout the 1960s. Israel sponsored and oversaw the construction of Nigeria's parliament buildings. Nigeria's foreign policy was put to the test in the 1970s after the country emerged united from its civil war. It supported movements against white minority governments in Southern Africa . Nigeria backed the African National Congress by taking a committed tough line about the South African government. Nigeria was a founding member of the Organisation for African Unity (now the African Union ) and has tremendous influence in West Africa and Africa on the whole. Nigeria founded regional cooperative efforts in West Africa, functioning as the standard-bearer for the Economic Community of West African States (ECOWAS) and ECOMOG (especially during the Liberia and Sierra Leone civil wars). With this Africa-centred stance, Nigeria readily sent troops to the Congo at the behest of the United Nations shortly after independence (and has maintained membership since that time). Nigeria also supported several Pan-African and pro-self government causes in the 1970s, including garnering support for Angola 's MPLA , SWAPO in Namibia, and aiding opposition to the minority governments of Portuguese Mozambique , and Rhodesia . Nigeria retains membership in the Non-Aligned Movement . In late November 2006, it organized an Africa-South America Summit in Abuja to promote what some attendees termed "South-South" linkages on a variety of fronts. Nigeria is also a member of the International Criminal Court and the Commonwealth of Nations . It was temporarily expelled from the latter in 1995 when ruled by the Abacha regime . Nigeria has remained a key player in the international oil industry since the 1970s and maintains membership in OPEC , which it joined in July 1971. Its status as a major petroleum producer figures prominently in its sometimes volatile international relations with developed countries , notably the United States, and with developing countries. Since 2000, Chinese–Nigerian trade relations have risen exponentially. There has been an increase in total trade of over 10.3 billion dollars between the two nations from 2000 to 2016. However, the structure of the Chinese–Nigerian trade relationship has become a major political issue for the Nigerian state. Chinese exports account for around 80 per cent of total bilateral trade volumes. This has resulted in a serious trade imbalance , with Nigeria importing ten times more than it exports to China. Subsequently, Nigeria's economy is becoming over-reliant on cheap imports to sustain itself, resulting in a clear decline in Nigerian industry under such arrangements. Continuing its Africa-centred foreign policy, Nigeria introduced the idea of a single currency for West Africa known as the Eco under the presumption that it would be led by the naira . But on 21 December 2019, Ivorian President Alassane Ouattara , Emmanuel Macron , and multiple other UEMOA states announced that they would merely rename the CFA franc instead of replacing the currency as originally intended. As of 2020, the Eco currency has been delayed to 2025. The Nigerian Armed Forces are the combined military forces of Nigeria. It consists of three uniformed service branches: the Nigerian Army , Nigerian Navy , and Nigerian Air Force . The President of Nigeria functions as the commander-in-chief of the armed forces, exercising his constitutional authority through the Ministry of Defence, which is responsible for the management of the military and its personnel. The operational head of the AFN is the Chief of the Defence Staff , who is subordinate to the Nigerian Defence Minister . With a force of more than 223,000 active personnel, the Nigerian military is one of the largest uniformed combat services in Africa. Nigeria has 143,000 troops in the armed forces (army 100,000, navy 25,000, air force 18,000) and another 80,000 personnel for "gendarmerie & paramilitary" in 2020, according to the International Institute for Strategic Studies . Nigeria spent just under 0.4 per cent of its economic output, or US$1.6 billion, on its armed forces in 2017. For 2022, US$2.26 billion has been budgeted for the Nigerian armed forces, which is just over a third of Belgium 's defence budget (US$5.99 billion). Boko Haram and the bandit conflict have been responsible for numerous serious attacks with thousands of casualties since mid-2010. Since then, according to the Council on Foreign Relations' Nigeria Security Tracker, over 41,600 lives have been lost to this conflict (as of October 2022). The United Nations refugee agency UNHCR counts about 1.8 million internally displaced persons and about 200,000 Nigerian refugees in neighbouring countries. The Boko Haram-affected states agreed in February 2015 to establish an 8,700-strong Multinational Joint Task Force to jointly fight Boko Haram. By October 2015, Boko Haram had been driven out of all the cities it controlled and almost all the counties in northeastern Nigeria. In 2016, Boko Haram split and in 2022, 40,000 fighters surrendered. The splinter group ISWAP (Islamic State in West Africa) remains active. The fight against Boko Haram, other sectarians and criminals has been accompanied by increasing police attacks. The Council on Foreign Relations ' Nigeria Security Tracker counted 1,086 deaths from Boko Haram attacks and 290 deaths from police violence in the first 12 months of its establishment in May 2011. In the 12 months after October 2021, 2,193 people died from police violence and 498 from Boko Haram and ISWAP, according to the NST. The Nigerian police are notorious for vigilante justice . The Niger Delta saw intense attacks on oil infrastructure in 2016 by militant groups such as the Movement for the Emancipation of the Niger Delta (MEND), the Niger Delta People's Volunteer Force (NDPVF), the Ijaw National Congress (INC) and the Pan Niger Delta Forum (PANDEF). In response, the new Buhari government pursued a dual strategy of repression and negotiation. In late 2016, the Nigerian federal government resorted to the gambit of offering the militant groups a 4.5 billion naira (US$144 million) contract to guard oil infrastructure. Most accepted. The contract was renewed in August 2022 , but led to fierce disputes among the above-mentioned groups over the distribution of the funds. Representatives speak of "war" - against each other. The high propensity for violence and the pettiness of the leaders, as well as the complete absence of social and environmental arguments in this dispute give rise to fears that the militant groups, despite their lofty names, have discarded responsibility for their region and ethnic groups and have moved into the realm of protection rackets and self-enrichment. In any case, the pipelines in the Niger Delta are not very effectively "guarded" - the pollution of the Niger Delta with stolen crude oil and illegally produced heavy fuel oil continued unhindered after 2016. In central Nigeria, conflicts between Muslim Hausa-Fulani herders and indigenous Christian farmers flared up again, especially in Kaduna, Plateau, Taraba and Benue states. In individual cases, these clashes have claimed several hundred lives. Conflict over land and resources is increasing due to the ongoing desertification in northern Nigeria, population growth and the generally tense economic situation. In June 2022, a massacre took place in the St. Francis Xavier Church, in Owo. The Government blamed ISWAP for the murder of over 50 parishioners, but locals suspect Fulani herdsmen involvement. Nigeria is a federal republic modelled after the United States , with 36 states and capital Abuja as an independent unit. The executive power is exercised by the President . The president is both head of state and head of the federal government ; the president is elected by popular vote to a maximum of two four-year terms. State governors , like the president, are elected for four years and may serve a maximum of two terms. The president's power is checked by a Senate and a House of Representatives , which are combined in a bicameral body called the National Assembly . The Senate is a 109-seat body with three members from each state and one from the capital region of Abuja; members are elected by popular vote to four-year terms. The House contains 360 seats, with the number of seats per state determined by population. The Nigerian president is elected in a modified two-round system. To be elected in the first round, a candidate must receive a relative majority of the votes and more than 25% of the votes in at least 24 of the 36 states. If no candidate reaches this hurdle, a second round of voting takes place between the leading candidate and the next candidate who received the majority of votes in the highest number of states. By convention, presidential candidates take a running mate (candidate for the vice-presidency) who is both ethnically and religiously the opposite of themselves. There is no law prescribing this, yet all presidential candidates since the existence of the Fourth Republic until 2023 adhered to this rule. However, this principle of religious and ethnic diversity in leadership was ignored in the 2023 General Elections, where the candidate for the All Progressives Congress , Bola Ahmed Tinubu , a Muslim, selected another Muslim, Senator Kashim Shettima , as running mate.Nigeria is divided into thirty-six states and one Federal Capital Territory , which are further sub-divided into 774 local government areas . In some contexts, the states are aggregated into six geopolitical zones : North West , North East , North Central , South West , South East , and South South . Nigeria has five cities with a population of over a million (from largest to smallest): Lagos , Kano , Ibadan , Benin City and Port Harcourt . Lagos is the largest city in Africa , with a population of over 12 million in its urban area . The south of the country in particular is characterised by very strong urbanisation and a relatively large number of cities. According to an estimate from 2015, there are 20 cities in Nigeria with more than 500,000 inhabitants, including ten cities with a population of one million.The Constitution of Nigeria is the supreme law of the country. There are four distinct legal systems in Nigeria, which include English law , common law , customary law , and Sharia law : The country has a judicial branch , the highest court of which is the Supreme Court of Nigeria . Upon gaining independence in 1960, Nigeria made African unity the centrepiece of its foreign policy. One exception to the African focus was Nigeria's close relationship developed with Israel throughout the 1960s. Israel sponsored and oversaw the construction of Nigeria's parliament buildings. Nigeria's foreign policy was put to the test in the 1970s after the country emerged united from its civil war. It supported movements against white minority governments in Southern Africa . Nigeria backed the African National Congress by taking a committed tough line about the South African government. Nigeria was a founding member of the Organisation for African Unity (now the African Union ) and has tremendous influence in West Africa and Africa on the whole. Nigeria founded regional cooperative efforts in West Africa, functioning as the standard-bearer for the Economic Community of West African States (ECOWAS) and ECOMOG (especially during the Liberia and Sierra Leone civil wars). With this Africa-centred stance, Nigeria readily sent troops to the Congo at the behest of the United Nations shortly after independence (and has maintained membership since that time). Nigeria also supported several Pan-African and pro-self government causes in the 1970s, including garnering support for Angola 's MPLA , SWAPO in Namibia, and aiding opposition to the minority governments of Portuguese Mozambique , and Rhodesia . Nigeria retains membership in the Non-Aligned Movement . In late November 2006, it organized an Africa-South America Summit in Abuja to promote what some attendees termed "South-South" linkages on a variety of fronts. Nigeria is also a member of the International Criminal Court and the Commonwealth of Nations . It was temporarily expelled from the latter in 1995 when ruled by the Abacha regime . Nigeria has remained a key player in the international oil industry since the 1970s and maintains membership in OPEC , which it joined in July 1971. Its status as a major petroleum producer figures prominently in its sometimes volatile international relations with developed countries , notably the United States, and with developing countries. Since 2000, Chinese–Nigerian trade relations have risen exponentially. There has been an increase in total trade of over 10.3 billion dollars between the two nations from 2000 to 2016. However, the structure of the Chinese–Nigerian trade relationship has become a major political issue for the Nigerian state. Chinese exports account for around 80 per cent of total bilateral trade volumes. This has resulted in a serious trade imbalance , with Nigeria importing ten times more than it exports to China. Subsequently, Nigeria's economy is becoming over-reliant on cheap imports to sustain itself, resulting in a clear decline in Nigerian industry under such arrangements. Continuing its Africa-centred foreign policy, Nigeria introduced the idea of a single currency for West Africa known as the Eco under the presumption that it would be led by the naira . But on 21 December 2019, Ivorian President Alassane Ouattara , Emmanuel Macron , and multiple other UEMOA states announced that they would merely rename the CFA franc instead of replacing the currency as originally intended. As of 2020, the Eco currency has been delayed to 2025. The Nigerian Armed Forces are the combined military forces of Nigeria. It consists of three uniformed service branches: the Nigerian Army , Nigerian Navy , and Nigerian Air Force . The President of Nigeria functions as the commander-in-chief of the armed forces, exercising his constitutional authority through the Ministry of Defence, which is responsible for the management of the military and its personnel. The operational head of the AFN is the Chief of the Defence Staff , who is subordinate to the Nigerian Defence Minister . With a force of more than 223,000 active personnel, the Nigerian military is one of the largest uniformed combat services in Africa. Nigeria has 143,000 troops in the armed forces (army 100,000, navy 25,000, air force 18,000) and another 80,000 personnel for "gendarmerie & paramilitary" in 2020, according to the International Institute for Strategic Studies . Nigeria spent just under 0.4 per cent of its economic output, or US$1.6 billion, on its armed forces in 2017. For 2022, US$2.26 billion has been budgeted for the Nigerian armed forces, which is just over a third of Belgium 's defence budget (US$5.99 billion). Boko Haram and the bandit conflict have been responsible for numerous serious attacks with thousands of casualties since mid-2010. Since then, according to the Council on Foreign Relations' Nigeria Security Tracker, over 41,600 lives have been lost to this conflict (as of October 2022). The United Nations refugee agency UNHCR counts about 1.8 million internally displaced persons and about 200,000 Nigerian refugees in neighbouring countries. The Boko Haram-affected states agreed in February 2015 to establish an 8,700-strong Multinational Joint Task Force to jointly fight Boko Haram. By October 2015, Boko Haram had been driven out of all the cities it controlled and almost all the counties in northeastern Nigeria. In 2016, Boko Haram split and in 2022, 40,000 fighters surrendered. The splinter group ISWAP (Islamic State in West Africa) remains active. The fight against Boko Haram, other sectarians and criminals has been accompanied by increasing police attacks. The Council on Foreign Relations ' Nigeria Security Tracker counted 1,086 deaths from Boko Haram attacks and 290 deaths from police violence in the first 12 months of its establishment in May 2011. In the 12 months after October 2021, 2,193 people died from police violence and 498 from Boko Haram and ISWAP, according to the NST. The Nigerian police are notorious for vigilante justice . The Niger Delta saw intense attacks on oil infrastructure in 2016 by militant groups such as the Movement for the Emancipation of the Niger Delta (MEND), the Niger Delta People's Volunteer Force (NDPVF), the Ijaw National Congress (INC) and the Pan Niger Delta Forum (PANDEF). In response, the new Buhari government pursued a dual strategy of repression and negotiation. In late 2016, the Nigerian federal government resorted to the gambit of offering the militant groups a 4.5 billion naira (US$144 million) contract to guard oil infrastructure. Most accepted. The contract was renewed in August 2022 , but led to fierce disputes among the above-mentioned groups over the distribution of the funds. Representatives speak of "war" - against each other. The high propensity for violence and the pettiness of the leaders, as well as the complete absence of social and environmental arguments in this dispute give rise to fears that the militant groups, despite their lofty names, have discarded responsibility for their region and ethnic groups and have moved into the realm of protection rackets and self-enrichment. In any case, the pipelines in the Niger Delta are not very effectively "guarded" - the pollution of the Niger Delta with stolen crude oil and illegally produced heavy fuel oil continued unhindered after 2016. In central Nigeria, conflicts between Muslim Hausa-Fulani herders and indigenous Christian farmers flared up again, especially in Kaduna, Plateau, Taraba and Benue states. In individual cases, these clashes have claimed several hundred lives. Conflict over land and resources is increasing due to the ongoing desertification in northern Nigeria, population growth and the generally tense economic situation. In June 2022, a massacre took place in the St. Francis Xavier Church, in Owo. The Government blamed ISWAP for the murder of over 50 parishioners, but locals suspect Fulani herdsmen involvement. Nigeria's economy is the largest in Africa , the 31st-largest in the world by nominal GDP, and 30th-largest by PPP . GDP (PPP) per capita is US$9,148 (as of 2022), which is less than South Africa, Egypt or Morocco, but a little more than Ghana or Ivory Coast. Nigeria is a leader in Africa as an energy power, financial market , in pharmaceuticals and in the entertainment industry . Next to petroleum, the second-largest source of foreign exchange earnings for Nigeria are remittances sent home by Nigerians living abroad. Nigeria has a highly developed financial services sector , with a mix of local and international banks, asset management companies, brokerage houses, insurance companies and brokers, private equity funds and investment banks. Nigeria has a lower-middle-income economy with an abundant supply of natural resources. Its wide array of underexploited mineral resources include coal, bauxite , tantalite , gold, tin , iron ore, limestone , niobium , lead and zinc . Despite huge deposits of these natural resources, the mining industry in Nigeria is still in its infancy. Before 1999, economic development has been hindered by years of military rule, corruption, and mismanagement. The restoration of democracy and subsequent economic reforms have supported economic potential. After 2015, the Nigerian economy was able to diversify somewhat. Apart from oil and gas, Nigeria exports fertilisers and cement /cement board, moulded polypropylene (plastic) products, personal care products , paint, malt beverages and armoured vehicles. In 2021, about 23.4% of Nigeria's GDP is contributed by agriculture, forestry and fishing combined. Nigeria is the world's largest producer of cassava . Further major crops include maize , rice , millet , yam beans , and guinea corn (sorghum). Cocoa is the principal agricultural export, and one of the country's most significant non-petroleum products. Nigeria is also one of the world's top twenty exporters of natural rubber , generating $20.9 million in 2019. Before the Nigerian Civil War and the oil boom , Nigeria was self-sufficient in food. Agriculture used to be the principal foreign exchange earner of Nigeria. Agriculture has failed to keep pace with Nigeria's rapid population growth, and Nigeria now relies upon food imports to sustain itself. It spends US$6.7 billion yearly for food imports, four times more than revenues from food export. The Nigerian government promoted the use of inorganic fertilizers in the 1970s. Nigeria's rice production increased by 10% from 2017/18 to 2021/22 to 5 million tonnes a year, but could hardly keep up with the increased demand. Rice imports therefore remained constant at 2 million tonnes per year. In August 2019, Nigeria closed its border with Benin and other neighbouring countries to stop rice smuggling into the country as part of efforts to boost local production. Until now, Nigeria exported unhusked rice but had to import husked rice, the country's staple food. - The rice mill in Imota , near Lagos, is intended to handle the corresponding processing at home, improve the balance of trade and the labour market, and save unnecessary costs for transport and middlemen. When fully operational at the end of 2022, the plant, the largest south of the Sahara, is expected to employ 250,000 people and produce 2.5 million 50-kg bags of rice annually. Nigeria is the 15th largest producer of petroleum in the world , the 6th largest exporter , and has the 9th largest proven reserves . Petroleum plays a large role in the Nigerian economy and politics, accounting for about 80% of government earnings. Nigeria also has the 9th largest proven natural gas reserves estimated by OPEC ; the government's value of its about 206.53 trillion cubic feet has been valued at $803.4 trillion. Natural gas is seen as having the potential to unlock an economic miracle on the Niger River. Nigeria each year loses to gas flaring an estimate of US$2.5 billion, and over 120,000 barrels of oil per day to crude theft in the Niger Delta , its main oil-producing region. This has led to piracy and conflict for control in the region and has led to disruptions in production preventing the country from meeting its OPEC quota and exporting petroleum at full capability. Nigeria has a total of 159 oil fields and 1,481 wells in operation according to the Department of Petroleum Resources . The most productive region of the nation is the coastal Niger Delta Basin in the Niger Delta or "south-south" region which encompasses 78 of the 159 oil fields. Most of Nigeria's oil fields are small and scattered, and as of 1990, these small fields accounted for 62.1% of all Nigerian production. This contrasts with the sixteen largest fields which produced 37.9% of Nigeria's petroleum at that time. Petrol was Nigeria's main import commodity until 2021, accounting for 24% of import volume. The Niger Delta Nembe Creek oil field was discovered in 1973 and produces from middle Miocene deltaic sandstone - shale in an anticline structural trap at a depth of 2 to 4 kilometres (7,000 to 13,000 feet) . In June 2013, Shell announced a strategic review of its operations in Nigeria, hinting that assets could be divested. While many international oil companies have operated there for decades, by 2014 most were making moves to divest their interests, citing a range of issues including oil theft. In August 2014, Shell said it was finalising its interests in four Nigerian oil fields. The supply of natural gas to Europe, threatened by the Ukraine war, is pushing projects to transport Nigerian natural gas via pipelines to Morocco or Algeria. As of May 2022, however, there are no results on this yet. Nigeria's energy consumption is much more than its generation capacity. Most of the energy comes from traditional fossil fuel, which account for 73% of total primary production. The rest is from hydropower (27%). Since independence, Nigeria has tried to develop a domestic nuclear industry for energy. Nigeria opened in 2004 a Chinese-origin research reactor at Ahmadu Bello University and has sought the support of the International Atomic Energy Agency to develop plans for up to 4,000 MWe of nuclear capacity by 2027 according to the National Program for the Deployment of Nuclear Power for Generation of Electricity. In 2007, President Umaru Yar'Adua urged the country to embrace nuclear power to meet its growing energy needs. In 2017, Nigeria signed the UN Treaty on the Prohibition of Nuclear Weapons . In April 2015, Nigeria began talks with Russia's state-owned Rosatom to collaborate on the design, construction and operation of four nuclear power plants by 2035, the first of which will be in operation by 2025. In June 2015, Nigeria selected two sites for the planned construction of the nuclear plants. Neither the Nigerian government nor Rosatom would disclose the specific locations of the sites, but it is believed that the nuclear plants will be sited in Akwa Ibom State and Kogi State . The sites are planned to house two plants each. In 2017 agreements were signed for the construction of the Itu nuclear power plant . 94% of Nigerians are connected to the national grid, according to the survey, but only 57% have their electricity consumption recorded by an electricity meter. Only 1% of Nigerians surveyed reported having electricity 24 hours a day. 68% have electricity 1 to 9 hours a day, according to the NIO. 66% of Nigerians pay up to 10,000 Naira (US$13) a month for electricity, which is almost 3% of the average income in Nigeria. 67% of respondents were willing to pay more for uninterrupted electricity supply. 21% own a power generator, 14% of Nigerians use solar energy. Nigeria has a manufacturing industry that includes leather and textiles (centred in Kano , Abeokuta , Onitsha , and Lagos), plastics and processed food. Ogun is considered to be Nigeria's current industrial hub, as most factories are located in Ogun and more companies are moving there, followed by Lagos. The city of Aba in the south-eastern part of the country is well known for handicrafts and shoes, known as "Aba made". Nigeria has a market of 720,000 cars per year, but less than 20% of these are produced domestically. In 2016, Nigeria was the leading cement producer south of the Sahara, ahead of South Africa. Aliko Dangote , Nigeria's richest inhabitant, based his wealth on cement production, as well as agricultural commodities. According to its own information, the Ajaokuta Steel Company Limited produces 1.3 million tonnes of steel per year. This would be equivalent to one-sixth of the United Kingdom's steel production in 2021. However, steel plants in Katsina , Jos and Osogbo no longer appear to be active. In June 2019, Nigeria EduSat-1 was deployed from the International Space Station . It is the first satellite that was built in Nigeria, which followed many other Nigerian satellites that were built by other countries. [lower-alpha 2] In 2021, Nigeria hosts about 60 percent of the pharmaceutical production capacity in Africa, the larger pharmaceutical companies are located in Lagos . The pharmaceutical producer with the most employees in Nigeria is Emzor Pharmaceutical Industries Ltd. Nigeria has a few electronic manufacturers like Zinox , the first branded Nigerian computer, and manufacturers of electronic gadgets such as tablet PCs. As of January 2022, Nigeria is the host to 5 out of the 7 unicorn companies in Africa. Nigerian telecommunications market is one of the fastest-growing in the world, with major emerging market operators (like MTN , 9mobile , Airtel and Globacom ) basing their largest and most profitable centres in the country. Nigeria's ICT sector has experienced a lot of growth, representing 10% of the nation's GDP in 2018 as compared to just 1% in 2001. Lagos is regarded as one of the largest technology hubs in Africa with its thriving tech ecosystem. According to a survey by the GSM Association , 92% of adult Nigerian men and 88% of women owned a mobile phone. Using various measures including but not limited to Illegal arrest, taking down of websites, passport seizures, and restricted access to bank accounts, the Nigerian government is punishing citizens for expressing themselves on the internet and working to stifle internet freedom. Tourism in Nigeria centres largely on events, because of the country's ample amount of ethnic groups, but also includes rain forests, savannah, waterfalls, and other natural attractions. Abuja is home to several parks and green areas. The largest, Millennium Park , was designed by architect Manfredi Nicoletti and officially opened in December 2003. After the re-modernization project achieved by the administration of Governor Raji Babatunde Fashola, Lagos is gradually becoming a major tourist destination. Lagos is currently taking steps to become a global city . The 2009 Eyo carnival (a yearly festival originating from Iperu Remo , Ogun State) was a step toward world city status. Currently, Lagos is primarily known as a business-oriented and fast-paced community. Lagos has become an important location for African and black cultural identity. Lagos has sandy beaches by the Atlantic Ocean, including Elegushi Beach and Alpha Beach. Lagos also has many private beach resorts including Inagbe Grand Beach Resort and several others in the outskirts. Lagos has a variety of hotels ranging from three-star to five-star hotels, with a mixture of local hotels such as Eko Hotels and Suites , Federal Palace Hotel and franchises of multinational chains such as Intercontinental Hotel , Sheraton , and Four Points by Sheraton . Other places of interest include the Tafawa Balewa Square , Festac town, The Nike Art Gallery , Freedom Park , and the Cathedral Church of Christ .In 2021, about 23.4% of Nigeria's GDP is contributed by agriculture, forestry and fishing combined. Nigeria is the world's largest producer of cassava . Further major crops include maize , rice , millet , yam beans , and guinea corn (sorghum). Cocoa is the principal agricultural export, and one of the country's most significant non-petroleum products. Nigeria is also one of the world's top twenty exporters of natural rubber , generating $20.9 million in 2019. Before the Nigerian Civil War and the oil boom , Nigeria was self-sufficient in food. Agriculture used to be the principal foreign exchange earner of Nigeria. Agriculture has failed to keep pace with Nigeria's rapid population growth, and Nigeria now relies upon food imports to sustain itself. It spends US$6.7 billion yearly for food imports, four times more than revenues from food export. The Nigerian government promoted the use of inorganic fertilizers in the 1970s. Nigeria's rice production increased by 10% from 2017/18 to 2021/22 to 5 million tonnes a year, but could hardly keep up with the increased demand. Rice imports therefore remained constant at 2 million tonnes per year. In August 2019, Nigeria closed its border with Benin and other neighbouring countries to stop rice smuggling into the country as part of efforts to boost local production. Until now, Nigeria exported unhusked rice but had to import husked rice, the country's staple food. - The rice mill in Imota , near Lagos, is intended to handle the corresponding processing at home, improve the balance of trade and the labour market, and save unnecessary costs for transport and middlemen. When fully operational at the end of 2022, the plant, the largest south of the Sahara, is expected to employ 250,000 people and produce 2.5 million 50-kg bags of rice annually. Nigeria is the 15th largest producer of petroleum in the world , the 6th largest exporter , and has the 9th largest proven reserves . Petroleum plays a large role in the Nigerian economy and politics, accounting for about 80% of government earnings. Nigeria also has the 9th largest proven natural gas reserves estimated by OPEC ; the government's value of its about 206.53 trillion cubic feet has been valued at $803.4 trillion. Natural gas is seen as having the potential to unlock an economic miracle on the Niger River. Nigeria each year loses to gas flaring an estimate of US$2.5 billion, and over 120,000 barrels of oil per day to crude theft in the Niger Delta , its main oil-producing region. This has led to piracy and conflict for control in the region and has led to disruptions in production preventing the country from meeting its OPEC quota and exporting petroleum at full capability. Nigeria has a total of 159 oil fields and 1,481 wells in operation according to the Department of Petroleum Resources . The most productive region of the nation is the coastal Niger Delta Basin in the Niger Delta or "south-south" region which encompasses 78 of the 159 oil fields. Most of Nigeria's oil fields are small and scattered, and as of 1990, these small fields accounted for 62.1% of all Nigerian production. This contrasts with the sixteen largest fields which produced 37.9% of Nigeria's petroleum at that time. Petrol was Nigeria's main import commodity until 2021, accounting for 24% of import volume. The Niger Delta Nembe Creek oil field was discovered in 1973 and produces from middle Miocene deltaic sandstone - shale in an anticline structural trap at a depth of 2 to 4 kilometres (7,000 to 13,000 feet) . In June 2013, Shell announced a strategic review of its operations in Nigeria, hinting that assets could be divested. While many international oil companies have operated there for decades, by 2014 most were making moves to divest their interests, citing a range of issues including oil theft. In August 2014, Shell said it was finalising its interests in four Nigerian oil fields. The supply of natural gas to Europe, threatened by the Ukraine war, is pushing projects to transport Nigerian natural gas via pipelines to Morocco or Algeria. As of May 2022, however, there are no results on this yet.Nigeria's energy consumption is much more than its generation capacity. Most of the energy comes from traditional fossil fuel, which account for 73% of total primary production. The rest is from hydropower (27%). Since independence, Nigeria has tried to develop a domestic nuclear industry for energy. Nigeria opened in 2004 a Chinese-origin research reactor at Ahmadu Bello University and has sought the support of the International Atomic Energy Agency to develop plans for up to 4,000 MWe of nuclear capacity by 2027 according to the National Program for the Deployment of Nuclear Power for Generation of Electricity. In 2007, President Umaru Yar'Adua urged the country to embrace nuclear power to meet its growing energy needs. In 2017, Nigeria signed the UN Treaty on the Prohibition of Nuclear Weapons . In April 2015, Nigeria began talks with Russia's state-owned Rosatom to collaborate on the design, construction and operation of four nuclear power plants by 2035, the first of which will be in operation by 2025. In June 2015, Nigeria selected two sites for the planned construction of the nuclear plants. Neither the Nigerian government nor Rosatom would disclose the specific locations of the sites, but it is believed that the nuclear plants will be sited in Akwa Ibom State and Kogi State . The sites are planned to house two plants each. In 2017 agreements were signed for the construction of the Itu nuclear power plant . 94% of Nigerians are connected to the national grid, according to the survey, but only 57% have their electricity consumption recorded by an electricity meter. Only 1% of Nigerians surveyed reported having electricity 24 hours a day. 68% have electricity 1 to 9 hours a day, according to the NIO. 66% of Nigerians pay up to 10,000 Naira (US$13) a month for electricity, which is almost 3% of the average income in Nigeria. 67% of respondents were willing to pay more for uninterrupted electricity supply. 21% own a power generator, 14% of Nigerians use solar energy. 94% of Nigerians are connected to the national grid, according to the survey, but only 57% have their electricity consumption recorded by an electricity meter. Only 1% of Nigerians surveyed reported having electricity 24 hours a day. 68% have electricity 1 to 9 hours a day, according to the NIO. 66% of Nigerians pay up to 10,000 Naira (US$13) a month for electricity, which is almost 3% of the average income in Nigeria. 67% of respondents were willing to pay more for uninterrupted electricity supply. 21% own a power generator, 14% of Nigerians use solar energy. Nigeria has a manufacturing industry that includes leather and textiles (centred in Kano , Abeokuta , Onitsha , and Lagos), plastics and processed food. Ogun is considered to be Nigeria's current industrial hub, as most factories are located in Ogun and more companies are moving there, followed by Lagos. The city of Aba in the south-eastern part of the country is well known for handicrafts and shoes, known as "Aba made". Nigeria has a market of 720,000 cars per year, but less than 20% of these are produced domestically. In 2016, Nigeria was the leading cement producer south of the Sahara, ahead of South Africa. Aliko Dangote , Nigeria's richest inhabitant, based his wealth on cement production, as well as agricultural commodities. According to its own information, the Ajaokuta Steel Company Limited produces 1.3 million tonnes of steel per year. This would be equivalent to one-sixth of the United Kingdom's steel production in 2021. However, steel plants in Katsina , Jos and Osogbo no longer appear to be active. In June 2019, Nigeria EduSat-1 was deployed from the International Space Station . It is the first satellite that was built in Nigeria, which followed many other Nigerian satellites that were built by other countries. [lower-alpha 2] In 2021, Nigeria hosts about 60 percent of the pharmaceutical production capacity in Africa, the larger pharmaceutical companies are located in Lagos . The pharmaceutical producer with the most employees in Nigeria is Emzor Pharmaceutical Industries Ltd. Nigeria has a few electronic manufacturers like Zinox , the first branded Nigerian computer, and manufacturers of electronic gadgets such as tablet PCs. As of January 2022, Nigeria is the host to 5 out of the 7 unicorn companies in Africa. Nigerian telecommunications market is one of the fastest-growing in the world, with major emerging market operators (like MTN , 9mobile , Airtel and Globacom ) basing their largest and most profitable centres in the country. Nigeria's ICT sector has experienced a lot of growth, representing 10% of the nation's GDP in 2018 as compared to just 1% in 2001. Lagos is regarded as one of the largest technology hubs in Africa with its thriving tech ecosystem. According to a survey by the GSM Association , 92% of adult Nigerian men and 88% of women owned a mobile phone. Using various measures including but not limited to Illegal arrest, taking down of websites, passport seizures, and restricted access to bank accounts, the Nigerian government is punishing citizens for expressing themselves on the internet and working to stifle internet freedom. Tourism in Nigeria centres largely on events, because of the country's ample amount of ethnic groups, but also includes rain forests, savannah, waterfalls, and other natural attractions. Abuja is home to several parks and green areas. The largest, Millennium Park , was designed by architect Manfredi Nicoletti and officially opened in December 2003. After the re-modernization project achieved by the administration of Governor Raji Babatunde Fashola, Lagos is gradually becoming a major tourist destination. Lagos is currently taking steps to become a global city . The 2009 Eyo carnival (a yearly festival originating from Iperu Remo , Ogun State) was a step toward world city status. Currently, Lagos is primarily known as a business-oriented and fast-paced community. Lagos has become an important location for African and black cultural identity. Lagos has sandy beaches by the Atlantic Ocean, including Elegushi Beach and Alpha Beach. Lagos also has many private beach resorts including Inagbe Grand Beach Resort and several others in the outskirts. Lagos has a variety of hotels ranging from three-star to five-star hotels, with a mixture of local hotels such as Eko Hotels and Suites , Federal Palace Hotel and franchises of multinational chains such as Intercontinental Hotel , Sheraton , and Four Points by Sheraton . Other places of interest include the Tafawa Balewa Square , Festac town, The Nike Art Gallery , Freedom Park , and the Cathedral Church of Christ .Due to Nigeria's location in the centre of West Africa, transport plays a major role in the national service sector . The government investments has seen an increase in extensive road repairs and new construction have been carried out gradually as states in particular spend their share of increased government allocations. Representative of these improvements is the Second Niger Bridge near Onitsha, which was largely completed in 2022. A 2017 World Bank report on logistics hubs in Africa placed the country in fourth place, behind Côte d'Ivoire, Senegal, and Sao Tome, but in 2021, Nigeria joined the World Logistics Passport, a private sector group working to increase the effiency of global trade. Four trans-African automobile routes pass through Nigeria: Nigeria has the largest road network in West Africa . It covers about 200,000 km, of which 60,000 km are asphalted. Nigeria's roads and highways handle 90% of all passenger and freight traffic. It contributes N2.4trn ($6.4bn) to GDP in 2020. 35,000 km of the road network fall under the jurisdiction of the federal government. The motorway links of important economic centres such as Lagos - Ibadan , Lagos- Badagry and Enugu - Onitsha have been renovated. The rest of the road network is a state matter and therefore in very different shape, depending on which state you are in. Economically strong states such as Lagos, Anambra and Rivers receive particularly poor evaluations. Most roads were built in the 1980s and early 1990s. Poor maintenance and inferior materials have worsened the condition of the roads. Travelling is very difficult. Especially during the rainy season, the use of secondary roads is sometimes almost impossible due to potholes. Road bandits often take advantage of this situation for their criminal purposes. Railways have undergone a massive revamping with projects such as the Lagos-Kano Standard Gauge Railway being completed connecting northern cities of Kano , Kaduna , Abuja , Ibadan and Lagos . The Nigerian aviation industry generated 198.62 billion naira (€400 million) in 2019, representing a contribution of 0.14 per cent to GDP. It was the fastest growing sector of the Nigerian economy in 2019. Passenger traffic increased from 9,358,166 in 2020 to 15,886,955 in 2021, a significant increase of over 69 per cent. Aircraft movements increased by more than 46 per cent from 2020 to 2021. Total freight volumes were 191 tonnes in 2020 but increased to 391 tonnes in 2021. In December 2021, the Anambra International Cargo Airport started its operation. In April 2022, the second terminal of the Murtala Muhammed International Airport has been inaugurated. It will increase the capacity of the airport to 14 million passengers per year. There are 54 airports in Nigeria; the principal airports are Nigeria had in the past operated state-owned airline Nigeria Airways which was over-indebted in 2003 and was bought by the British Virgin Group ; since 28 June 2005 it has flown under the name Virgin Nigeria Airways . At the end of 2008, the Virgin Group announced its withdrawal from the airline, so that since September 2009 the airline has been operating as Nigerian Eagle Airlines. The largest airline in Nigeria is privately owned Air Peace , founded in 2012.Four trans-African automobile routes pass through Nigeria: Nigeria has the largest road network in West Africa . It covers about 200,000 km, of which 60,000 km are asphalted. Nigeria's roads and highways handle 90% of all passenger and freight traffic. It contributes N2.4trn ($6.4bn) to GDP in 2020. 35,000 km of the road network fall under the jurisdiction of the federal government. The motorway links of important economic centres such as Lagos - Ibadan , Lagos- Badagry and Enugu - Onitsha have been renovated. The rest of the road network is a state matter and therefore in very different shape, depending on which state you are in. Economically strong states such as Lagos, Anambra and Rivers receive particularly poor evaluations. Most roads were built in the 1980s and early 1990s. Poor maintenance and inferior materials have worsened the condition of the roads. Travelling is very difficult. Especially during the rainy season, the use of secondary roads is sometimes almost impossible due to potholes. Road bandits often take advantage of this situation for their criminal purposes. Railways have undergone a massive revamping with projects such as the Lagos-Kano Standard Gauge Railway being completed connecting northern cities of Kano , Kaduna , Abuja , Ibadan and Lagos .The Nigerian aviation industry generated 198.62 billion naira (€400 million) in 2019, representing a contribution of 0.14 per cent to GDP. It was the fastest growing sector of the Nigerian economy in 2019. Passenger traffic increased from 9,358,166 in 2020 to 15,886,955 in 2021, a significant increase of over 69 per cent. Aircraft movements increased by more than 46 per cent from 2020 to 2021. Total freight volumes were 191 tonnes in 2020 but increased to 391 tonnes in 2021. In December 2021, the Anambra International Cargo Airport started its operation. In April 2022, the second terminal of the Murtala Muhammed International Airport has been inaugurated. It will increase the capacity of the airport to 14 million passengers per year. There are 54 airports in Nigeria; the principal airports are Nigeria had in the past operated state-owned airline Nigeria Airways which was over-indebted in 2003 and was bought by the British Virgin Group ; since 28 June 2005 it has flown under the name Virgin Nigeria Airways . At the end of 2008, the Virgin Group announced its withdrawal from the airline, so that since September 2009 the airline has been operating as Nigerian Eagle Airlines. The largest airline in Nigeria is privately owned Air Peace , founded in 2012.The United Nations estimates that the population of Nigeria in 2021 was at 213,401,323 , distributed as 51.7% rural and 48.3% urban, and with a population density of 167.5 people per square kilometer. Around 42.5% of the population were 14 years or younger, 19.6% were aged 15–24, 30.7% were aged 25–54, 4.0% were aged 55–64, and 3.1% were aged 65 years or older. The median age in 2017 was 18.4 years. Nigeria is the world's sixth-most populous country . The birth rate is 35.2-births/1,000 population and the death rate is 9.6 deaths/1,000 population as of 2017, while the total fertility rate is 5.07 children born/woman. Nigeria's population increased by 57 million from 1990 to 2008, a 60% growth rate in less than two decades. Nigeria is the most populous country in Africa and accounts for about 17% of the continent's total population as of 2017; however, exactly how populous is a subject of speculation. Millions of Nigerians have emigrated during times of economic hardship, primarily to Europe, North America and Australia. It is estimated that over a million Nigerians have emigrated to the United States and constitute the Nigerian American populace. Individuals in many such Diasporic communities have joined the "Egbe Omo Yoruba" society, a national association of Yoruba descendants in North America. Nigeria's largest city is Lagos . Lagos has grown from about 300,000 in 1950 to an estimated 13.4 million in 2017. Nigeria has more than 250 ethnic groups, with varying languages and customs, creating a country of rich ethnic diversity. The three largest ethnic groups are the Hausa , Yoruba and Igbo , together accounting for more than 60% of the population, while the Edo , Ijaw , Fulɓe , Kanuri , Urhobo-Isoko , Ibibio , Ebira , Nupe , Gbagyi , Jukun , Igala , Idoma , Ogoni and Tiv account for between 35 and 40%; other minorities make up the remaining 5%. The Middle Belt of Nigeria is known for its diversity of ethnic groups, including the Atyap , Berom , Goemai, Igala, Kofyar , Pyem, and Tiv . There are small minorities of British, American, Indian , Chinese (est. 50,000), white Zimbabwean , Japanese, Greek, Syrian and Lebanese immigrants. Immigrants also include those from other West African or East African nations. 525 languages have been spoken in Nigeria; eight of them are now extinct. In some areas of Nigeria, ethnic groups speak more than one language. The official language of Nigeria, English, was chosen to facilitate the cultural and linguistic unity of the country, owing to the influence of British colonisation which ended in 1960. Many French speakers from surrounding countries have influenced the English spoken in the border regions of Nigeria and some Nigerian citizens have become fluent enough in French to work in the surrounding countries. The French spoken in Nigeria may be mixed with some native languages and English. The major languages spoken in Nigeria represent three major families of languages of Africa : the majority are Niger-Congo languages, such as Igbo , Yoruba , Ibibio , Ijaw , Fulfulde , Ogoni , and Edo . Kanuri , spoken in the northeast, primarily in Borno and Yobe State , is part of the Nilo-Saharan family, and Hausa is an Afroasiatic language. Even though most ethnic groups prefer to communicate in their languages, English as the official language is widely used for education, business transactions and official purposes. English as a first language is used by only a small minority of the country's urban elite, and it is not spoken at all in some rural areas. Hausa is the most widely spoken of the three main languages spoken in Nigeria. With the majority of Nigeria's populace in the rural areas, the major languages of communication in the country remain indigenous languages. Some of the largest of these, notably Yoruba and Igbo, have derived standardised languages from several different dialects and are widely spoken by those ethnic groups. Nigerian Pidgin English , often known simply as " Pidgin " or "Broken" (Broken English), is also a popular lingua franca , though with varying regional influences on dialect and slang. The pidgin English or Nigerian English is widely spoken within the Niger Delta Region. Nigeria is a religiously diverse society, with Islam (predominantly in the north) and Christianity (predominantly in the south) being the most widely professed religions. Nigerians are nearly equally divided into Muslims and Christians , with a tiny minority of adherents of traditional African religions and other religions. The Christian share of Nigeria's population is in decline because of the lower fertility rate compared to Muslims in the country. As in other parts of Africa where Islam and Christianity are dominant, religious syncretism with the traditional African religions is common. A 2012 report on religion and public life by the Pew Research Center stated that in 2010, 49.3% of Nigeria's population was Christian, 48.8% was Muslim, and 1.9% were followers of indigenous and other religions (such as the Bori in the North) or unaffiliated. However, in a report released by Pew Research Center in 2015, the Muslim population was estimated to be 50%, and by 2060, according to the report, Muslims will account for about 60% of the country. The 2010 census of Association of Religion Data Archives has also reported that 48.8% of the total population was Christian, slightly larger than the Muslim population of 43.4%, while 7.5% were members of other religions. However, these estimates should be taken with caution because sample data is mostly collected from major urban areas in the south, which are predominantly Christian. According to a 2018 estimate in The World Factbook by the CIA , the population is estimated to be 53.5% Muslim, 45.9% Christian (10.6% Roman Catholic and 35.3% Protestant and other Christian), and 0.6% as other. Islam dominates northwestern Nigeria and northeastern Nigeria ( Kanuri , Fulani and other groups). In the west, the Yoruba people are predominantly Muslim with a significant Christian minority in addition to a few adherents of traditional religions. Protestant and locally cultivated Christianity are widely practised in Western areas, while Roman Catholicism is a more prominent Christian feature of southeastern Nigeria. Both Roman Catholicism and Protestantism are observed in the Ibibio, Efik , Ijo and Ogoni lands of the south. The Igbos (predominant in the east) and the Ibibio (south) are 98% Christian, with 2% practising traditional religions. The middle belt of Nigeria contains the largest number of minority ethnic groups in Nigeria, who were found to be majority Christians and members of traditional religions, with a significant Muslim minority. Since mid-2010, Boko Haram has terrorised northeastern Nigeria. In the following 12 years, according to the Council on Foreign Relations' "Nigeria Security Tracker", over 41,600 people died because of this group (as of October 2022). Millions of people fled south or to the big cities, such as Maiduguri. However, the formula "Muslims against Christians" falls short. Despite Boko Haram's murderous hostility towards Christians, most of their victims have always been Muslims, not least because the insurgency is taking place in a predominantly Muslim part of the country, mainly Borno state in the far northeast of Nigeria . The killing of such a large number of Muslims by Boko Haram, based on a broad definition of apostasy, is believed to have been one of the reasons for the group's split in 2016. Nigeria Security Tracker (NST) data shows (as of March 2022) that Boko Haram attacks on churches have decreased over time, while attacks on mosques have increased. The lower number of Christian fatalities at the hands of Boko Haram probably reflects the fact that most of them have fled. Boko Haram has been in decline since at least March 2022. 40,000 of its fighters surrendered in 2022. Since 2021, the Islamic State in West Africa (ISWAP) appears more dominant than Boko Haram. ISWAP is, for example, credited with the church attack in Owo at Pentecost 2022. Health care delivery in Nigeria is a concurrent responsibility of the three tiers of government in the country, and the private sector. Nigeria has been reorganising its health system since the Bamako Initiative of 1987, which formally promoted community-based methods of increasing accessibility of drugs and health care services to the population, in part by implementing user fees. The new strategy dramatically increased accessibility through community-based health care reform, resulting in more efficient and equitable provision of services. A comprehensive approach strategy was extended to all areas of health care, with subsequent improvement in the health care indicators and improvement in health care efficiency and cost. 48% of Nigerians report that they or a household member have fallen ill in the last three months. Malaria had been diagnosed in 88% of the cases and typhoid fever in 32%. High blood pressure was in third place with 8%. For symptoms of malaria, 41% of Nigerians turn to a hospital , 22% to a chemist's shop, 21% to a pharmacy and 11% seek cure through herbs. The HIV/AIDS rate in Nigeria is much lower than in other African nations such as Botswana or South Africa whose prevalence (percentage) rates are in the double digits. As of 2019 [ update ] , the HIV prevalence rate among adults of ages 15–49 was 1.5 per cent. Life expectancy in Nigeria is 54.7 years on average, and 71% and 39% of the population have access to improved water sources and improved sanitation , respectively. As of 2019 [ update ] , the infant mortality is 74.2 deaths per 1,000 live births . In 2012, a new bone marrow donor program was launched by the University of Nigeria to help people with leukaemia , lymphoma , or sickle cell disease to find a compatible donor for a life-saving bone marrow transplant , which cures them of their conditions. Nigeria became the second African country to have successfully carried out this surgery. In the 2014 Ebola outbreak , Nigeria was the first country to effectively contain and eliminate the Ebola threat that was ravaging three other countries in the West African region; the unique method of contact tracing employed by Nigeria became an effective method later used by countries such as the United States when Ebola threats were discovered. The Nigerian health care system is continuously faced with a shortage of doctors known as " brain drain ", because of emigration by skilled Nigerian doctors to North America and Europe. In 1995, an estimated 21,000 Nigerian doctors were practising in the United States alone, which is about the same as the number of doctors working in the Nigerian public service. Retaining these expensively trained professionals has been identified as one of the goals of the government. Education in Nigeria is overseen by the Ministry of Education . Local authorities take responsibility for implementing policy for state-controlled public education and state schools at a regional level. The education system is divided into kindergarten , primary education , secondary education and tertiary education . After the 1970s oil boom, tertiary education was improved so it would reach every subregion of Nigeria. 68% of the Nigerian population is literate, and the rate for men (75.7%) is higher than that for women (60.6%). Nigeria provides free, government-supported education, but attendance is not compulsory at any level, and certain groups, such as nomads and the handicapped, are under-served. Nearly 10.5 million Nigerian children aged 5–14 years are not in school. Only 61% of 6–11 year-olds regularly attend primary school. The education system consists of six years of primary school, three years of junior secondary school, three years of senior secondary school, and four, five or six years of university education leading to a bachelor's degree. The government has majority control of university education. Tertiary education in Nigeria consists of universities (public and private), polytechnics, monotechnics, and colleges of education. The country has a total of 138 universities, with 40 federally owned, 39 state-owned, and 59 privately owned. Nigeria was ranked 109th in the Global Innovation Index in 2023, up from 118th in 2021. The security situation in Nigeria is considered inadequate despite political stability. 68% of Nigerians feel "not safe" in their country. 77% do not know of an alarm number ("helpline") for emergencies. Nigerians, according to the above survey, fear being robbed (24%) or kidnapped (also 24%), being victims of armed bandits or of petty theft (both 8%), or being harmed in the herdsmen-farmers conflict (also 8%). This is followed by "ritual killings" (4%) and "Boko Haram" (3.5%). Respondents see "more security personnel and better training" (37%), "reduction of unemployment" (13%) and "prayers / divine intervention" (8%) as promising countermeasures. The number of homicides in Nigeria varies greatly depending on the state. Metropoles such as Lagos , Kano and Ibadan seem much safer than rural areas. Kano has better statistics than the UK , with 1.5 homicides per year and 1 million inhabitants - which can be explained by the fact that the region's religious and morality police not only monitor the morality of the inhabitants and crack down on drug users, but also have a curbing effect on murder and manslaughter. This contrasts with other cities that are also Islamic, such as Maiduguri and Kaduna , which have worrying statistics on homicides. There is some piracy in the Gulf of Guinea , with attacks directed at all types of vessels. However, security measures on board of mentioned vessels have recently meant that pirates are now more likely to attack fishing villages. Internationally, Nigeria is infamous for a type of advance-fee scam along with a form of confidence trick . The victim is talked into exchanging bank account information on the premise that the money will be transferred to them. In reality, money is taken out instead. In 2003, the Nigerian Economic and Financial Crimes Commission was created to combat this and other forms of organised financial crime. The EFCC is quite active. According to the International Monetary Fund , 32% of Nigeria's population lives in extreme poverty (as of 2017), living on less than US$2.15 a day. The World Bank stated in March 2022 that the number of poor Nigerians had increased by 5 million to 95.1 million during the Covid period. Accordingly, 40% of Nigerians live below the poverty line of US$1.90 as handled by the World Bank. The threshold amounts used internationally by the IMF and the World Bank do not take into account the local purchasing power of a US dollar. [ citation needed ] The methodology is therefore not without controversy. Despite the undoubted existence of slums in Nigeria, for example, the fact that 92% of men and 88% of women in Nigeria own a mobile phone is difficult to reconcile with the poverty percentages published by the IMF and the World Bank. Nigeria's human rights record remains poor. According to the U.S. Department of State, the most significant human rights problems are the use of excessive force by security forces, impunity for abuses by security forces, arbitrary arrests, prolonged pretrial detention, judicial corruption and executive influence on the judiciary, rape, torture and other cruel, inhuman or degrading treatment of prisoners, detainees and suspects; harsh and life‑threatening prison and detention centre conditions; human trafficking for prostitution and forced labour, societal violence and vigilante killings, child labour , child abuse and child sexual exploitation , domestic violence , discrimination based on ethnicity, region and religion. Nigeria is a state party of the Convention on the Elimination of All Forms of Discrimination Against Women It also has signed the Maputo Protocol , an international treaty on women's rights, and the African Union Women's Rights Framework. Discrimination based on sex is a significant human rights issue. Forced marriages are common. Child marriage remains common in Northern Nigeria; 39% of girls are married before age 15, although the Marriage Rights Act banning marriage of girls under 18 was introduced on a federal level in 2008. There is rampant polygamy in Northern Nigeria . Domestic violence is common . Women have fewer land rights. Maternal mortality was at 814 per 100,000 live births in 2015. Female genital mutilation is common , although a ban was implemented in 2015. At least half a million suffer from vaginal fistula , largely as a result of lack of medical care. Women face a large amount of inequality politically in Nigeria, being subjugated to a bias that is sexist and reinforced by socio-cultural, economic and oppressive ways. Women throughout the country were only politically emancipated in 1979. Yet husbands continue to dictate the votes for many women, which upholds the patriarchal system. Most workers in the informal sector are women. Women's representation in government since independence from Britain is very poor. Women have been reduced to sideline roles in appointive posts throughout all levels of government and still make up a tiny minority of elected officials. But nowadays with more education available to the public, Nigerian women are taking steps to have more active roles in the public, and with the help of different initiatives, more businesses are being started by women. Under the Shari'a penal code that applies to Muslims in twelve northern states, offences such as alcohol consumption, homosexuality , infidelity and theft carry harsh sentences, including amputation, lashing, stoning and long prison terms. Nigeria is considered to be one of the most homophobic countries in the world. In the 23 years up to September 2022, university workers in Nigeria went on strike 17 times, for a total of 57 months. As a result, the 2022 summer semester was cancelled nationwide. 525 languages have been spoken in Nigeria; eight of them are now extinct. In some areas of Nigeria, ethnic groups speak more than one language. The official language of Nigeria, English, was chosen to facilitate the cultural and linguistic unity of the country, owing to the influence of British colonisation which ended in 1960. Many French speakers from surrounding countries have influenced the English spoken in the border regions of Nigeria and some Nigerian citizens have become fluent enough in French to work in the surrounding countries. The French spoken in Nigeria may be mixed with some native languages and English. The major languages spoken in Nigeria represent three major families of languages of Africa : the majority are Niger-Congo languages, such as Igbo , Yoruba , Ibibio , Ijaw , Fulfulde , Ogoni , and Edo . Kanuri , spoken in the northeast, primarily in Borno and Yobe State , is part of the Nilo-Saharan family, and Hausa is an Afroasiatic language. Even though most ethnic groups prefer to communicate in their languages, English as the official language is widely used for education, business transactions and official purposes. English as a first language is used by only a small minority of the country's urban elite, and it is not spoken at all in some rural areas. Hausa is the most widely spoken of the three main languages spoken in Nigeria. With the majority of Nigeria's populace in the rural areas, the major languages of communication in the country remain indigenous languages. Some of the largest of these, notably Yoruba and Igbo, have derived standardised languages from several different dialects and are widely spoken by those ethnic groups. Nigerian Pidgin English , often known simply as " Pidgin " or "Broken" (Broken English), is also a popular lingua franca , though with varying regional influences on dialect and slang. The pidgin English or Nigerian English is widely spoken within the Niger Delta Region. Nigeria is a religiously diverse society, with Islam (predominantly in the north) and Christianity (predominantly in the south) being the most widely professed religions. Nigerians are nearly equally divided into Muslims and Christians , with a tiny minority of adherents of traditional African religions and other religions. The Christian share of Nigeria's population is in decline because of the lower fertility rate compared to Muslims in the country. As in other parts of Africa where Islam and Christianity are dominant, religious syncretism with the traditional African religions is common. A 2012 report on religion and public life by the Pew Research Center stated that in 2010, 49.3% of Nigeria's population was Christian, 48.8% was Muslim, and 1.9% were followers of indigenous and other religions (such as the Bori in the North) or unaffiliated. However, in a report released by Pew Research Center in 2015, the Muslim population was estimated to be 50%, and by 2060, according to the report, Muslims will account for about 60% of the country. The 2010 census of Association of Religion Data Archives has also reported that 48.8% of the total population was Christian, slightly larger than the Muslim population of 43.4%, while 7.5% were members of other religions. However, these estimates should be taken with caution because sample data is mostly collected from major urban areas in the south, which are predominantly Christian. According to a 2018 estimate in The World Factbook by the CIA , the population is estimated to be 53.5% Muslim, 45.9% Christian (10.6% Roman Catholic and 35.3% Protestant and other Christian), and 0.6% as other. Islam dominates northwestern Nigeria and northeastern Nigeria ( Kanuri , Fulani and other groups). In the west, the Yoruba people are predominantly Muslim with a significant Christian minority in addition to a few adherents of traditional religions. Protestant and locally cultivated Christianity are widely practised in Western areas, while Roman Catholicism is a more prominent Christian feature of southeastern Nigeria. Both Roman Catholicism and Protestantism are observed in the Ibibio, Efik , Ijo and Ogoni lands of the south. The Igbos (predominant in the east) and the Ibibio (south) are 98% Christian, with 2% practising traditional religions. The middle belt of Nigeria contains the largest number of minority ethnic groups in Nigeria, who were found to be majority Christians and members of traditional religions, with a significant Muslim minority. Since mid-2010, Boko Haram has terrorised northeastern Nigeria. In the following 12 years, according to the Council on Foreign Relations' "Nigeria Security Tracker", over 41,600 people died because of this group (as of October 2022). Millions of people fled south or to the big cities, such as Maiduguri. However, the formula "Muslims against Christians" falls short. Despite Boko Haram's murderous hostility towards Christians, most of their victims have always been Muslims, not least because the insurgency is taking place in a predominantly Muslim part of the country, mainly Borno state in the far northeast of Nigeria . The killing of such a large number of Muslims by Boko Haram, based on a broad definition of apostasy, is believed to have been one of the reasons for the group's split in 2016. Nigeria Security Tracker (NST) data shows (as of March 2022) that Boko Haram attacks on churches have decreased over time, while attacks on mosques have increased. The lower number of Christian fatalities at the hands of Boko Haram probably reflects the fact that most of them have fled. Boko Haram has been in decline since at least March 2022. 40,000 of its fighters surrendered in 2022. Since 2021, the Islamic State in West Africa (ISWAP) appears more dominant than Boko Haram. ISWAP is, for example, credited with the church attack in Owo at Pentecost 2022. Since mid-2010, Boko Haram has terrorised northeastern Nigeria. In the following 12 years, according to the Council on Foreign Relations' "Nigeria Security Tracker", over 41,600 people died because of this group (as of October 2022). Millions of people fled south or to the big cities, such as Maiduguri. However, the formula "Muslims against Christians" falls short. Despite Boko Haram's murderous hostility towards Christians, most of their victims have always been Muslims, not least because the insurgency is taking place in a predominantly Muslim part of the country, mainly Borno state in the far northeast of Nigeria . The killing of such a large number of Muslims by Boko Haram, based on a broad definition of apostasy, is believed to have been one of the reasons for the group's split in 2016. Nigeria Security Tracker (NST) data shows (as of March 2022) that Boko Haram attacks on churches have decreased over time, while attacks on mosques have increased. The lower number of Christian fatalities at the hands of Boko Haram probably reflects the fact that most of them have fled. Boko Haram has been in decline since at least March 2022. 40,000 of its fighters surrendered in 2022. Since 2021, the Islamic State in West Africa (ISWAP) appears more dominant than Boko Haram. ISWAP is, for example, credited with the church attack in Owo at Pentecost 2022. Health care delivery in Nigeria is a concurrent responsibility of the three tiers of government in the country, and the private sector. Nigeria has been reorganising its health system since the Bamako Initiative of 1987, which formally promoted community-based methods of increasing accessibility of drugs and health care services to the population, in part by implementing user fees. The new strategy dramatically increased accessibility through community-based health care reform, resulting in more efficient and equitable provision of services. A comprehensive approach strategy was extended to all areas of health care, with subsequent improvement in the health care indicators and improvement in health care efficiency and cost. 48% of Nigerians report that they or a household member have fallen ill in the last three months. Malaria had been diagnosed in 88% of the cases and typhoid fever in 32%. High blood pressure was in third place with 8%. For symptoms of malaria, 41% of Nigerians turn to a hospital , 22% to a chemist's shop, 21% to a pharmacy and 11% seek cure through herbs. The HIV/AIDS rate in Nigeria is much lower than in other African nations such as Botswana or South Africa whose prevalence (percentage) rates are in the double digits. As of 2019 [ update ] , the HIV prevalence rate among adults of ages 15–49 was 1.5 per cent. Life expectancy in Nigeria is 54.7 years on average, and 71% and 39% of the population have access to improved water sources and improved sanitation , respectively. As of 2019 [ update ] , the infant mortality is 74.2 deaths per 1,000 live births . In 2012, a new bone marrow donor program was launched by the University of Nigeria to help people with leukaemia , lymphoma , or sickle cell disease to find a compatible donor for a life-saving bone marrow transplant , which cures them of their conditions. Nigeria became the second African country to have successfully carried out this surgery. In the 2014 Ebola outbreak , Nigeria was the first country to effectively contain and eliminate the Ebola threat that was ravaging three other countries in the West African region; the unique method of contact tracing employed by Nigeria became an effective method later used by countries such as the United States when Ebola threats were discovered. The Nigerian health care system is continuously faced with a shortage of doctors known as " brain drain ", because of emigration by skilled Nigerian doctors to North America and Europe. In 1995, an estimated 21,000 Nigerian doctors were practising in the United States alone, which is about the same as the number of doctors working in the Nigerian public service. Retaining these expensively trained professionals has been identified as one of the goals of the government. Education in Nigeria is overseen by the Ministry of Education . Local authorities take responsibility for implementing policy for state-controlled public education and state schools at a regional level. The education system is divided into kindergarten , primary education , secondary education and tertiary education . After the 1970s oil boom, tertiary education was improved so it would reach every subregion of Nigeria. 68% of the Nigerian population is literate, and the rate for men (75.7%) is higher than that for women (60.6%). Nigeria provides free, government-supported education, but attendance is not compulsory at any level, and certain groups, such as nomads and the handicapped, are under-served. Nearly 10.5 million Nigerian children aged 5–14 years are not in school. Only 61% of 6–11 year-olds regularly attend primary school. The education system consists of six years of primary school, three years of junior secondary school, three years of senior secondary school, and four, five or six years of university education leading to a bachelor's degree. The government has majority control of university education. Tertiary education in Nigeria consists of universities (public and private), polytechnics, monotechnics, and colleges of education. The country has a total of 138 universities, with 40 federally owned, 39 state-owned, and 59 privately owned. Nigeria was ranked 109th in the Global Innovation Index in 2023, up from 118th in 2021. The security situation in Nigeria is considered inadequate despite political stability. 68% of Nigerians feel "not safe" in their country. 77% do not know of an alarm number ("helpline") for emergencies. Nigerians, according to the above survey, fear being robbed (24%) or kidnapped (also 24%), being victims of armed bandits or of petty theft (both 8%), or being harmed in the herdsmen-farmers conflict (also 8%). This is followed by "ritual killings" (4%) and "Boko Haram" (3.5%). Respondents see "more security personnel and better training" (37%), "reduction of unemployment" (13%) and "prayers / divine intervention" (8%) as promising countermeasures. The number of homicides in Nigeria varies greatly depending on the state. Metropoles such as Lagos , Kano and Ibadan seem much safer than rural areas. Kano has better statistics than the UK , with 1.5 homicides per year and 1 million inhabitants - which can be explained by the fact that the region's religious and morality police not only monitor the morality of the inhabitants and crack down on drug users, but also have a curbing effect on murder and manslaughter. This contrasts with other cities that are also Islamic, such as Maiduguri and Kaduna , which have worrying statistics on homicides. There is some piracy in the Gulf of Guinea , with attacks directed at all types of vessels. However, security measures on board of mentioned vessels have recently meant that pirates are now more likely to attack fishing villages. Internationally, Nigeria is infamous for a type of advance-fee scam along with a form of confidence trick . The victim is talked into exchanging bank account information on the premise that the money will be transferred to them. In reality, money is taken out instead. In 2003, the Nigerian Economic and Financial Crimes Commission was created to combat this and other forms of organised financial crime. The EFCC is quite active. According to the International Monetary Fund , 32% of Nigeria's population lives in extreme poverty (as of 2017), living on less than US$2.15 a day. The World Bank stated in March 2022 that the number of poor Nigerians had increased by 5 million to 95.1 million during the Covid period. Accordingly, 40% of Nigerians live below the poverty line of US$1.90 as handled by the World Bank. The threshold amounts used internationally by the IMF and the World Bank do not take into account the local purchasing power of a US dollar. [ citation needed ] The methodology is therefore not without controversy. Despite the undoubted existence of slums in Nigeria, for example, the fact that 92% of men and 88% of women in Nigeria own a mobile phone is difficult to reconcile with the poverty percentages published by the IMF and the World Bank.Nigeria's human rights record remains poor. According to the U.S. Department of State, the most significant human rights problems are the use of excessive force by security forces, impunity for abuses by security forces, arbitrary arrests, prolonged pretrial detention, judicial corruption and executive influence on the judiciary, rape, torture and other cruel, inhuman or degrading treatment of prisoners, detainees and suspects; harsh and life‑threatening prison and detention centre conditions; human trafficking for prostitution and forced labour, societal violence and vigilante killings, child labour , child abuse and child sexual exploitation , domestic violence , discrimination based on ethnicity, region and religion. Nigeria is a state party of the Convention on the Elimination of All Forms of Discrimination Against Women It also has signed the Maputo Protocol , an international treaty on women's rights, and the African Union Women's Rights Framework. Discrimination based on sex is a significant human rights issue. Forced marriages are common. Child marriage remains common in Northern Nigeria; 39% of girls are married before age 15, although the Marriage Rights Act banning marriage of girls under 18 was introduced on a federal level in 2008. There is rampant polygamy in Northern Nigeria . Domestic violence is common . Women have fewer land rights. Maternal mortality was at 814 per 100,000 live births in 2015. Female genital mutilation is common , although a ban was implemented in 2015. At least half a million suffer from vaginal fistula , largely as a result of lack of medical care. Women face a large amount of inequality politically in Nigeria, being subjugated to a bias that is sexist and reinforced by socio-cultural, economic and oppressive ways. Women throughout the country were only politically emancipated in 1979. Yet husbands continue to dictate the votes for many women, which upholds the patriarchal system. Most workers in the informal sector are women. Women's representation in government since independence from Britain is very poor. Women have been reduced to sideline roles in appointive posts throughout all levels of government and still make up a tiny minority of elected officials. But nowadays with more education available to the public, Nigerian women are taking steps to have more active roles in the public, and with the help of different initiatives, more businesses are being started by women. Under the Shari'a penal code that applies to Muslims in twelve northern states, offences such as alcohol consumption, homosexuality , infidelity and theft carry harsh sentences, including amputation, lashing, stoning and long prison terms. Nigeria is considered to be one of the most homophobic countries in the world. In the 23 years up to September 2022, university workers in Nigeria went on strike 17 times, for a total of 57 months. As a result, the 2022 summer semester was cancelled nationwide. Most Nigerian literature is written in English , partly because this language is understood by most Nigerians. Literature in the Yoruba , Hausa and Igbo languages (the three most populous language groups in Nigeria) does exist, however, and in the case of the Hausa, for example, can look back on a centuries-old tradition. With Wole Soyinka , Nigeria can present a Nobel Prize winner for literature . Chinua Achebe won the prestigious Booker Prize in 2007 and Ben Okri in 1991. Achebe also won the Peace Award of the German Book Trade in 2002. Lola Shoneyin has won several awards for her book The Secret Lives of Baba Segi's Wives (novel) . The earliest known form of popular music in Nigeria was the palm-wine music which dominated the music landscape in the 1920s. Tunde King was a prominent name in the genre. 1930s saw the emergence of Onitsha Native Orchestra. They explored various social themes and trends in their native singing style. In the 1950s and 1960s, Highlife music became a popular staple in the country with regional genres such as the Igbo Highlife . A notable exponent of the genre were the genre's first Nigerian boy band Oriental Brothers International , Bobby Benson , Osita Osadebe , Victor Olaiya , Rex Lawson , Dr Sir Warrior and Oliver De Coque . The 1970s was the era of Fela Kuti , the pioneer of afrobeat genre - fused from Highlife , Jazz and Yoruba Music . Fela later evolved into social activism and black consciousness. In the 1980s, King Sunny Ade achieved success with Juju Music . Prominent singer of the era is William Onyeabor who is known for his fusion of Funk Music and Disco . By 1990s, Reggae music transitioned into the music scene. Prominent reggae artiste of the era was Majek Fashek . By the mid-1990s, Hip hop Music began to gain popularity, led by acts such as Remedies , Trybes Men, JJC, etc. All throughout the years, highlife music retained its popularity in the country. At the turn of the century, famous 2000s Acts like P-Square , 2face , and Dbanj were credited to have made tremendous impact in the evolution of Afrobeats and its popularization on the international stage. In November 2008, Nigeria's music scene (and that of Africa) received international attention when MTV hosted the continent's first African music awards show in Abuja. over a decade later and Afro beats has widely taken over with artist like Davido , Wizkid and Burna Boy . Top five highest grossing Nigerian films : The Nigerian film industry is known as Nollywood (a blend of "Nigeria" and "Hollywood") and is now the second-largest producer of movies in the world, having surpassed Hollywood. Only India's Bollywood is larger. Nigerian film studios are based in Lagos , Kano , and Enugu , and form a major portion of the local economy of these cities. Nigerian cinema is Africa's largest movie industry in terms of both value and the number of movies produced per year. Although Nigerian films have been produced since the 1960s, the country's film industry has been aided by the rise of affordable digital filming and editing technologies. The 2009 thriller film The Figurine heightened the media attention towards the New Nigerian Cinema revolution. The film was a critical and commercial success in Nigeria, and it was also screened in international film festivals. The 2010 film Ijé by Chineze Anyaene, overtook The Figurine to become the highest-grossing Nigerian film ; a record it held for four years until it was overtaken in 2014 by Half of a Yellow Sun (2013). By 2016, this record was held by The Wedding Party by Kemi Adetiba . By the end of 2013, the film industry reportedly hit a record-breaking revenue of ₦1.72 trillion (US$4.1 billion). As of 2014, the industry was worth ₦853.9 billion (US$5.1 billion), making it the third most valuable film industry in the world behind the United States and India . It contributed about 1.4% to Nigeria's economy; this was attributed to the increase in the number of quality films produced and more formal distribution methods. T.B. Joshua 's Emmanuel TV , originating from Nigeria, is one of the most viewed television stations across Africa. There are many festivals in Nigeria , some of which date to the period before the arrival of the major religions in this ethnically and culturally diverse society. The main Muslim and Christian festivals are often celebrated in ways that are unique to Nigeria or unique to the people of a locality. The Nigerian Tourism Development Corporation has been working with the states to upgrade the traditional festivals, which may become important sources of tourism revenue. Nigerian cuisine , like West African cuisine in general, is known for its richness and variety. Many different spices, herbs, and flavourings are used in conjunction with palm oil or groundnut oil to create deeply flavoured sauces and soups often made very hot with chilli peppers . Nigerian feasts are colourful and lavish, while aromatic market and roadside snacks cooked on barbecues or fried in oil are plentiful and varied. Suya is usually sold in urban areas especially during night-time. The fashion industry in Nigeria contributes significantly to the country's economics. Casual attire is commonly worn but formal and traditional styles are also worn depending on the occasion. Nigeria is known not only for its fashionable textiles and garments, but also for its fashion designers who have increasingly gained international recognition. Euromonitor estimates the Sub-Saharan fashion market to be worth $31 billion, with Nigeria accounting for 15% of these $31 billion. Nigeria is not only known for their many fashion textiles and garment pieces that are secret to their culture. They also outputted many fashion designers who have developed many techniques and businesses along the way. Football is largely considered Nigeria's national sport, and the country has its own Premier League of football. Nigeria's national football team , known as the "Super Eagles", has played in the FIFA World Cup on six occasions ( 1994 , 1998 , 2002 , 2010 , 2014 , and 2018 ). In April 1994, the Super Eagles ranked fifth in the FIFA World Rankings , the highest-ranking achieved by an African team. They won the Africa Cup of Nations in 1980 , 1994 , and 2013 , and have also hosted both the U17 and U20 FIFA World Cup. They won the gold medal for football in the 1996 Summer Olympics (in which they beat Argentina) becoming the first African football team to win gold in Olympic football. Nigeria is also involved in other sports such as basketball, cricket and track and field. Nigeria's national basketball team made the headlines internationally when it became the first African team to beat the United States men's national team . In earlier years, Nigeria qualified for the 2012 Summer Olympics as it beat heavily favoured world elite teams such as Greece and Lithuania . Nigeria has been home to numerous internationally recognised basketball players in the world's top leagues in America, Europe and Asia. These players include Basketball Hall of Famer Hakeem Olajuwon , and later players in the NBA . The Nigerian Premier League has become one of the biggest and most-watched basketball competitions in Africa. The games have aired on Kwese TV and have averaged a viewership of over a million people. Nigeria made history by qualifying the first bobsled team for the Winter Olympics from Africa when their women's two-person team qualified for the bobsled competition at the XXIII Olympic Winter Games . In the early 1990s, Scrabble was made an official sport in Nigeria; by the end of 2017, there were around 4,000 players in more than 100 clubs in the country. In 2018, the Nigerian Curling Federation was established to introduce a new sport to the country with the hope of getting the game to be a part of the curriculum at the elementary, high school, and university levels respectively. At the 2019 World Mixed Doubles Curling Championship in Norway, Nigeria won their first international match beating France 8–5. Nigeria's women's and men's national teams in beach volleyball competed at the 2018–2020 CAVB Beach Volleyball Continental Cup . The country's U21 national teams qualified for the 2019 FIVB Beach Volleyball U21 World Championships . Nigeria is the birthplace of the sport loofball . Most Nigerian literature is written in English , partly because this language is understood by most Nigerians. Literature in the Yoruba , Hausa and Igbo languages (the three most populous language groups in Nigeria) does exist, however, and in the case of the Hausa, for example, can look back on a centuries-old tradition. With Wole Soyinka , Nigeria can present a Nobel Prize winner for literature . Chinua Achebe won the prestigious Booker Prize in 2007 and Ben Okri in 1991. Achebe also won the Peace Award of the German Book Trade in 2002. Lola Shoneyin has won several awards for her book The Secret Lives of Baba Segi's Wives (novel) .The earliest known form of popular music in Nigeria was the palm-wine music which dominated the music landscape in the 1920s. Tunde King was a prominent name in the genre. 1930s saw the emergence of Onitsha Native Orchestra. They explored various social themes and trends in their native singing style. In the 1950s and 1960s, Highlife music became a popular staple in the country with regional genres such as the Igbo Highlife . A notable exponent of the genre were the genre's first Nigerian boy band Oriental Brothers International , Bobby Benson , Osita Osadebe , Victor Olaiya , Rex Lawson , Dr Sir Warrior and Oliver De Coque . The 1970s was the era of Fela Kuti , the pioneer of afrobeat genre - fused from Highlife , Jazz and Yoruba Music . Fela later evolved into social activism and black consciousness. In the 1980s, King Sunny Ade achieved success with Juju Music . Prominent singer of the era is William Onyeabor who is known for his fusion of Funk Music and Disco . By 1990s, Reggae music transitioned into the music scene. Prominent reggae artiste of the era was Majek Fashek . By the mid-1990s, Hip hop Music began to gain popularity, led by acts such as Remedies , Trybes Men, JJC, etc. All throughout the years, highlife music retained its popularity in the country. At the turn of the century, famous 2000s Acts like P-Square , 2face , and Dbanj were credited to have made tremendous impact in the evolution of Afrobeats and its popularization on the international stage. In November 2008, Nigeria's music scene (and that of Africa) received international attention when MTV hosted the continent's first African music awards show in Abuja. over a decade later and Afro beats has widely taken over with artist like Davido , Wizkid and Burna Boy .Top five highest grossing Nigerian films : The Nigerian film industry is known as Nollywood (a blend of "Nigeria" and "Hollywood") and is now the second-largest producer of movies in the world, having surpassed Hollywood. Only India's Bollywood is larger. Nigerian film studios are based in Lagos , Kano , and Enugu , and form a major portion of the local economy of these cities. Nigerian cinema is Africa's largest movie industry in terms of both value and the number of movies produced per year. Although Nigerian films have been produced since the 1960s, the country's film industry has been aided by the rise of affordable digital filming and editing technologies. The 2009 thriller film The Figurine heightened the media attention towards the New Nigerian Cinema revolution. The film was a critical and commercial success in Nigeria, and it was also screened in international film festivals. The 2010 film Ijé by Chineze Anyaene, overtook The Figurine to become the highest-grossing Nigerian film ; a record it held for four years until it was overtaken in 2014 by Half of a Yellow Sun (2013). By 2016, this record was held by The Wedding Party by Kemi Adetiba . By the end of 2013, the film industry reportedly hit a record-breaking revenue of ₦1.72 trillion (US$4.1 billion). As of 2014, the industry was worth ₦853.9 billion (US$5.1 billion), making it the third most valuable film industry in the world behind the United States and India . It contributed about 1.4% to Nigeria's economy; this was attributed to the increase in the number of quality films produced and more formal distribution methods. T.B. Joshua 's Emmanuel TV , originating from Nigeria, is one of the most viewed television stations across Africa. There are many festivals in Nigeria , some of which date to the period before the arrival of the major religions in this ethnically and culturally diverse society. The main Muslim and Christian festivals are often celebrated in ways that are unique to Nigeria or unique to the people of a locality. The Nigerian Tourism Development Corporation has been working with the states to upgrade the traditional festivals, which may become important sources of tourism revenue. Nigerian cuisine , like West African cuisine in general, is known for its richness and variety. Many different spices, herbs, and flavourings are used in conjunction with palm oil or groundnut oil to create deeply flavoured sauces and soups often made very hot with chilli peppers . Nigerian feasts are colourful and lavish, while aromatic market and roadside snacks cooked on barbecues or fried in oil are plentiful and varied. Suya is usually sold in urban areas especially during night-time. The fashion industry in Nigeria contributes significantly to the country's economics. Casual attire is commonly worn but formal and traditional styles are also worn depending on the occasion. Nigeria is known not only for its fashionable textiles and garments, but also for its fashion designers who have increasingly gained international recognition. Euromonitor estimates the Sub-Saharan fashion market to be worth $31 billion, with Nigeria accounting for 15% of these $31 billion. Nigeria is not only known for their many fashion textiles and garment pieces that are secret to their culture. They also outputted many fashion designers who have developed many techniques and businesses along the way.Football is largely considered Nigeria's national sport, and the country has its own Premier League of football. Nigeria's national football team , known as the "Super Eagles", has played in the FIFA World Cup on six occasions ( 1994 , 1998 , 2002 , 2010 , 2014 , and 2018 ). In April 1994, the Super Eagles ranked fifth in the FIFA World Rankings , the highest-ranking achieved by an African team. They won the Africa Cup of Nations in 1980 , 1994 , and 2013 , and have also hosted both the U17 and U20 FIFA World Cup. They won the gold medal for football in the 1996 Summer Olympics (in which they beat Argentina) becoming the first African football team to win gold in Olympic football. Nigeria is also involved in other sports such as basketball, cricket and track and field. Nigeria's national basketball team made the headlines internationally when it became the first African team to beat the United States men's national team . In earlier years, Nigeria qualified for the 2012 Summer Olympics as it beat heavily favoured world elite teams such as Greece and Lithuania . Nigeria has been home to numerous internationally recognised basketball players in the world's top leagues in America, Europe and Asia. These players include Basketball Hall of Famer Hakeem Olajuwon , and later players in the NBA . The Nigerian Premier League has become one of the biggest and most-watched basketball competitions in Africa. The games have aired on Kwese TV and have averaged a viewership of over a million people. Nigeria made history by qualifying the first bobsled team for the Winter Olympics from Africa when their women's two-person team qualified for the bobsled competition at the XXIII Olympic Winter Games . In the early 1990s, Scrabble was made an official sport in Nigeria; by the end of 2017, there were around 4,000 players in more than 100 clubs in the country. In 2018, the Nigerian Curling Federation was established to introduce a new sport to the country with the hope of getting the game to be a part of the curriculum at the elementary, high school, and university levels respectively. At the 2019 World Mixed Doubles Curling Championship in Norway, Nigeria won their first international match beating France 8–5. Nigeria's women's and men's national teams in beach volleyball competed at the 2018–2020 CAVB Beach Volleyball Continental Cup . The country's U21 national teams qualified for the 2019 FIVB Beach Volleyball U21 World Championships . Nigeria is the birthplace of the sport loofball .

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Prevention_of_viral_hemorrhagic_fever/html

Prevention of viral hemorrhagic fever

Prevention of viral hemorrhagic fever is similar for the different viruses. There are a number of different viral hemorrhagic fevers including Ebola virus disease , Lassa fever , Rift valley fever , Marburg virus disease , Crimean-Congo haemorrhagic fever (CCHF) and yellow fever . Lassa, Ebola, Marburg and CCHF can be spread by direct contact with the body fluids of those infected. Thus the content here covers the prevention of Ebola .The use of standard precautions is recommended with all patients in a healthcare environment. This includes a minimum level of standard precautions for use with all people regardless of their infection status, routine handwashing practices, safe handling and disposal of used needles and syringes, and intensifying standard precautions. It also includes VHF isolation precautions when needed. Limited supplies and resources may prevent a health facility from using all the standard precautions all the time. However, health facilities should establish and maintain a basic, practical level of standard precautions that can be used routinely with patients in their health facility. This requires a source of clean water, routine handwashing before and after any contact with a person who has fever, and safe handling and disposal of sharp instruments and equipment. Washing hands with soap and water eliminates microorganisms from the skin and hands. This provides some protection against transmission of VHF and other diseases. This requires at least cake soap cut into small pieces, soap dishes with openings that allow water to drain away, running water or a bucket kept full with clean water, a bucket for collecting rinse water and a ladle for dipping, if running water is not available, and one-use towels. The handwashing technique that is recommended is to place a piece of soap in the palm of one hand, wash the opposite hand and forearm, rub the surfaces vigorously for at least 10 seconds, move soap to the opposite hand and repeat, use clean water to rinse both hands and then the forearms, dry the hands and forearms with a clean one-use towel, or let rinsed hands and forearms air-dry. Reusable needles and syringes are not recommended. If reusable needles and syringes are used, clean, disinfect and sterilize them before reuse. Needles and syringes used with VHF patients require special care. Cleaning staff should wear two pairs of gloves when handling needles and syringes used with any patient with a known or suspected VHF. In an outbreak situation, several cases occur around the same time. They may be grouped together, and there may be person-to-person transmission. An initial diagnosis of a VHF can be made based on the signs and symptoms of the specific VHF. Suspecting a VHF during a non-outbreak situation in a single case is more difficult. The early symptoms of a VHF include high fever and headache. These are also symptoms for many infections seen at the health facility. Most people who present with fever do not have a VHF. Their fever is more often caused by malaria , typhoid fever , dysentery , severe bacterial infection or other fever-producing illnesses usually seen in the area. The health worker probably will not suspect a VHF until more severe signs develop and the patient does not respond to recommended treatment for other illnesses. However, health workers should be aware of the possibility of VHF in a non-outbreak situation. As soon as a VHF is suspected, VHF isolation precautions should begin. This will help reduce the number of people exposed to the VHF. Isolating the VHF patient will restrict patient access to health facility staff trained to use VHF isolation precautions. Establish a barrier between the VHF patient and uninfected patients, other health facility staff, and visitors. When a VHF case is suspected in the health facility, the following protective clothing should be worn in the isolation area: A scrub suit or inner layer of clothing (an old shirt and trousers brought from home) A pair of thin gloves Rubber boots or overshoes (only if the floor is soiled) A gown or outer layer of clothing (surgical or disposable gown with long sleeves and cuffs) A plastic apron worn over both layers of clothes A second pair of thin or thick gloves. Wearing a second pair of gloves provides an added measure of safety during patient care and when handling contaminated supplies A HEPA-filter (high-efficiency particulate air respirator) or other biosafety mask (or surgical mask if HEPA-filter or other biosafety mask is not available) Cotton head covering Clear eyeglasses or non-fogging goggles When protective clothing is not available or is in short supply, adaptations must be made and used. There are specific recommendation regarding the putting on of protective clothing including: Before entering the changing room, remove jewelry, wallets and other valuables. Remove street clothes and hang them on a hook. Put on the scrub suit or set of old clothes. Enter the changing room. Put on rubber boots. Put on each boot and tuck the trouser leg inside the boot. If overboots are used, tape the top of the boot to the leg with plastic tape. This will help prevent spills from running inside the boots. Put on the first pair of gloves. Look at your hands for cut or broken skin. If the skin is cut or broken, refrain from direct patient contact. Put on one glove at a time. If the scrub suit or set of old clothes has long sleeves, place the edge of each glove under the cuff. When only one pair of gloves is worn, place the edge of the glove over the cuff or gown. If gloves are not available, use plastic bags. Put on one layer now. Attach and close the first layer with tape or elastic bands Put on the outer gown. Pick up the gown from the inside. This is especially important if the gown is being reused Put on the plastic or rubber apron. Put on the second pair of gloves Put on the mask and head cover Put on the protective eyewear. Attach the eyeglasses or goggles behind the head with string or cord to prevent the eyewear from falling off. Introduction Trained oberserver Removing own clothing Examining equipment Hand cleaning Boot covers Inner gloves Coverall N95 respirator surgical hood Outer apron Outer gloves Face shield Verification There are also specific recommendations regarding the removal of protective clothing including: Disinfect the outer pair of gloves, wash the gloved hands in soap and water, dip the gloved hands in 1:100 bleach solution (see below) for one minute Disinfect the apron. Spray or wipe it with 1:100 bleach solution. Disinfect the boots. Use a sprayer containing 1:100 bleach solution to spray boots or hold the foot over a pan or basin and ask another health worker to pour 1:100 bleach solution over the boots or step into a shallow pan containing 1:100 bleach solution and wipe boots on a bleach-drenched cloth Remove the outer pair of gloves Remove the apron and outer gown Disinfect the gloved hands after contact with apron and outer gown. Remove the eyewear, head cover and mask. Remove the boots. Place a towel that has been soaked in 1:100 bleach solution on the floor for health facility staff to stand on when removing boots Remove the inner pair of gloves. Remove inner layer of clothes and dress in street clothes. Wash hands with soap and clean water before leaving the changing roomThere are specific recommendation regarding the putting on of protective clothing including: Before entering the changing room, remove jewelry, wallets and other valuables. Remove street clothes and hang them on a hook. Put on the scrub suit or set of old clothes. Enter the changing room. Put on rubber boots. Put on each boot and tuck the trouser leg inside the boot. If overboots are used, tape the top of the boot to the leg with plastic tape. This will help prevent spills from running inside the boots. Put on the first pair of gloves. Look at your hands for cut or broken skin. If the skin is cut or broken, refrain from direct patient contact. Put on one glove at a time. If the scrub suit or set of old clothes has long sleeves, place the edge of each glove under the cuff. When only one pair of gloves is worn, place the edge of the glove over the cuff or gown. If gloves are not available, use plastic bags. Put on one layer now. Attach and close the first layer with tape or elastic bands Put on the outer gown. Pick up the gown from the inside. This is especially important if the gown is being reused Put on the plastic or rubber apron. Put on the second pair of gloves Put on the mask and head cover Put on the protective eyewear. Attach the eyeglasses or goggles behind the head with string or cord to prevent the eyewear from falling off. Introduction Trained oberserver Removing own clothing Examining equipment Hand cleaning Boot covers Inner gloves Coverall N95 respirator surgical hood Outer apron Outer gloves Face shield VerificationThere are also specific recommendations regarding the removal of protective clothing including: Disinfect the outer pair of gloves, wash the gloved hands in soap and water, dip the gloved hands in 1:100 bleach solution (see below) for one minute Disinfect the apron. Spray or wipe it with 1:100 bleach solution. Disinfect the boots. Use a sprayer containing 1:100 bleach solution to spray boots or hold the foot over a pan or basin and ask another health worker to pour 1:100 bleach solution over the boots or step into a shallow pan containing 1:100 bleach solution and wipe boots on a bleach-drenched cloth Remove the outer pair of gloves Remove the apron and outer gown Disinfect the gloved hands after contact with apron and outer gown. Remove the eyewear, head cover and mask. Remove the boots. Place a towel that has been soaked in 1:100 bleach solution on the floor for health facility staff to stand on when removing boots Remove the inner pair of gloves. Remove inner layer of clothes and dress in street clothes. Wash hands with soap and clean water before leaving the changing roomDisinfection kills almost all bacteria, fungi, viruses, and protozoa. It reduces the number of microorganisms to make equipment and surfaces safer for use. When VHF is suspected in the health facility, all medical, nursing, laboratory and cleaning staff should disinfect: Hands and skin after contact with a VHF patient or infectious body fluids Gloved hands after contact with each VHF patient or after contact with infectious body fluids (when gloves cannot be changed) Thermometers, stethoscopes and other medical instruments after use with each VHF patient Spills of infectious body fluids on the walls and floors Patient excreta and containers contaminated by patient excreta Reusable supplies such as protective clothing and patient bedding Used needles and syringes Two strengths of solution are recommended. 1:10 bleach solution is a strong solution used to disinfect excreta and bodies. It is also used to prepare the 1:100 bleach solution. 1:100 bleach solution is used to disinfect surfaces, medical equipment, patient bedding, reusable protective clothing before it is laundered, rinsing gloves between contact with each patient, rinsing gloves, apron and boots before leaving the patient's room, disinfecting contaminated waste for disposal The dilutions mentioned pertain to a starting concentration of 5% active chlorine , so the 1:10 solution is 0.5% and the 1:100 is 0.05%. These solutions must be prepared new each day as they lose their strength after 24 hours. Two strengths of solution are recommended. 1:10 bleach solution is a strong solution used to disinfect excreta and bodies. It is also used to prepare the 1:100 bleach solution. 1:100 bleach solution is used to disinfect surfaces, medical equipment, patient bedding, reusable protective clothing before it is laundered, rinsing gloves between contact with each patient, rinsing gloves, apron and boots before leaving the patient's room, disinfecting contaminated waste for disposal The dilutions mentioned pertain to a starting concentration of 5% active chlorine , so the 1:10 solution is 0.5% and the 1:100 is 0.05%. These solutions must be prepared new each day as they lose their strength after 24 hours. Direct, unprotected contact during disposal of infectious waste can result in accidental transmission of VHF. For this reason, all contaminated waste produced in the care of the VHF patient must be disposed of safely. All non-reusable items should be destroyed so they cannot be used again. Burning should be carried out at least daily. Liquid waste, including patient excreta, can be disposed of in an isolated latrine or toilet set aside for VHF cases. Burning is the recommended method for disposal of other VHF-contaminated waste. A safe and inexpensive disposal system can be made by using an incinerator or a pit for burning. Use fuel to accelerate the burning and ensure that all waste is completely destroyed. There is risk of transmission in the health facility when a VHF patient dies because the bodies and body fluids of deceased VHF patients remain contagious for several days after death. Family and community members are also at risk if burial practices involve touching and washing the body. Burial should take place as soon as possible after the body is prepared in the health facility. Health facility staff should prepare the body safely and instruct families on what is and is not safe. To prepare the body, protective clothing is recommended per usually with a second pair of thick rubber gloves. The body and the area around it is sprayed with 1:10 bleach solution. The body is placed in a " body bag " (mortuary sack) and it is closed securely. The body bag is sprayed with 1:10 bleach solution. The body is then transported to the burial site as soon as possible. Any person who must touch or carry the body during transport should wear the same protective clothing as is worn in the isolation area. The grave should be at least 2 meters deep. Viewing the body is not possible and the burial ceremony should be limited to family only. The interior of the vehicle where the body was carried should be rinsed with 1:10 bleach solution. Community education and involvement is an important part of the prevention of the spread of VHF.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Democratic_Republic_of_the_Congo/html

Democratic Republic of the Congo

The Democratic Republic of the Congo [lower-alpha 3] is a country in Central Africa . By land area, the DRC is the second-largest country in Africa and the 11th-largest in the world . With a population of around 112 million, the Democratic Republic of the Congo is the most populous Francophone country in the world. The national capital and largest city is Kinshasa , which is also the economic center. The country is bordered by the Republic of the Congo , Central African Republic , South Sudan , Uganda , Rwanda , Burundi , Tanzania (across Lake Tanganyika ), Zambia , Angola , the Cabinda exclave of Angola , and the South Atlantic Ocean . Centered on the Congo Basin , the territory of the DRC was first inhabited by Central African foragers around 90,000 years ago and was reached by the Bantu expansion about 3,000 years ago. In the west, the Kingdom of Kongo ruled around the mouth of the Congo River from the 14th to 19th centuries. In the northeast, center, and east, the kingdoms of Azande , Luba , and Lunda ruled from the 16th and 17th centuries to the 19th century. King Leopold II of Belgium formally acquired rights to the Congo territory from the colonial nations of Europe in 1885 and declared the land his private property, naming it the Congo Free State . From 1885 to 1908, his colonial military forced the local population to produce rubber and committed widespread atrocities . In 1908, Leopold ceded the territory, which thus became a Belgian colony . Congo achieved independence from Belgium on 30 June 1960 and was immediately confronted by a series of secessionist movements , the assassination of Prime Minister Patrice Lumumba , and the seizure of power by Mobutu Sese Seko in a 1965 coup d'état . Mobutu renamed the country Zaire in 1971 and imposed a harsh personalist dictatorship until his overthrow in 1997 by the First Congo War . The country then had its name changed back and was confronted by the Second Congo War from 1998 to 2003, which resulted in the deaths of 5.4 million people. The war ended under President Joseph Kabila , who governed the country from 2001 to 2019, under whom human rights in the country remained poor and included frequent abuses such as forced disappearances , torture, arbitrary imprisonment and restrictions on civil liberties. Following the 2018 general election , in the country's first peaceful transition of power since independence, Kabila was succeeded as president by Félix Tshisekedi , who has served as president since. Since 2015, the Eastern DR Congo has been the site of an ongoing military conflict in Kivu . The Democratic Republic of the Congo is extremely rich in natural resources but has suffered from political instability, a lack of infrastructure, corruption, and centuries of both commercial and colonial extraction and exploitation, followed by more than 60 years of independence, with little widespread development. Besides the capital Kinshasa, the two next largest cities, Lubumbashi and Mbuji-Mayi , are both mining communities. The DRC's largest export is raw minerals, with China accepting over 50% of its exports in 2019. In 2021, DR Congo's level of human development was ranked 179th out of 191 countries by the Human Development Index and is classed as a least developed country by the UN . As of 2018 [ update ] , following two decades of various civil wars and continued internal conflicts , around 600,000 Congolese refugees were still living in neighbouring countries. Two million children risk starvation, and the fighting has displaced 4.5 million people. The country is a member of the United Nations , Non-Aligned Movement , African Union , COMESA , Southern African Development Community , Organisation Internationale de la Francophonie , and Economic Community of Central African States .The Democratic Republic of the Congo is named after the Congo River , which flows through the country. The Congo River is the world's deepest river and the world's third-largest river by discharge . The Comité d'études du haut Congo ("Committee for the Study of the Upper Congo"), established by King Leopold II of Belgium in 1876, and the International Association of the Congo , established by him in 1879, were also named after the river. The Congo River was named by early European sailors after the Kingdom of Kongo and its Bantu inhabitants, the Kongo people , when they encountered them in the 16th century. The word Kongo comes from the Kongo language (also called Kikongo ). According to American writer Samuel Henry Nelson: "It is probable that the word 'Kongo' itself implies a public gathering and that it is based on the root konga , 'to gather' (trans[itive])." The modern name of the Kongo people, Bakongo , was introduced in the early 20th century. [ citation needed ] The Democratic Republic of the Congo has been known in the past as, in chronological order, the Congo Free State , Belgian Congo , the Republic of the Congo-Léopoldville , the Democratic Republic of the Congo and the Republic of Zaire , before returning to its current name the Democratic Republic of the Congo. At the time of independence, the country was named the Republic of the Congo-Léopoldville to distinguish it from its neighbour the Republic of the Congo-Brazzaville . With the promulgation of the Luluabourg Constitution on 1 August 1964, the country became the DRC but was renamed Zaire (a past name for the Congo River) on 27 October 1971 by President Mobutu Sese Seko as part of his Authenticité initiative. The word Zaire is from a Portuguese adaptation of a Kikongo word nzadi ("river"), a truncation of nzadi o nzere ("river swallowing rivers"). The river was known as Zaire during the 16th and 17th centuries; Congo seems to have replaced Zaire gradually in English usage during the 18th century, and Congo is the preferred English name in 19th-century literature, although references to Zaire as the name used by the natives (i.e. derived from Portuguese usage) remained common. In 1992, the Sovereign National Conference voted to change the name of the country to the "Democratic Republic of the Congo", but the change was not made. The country's name was later restored by President Laurent-Désiré Kabila when he overthrew Mobutu in 1997. To distinguish it from the neighboring Republic of the Congo, it is sometimes referred to as Congo (Kinshasa) , Congo-Kinshasa , or Big Congo . Its name is sometimes also abbreviated as DR Congo , DRC , the DROC and RDC (in French). Before Bantu expansion , the territory comprising the Democratic Republic of the Congo was home to Central Africa's oldest settled groups, the Mbuti peoples . Most of the remnants of their hunter-gatherer culture remain in the present time. The geographical area now known as the Democratic Republic of the Congo was populated as early as 90,000 years ago, as shown by the 1988 discovery of the Semliki harpoon at Katanda , one of the oldest barbed harpoons ever found, believed to have been used to catch giant river catfish . Bantu peoples reached Central Africa at some point during the first millennium BC, then gradually started to expand southward. Their propagation was accelerated by the adoption of pastoralism and of Iron Age techniques. The people living in the south and southwest were foraging groups, whose technology involved only minimal use of metal technologies. The development of metal tools during this time period revolutionized agriculture. This led to the displacement of the hunter-gatherer groups in the east and southeast. The final wave of the Bantu expansion was complete by the 10th century, followed by the establishment of the Bantu kingdoms, whose rising populations soon made possible intricate local, regional and foreign commercial networks that traded mostly in slaves, salt, iron and copper. Belgian exploration and administration took place from the 1870s until the 1920s. It was first led by Henry Morton Stanley , who undertook his explorations under the sponsorship of King Leopold II of Belgium . The eastern regions of the precolonial Congo were heavily disrupted by constant slave raiding , mainly from Arab–Swahili slave traders such as the infamous Tippu Tip , who was well known to Stanley. Leopold had designs on what was to become the Congo as a colony. In a succession of negotiations, Leopold, professing humanitarian objectives in his capacity as chairman of the front organization Association Internationale Africaine , actually played one European rival against another. [ citation needed ] King Leopold formally acquired rights to the Congo territory at the Conference of Berlin in 1885 and made the land his private property. He named it the Congo Free State . Leopold's regime began various infrastructure projects, such as the construction of the railway that ran from the coast to the capital of Leopoldville (now Kinshasa), which took eight years to complete. In the Free State, colonists coerced the local population into producing rubber, for which the spread of automobiles and development of rubber tires created a growing international market. Rubber sales made a fortune for Leopold, who built several buildings in Brussels and Ostend to honor himself and his country. To enforce the rubber quotas, the Force Publique was called in and made the practice of cutting off the limbs of the natives a matter of policy. During 1885–1908, millions of Congolese died as a consequence of exploitation and disease. In some areas the population declined dramatically – it has been estimated that sleeping sickness and smallpox killed nearly half the population in the areas surrounding the lower Congo River. News of the abuses began to circulate. In 1904, the British consul at Boma in the Congo, Roger Casement , was instructed by the British government to investigate. His report, called the Casement Report , confirmed the accusations of humanitarian abuses. The Belgian Parliament forced Leopold II to set up an independent commission of inquiry. Its findings confirmed Casement's report of abuses, concluding that the population of the Congo had been "reduced by half" during this period. Determining precisely how many people died is impossible, as no accurate records exist. In 1908, the Belgian parliament, in spite of initial reluctance, bowed to international pressure (especially from the United Kingdom ) and took over the Free State from King Leopold II. On 18 October 1908, the Belgian parliament voted in favour of annexing the Congo as a Belgian colony. Executive power went to the Belgian minister of colonial affairs , assisted by a Colonial Council (Conseil Colonial) (both located in Brussels). The Belgian parliament exercised legislative authority over the Belgian Congo. In 1923 the colonial capital moved from Boma to Léopoldville, some 300 kilometres (190 mi) further upstream into the interior. The transition from the Congo Free State to the Belgian Congo was a break, but it also featured a large degree of continuity. The last governor-general of the Congo Free State, Baron Théophile Wahis , remained in office in the Belgian Congo and the majority of Leopold II's administration with him. Opening up the Congo and its natural and mineral riches to the Belgian economy remained the main motive for colonial expansion – however, other priorities, such as healthcare and basic education, slowly gained in importance. Colonial administrators ruled the territory and a dual legal system existed (a system of European courts and another one of indigenous courts, tribunaux indigènes ). Indigenous courts had only limited powers and remained under the firm control of the colonial administration. The Belgian authorities permitted no political activity in the Congo whatsoever, and the Force Publique put down any attempts at rebellion. The Belgian Congo was directly involved in the two world wars. During World War I (1914–1918), an initial stand-off between the Force Publique and the German colonial army in German East Africa turned into open warfare with a joint Anglo-Belgian-Portuguese invasion of German colonial territory in 1916 and 1917 during the East African campaign . The Force Publique gained a notable victory when it marched into Tabora in September 1916 under the command of General Charles Tombeur after heavy fighting. After 1918, Belgium was rewarded for the participation of the Force Publique in the East African campaign with a League of Nations mandate over the previously German colony of Ruanda-Urundi . During World War II , the Belgian Congo provided a crucial source of income for the Belgian government in exile in London, and the Force Publique again participated in Allied campaigns in Africa . Belgian Congolese forces under the command of Belgian officers notably fought against the Italian colonial army in Ethiopia in Asosa , Bortaï and Saïo under Major-General Auguste-Eduard Gilliaert . In May 1960, a growing nationalist movement, the Mouvement National Congolais led by Patrice Lumumba , won the parliamentary elections . Lumumba became the first Prime Minister of the Republic of the Congo, on 24 June 1960. The parliament elected Joseph Kasa-Vubu as president , of the Alliance des Bakongo ( ABAKO ) party. Other parties that emerged included the Parti Solidaire Africain led by Antoine Gizenga , and the Parti National du Peuple led by Albert Delvaux and Laurent Mbariko . The Belgian Congo achieved independence on 30 June 1960 under the name "République du Congo" ("Republic of Congo" or "Republic of the Congo" in English). As the neighboring French colony of Middle Congo ( Moyen Congo ) also chose the name "Republic of Congo" upon achieving its independence, the two countries were more commonly known as "Congo-Léopoldville" and "Congo-Brazzaville", after their capital cities. Shortly after independence the Force Publique mutinied, and on 11 July the province of Katanga (led by Moïse Tshombe ) and South Kasai engaged in secessionist struggles against the new leadership. Most of the 100,000 Europeans who had remained behind after independence fled the country, opening the way for Congolese to replace the European military and administrative elite. After the United Nations rejected Lumumba's call for help to put down the secessionist movements, Lumumba asked for assistance from the Soviet Union, who accepted and sent military supplies and advisers. On 23 August, the Congolese armed forces invaded South Kasai . Lumumba was dismissed from office on 5 September 1960 by Kasa-Vubu who publicly blamed him for massacres by the armed forces in South Kasai and for involving Soviets in the country. Lumumba declared Kasa-Vubu's action unconstitutional, and a crisis between the two leaders developed. On 14 September, Colonel Joseph Mobutu , with the backing of the US and Belgium, removed Lumumba from office. On 17 January 1961, Lumumba was handed over to Katangan authorities and executed by Belgian-led Katangan troops. A 2001 investigation by Belgium's Parliament found Belgium "morally responsible" for the murder of Lumumba, and the country has since officially apologised for its role in his death. On 18 September 1961, in ongoing negotiations of a ceasefire, a plane crash near Ndola resulted in the death of Dag Hammarskjöld , the Secretary-General of the United Nations , along with all 15 passengers, setting off a succession crisis. Amidst widespread confusion and chaos, a temporary government was led by technicians (the Collège des commissaires généraux ). Katangan secession ended in January 1963 with the assistance of UN forces . Several short-lived governments of Joseph Ileo , Cyrille Adoula , and Moise Kapenda Tshombe took over in quick succession. Meanwhile, in the east of the country, Soviet and Cuban-backed rebels called the Simbas rose up, taking a significant amount of territory and proclaiming a communist "People's Republic of the Congo" in Stanleyville. The Simbas were pushed out of Stanleyville in November 1964 during Operation Dragon Rouge , a military operation conducted by Belgian and American forces to rescue hundreds of hostages. Congolese government forces fully defeated the Simba rebels by November 1965. Lumumba had previously appointed Mobutu chief of staff of the new Congo army, Armée Nationale Congolaise . Taking advantage of the leadership crisis between Kasavubu and Tshombe, Mobutu garnered enough support within the army to launch a coup. A constitutional referendum the year before Mobutu's coup of 1965 resulted in the country's official name being changed to the "Democratic Republic of the Congo". In 1971 Mobutu changed the name again, this time to "Republic of Zaire". Mobutu had the staunch support of the United States because of his opposition to communism ; the U.S. believed that his administration would serve as an effective counter to communist movements in Africa. A single-party system was established, and Mobutu declared himself head of state . He periodically held elections in which he was the only candidate. Although relative peace and stability were achieved, Mobutu's government was guilty of severe human rights violations, political repression , a cult of personality and corruption . By late 1967 Mobutu had successfully neutralized his political opponents and rivals, either through co-opting them into his regime, arresting them, or rendering them otherwise politically impotent. Throughout the late 1960s, Mobutu continued to shuffle his governments and cycle officials in and out of the office to maintain control. Joseph Kasa-Vubu's death in April 1969 ensured that no person with First Republic credentials could challenge his rule. By the early 1970s, Mobutu was attempting to assert Zaire as a leading African nation. He traveled frequently across the continent while the government became more vocal about African issues, particularly those relating to the southern region. Zaire established semi-clientelist relationships with several smaller African states, especially Burundi, Chad, and Togo. Corruption became so common the term " le mal Zairois " or "Zairian sickness", meaning gross corruption, theft and mismanagement, was coined, reportedly by Mobutu. International aid, most often in the form of loans, enriched Mobutu while he allowed national infrastructure such as roads to deteriorate to as little as one-quarter of what had existed in 1960. Zaire became a kleptocracy as Mobutu and his associates embezzled government funds. In a campaign to identify himself with African nationalism, starting on 1 June 1966, Mobutu renamed the nation's cities: Léopoldville became Kinshasa (the country was known as Congo-Kinshasa), Stanleyville became Kisangani , Elisabethville became Lubumbashi , and Coquilhatville became Mbandaka . In 1971, Mobutu renamed the country the Republic of Zaire , its fourth name change in eleven years and its sixth overall. The Congo River was renamed the Zaire River. During the 1970s and 1980s, Mobutu was invited to visit the United States on several occasions, meeting with U.S. Presidents Richard Nixon , Ronald Reagan and George H. W. Bush . Following the dissolution of the Soviet Union U.S. relations with Mobutu cooled, as he was no longer deemed necessary as a Cold War ally. Opponents within Zaire stepped up demands for reform. This atmosphere contributed to Mobutu's declaring the Third Republic in 1990, whose constitution was supposed to pave the way for democratic reform. The reforms turned out to be largely cosmetic. Mobutu continued in power until armed forces forced him to flee in 1997. "From 1990 to 1993, the United States facilitated Mobutu's attempts to hijack political change", one academic wrote, and "also assisted the rebellion of Laurent-Desire Kabila that overthrew the Mobutu regime." In September 1997, Mobutu died in exile in Morocco. By 1996, following the Rwandan Civil War and genocide and the ascension of a Tutsi -led government in Rwanda, Rwandan Hutu militia forces ( Interahamwe ) fled to eastern Zaire and used refugee camps as bases for incursions against Rwanda. They allied with the Zairian Armed Forces to launch a campaign against Congolese ethnic Tutsis in eastern Zaire. A coalition of Rwandan and Ugandan armies invaded Zaire to overthrow the government of Mobutu, launching the First Congo War. The coalition allied with some opposition figures, led by Laurent-Désiré Kabila , becoming the Alliance of Democratic Forces for the Liberation of Congo . In 1997 Mobutu fled and Kabila marched into Kinshasa, naming himself as president and reverting the name of the country to the Democratic Republic of the Congo. Kabila later requested that foreign military forces return to their own countries. Rwandan troops retreated to Goma and launched a new Tutsi-led rebel military movement called the Rassemblement Congolais pour la Democratie to fight Kabila, while Uganda instigated the creation of a rebel movement called the Movement for the Liberation of the Congo , led by Congolese warlord Jean-Pierre Bemba . [ citation needed ] The two rebel movements, along with Rwandan and Ugandan troops, started the Second Congo War by attacking the DRC army in 1998. Angolan, Zimbabwean, and Namibian militaries entered the hostilities on the side of the government. Kabila was assassinated in 2001. His son Joseph Kabila succeeded him and called for multilateral peace talks. UN peacekeepers, MONUC, now known as MONUSCO , arrived in April 2001. In 2002–03 Bemba intervened in the Central African Republic on behalf of its former president, Ange-Félix Patassé . Talks led to a peace accord under which Kabila would share power with former rebels. By June 2003 all foreign armies except those of Rwanda had pulled out of Congo. A transitional government was set up until after the election. A constitution was approved by voters, and on 30 July 2006 DRC held its first multi-party elections . These were the first free national elections since 1960, which many believed would mark the end to violence in the region. However, an election-result dispute between Kabila and Bemba turned into a skirmish between their supporters in Kinshasa. MONUC took control of the city. A new election took place in October 2006, which Kabila won, and in December 2006 he was sworn in as president. Laurent Nkunda , a member of Rally for Congolese Democracy–Goma , defected along with troops loyal to him and formed the National Congress for the Defence of the People (CNDP), which began an armed rebellion against the government. In March 2009, after a deal between the DRC and Rwanda, Rwandan troops entered the DRC and arrested Nkunda and were allowed to pursue FDLR militants. The CNDP signed a peace treaty with the government in which it agreed to become a political party and to have its soldiers integrated into the national army in exchange for the release of its imprisoned members. In 2012 Bosco Ntaganda , the leader of the CNDP, and troops loyal to him, mutinied and formed the rebel military March 23 Movement (M23), claiming the government had violated the treaty. In the resulting M23 rebellion , M23 briefly captured the provincial capital of Goma in November 2012. Neighboring countries, particularly Rwanda, have been accused of arming rebels groups and using them as proxies to gain control of the resource-rich country, an accusation they deny. In March 2013, the United Nations Security Council authorized the United Nations Force Intervention Brigade to neutralize armed groups. On 5 November 2013, M23 declared an end to its insurgency. Additionally, in northern Katanga , the Mai-Mai created by Laurent Kabila slipped out of the control of Kinshasa with Gédéon Kyungu Mutanga 's Mai Mai Kata Katanga briefly invading the provincial capital of Lubumbashi in 2013 and 400,000 persons displaced in the province as of 2013 [ update ] . On and off fighting in the Ituri conflict occurred between the Nationalist and Integrationist Front and the Union of Congolese Patriots who claimed to represent the Lendu and Hema ethnic groups, respectively. In the northeast, Joseph Kony 's Lord's Resistance Army moved from their original bases in Uganda and South Sudan to DR Congo in 2005 and set up camps in the Garamba National Park . The war in the Congo has been described as the bloodiest war since World War II. In 2009, The New York Times reported that people in the Congo continued to die at a rate of an estimated 45,000 per month – estimates of the number who have died from the long conflict range from 900,000 to 5,400,000. The death toll is caused by widespread disease and famine; reports indicate that almost half of the individuals who have died are children under five years of age. There have been frequent reports of weapon bearers killing civilians, of the destruction of property, of widespread sexual violence, causing hundreds of thousands of people to flee their homes, and of other breaches of humanitarian and human rights law. One study found that more than 400,000 women are raped in the Democratic Republic of Congo every year. In 2018 and 2019, Congo reported the highest levels of sexual violence in the world. According to the Human Rights Watch and the New York University-based Congo Research Group, armed troops in DRC's eastern Kivu region have killed over 1,900 civilians and kidnapped at least 3,300 people since June 2017 to June 2019. On 10 May 2018, Congolese gynecologist Denis Mukwege was awarded the Nobel Peace Prize for his effort to end the use of sexual violence as a weapon of war and armed conflict . In 2015, major protests broke out across the country and protesters demanded that Kabila step down as president. The protests began after the passage of a law by the Congolese lower house that, if also passed by the Congolese upper house, would keep Kabila in power at least until a national census was conducted (a process which would likely take several years and therefore keep him in power past the planned 2016 elections, which he is constitutionally barred from participating in). This bill passed; however, it was gutted of the provision that would keep Kabila in power until a census took place. A census is supposed to take place, but it is no longer tied to when the elections take place. In 2015, elections were scheduled for late 2016 and a tenuous peace held in the Congo. On 27 November 2016 Congolese foreign minister Raymond Tshibanda told the press no elections would be held in 2016: "it has been decided that the voter registration operation will end on July 31, 2017, and that election will take place in April 2018." Protests broke out in the country on 20 December when Kabila's term in office ended. Across the country, dozens of protesters were killed and hundreds were arrested. According to Jan Egeland , presently Secretary-General of the Norwegian Refugee Council , the situation in the DRC became much worse in 2016 and 2017 and is a major moral and humanitarian challenge comparable to the wars in Syria and Yemen, which receive much more attention. Women and children are abused sexually and "abused in all possible manners". Besides the conflict in North Kivu , violence increased in the Kasai region . The armed groups were after gold, diamonds, oil, and cobalt to line the pockets of rich men both in the region and internationally. There were also ethnic and cultural rivalries at play, as well as religious motives and the political crisis with postponed elections. Egeland says people believe the situation in the DRC is "stably bad" but in fact, it has become much, much worse. "The big wars of the Congo that were really on top of the agenda 15 years ago are back and worsening". Disruption in planting and harvesting caused by the conflict was estimated to escalate starvation in about two million children. Human Rights Watch said in 2017 that Kabila recruited former March 23 Movement fighters to put down country-wide protests over his refusal to step down from office at the end of his term. "M23 fighters patrolled the streets of Congo's main cities, firing on or arresting protesters or anyone else deemed to be a threat to the president," they said. Fierce fighting has erupted in Masisi between government forces and a powerful local warlord, General Delta. The United Nations mission in the DRC is its largest and most expensive peacekeeping effort, but it shut down five UN bases near Masisi in 2017, after the U.S. led a push to cut costs. A tribal conflict erupted on 16–17 December 2018 at Yumbi in Mai-Ndombe Province . Nearly 900 Banunu people from four villages were slaughtered by members of the Batende community in a deep-rooted rivalry over monthly tribal duties, land, fields and water resources. Some 100 Banunus fled to Moniende island in the Congo River, and another 16,000 to Makotimpoko District in Republic of Congo. Military-style tactics were employed in the bloodbath, and some assailants were clothed in army uniforms. Local authorities and elements within the security forces were suspected of lending them support. On 30 December 2018 a general election was held. On 10 January 2019, the electoral commission announced opposition candidate Félix Tshisekedi as the winner of the presidential vote, and he was officially sworn in as president on 24 January. However, there were widespread suspicions that the results were rigged and that a deal had been made between Tshisekedi and Kabila. The Catholic Church said that the official results did not correspond to the information its election monitors had collected. The government had also "delayed" the vote until March in some areas, citing the Ebola outbreak in Kivu as well as the ongoing military conflict. This was criticized as these regions are known as opposition strongholds. In August 2019, six months after the inauguration of Félix Tshisekedi, a coalition government was announced. The political allies of Kabila maintained control of key ministries, the legislature, judiciary and security services. However, Tshisekedi succeeded in strengthening his hold on power. In a series of moves, he won over more legislators, gaining the support of almost 400 out of 500 members of the National Assembly. The pro-Kabila speakers of both houses of parliament were forced out. In April 2021, the new government was formed without the supporters of Kabila. A major measles outbreak in the country left nearly 5,000 dead in 2019. The Ebola outbreak ended in June 2020, which had caused 2,280 deaths over 2 years. Another, smaller Ebola outbreak in the Équateur Province began in June 2020, ultimately causing 55 deaths. The global COVID-19 pandemic also reached the DRC in March 2020, with a vaccination campaign beginning on 19 April 2021. The Italian ambassador to the DRC, Luca Attanasio , and his bodyguard were killed in North Kivu on 22 February 2021 . On 22 April 2021, meetings between Kenyan President Uhuru Kenyatta and Tshisekedi resulted in new agreements increasing international trade and security (counterterrorism, immigration, cyber security, and customs) between the two countries. In February 2022, allegations of a coup d'état in the country led to uncertainty, but the coup attempt failed. After the 2023 presidential election , Tshisekedi had a clear lead in his run for a second term. On 31 December 2023, officials said that President Felix Tshisekedi had been re-elected with 73% of the vote. Nine opposition candidates signed a declaration rejecting the election and called for a rerun. The geographical area now known as the Democratic Republic of the Congo was populated as early as 90,000 years ago, as shown by the 1988 discovery of the Semliki harpoon at Katanda , one of the oldest barbed harpoons ever found, believed to have been used to catch giant river catfish . Bantu peoples reached Central Africa at some point during the first millennium BC, then gradually started to expand southward. Their propagation was accelerated by the adoption of pastoralism and of Iron Age techniques. The people living in the south and southwest were foraging groups, whose technology involved only minimal use of metal technologies. The development of metal tools during this time period revolutionized agriculture. This led to the displacement of the hunter-gatherer groups in the east and southeast. The final wave of the Bantu expansion was complete by the 10th century, followed by the establishment of the Bantu kingdoms, whose rising populations soon made possible intricate local, regional and foreign commercial networks that traded mostly in slaves, salt, iron and copper.Belgian exploration and administration took place from the 1870s until the 1920s. It was first led by Henry Morton Stanley , who undertook his explorations under the sponsorship of King Leopold II of Belgium . The eastern regions of the precolonial Congo were heavily disrupted by constant slave raiding , mainly from Arab–Swahili slave traders such as the infamous Tippu Tip , who was well known to Stanley. Leopold had designs on what was to become the Congo as a colony. In a succession of negotiations, Leopold, professing humanitarian objectives in his capacity as chairman of the front organization Association Internationale Africaine , actually played one European rival against another. [ citation needed ] King Leopold formally acquired rights to the Congo territory at the Conference of Berlin in 1885 and made the land his private property. He named it the Congo Free State . Leopold's regime began various infrastructure projects, such as the construction of the railway that ran from the coast to the capital of Leopoldville (now Kinshasa), which took eight years to complete. In the Free State, colonists coerced the local population into producing rubber, for which the spread of automobiles and development of rubber tires created a growing international market. Rubber sales made a fortune for Leopold, who built several buildings in Brussels and Ostend to honor himself and his country. To enforce the rubber quotas, the Force Publique was called in and made the practice of cutting off the limbs of the natives a matter of policy. During 1885–1908, millions of Congolese died as a consequence of exploitation and disease. In some areas the population declined dramatically – it has been estimated that sleeping sickness and smallpox killed nearly half the population in the areas surrounding the lower Congo River. News of the abuses began to circulate. In 1904, the British consul at Boma in the Congo, Roger Casement , was instructed by the British government to investigate. His report, called the Casement Report , confirmed the accusations of humanitarian abuses. The Belgian Parliament forced Leopold II to set up an independent commission of inquiry. Its findings confirmed Casement's report of abuses, concluding that the population of the Congo had been "reduced by half" during this period. Determining precisely how many people died is impossible, as no accurate records exist.In 1908, the Belgian parliament, in spite of initial reluctance, bowed to international pressure (especially from the United Kingdom ) and took over the Free State from King Leopold II. On 18 October 1908, the Belgian parliament voted in favour of annexing the Congo as a Belgian colony. Executive power went to the Belgian minister of colonial affairs , assisted by a Colonial Council (Conseil Colonial) (both located in Brussels). The Belgian parliament exercised legislative authority over the Belgian Congo. In 1923 the colonial capital moved from Boma to Léopoldville, some 300 kilometres (190 mi) further upstream into the interior. The transition from the Congo Free State to the Belgian Congo was a break, but it also featured a large degree of continuity. The last governor-general of the Congo Free State, Baron Théophile Wahis , remained in office in the Belgian Congo and the majority of Leopold II's administration with him. Opening up the Congo and its natural and mineral riches to the Belgian economy remained the main motive for colonial expansion – however, other priorities, such as healthcare and basic education, slowly gained in importance. Colonial administrators ruled the territory and a dual legal system existed (a system of European courts and another one of indigenous courts, tribunaux indigènes ). Indigenous courts had only limited powers and remained under the firm control of the colonial administration. The Belgian authorities permitted no political activity in the Congo whatsoever, and the Force Publique put down any attempts at rebellion. The Belgian Congo was directly involved in the two world wars. During World War I (1914–1918), an initial stand-off between the Force Publique and the German colonial army in German East Africa turned into open warfare with a joint Anglo-Belgian-Portuguese invasion of German colonial territory in 1916 and 1917 during the East African campaign . The Force Publique gained a notable victory when it marched into Tabora in September 1916 under the command of General Charles Tombeur after heavy fighting. After 1918, Belgium was rewarded for the participation of the Force Publique in the East African campaign with a League of Nations mandate over the previously German colony of Ruanda-Urundi . During World War II , the Belgian Congo provided a crucial source of income for the Belgian government in exile in London, and the Force Publique again participated in Allied campaigns in Africa . Belgian Congolese forces under the command of Belgian officers notably fought against the Italian colonial army in Ethiopia in Asosa , Bortaï and Saïo under Major-General Auguste-Eduard Gilliaert . In May 1960, a growing nationalist movement, the Mouvement National Congolais led by Patrice Lumumba , won the parliamentary elections . Lumumba became the first Prime Minister of the Republic of the Congo, on 24 June 1960. The parliament elected Joseph Kasa-Vubu as president , of the Alliance des Bakongo ( ABAKO ) party. Other parties that emerged included the Parti Solidaire Africain led by Antoine Gizenga , and the Parti National du Peuple led by Albert Delvaux and Laurent Mbariko . The Belgian Congo achieved independence on 30 June 1960 under the name "République du Congo" ("Republic of Congo" or "Republic of the Congo" in English). As the neighboring French colony of Middle Congo ( Moyen Congo ) also chose the name "Republic of Congo" upon achieving its independence, the two countries were more commonly known as "Congo-Léopoldville" and "Congo-Brazzaville", after their capital cities. Shortly after independence the Force Publique mutinied, and on 11 July the province of Katanga (led by Moïse Tshombe ) and South Kasai engaged in secessionist struggles against the new leadership. Most of the 100,000 Europeans who had remained behind after independence fled the country, opening the way for Congolese to replace the European military and administrative elite. After the United Nations rejected Lumumba's call for help to put down the secessionist movements, Lumumba asked for assistance from the Soviet Union, who accepted and sent military supplies and advisers. On 23 August, the Congolese armed forces invaded South Kasai . Lumumba was dismissed from office on 5 September 1960 by Kasa-Vubu who publicly blamed him for massacres by the armed forces in South Kasai and for involving Soviets in the country. Lumumba declared Kasa-Vubu's action unconstitutional, and a crisis between the two leaders developed. On 14 September, Colonel Joseph Mobutu , with the backing of the US and Belgium, removed Lumumba from office. On 17 January 1961, Lumumba was handed over to Katangan authorities and executed by Belgian-led Katangan troops. A 2001 investigation by Belgium's Parliament found Belgium "morally responsible" for the murder of Lumumba, and the country has since officially apologised for its role in his death. On 18 September 1961, in ongoing negotiations of a ceasefire, a plane crash near Ndola resulted in the death of Dag Hammarskjöld , the Secretary-General of the United Nations , along with all 15 passengers, setting off a succession crisis. Amidst widespread confusion and chaos, a temporary government was led by technicians (the Collège des commissaires généraux ). Katangan secession ended in January 1963 with the assistance of UN forces . Several short-lived governments of Joseph Ileo , Cyrille Adoula , and Moise Kapenda Tshombe took over in quick succession. Meanwhile, in the east of the country, Soviet and Cuban-backed rebels called the Simbas rose up, taking a significant amount of territory and proclaiming a communist "People's Republic of the Congo" in Stanleyville. The Simbas were pushed out of Stanleyville in November 1964 during Operation Dragon Rouge , a military operation conducted by Belgian and American forces to rescue hundreds of hostages. Congolese government forces fully defeated the Simba rebels by November 1965. Lumumba had previously appointed Mobutu chief of staff of the new Congo army, Armée Nationale Congolaise . Taking advantage of the leadership crisis between Kasavubu and Tshombe, Mobutu garnered enough support within the army to launch a coup. A constitutional referendum the year before Mobutu's coup of 1965 resulted in the country's official name being changed to the "Democratic Republic of the Congo". In 1971 Mobutu changed the name again, this time to "Republic of Zaire". Mobutu had the staunch support of the United States because of his opposition to communism ; the U.S. believed that his administration would serve as an effective counter to communist movements in Africa. A single-party system was established, and Mobutu declared himself head of state . He periodically held elections in which he was the only candidate. Although relative peace and stability were achieved, Mobutu's government was guilty of severe human rights violations, political repression , a cult of personality and corruption . By late 1967 Mobutu had successfully neutralized his political opponents and rivals, either through co-opting them into his regime, arresting them, or rendering them otherwise politically impotent. Throughout the late 1960s, Mobutu continued to shuffle his governments and cycle officials in and out of the office to maintain control. Joseph Kasa-Vubu's death in April 1969 ensured that no person with First Republic credentials could challenge his rule. By the early 1970s, Mobutu was attempting to assert Zaire as a leading African nation. He traveled frequently across the continent while the government became more vocal about African issues, particularly those relating to the southern region. Zaire established semi-clientelist relationships with several smaller African states, especially Burundi, Chad, and Togo. Corruption became so common the term " le mal Zairois " or "Zairian sickness", meaning gross corruption, theft and mismanagement, was coined, reportedly by Mobutu. International aid, most often in the form of loans, enriched Mobutu while he allowed national infrastructure such as roads to deteriorate to as little as one-quarter of what had existed in 1960. Zaire became a kleptocracy as Mobutu and his associates embezzled government funds. In a campaign to identify himself with African nationalism, starting on 1 June 1966, Mobutu renamed the nation's cities: Léopoldville became Kinshasa (the country was known as Congo-Kinshasa), Stanleyville became Kisangani , Elisabethville became Lubumbashi , and Coquilhatville became Mbandaka . In 1971, Mobutu renamed the country the Republic of Zaire , its fourth name change in eleven years and its sixth overall. The Congo River was renamed the Zaire River. During the 1970s and 1980s, Mobutu was invited to visit the United States on several occasions, meeting with U.S. Presidents Richard Nixon , Ronald Reagan and George H. W. Bush . Following the dissolution of the Soviet Union U.S. relations with Mobutu cooled, as he was no longer deemed necessary as a Cold War ally. Opponents within Zaire stepped up demands for reform. This atmosphere contributed to Mobutu's declaring the Third Republic in 1990, whose constitution was supposed to pave the way for democratic reform. The reforms turned out to be largely cosmetic. Mobutu continued in power until armed forces forced him to flee in 1997. "From 1990 to 1993, the United States facilitated Mobutu's attempts to hijack political change", one academic wrote, and "also assisted the rebellion of Laurent-Desire Kabila that overthrew the Mobutu regime." In September 1997, Mobutu died in exile in Morocco. By 1996, following the Rwandan Civil War and genocide and the ascension of a Tutsi -led government in Rwanda, Rwandan Hutu militia forces ( Interahamwe ) fled to eastern Zaire and used refugee camps as bases for incursions against Rwanda. They allied with the Zairian Armed Forces to launch a campaign against Congolese ethnic Tutsis in eastern Zaire. A coalition of Rwandan and Ugandan armies invaded Zaire to overthrow the government of Mobutu, launching the First Congo War. The coalition allied with some opposition figures, led by Laurent-Désiré Kabila , becoming the Alliance of Democratic Forces for the Liberation of Congo . In 1997 Mobutu fled and Kabila marched into Kinshasa, naming himself as president and reverting the name of the country to the Democratic Republic of the Congo. Kabila later requested that foreign military forces return to their own countries. Rwandan troops retreated to Goma and launched a new Tutsi-led rebel military movement called the Rassemblement Congolais pour la Democratie to fight Kabila, while Uganda instigated the creation of a rebel movement called the Movement for the Liberation of the Congo , led by Congolese warlord Jean-Pierre Bemba . [ citation needed ] The two rebel movements, along with Rwandan and Ugandan troops, started the Second Congo War by attacking the DRC army in 1998. Angolan, Zimbabwean, and Namibian militaries entered the hostilities on the side of the government. Kabila was assassinated in 2001. His son Joseph Kabila succeeded him and called for multilateral peace talks. UN peacekeepers, MONUC, now known as MONUSCO , arrived in April 2001. In 2002–03 Bemba intervened in the Central African Republic on behalf of its former president, Ange-Félix Patassé . Talks led to a peace accord under which Kabila would share power with former rebels. By June 2003 all foreign armies except those of Rwanda had pulled out of Congo. A transitional government was set up until after the election. A constitution was approved by voters, and on 30 July 2006 DRC held its first multi-party elections . These were the first free national elections since 1960, which many believed would mark the end to violence in the region. However, an election-result dispute between Kabila and Bemba turned into a skirmish between their supporters in Kinshasa. MONUC took control of the city. A new election took place in October 2006, which Kabila won, and in December 2006 he was sworn in as president.Laurent Nkunda , a member of Rally for Congolese Democracy–Goma , defected along with troops loyal to him and formed the National Congress for the Defence of the People (CNDP), which began an armed rebellion against the government. In March 2009, after a deal between the DRC and Rwanda, Rwandan troops entered the DRC and arrested Nkunda and were allowed to pursue FDLR militants. The CNDP signed a peace treaty with the government in which it agreed to become a political party and to have its soldiers integrated into the national army in exchange for the release of its imprisoned members. In 2012 Bosco Ntaganda , the leader of the CNDP, and troops loyal to him, mutinied and formed the rebel military March 23 Movement (M23), claiming the government had violated the treaty. In the resulting M23 rebellion , M23 briefly captured the provincial capital of Goma in November 2012. Neighboring countries, particularly Rwanda, have been accused of arming rebels groups and using them as proxies to gain control of the resource-rich country, an accusation they deny. In March 2013, the United Nations Security Council authorized the United Nations Force Intervention Brigade to neutralize armed groups. On 5 November 2013, M23 declared an end to its insurgency. Additionally, in northern Katanga , the Mai-Mai created by Laurent Kabila slipped out of the control of Kinshasa with Gédéon Kyungu Mutanga 's Mai Mai Kata Katanga briefly invading the provincial capital of Lubumbashi in 2013 and 400,000 persons displaced in the province as of 2013 [ update ] . On and off fighting in the Ituri conflict occurred between the Nationalist and Integrationist Front and the Union of Congolese Patriots who claimed to represent the Lendu and Hema ethnic groups, respectively. In the northeast, Joseph Kony 's Lord's Resistance Army moved from their original bases in Uganda and South Sudan to DR Congo in 2005 and set up camps in the Garamba National Park . The war in the Congo has been described as the bloodiest war since World War II. In 2009, The New York Times reported that people in the Congo continued to die at a rate of an estimated 45,000 per month – estimates of the number who have died from the long conflict range from 900,000 to 5,400,000. The death toll is caused by widespread disease and famine; reports indicate that almost half of the individuals who have died are children under five years of age. There have been frequent reports of weapon bearers killing civilians, of the destruction of property, of widespread sexual violence, causing hundreds of thousands of people to flee their homes, and of other breaches of humanitarian and human rights law. One study found that more than 400,000 women are raped in the Democratic Republic of Congo every year. In 2018 and 2019, Congo reported the highest levels of sexual violence in the world. According to the Human Rights Watch and the New York University-based Congo Research Group, armed troops in DRC's eastern Kivu region have killed over 1,900 civilians and kidnapped at least 3,300 people since June 2017 to June 2019. On 10 May 2018, Congolese gynecologist Denis Mukwege was awarded the Nobel Peace Prize for his effort to end the use of sexual violence as a weapon of war and armed conflict . In 2015, major protests broke out across the country and protesters demanded that Kabila step down as president. The protests began after the passage of a law by the Congolese lower house that, if also passed by the Congolese upper house, would keep Kabila in power at least until a national census was conducted (a process which would likely take several years and therefore keep him in power past the planned 2016 elections, which he is constitutionally barred from participating in). This bill passed; however, it was gutted of the provision that would keep Kabila in power until a census took place. A census is supposed to take place, but it is no longer tied to when the elections take place. In 2015, elections were scheduled for late 2016 and a tenuous peace held in the Congo. On 27 November 2016 Congolese foreign minister Raymond Tshibanda told the press no elections would be held in 2016: "it has been decided that the voter registration operation will end on July 31, 2017, and that election will take place in April 2018." Protests broke out in the country on 20 December when Kabila's term in office ended. Across the country, dozens of protesters were killed and hundreds were arrested. According to Jan Egeland , presently Secretary-General of the Norwegian Refugee Council , the situation in the DRC became much worse in 2016 and 2017 and is a major moral and humanitarian challenge comparable to the wars in Syria and Yemen, which receive much more attention. Women and children are abused sexually and "abused in all possible manners". Besides the conflict in North Kivu , violence increased in the Kasai region . The armed groups were after gold, diamonds, oil, and cobalt to line the pockets of rich men both in the region and internationally. There were also ethnic and cultural rivalries at play, as well as religious motives and the political crisis with postponed elections. Egeland says people believe the situation in the DRC is "stably bad" but in fact, it has become much, much worse. "The big wars of the Congo that were really on top of the agenda 15 years ago are back and worsening". Disruption in planting and harvesting caused by the conflict was estimated to escalate starvation in about two million children. Human Rights Watch said in 2017 that Kabila recruited former March 23 Movement fighters to put down country-wide protests over his refusal to step down from office at the end of his term. "M23 fighters patrolled the streets of Congo's main cities, firing on or arresting protesters or anyone else deemed to be a threat to the president," they said. Fierce fighting has erupted in Masisi between government forces and a powerful local warlord, General Delta. The United Nations mission in the DRC is its largest and most expensive peacekeeping effort, but it shut down five UN bases near Masisi in 2017, after the U.S. led a push to cut costs. A tribal conflict erupted on 16–17 December 2018 at Yumbi in Mai-Ndombe Province . Nearly 900 Banunu people from four villages were slaughtered by members of the Batende community in a deep-rooted rivalry over monthly tribal duties, land, fields and water resources. Some 100 Banunus fled to Moniende island in the Congo River, and another 16,000 to Makotimpoko District in Republic of Congo. Military-style tactics were employed in the bloodbath, and some assailants were clothed in army uniforms. Local authorities and elements within the security forces were suspected of lending them support. On 30 December 2018 a general election was held. On 10 January 2019, the electoral commission announced opposition candidate Félix Tshisekedi as the winner of the presidential vote, and he was officially sworn in as president on 24 January. However, there were widespread suspicions that the results were rigged and that a deal had been made between Tshisekedi and Kabila. The Catholic Church said that the official results did not correspond to the information its election monitors had collected. The government had also "delayed" the vote until March in some areas, citing the Ebola outbreak in Kivu as well as the ongoing military conflict. This was criticized as these regions are known as opposition strongholds. In August 2019, six months after the inauguration of Félix Tshisekedi, a coalition government was announced. The political allies of Kabila maintained control of key ministries, the legislature, judiciary and security services. However, Tshisekedi succeeded in strengthening his hold on power. In a series of moves, he won over more legislators, gaining the support of almost 400 out of 500 members of the National Assembly. The pro-Kabila speakers of both houses of parliament were forced out. In April 2021, the new government was formed without the supporters of Kabila. A major measles outbreak in the country left nearly 5,000 dead in 2019. The Ebola outbreak ended in June 2020, which had caused 2,280 deaths over 2 years. Another, smaller Ebola outbreak in the Équateur Province began in June 2020, ultimately causing 55 deaths. The global COVID-19 pandemic also reached the DRC in March 2020, with a vaccination campaign beginning on 19 April 2021. The Italian ambassador to the DRC, Luca Attanasio , and his bodyguard were killed in North Kivu on 22 February 2021 . On 22 April 2021, meetings between Kenyan President Uhuru Kenyatta and Tshisekedi resulted in new agreements increasing international trade and security (counterterrorism, immigration, cyber security, and customs) between the two countries. In February 2022, allegations of a coup d'état in the country led to uncertainty, but the coup attempt failed. After the 2023 presidential election , Tshisekedi had a clear lead in his run for a second term. On 31 December 2023, officials said that President Felix Tshisekedi had been re-elected with 73% of the vote. Nine opposition candidates signed a declaration rejecting the election and called for a rerun. The DRC is located in central sub-Saharan Africa , bordered to the northwest by the Republic of the Congo , to the north by the Central African Republic , to the northeast by South Sudan , to the east by Uganda , Rwanda and Burundi , and by Tanzania (across Lake Tanganyika), to the south and southeast by Zambia , to the southwest by Angola , and to the west by the South Atlantic Ocean and the Cabinda Province exclave of Angola . The country lies between latitudes 6°N and 14°S , and longitudes 12°E and 32°E . It straddles the Equator , with one-third to the north and two-thirds to the south. With an area of 2,345,408 square kilometres (905,567 sq mi) , it is the second-largest country in Africa by area, after Algeria. As a result of its equatorial location, the DRC experiences high precipitation and has the highest frequency of thunderstorms in the world. The annual rainfall can total upwards of 2,000 millimetres (80 in) in some places, and the area sustains the Congo rainforest , the second-largest rain forest in the world after the Amazon rainforest . This massive expanse of lush jungle covers most of the vast, low-lying central basin of the river, which slopes toward the Atlantic Ocean in the west. This area is surrounded by plateaus merging into savannas in the south and southwest, by mountainous terraces in the west, and dense grasslands extending beyond the Congo River in the north. The glaciated Rwenzori Mountains are found in the extreme eastern region. The tropical climate produced the Congo River system which dominates the region topographically along with the rainforest it flows through. The Congo Basin occupies nearly the entire country and an area of nearly 1,000,000 km 2 (390,000 sq mi) . The river and its tributaries form the backbone of Congolese economics and transportation. Major tributaries include the Kasai , Sangha , Ubangi , Ruzizi , Aruwimi , and Lulonga . The Congo River has the second-largest flow and the second-largest watershed of any river in the world (trailing the Amazon in both respects). The sources of the Congo River are in the Albertine Rift Mountains that flank the western branch of the East African Rift , as well as Lake Tanganyika and Lake Mweru . The river flows generally west from Kisangani just below Boyoma Falls , then gradually bends southwest, passing by Mbandaka , joining with the Ubangi River, and running into the Pool Malebo (Stanley Pool). Kinshasa and Brazzaville are on opposite sides of the river at the Pool. Then the river narrows and falls through a number of cataracts in deep canyons, collectively known as the Livingstone Falls , and runs past Boma into the Atlantic Ocean. The river and a 37-kilometre-wide (23 mi) strip of coastline on its north bank provide the country's only outlet to the Atlantic. The Albertine Rift plays a key role in shaping the Congo's geography. Not only is the northeastern section of the country much more mountainous, but tectonic movement results in volcanic activity, occasionally with loss of life. The geologic activity in this area also created the African Great Lakes , four of which lie on the Congo's eastern frontier: Lake Albert , Lake Kivu , Lake Edward , and Lake Tanganyika . The rift valley has exposed an enormous amount of mineral wealth throughout the south and east of the Congo, making it accessible to mining. Cobalt , copper, cadmium , industrial and gem-quality diamonds , gold, silver, zinc , manganese , tin , germanium , uranium , radium , bauxite , iron ore, and coal are all found in plentiful supply, especially in the Congo's southeastern Katanga region. On 17 January 2002, Mount Nyiragongo erupted , with three streams of extremely fluid lava running out at 64 km/h (40 mph) and 46 m (50 yd) wide. One of the three streams flowed directly through Goma, killing 45 people and leaving 120,000 homeless. Over 400,000 people were evacuated from the city during the eruption. The lava flowed into and poisoned the water of Lake Kivu killing its plants, animals and fish. Only two planes left the local airport because of the possibility of the explosion of stored petrol. The lava flowed through and past the airport, destroying a runway and trapping several parked airplanes. Six months after the event, nearby Mount Nyamuragira also erupted. The mountain subsequently erupted again in 2006, and once again in January 2010. The rainforests of the Democratic Republic of the Congo contain great biodiversity , including many rare and endemic species, such as the common chimpanzee and the bonobo (or pygmy chimpanzee), the African forest elephant , mountain gorilla , okapi , forest buffalo , leopard and, further south in the country, the southern white rhinoceros . Five of the country's national parks are listed as World Heritage Sites : the Garumba , Kahuzi-Biega , Salonga and Virunga National Parks , and the Okapi Wildlife Reserve . The Democratic Republic of the Congo is one of 17 Megadiverse countries and is the most biodiverse African country. Conservationists have particularly worried about primates . The Congo is inhabited by several great ape species: the common chimpanzee ( Pan troglodytes ), the bonobo ( Pan paniscus ), the eastern gorilla ( Gorilla beringei ), and possibly a population of the western gorilla ( Gorilla gorilla ). It is the only country in the world in which bonobos are found in the wild. Much concern has been raised about great ape extinction. Because of hunting and habitat destruction, the numbers of chimpanzee, bonobo and gorilla (each of whose populations once numbered in the millions) have now dwindled down to only about 200,000 gorillas, 100,000 chimpanzees and possibly only about 10,000 bonobos. The gorillas, chimpanzee, bonobo, and okapi are all classified as endangered by the World Conservation Union . Major environmental issues in DRC include deforestation , poaching , which threatens wildlife populations, water pollution and mining. From 2015 to 2019, the rate of deforestation in the Democratic Republic of the Congo doubled. In 2021, deforestation of the Congolian rainforests increased by 5%. The rainforests of the Democratic Republic of the Congo contain great biodiversity , including many rare and endemic species, such as the common chimpanzee and the bonobo (or pygmy chimpanzee), the African forest elephant , mountain gorilla , okapi , forest buffalo , leopard and, further south in the country, the southern white rhinoceros . Five of the country's national parks are listed as World Heritage Sites : the Garumba , Kahuzi-Biega , Salonga and Virunga National Parks , and the Okapi Wildlife Reserve . The Democratic Republic of the Congo is one of 17 Megadiverse countries and is the most biodiverse African country. Conservationists have particularly worried about primates . The Congo is inhabited by several great ape species: the common chimpanzee ( Pan troglodytes ), the bonobo ( Pan paniscus ), the eastern gorilla ( Gorilla beringei ), and possibly a population of the western gorilla ( Gorilla gorilla ). It is the only country in the world in which bonobos are found in the wild. Much concern has been raised about great ape extinction. Because of hunting and habitat destruction, the numbers of chimpanzee, bonobo and gorilla (each of whose populations once numbered in the millions) have now dwindled down to only about 200,000 gorillas, 100,000 chimpanzees and possibly only about 10,000 bonobos. The gorillas, chimpanzee, bonobo, and okapi are all classified as endangered by the World Conservation Union . Major environmental issues in DRC include deforestation , poaching , which threatens wildlife populations, water pollution and mining. From 2015 to 2019, the rate of deforestation in the Democratic Republic of the Congo doubled. In 2021, deforestation of the Congolian rainforests increased by 5%. The country is currently divided into the city-province of Kinshasa and 25 other provinces . The provinces are subdivided into 145 territories and 32 cities. Before 2015, the country had 11 provinces. After a four-year interlude between two constitutions, with new political institutions established at the various levels of government, as well as new administrative divisions for the provinces throughout the country, a new constitution came into effect in 2006 and politics in the Democratic Republic of the Congo finally settled into a stable presidential democratic republic . The 2003 transitional constitution had established a parliament with a bicameral legislature, consisting of a Senate and a National Assembly . The Senate had, among other things, the charge of drafting the new constitution of the country. The executive branch was vested in a 60-member cabinet, headed by a President and four vice presidents. The President was also the Commander-in-Chief of the armed forces. The transitional constitution also established a relatively independent judiciary, headed by a Supreme Court with constitutional interpretation powers. The 2006 constitution, also known as the Constitution of the Third Republic, came into effect in February 2006. It had concurrent authority, however, with the transitional constitution until the inauguration of the elected officials who emerged from the July 2006 elections. Under the new constitution, the legislature remained bicameral; the executive was concomitantly undertaken by a President and the government, led by a Prime Minister, appointed from the party able to secure a majority in the National Assembly. The government – not the President – is responsible to the Parliament. The new constitution also granted new powers to the provincial governments, creating provincial parliaments which have oversight of the Governor and the head of the provincial government, whom they elect. The new constitution also saw the disappearance of the Supreme Court, which was divided into three new institutions. The constitutional interpretation prerogative of the Supreme Court is now held by the Constitutional Court . Although located in the Central African UN subregion , the nation is also economically and regionally affiliated with Southern Africa as a member of the Southern African Development Community (SADC). The global growth in demand for scarce raw materials and the industrial surges in China, India, Russia, Brazil and other developing countries require that developed countries employ new, integrated and responsive strategies for identifying and ensuring, on a continual basis, an adequate supply of strategic and critical materials required for their security needs. Highlighting the DR Congo's importance to United States national security, the effort to establish an elite Congolese unit is the latest push by the U.S. to professionalize armed forces in this strategically important region. There are economic and strategic incentives to bring more security to the Congo, which is rich in natural resources such as cobalt , a strategic and critical metal used in many industrial and military applications. The largest use of cobalt is in superalloys , used to make jet engine parts. Cobalt is also used in magnetic alloys and in cutting and wear-resistant materials such as cemented carbides . The chemical industry consumes significant quantities of cobalt in a variety of applications including catalysts for petroleum and chemical processing; drying agents for paints and inks; ground coats for porcelain enamels; decolorant for ceramics and glass; and pigments for ceramics, paints, and plastics. The country possesses 80% of the world's cobalt reserves. It is thought that due to the importance of cobalt for batteries for electric vehicles and stabilization of electric grids with large proportions of intermittent renewables in the electricity mix, the DRC could become an object of increased geopolitical competition. In the 21st century, Chinese investment in the DRC and Congolese exports to China have grown rapidly. In July 2019, UN ambassadors of 37 countries, including DRC, have signed a joint letter to the UNHRC defending China's treatment of Uyghurs and other Muslim ethnic minorities. In 2021, President Félix Tshisekedi called for a review of mining contracts signed with China by his predecessor Joseph Kabila , in particular the Sicomines multibillion 'minerals-for-infrastructure' deal . The military of the Democratic Republic of the Congo, known as the FARDC , consists of the Land Forces , the Air Force , and the Navy . The FARDC was established in 2003 after the end of the Second Congo War and integrated many former rebel groups into its ranks. Due to the presence of undisciplined and poorly trained ex-rebels, as well as a lack of funding and having spent years fighting against different militias, the FARDC suffers from rampant corruption and inefficiency. The agreements signed at the end of the Second Congo War called for a new "national, restructured and integrated" army that would be made up of Kabila's government forces (the FAC), the RCD, and the MLC. Also stipulated was that rebels like the RCD-N, RCD-ML, and the Mai-Mai would become part of the new armed forces. It also provided for the creation of a Conseil Supérieur de la Défense (Superior Defence Council) which would declare states of siege or war and give advice on security sector reform, disarmament/demobilisation, and national defence policy. The FARDC is organised on the basis of brigades, which are dispersed throughout the provinces of the Democratic Republic of the Congo . Congolese troops have been fighting the Kivu conflict in the eastern North Kivu region, the Ituri conflict in the Ituri region, and other rebellions since the Second Congo War. Besides the FARDC, the largest peacekeeping mission of the United Nations , known as MONUSCO , is also present in the country with about 18,000 peacekeepers. The Democratic Republic of Congo signed the UN treaty on the Prohibition of Nuclear Weapons . A relative of Mobutu explained how the government illicitly collected revenue during his rule: "Mobutu would ask one of us to go to the bank and take out a million. We'd go to an intermediary and tell him to get five million. He would go to the bank with Mobutu's authority and take out ten. Mobutu got one, and we took the other nine." Mobutu institutionalized corruption to prevent political rivals from challenging his control, leading to an economic collapse in 1996 . Mobutu allegedly amassed between US$50 million and $125 million during his rule. He was not the first corrupt Congolese leader by any means: "Government as a system of organized theft goes back to King Leopold II," noted Adam Hochschild in 2009. In July 2009, a Swiss court determined that the statute of limitations had run out on an international asset recovery case of about $6.7 million of deposits of Mobutu's in a Swiss bank, and therefore the assets should be returned to Mobutu's family. President Kabila established the Commission of Repression of Economic Crimes upon his ascension to power in 2001. However, in 2016 the Enough Project issued a report claiming that the Congo is run as a violent kleptocracy . In June 2020, a court in the Democratic Republic of Congo found President Tshisekedi's chief of staff Vital Kamerhe guilty of corruption. He was sentenced to 20 years' hard labour, after facing charges of embezzling almost $50m (£39m) of public funds. He was the most high-profile figure to be convicted of corruption in the DRC. However, Kamerhe was released already in December 2021. In November 2021, a judicial investigation targeting Kabila and his associates was opened in Kinshasa after revelations of alleged embezzlement of $138 million. The International Criminal Court investigation in the Democratic Republic of the Congo was initiated by Kabila in April 2004. The International Criminal Court prosecutor opened the case in June 2004. Child soldiers have been used on a large scale in DRC, and in 2011 it was estimated that 30,000 children were still operating with armed groups. Instances of child labor and forced labor have been observed and reported in the U.S. Department of Labor 's Findings on the Worst Forms of Child Labor in the DRC in 2013 and six goods produced by the country's mining industry appear on the department's December 2014 List of Goods Produced by Child Labor or Forced Labor . The Democratic Republic of the Congo has prohibited same-sex marriage since 2006, and attitudes towards the LGBT community are generally negative throughout the nation. Violence against women seems to be perceived by large sectors of society to be normal. The 2013–2014 DHS survey (pp. 299) found that 74.8% of women agreed that a husband is justified in beating his wife in certain circumstances. The United Nations Committee on the Elimination of Discrimination against Women in 2006 expressed concern that in the post-war transition period, the promotion of women's human rights and gender equality is not seen as a priority. Mass rapes, sexual violence and sexual slavery are used as a weapon of war by the Armed Forces of the Democratic Republic of the Congo and armed groups in the eastern part of the country. The eastern part of the country in particular has been described as the "rape capital of the world" and the prevalence of sexual violence there described as the worst in the world. Female genital mutilation (FGM) is also practiced in DRC, although not on a large scale. The prevalence of FGM is estimated at 5% of women. FGM is illegal: the law imposes a penalty of two to five years of prison and a fine of 200,000 Congolese francs on any person who violates the "physical or functional integrity" of the genital organs. In July 2007, the International Committee of the Red Cross expressed concern about the situation in eastern DRC. A phenomenon of "pendulum displacement" has developed, where people hasten at night to safety. According to Yakin Ertürk, the UN Special Rapporteur on Violence against Women who toured eastern Congo in July 2007, violence against women in North and South Kivu included "unimaginable brutality". Ertürk added that "Armed groups attack local communities, loot, rape, kidnap women and children, and make them work as sexual slaves". In December 2008, GuardianFilms of The Guardian released a film documenting the testimony of over 400 women and girls who had been abused by marauding militia. In June 2010, Oxfam reported a dramatic increase in the number of rapes in the Democratic Republic of the Congo, and researchers from Harvard discovered that rapes committed by civilians had increased seventeenfold. In June 2014, Freedom from Torture published reported rape and sexual violence being used routinely by state officials in Congolese prisons as punishment for politically active women. The women included in the report were abused in several locations across the country including the capital Kinshasa and other areas away from the conflict zones. In 2015, figures both inside and outside of the country, such as Filimbi and Emmanuel Weyi, spoke out about the need to curb violence and instability as the 2016 elections approached. The Congolese National Police are the primary police force in the Democratic Republic of the Congo. The global growth in demand for scarce raw materials and the industrial surges in China, India, Russia, Brazil and other developing countries require that developed countries employ new, integrated and responsive strategies for identifying and ensuring, on a continual basis, an adequate supply of strategic and critical materials required for their security needs. Highlighting the DR Congo's importance to United States national security, the effort to establish an elite Congolese unit is the latest push by the U.S. to professionalize armed forces in this strategically important region. There are economic and strategic incentives to bring more security to the Congo, which is rich in natural resources such as cobalt , a strategic and critical metal used in many industrial and military applications. The largest use of cobalt is in superalloys , used to make jet engine parts. Cobalt is also used in magnetic alloys and in cutting and wear-resistant materials such as cemented carbides . The chemical industry consumes significant quantities of cobalt in a variety of applications including catalysts for petroleum and chemical processing; drying agents for paints and inks; ground coats for porcelain enamels; decolorant for ceramics and glass; and pigments for ceramics, paints, and plastics. The country possesses 80% of the world's cobalt reserves. It is thought that due to the importance of cobalt for batteries for electric vehicles and stabilization of electric grids with large proportions of intermittent renewables in the electricity mix, the DRC could become an object of increased geopolitical competition. In the 21st century, Chinese investment in the DRC and Congolese exports to China have grown rapidly. In July 2019, UN ambassadors of 37 countries, including DRC, have signed a joint letter to the UNHRC defending China's treatment of Uyghurs and other Muslim ethnic minorities. In 2021, President Félix Tshisekedi called for a review of mining contracts signed with China by his predecessor Joseph Kabila , in particular the Sicomines multibillion 'minerals-for-infrastructure' deal . The military of the Democratic Republic of the Congo, known as the FARDC , consists of the Land Forces , the Air Force , and the Navy . The FARDC was established in 2003 after the end of the Second Congo War and integrated many former rebel groups into its ranks. Due to the presence of undisciplined and poorly trained ex-rebels, as well as a lack of funding and having spent years fighting against different militias, the FARDC suffers from rampant corruption and inefficiency. The agreements signed at the end of the Second Congo War called for a new "national, restructured and integrated" army that would be made up of Kabila's government forces (the FAC), the RCD, and the MLC. Also stipulated was that rebels like the RCD-N, RCD-ML, and the Mai-Mai would become part of the new armed forces. It also provided for the creation of a Conseil Supérieur de la Défense (Superior Defence Council) which would declare states of siege or war and give advice on security sector reform, disarmament/demobilisation, and national defence policy. The FARDC is organised on the basis of brigades, which are dispersed throughout the provinces of the Democratic Republic of the Congo . Congolese troops have been fighting the Kivu conflict in the eastern North Kivu region, the Ituri conflict in the Ituri region, and other rebellions since the Second Congo War. Besides the FARDC, the largest peacekeeping mission of the United Nations , known as MONUSCO , is also present in the country with about 18,000 peacekeepers. The Democratic Republic of Congo signed the UN treaty on the Prohibition of Nuclear Weapons . A relative of Mobutu explained how the government illicitly collected revenue during his rule: "Mobutu would ask one of us to go to the bank and take out a million. We'd go to an intermediary and tell him to get five million. He would go to the bank with Mobutu's authority and take out ten. Mobutu got one, and we took the other nine." Mobutu institutionalized corruption to prevent political rivals from challenging his control, leading to an economic collapse in 1996 . Mobutu allegedly amassed between US$50 million and $125 million during his rule. He was not the first corrupt Congolese leader by any means: "Government as a system of organized theft goes back to King Leopold II," noted Adam Hochschild in 2009. In July 2009, a Swiss court determined that the statute of limitations had run out on an international asset recovery case of about $6.7 million of deposits of Mobutu's in a Swiss bank, and therefore the assets should be returned to Mobutu's family. President Kabila established the Commission of Repression of Economic Crimes upon his ascension to power in 2001. However, in 2016 the Enough Project issued a report claiming that the Congo is run as a violent kleptocracy . In June 2020, a court in the Democratic Republic of Congo found President Tshisekedi's chief of staff Vital Kamerhe guilty of corruption. He was sentenced to 20 years' hard labour, after facing charges of embezzling almost $50m (£39m) of public funds. He was the most high-profile figure to be convicted of corruption in the DRC. However, Kamerhe was released already in December 2021. In November 2021, a judicial investigation targeting Kabila and his associates was opened in Kinshasa after revelations of alleged embezzlement of $138 million. The International Criminal Court investigation in the Democratic Republic of the Congo was initiated by Kabila in April 2004. The International Criminal Court prosecutor opened the case in June 2004. Child soldiers have been used on a large scale in DRC, and in 2011 it was estimated that 30,000 children were still operating with armed groups. Instances of child labor and forced labor have been observed and reported in the U.S. Department of Labor 's Findings on the Worst Forms of Child Labor in the DRC in 2013 and six goods produced by the country's mining industry appear on the department's December 2014 List of Goods Produced by Child Labor or Forced Labor . The Democratic Republic of the Congo has prohibited same-sex marriage since 2006, and attitudes towards the LGBT community are generally negative throughout the nation. Violence against women seems to be perceived by large sectors of society to be normal. The 2013–2014 DHS survey (pp. 299) found that 74.8% of women agreed that a husband is justified in beating his wife in certain circumstances. The United Nations Committee on the Elimination of Discrimination against Women in 2006 expressed concern that in the post-war transition period, the promotion of women's human rights and gender equality is not seen as a priority. Mass rapes, sexual violence and sexual slavery are used as a weapon of war by the Armed Forces of the Democratic Republic of the Congo and armed groups in the eastern part of the country. The eastern part of the country in particular has been described as the "rape capital of the world" and the prevalence of sexual violence there described as the worst in the world. Female genital mutilation (FGM) is also practiced in DRC, although not on a large scale. The prevalence of FGM is estimated at 5% of women. FGM is illegal: the law imposes a penalty of two to five years of prison and a fine of 200,000 Congolese francs on any person who violates the "physical or functional integrity" of the genital organs. In July 2007, the International Committee of the Red Cross expressed concern about the situation in eastern DRC. A phenomenon of "pendulum displacement" has developed, where people hasten at night to safety. According to Yakin Ertürk, the UN Special Rapporteur on Violence against Women who toured eastern Congo in July 2007, violence against women in North and South Kivu included "unimaginable brutality". Ertürk added that "Armed groups attack local communities, loot, rape, kidnap women and children, and make them work as sexual slaves". In December 2008, GuardianFilms of The Guardian released a film documenting the testimony of over 400 women and girls who had been abused by marauding militia. In June 2010, Oxfam reported a dramatic increase in the number of rapes in the Democratic Republic of the Congo, and researchers from Harvard discovered that rapes committed by civilians had increased seventeenfold. In June 2014, Freedom from Torture published reported rape and sexual violence being used routinely by state officials in Congolese prisons as punishment for politically active women. The women included in the report were abused in several locations across the country including the capital Kinshasa and other areas away from the conflict zones. In 2015, figures both inside and outside of the country, such as Filimbi and Emmanuel Weyi, spoke out about the need to curb violence and instability as the 2016 elections approached. The Congolese National Police are the primary police force in the Democratic Republic of the Congo. The Central Bank of the Congo is responsible for developing and maintaining the Congolese franc , which serves as the primary form of currency in the Democratic Republic of the Congo. In 2007, The World Bank decided to grant the Democratic Republic of Congo up to $1.3 billion in assistance funds over the following three years. The Congolese government started negotiating membership in the Organization for the Harmonization of Business Law in Africa (OHADA), in 2009. The DRC is widely considered one of the world's richest countries in natural resources; its untapped deposits of raw minerals are estimated to be worth in excess of US$24 trillion. The DRC has 70% of the world's coltan , a third of its cobalt, more than 30% of its diamond reserves, and a tenth of its copper. Despite such vast mineral wealth, the economy of the Democratic Republic of the Congo has declined drastically since the mid-1980s. The DRC generated up to 70% of its export revenue from minerals in the 1970s and 1980s and was particularly hit when resource prices deteriorated at that time. By 2005, 90% of the DRC's revenues derived from its minerals. Congolese citizens are among the poorest people on Earth. In 2023, 60% of Congolese subsisted on less than $2.15 a day, and food-price inflation had reached 173%. DR Congo consistently has the lowest, or nearly the lowest, nominal GDP per capita in the world. The DRC is also one of the twenty lowest-ranked countries on the Corruption Perceptions Index . The DRC is the world's largest producer of cobalt ore, and a major producer of copper and diamonds. As of 2023, the country is estimated to possess around 70% of the world's cobalt production. Diamonds come from Kasaï Province in the west. By far the largest mines in the DRC are located in southern Katanga Province and are highly mechanized, with a capacity of several million tons per year of copper and cobalt ore, and refining capability for metal ore. The DRC is the second-largest diamond-producing nation in the world, [lower-alpha 4] and artisanal and small-scale miners account for most of its production. At independence in 1960, DRC was the second-most-industrialized country in Africa after South Africa; it boasted a thriving mining sector and a relatively productive agriculture sector. Foreign businesses have curtailed operations because of uncertainty about the outcome of long-term conflicts, lack of infrastructure, and the difficult operating environment. The wars intensified the impact of such basic problems as an uncertain legal framework, corruption, inflation, and lack of openness in government economic policy and financial operations. Conditions improved in late 2002, when a large portion of the invading foreign troops withdrew. A number of International Monetary Fund and World Bank missions met with the government to help it develop a coherent economic plan, and President Kabila began implementing reforms. Much economic activity still lies outside the GDP data. Through 2011 the DRC had the lowest Human Development Index of the 187 ranked countries. The economy of DRC relies heavily on mining. However, the smaller-scale economic activity from artisanal mining occurs in the informal sector and is not reflected in GDP data. A third of the DRC's diamonds are believed to be smuggled out of the country, making it difficult to quantify diamond production levels. In 2002, tin was discovered in the east of the country but to date has only been mined on a small scale. Smuggling of conflict minerals such as coltan and cassiterite , ores of tantalum and tin, respectively, helped to fuel the war in the eastern Congo. Katanga Mining Limited , a Swiss-owned company, owns the Luilu Metallurgical Plant, which has a capacity of 175,000 tonnes of copper and 8,000 tonnes of cobalt per year, making it the largest cobalt refinery in the world. After a major rehabilitation program, the company resumed copper production operations in December 2007 and cobalt production in May 2008. In April 2013, anti-corruption NGOs revealed that Congolese tax authorities had failed to account for $88 million from the mining sector, despite booming production and positive industrial performance. The missing funds date from 2010 and tax bodies should have paid them into the central bank. Later in 2013, the Extractive Industries Transparency Initiative suspended the country's candidacy for membership due to insufficient reporting, monitoring and independent audits, but in July 2013 the country improved its accounting and transparency practices to the point where the EITI gave the country full membership. In February 2018, global asset management firm AllianceBernstein defined the DRC as economically "the Saudi Arabia of the electric vehicle age," because of its cobalt resources, as essential to the lithium-ion batteries that drive electric vehicles . Ground transport in the Democratic Republic of Congo has always been difficult. The terrain and climate of the Congo Basin present serious barriers to road and rail construction, and the distances are enormous across this vast country. The DRC has more navigable rivers and moves more passengers and goods by boat and ferry than any other country in Africa, but air transport remains the only effective means of moving goods and people between many places within the country, especially in rural areas. Chronic economic mismanagement, political corruption and internal conflicts have led to long-term under-investment of infrastructure. [ citation needed ] Rail transportation is provided by the Congo Railroad Company ( Société nationale des chemins de fer du Congo ), the Office National des Transports Congo and the Office of the Uele Railways (Office des Chemins de fer des Ueles, CFU). The DRC has fewer all-weather paved highways than any country of its population and size in Africa — a total of 2,250 km (1,400 mi) , of which only 1,226 km (762 mi) is in good condition. To put this in perspective, the road distance across the country in any direction is more than 2,500 km (1,600 mi) (e.g. Matadi to Lubumbashi, 2,700 km (1,700 mi) by road). The figure of 2,250 km (1,400 mi) converts to 35 km (22 mi) of paved road per one million of population. Comparative figures for Zambia and Botswana are 721 km (448 mi) and 3,427 km (2,129 mi) , respectively. [lower-alpha 5] Three routes in the Trans-African Highway network pass through DR Congo: The DRC has thousands of kilometres of navigable waterways . Traditionally water transport has been the dominant means of moving around in approximately two-thirds of the country. As of February 2024 [ update ] , DR Congo had one major national airline ( Congo Airways ) that offered flights inside DR Congo. Congo Airways was based at Kinshasa's international airport . All air carriers certified by the DRC have been banned from European Union airports by the European Commission, because of inadequate safety standards. Several international airlines service Kinshasa's international airport and a few also offer international flights to Lubumbashi International Airport . Both coal and crude oil resources were mainly used domestically up to 2008. The DRC has the infrastructure for hydro-electricity from the Congo River at the Inga dams . The country also possesses 50% of Africa's forests and a river system that could provide hydro-electric power to the entire continent, according to a UN report on the country's strategic significance and its potential role as an economic power in central Africa. The generation and distribution of electricity are controlled by Société nationale d'électricité , but only 15% of the country has access to electricity. The DRC is a member of three electrical power pools. These are Southern African Power Pool, East African Power Pool, and Central African Power Pool. Because of abundant sunlight, the potential for solar development is very high in the DRC. There are already about 836 solar power systems in the DRC, with a total power of 83 MW, located in Équateur (167), Katanga (159), Nord-Kivu (170), the two Kasaï provinces (170), and Bas-Congo (170). Also, the 148 Caritas network system has a total power of 6.31 MW. The DRC is the world's largest producer of cobalt ore, and a major producer of copper and diamonds. As of 2023, the country is estimated to possess around 70% of the world's cobalt production. Diamonds come from Kasaï Province in the west. By far the largest mines in the DRC are located in southern Katanga Province and are highly mechanized, with a capacity of several million tons per year of copper and cobalt ore, and refining capability for metal ore. The DRC is the second-largest diamond-producing nation in the world, [lower-alpha 4] and artisanal and small-scale miners account for most of its production. At independence in 1960, DRC was the second-most-industrialized country in Africa after South Africa; it boasted a thriving mining sector and a relatively productive agriculture sector. Foreign businesses have curtailed operations because of uncertainty about the outcome of long-term conflicts, lack of infrastructure, and the difficult operating environment. The wars intensified the impact of such basic problems as an uncertain legal framework, corruption, inflation, and lack of openness in government economic policy and financial operations. Conditions improved in late 2002, when a large portion of the invading foreign troops withdrew. A number of International Monetary Fund and World Bank missions met with the government to help it develop a coherent economic plan, and President Kabila began implementing reforms. Much economic activity still lies outside the GDP data. Through 2011 the DRC had the lowest Human Development Index of the 187 ranked countries. The economy of DRC relies heavily on mining. However, the smaller-scale economic activity from artisanal mining occurs in the informal sector and is not reflected in GDP data. A third of the DRC's diamonds are believed to be smuggled out of the country, making it difficult to quantify diamond production levels. In 2002, tin was discovered in the east of the country but to date has only been mined on a small scale. Smuggling of conflict minerals such as coltan and cassiterite , ores of tantalum and tin, respectively, helped to fuel the war in the eastern Congo. Katanga Mining Limited , a Swiss-owned company, owns the Luilu Metallurgical Plant, which has a capacity of 175,000 tonnes of copper and 8,000 tonnes of cobalt per year, making it the largest cobalt refinery in the world. After a major rehabilitation program, the company resumed copper production operations in December 2007 and cobalt production in May 2008. In April 2013, anti-corruption NGOs revealed that Congolese tax authorities had failed to account for $88 million from the mining sector, despite booming production and positive industrial performance. The missing funds date from 2010 and tax bodies should have paid them into the central bank. Later in 2013, the Extractive Industries Transparency Initiative suspended the country's candidacy for membership due to insufficient reporting, monitoring and independent audits, but in July 2013 the country improved its accounting and transparency practices to the point where the EITI gave the country full membership. In February 2018, global asset management firm AllianceBernstein defined the DRC as economically "the Saudi Arabia of the electric vehicle age," because of its cobalt resources, as essential to the lithium-ion batteries that drive electric vehicles . Ground transport in the Democratic Republic of Congo has always been difficult. The terrain and climate of the Congo Basin present serious barriers to road and rail construction, and the distances are enormous across this vast country. The DRC has more navigable rivers and moves more passengers and goods by boat and ferry than any other country in Africa, but air transport remains the only effective means of moving goods and people between many places within the country, especially in rural areas. Chronic economic mismanagement, political corruption and internal conflicts have led to long-term under-investment of infrastructure. [ citation needed ] Rail transportation is provided by the Congo Railroad Company ( Société nationale des chemins de fer du Congo ), the Office National des Transports Congo and the Office of the Uele Railways (Office des Chemins de fer des Ueles, CFU). The DRC has fewer all-weather paved highways than any country of its population and size in Africa — a total of 2,250 km (1,400 mi) , of which only 1,226 km (762 mi) is in good condition. To put this in perspective, the road distance across the country in any direction is more than 2,500 km (1,600 mi) (e.g. Matadi to Lubumbashi, 2,700 km (1,700 mi) by road). The figure of 2,250 km (1,400 mi) converts to 35 km (22 mi) of paved road per one million of population. Comparative figures for Zambia and Botswana are 721 km (448 mi) and 3,427 km (2,129 mi) , respectively. [lower-alpha 5] Three routes in the Trans-African Highway network pass through DR Congo: The DRC has thousands of kilometres of navigable waterways . Traditionally water transport has been the dominant means of moving around in approximately two-thirds of the country. As of February 2024 [ update ] , DR Congo had one major national airline ( Congo Airways ) that offered flights inside DR Congo. Congo Airways was based at Kinshasa's international airport . All air carriers certified by the DRC have been banned from European Union airports by the European Commission, because of inadequate safety standards. Several international airlines service Kinshasa's international airport and a few also offer international flights to Lubumbashi International Airport .Both coal and crude oil resources were mainly used domestically up to 2008. The DRC has the infrastructure for hydro-electricity from the Congo River at the Inga dams . The country also possesses 50% of Africa's forests and a river system that could provide hydro-electric power to the entire continent, according to a UN report on the country's strategic significance and its potential role as an economic power in central Africa. The generation and distribution of electricity are controlled by Société nationale d'électricité , but only 15% of the country has access to electricity. The DRC is a member of three electrical power pools. These are Southern African Power Pool, East African Power Pool, and Central African Power Pool. Because of abundant sunlight, the potential for solar development is very high in the DRC. There are already about 836 solar power systems in the DRC, with a total power of 83 MW, located in Équateur (167), Katanga (159), Nord-Kivu (170), the two Kasaï provinces (170), and Bas-Congo (170). Also, the 148 Caritas network system has a total power of 6.31 MW. The CIA World Factbook estimated the population to be over 111 million as of 2023. Between 1950 and 2000, the country's population nearly quadrupled from 12.2 million to 46.9 million. French is the official language of the Democratic Republic of the Congo. It is culturally accepted as the lingua franca , facilitating communication among the many different ethnic groups of the Congo. According to a 2018 OIF report, 49 million Congolese people (51% of the population) could read and write in French. A 2021 survey found that 74% of the population could speak French, making it the most widely spoken language in the country. In Kinshasa, 67% of the population in 2014 could read and write French, and 68.5% could speak and understand it. Approximately 242 languages are spoken in the country, of which four have the status of national languages: Kituba (Kikongo), Lingala , Tshiluba , and Swahili . Although some limited number of people speak these as first languages, most of the population speak them as a second language, after the native language of their own ethnic group. Lingala was the official language of the Force Publique under Belgian colonial rule and remains to this day the predominant language of the armed forces. Since the recent rebellions, a good part of the army in the east also uses Swahili, where it competes to be the regional lingua franca. Under Belgian rule, the Belgians instituted teaching and use of the four national languages in primary schools, making it one of the few African nations to have had literacy in local languages during the European colonial period. This trend was reversed after independence, when French became the sole language of education at all levels. Since 1975, the four national languages have been reintroduced in the first two years of primary education, with French becoming the sole language of education from the third year onward, but in practice many primary schools in urban areas solely use French from the first year of school onward. Portuguese is taught in the Congolese schools as a foreign language. The lexical similarity and phonology with French makes Portuguese a relatively easy language for the people to learn. Most of the roughly 175,000 Portuguese speakers in the DRC are Angolan and Mozambican expatriates. Over 250 ethnic groups and 450 tribes (ethnic subgroups) populate the DRC. They are in the Bantu , Sudanic , Nilotic , Ubangian and Pygmy linguistic groups. Because of this diversity, there is no dominant ethnic group in Congo, however the following ethnic groups account for 51.5% of the population: In 2021 , the UN estimated the country's population to be 96 million, a rapid increase from 39.1 million in 1992 despite the ongoing war. As many as 250 ethnic groups have been identified and named. About 600,000 Pygmies live in the DRC. Christianity is the predominant religion of the DRC. A 2013–14 survey, conducted by the Demographic and Health Surveys Program in 2013–2014 indicated that Christians constituted 93.7% of the population (with Catholics making up 29.7%, Protestants 26.8%, and other Christians 37.2%). A new Christian religious movement, Kimbanguism , had the adherence of 2.8%, while Muslims made up 1%. Other recent estimates have found Christianity the majority religion, followed by 95.8% of the population according to a 2010 Pew Research Center estimate, while the CIA World Factbook reports this figure to be 95.9%. The proportion of followers of Islam is variously estimated from 1% to 12%. There are about 35 million Catholics in the country with six archdioceses and 41 dioceses . The impact of the Catholic Church is difficult to overestimate. Schatzberg has called it the country's "only truly national institution apart from the state." Its schools have educated over 60% of the nation's primary school students and more than 40% of its secondary students. The church owns and manages an extensive network of hospitals, schools, and clinics, as well as many diocesan economic enterprises, including farms, ranches, stores, and artisans' shops. [ citation needed ] Sixty-two Protestant denominations are federated under the umbrella of the Church of Christ in the Congo . It is often referred to as the Protestant Church , since it covers most of the DRC Protestants. With more than 25 million members, it constitutes one of the largest Protestant bodies in the world. Kimbanguism was seen as a threat to the colonial regime and was banned by the Belgians. Kimbanguism, officially "the church of Christ on Earth by the prophet Simon Kimbangu", has about three million members, primarily among the Bakongo of Kongo Central and Kinshasa. Islam has been present in the Democratic Republic of the Congo since the 18th century, when Arab traders from East Africa pushed into the interior for ivory- and slave-trading purposes. Today, Muslims constitute approximately 1% of the Congolese population according to the Pew Research Center . The majority are Sunni Muslims. [ citation needed ] The first members of the Bahá'í Faith to live in the country came from Uganda in 1953. Four years later the first local administrative council was elected. In 1970 the National Spiritual Assembly (national administrative council) was first elected. Though the religion was banned in the 1970s and 1980s, due to misrepresentations of foreign governments, the ban was lifted by the end of the 1980s. In 2012 plans were announced to build a national Bahá'í House of Worship in the country. [ citation needed ] Traditional religions embody such concepts as monotheism , animism , vitalism , spirit and ancestor worship , witchcraft , and sorcery and vary widely among ethnic groups. The syncretic sects often merge elements of Christianity with traditional beliefs and rituals and are not recognized by mainstream churches as part of Christianity. New variants of ancient beliefs have become widespread, led by US-inspired Pentecostal churches which have been in the forefront of witchcraft accusations, particularly against children and the elderly. [ clarification needed ] Children accused of witchcraft are sent away from homes and family, often to live on the street, which can lead to physical violence against these children. [ clarification needed ] There are charities supporting street children such as the Congo Children Trust . The Congo Children Trust 's flagship project is Kimbilio, which works to reunite street children in Lubumbashi . The usual term for these children is enfants sorciers (child witches) or enfants dits sorciers (children accused of witchcraft). Non-denominational church organizations have been formed to capitalize on this belief by charging exorbitant fees for exorcisms . Though recently outlawed, children have been subjected in these exorcisms to often-violent abuse at the hands of self-proclaimed prophets and priests. In 2014, the literacy rate for the population between the ages of 15 and 49 was estimated to be 75.9% (88.1% male and 63.8% female) according to a DHS nationwide survey. The education system is governed by three government ministries: the Ministère de l'Enseignement Primaire, Secondaire et Professionnel (MEPSP ), the Ministère de l'Enseignement Supérieur et Universitaire (MESU) and the Ministère des Affaires Sociales (MAS) . Primary education is not free nor compulsory, [ citation needed ] even though the Congolese constitution says it should be (Article 43 of the 2005 Congolese Constitution). As a result of the First and Second Congo Wars in the late 1990s—early 2000s, over 5.2 million children in the country did not receive any education. Since the end of the civil war, the situation has improved tremendously, with the number of children enrolled in primary schools rising from 5.5 million in 2002 to 16.8 million in 2018, and the number of children enrolled in secondary schools rising from 2.8 million in 2007 to 4.6 million in 2015 according to UNESCO . Actual school attendance has also improved greatly in recent years, with primary school net attendance estimated to be 82.4% in 2014 (82.4% of children ages 6–11 attended school; 83.4% for boys, 80.6% for girls). The hospitals in the Democratic Republic of the Congo (DRC) include the General Hospital of Kinshasa . The DRC has the world's second-highest rate of infant mortality (after Chad). In April 2011, through aid from Global Alliance for Vaccines , a new vaccine to prevent pneumococcal disease was introduced around Kinshasa. In 2012, it was estimated that about 1.1% of adults aged 15–49 were living with HIV/AIDS . Malaria and yellow fever are problems. In May 2019, the death toll from the Ebola outbreak in DRC surpassed 1,000. The incidence of yellow fever-related fatalities in DRC is relatively low. According to the World Health Organization's (WHO) report in 2021, only two individuals died due to yellow fever in DRC. According to the World Bank Group , in 2016, 26,529 people died on the roads in DRC due to traffic accidents. Maternal health is poor in DRC. According to 2010 estimates, DRC has the 17th highest maternal mortality rate in the world. According to UNICEF , 43.5% of children under five are stunted . United Nations emergency food relief agency warned that amid the escalating conflict and worsening situation following COVID-19 in the DRC, millions of lives were at risk as they could die of hunger. According to the data of the World Food Programme , in 2020 four in ten people in Congo lacked food security and about 15.6 million were facing a potential hunger crisis. Air pollution levels in the Democratic Republic of the Congo are very unhealthy. In 2020, annual average air pollution in the DRC stood at 34.2 µg/m³, which is almost 6.8 times the World Health Organization PM2.5 guideline (5 µg/m³: set in September 2021). These pollution levels are estimated to reduce the life expectancy of an average citizen of the DRC by almost 2.9 years. Currently, the DRC does not have a national ambient air quality standard. Given the often unstable situation in the country and the condition of state structures, it is extremely difficult to obtain reliable migration data. However, evidence suggests that DRC continues to be a destination country for immigrants, in spite of recent declines in their numbers. Immigration is very diverse in nature; refugees and asylum-seekers – products of the numerous and violent conflicts in the Great Lakes Region – constitute an important subset of the population. Additionally, the country's large mine operations attract migrant workers from Africa and beyond. There is also considerable migration for commercial activities from other African countries and the rest of the world, but these movements are not well studied. Transit migration towards South Africa and Europe also plays a role. Immigration to the DRC has decreased steadily over the past two decades, most likely as a result of the armed violence that the country has experienced. According to the International Organization for Migration , the number of immigrants in the DRC has fallen from just over one million in 1960, to 754,000 in 1990, to 480,000 in 2005, to an estimated 445,000 in 2010. Official figures are unavailable, partly due to the predominance of the informal economy in the DRC. Data are also lacking on irregular immigrants, however given neighbouring countries' ethnic links to DRC nationals, irregular migration is assumed to be a significant phenomenon. Figures for Congolese nationals abroad vary greatly depending on the source, from three to six million. This discrepancy is due to a lack of official, reliable data. Emigrants from the DRC are above all long-term emigrants, the majority of whom live in Africa and to a lesser extent in Europe; 79.7% and 15.3% respectively, according to estimated 2000 data. New destination countries include South Africa and various points en route to Europe. The DRC has produced a considerable number of refugees and asylum-seekers located in the region and beyond. These numbers peaked in 2004 when, according to UNHCR , there were more than 460,000 refugees from the DRC; in 2008, Congolese refugees numbered 367,995 in total, 68% of whom were living in other African countries. Since 2003, more than 400,000 Congolese migrants have been expelled from Angola . The CIA World Factbook estimated the population to be over 111 million as of 2023. Between 1950 and 2000, the country's population nearly quadrupled from 12.2 million to 46.9 million. French is the official language of the Democratic Republic of the Congo. It is culturally accepted as the lingua franca , facilitating communication among the many different ethnic groups of the Congo. According to a 2018 OIF report, 49 million Congolese people (51% of the population) could read and write in French. A 2021 survey found that 74% of the population could speak French, making it the most widely spoken language in the country. In Kinshasa, 67% of the population in 2014 could read and write French, and 68.5% could speak and understand it. Approximately 242 languages are spoken in the country, of which four have the status of national languages: Kituba (Kikongo), Lingala , Tshiluba , and Swahili . Although some limited number of people speak these as first languages, most of the population speak them as a second language, after the native language of their own ethnic group. Lingala was the official language of the Force Publique under Belgian colonial rule and remains to this day the predominant language of the armed forces. Since the recent rebellions, a good part of the army in the east also uses Swahili, where it competes to be the regional lingua franca. Under Belgian rule, the Belgians instituted teaching and use of the four national languages in primary schools, making it one of the few African nations to have had literacy in local languages during the European colonial period. This trend was reversed after independence, when French became the sole language of education at all levels. Since 1975, the four national languages have been reintroduced in the first two years of primary education, with French becoming the sole language of education from the third year onward, but in practice many primary schools in urban areas solely use French from the first year of school onward. Portuguese is taught in the Congolese schools as a foreign language. The lexical similarity and phonology with French makes Portuguese a relatively easy language for the people to learn. Most of the roughly 175,000 Portuguese speakers in the DRC are Angolan and Mozambican expatriates.Over 250 ethnic groups and 450 tribes (ethnic subgroups) populate the DRC. They are in the Bantu , Sudanic , Nilotic , Ubangian and Pygmy linguistic groups. Because of this diversity, there is no dominant ethnic group in Congo, however the following ethnic groups account for 51.5% of the population: In 2021 , the UN estimated the country's population to be 96 million, a rapid increase from 39.1 million in 1992 despite the ongoing war. As many as 250 ethnic groups have been identified and named. About 600,000 Pygmies live in the DRC. Christianity is the predominant religion of the DRC. A 2013–14 survey, conducted by the Demographic and Health Surveys Program in 2013–2014 indicated that Christians constituted 93.7% of the population (with Catholics making up 29.7%, Protestants 26.8%, and other Christians 37.2%). A new Christian religious movement, Kimbanguism , had the adherence of 2.8%, while Muslims made up 1%. Other recent estimates have found Christianity the majority religion, followed by 95.8% of the population according to a 2010 Pew Research Center estimate, while the CIA World Factbook reports this figure to be 95.9%. The proportion of followers of Islam is variously estimated from 1% to 12%. There are about 35 million Catholics in the country with six archdioceses and 41 dioceses . The impact of the Catholic Church is difficult to overestimate. Schatzberg has called it the country's "only truly national institution apart from the state." Its schools have educated over 60% of the nation's primary school students and more than 40% of its secondary students. The church owns and manages an extensive network of hospitals, schools, and clinics, as well as many diocesan economic enterprises, including farms, ranches, stores, and artisans' shops. [ citation needed ] Sixty-two Protestant denominations are federated under the umbrella of the Church of Christ in the Congo . It is often referred to as the Protestant Church , since it covers most of the DRC Protestants. With more than 25 million members, it constitutes one of the largest Protestant bodies in the world. Kimbanguism was seen as a threat to the colonial regime and was banned by the Belgians. Kimbanguism, officially "the church of Christ on Earth by the prophet Simon Kimbangu", has about three million members, primarily among the Bakongo of Kongo Central and Kinshasa. Islam has been present in the Democratic Republic of the Congo since the 18th century, when Arab traders from East Africa pushed into the interior for ivory- and slave-trading purposes. Today, Muslims constitute approximately 1% of the Congolese population according to the Pew Research Center . The majority are Sunni Muslims. [ citation needed ] The first members of the Bahá'í Faith to live in the country came from Uganda in 1953. Four years later the first local administrative council was elected. In 1970 the National Spiritual Assembly (national administrative council) was first elected. Though the religion was banned in the 1970s and 1980s, due to misrepresentations of foreign governments, the ban was lifted by the end of the 1980s. In 2012 plans were announced to build a national Bahá'í House of Worship in the country. [ citation needed ] Traditional religions embody such concepts as monotheism , animism , vitalism , spirit and ancestor worship , witchcraft , and sorcery and vary widely among ethnic groups. The syncretic sects often merge elements of Christianity with traditional beliefs and rituals and are not recognized by mainstream churches as part of Christianity. New variants of ancient beliefs have become widespread, led by US-inspired Pentecostal churches which have been in the forefront of witchcraft accusations, particularly against children and the elderly. [ clarification needed ] Children accused of witchcraft are sent away from homes and family, often to live on the street, which can lead to physical violence against these children. [ clarification needed ] There are charities supporting street children such as the Congo Children Trust . The Congo Children Trust 's flagship project is Kimbilio, which works to reunite street children in Lubumbashi . The usual term for these children is enfants sorciers (child witches) or enfants dits sorciers (children accused of witchcraft). Non-denominational church organizations have been formed to capitalize on this belief by charging exorbitant fees for exorcisms . Though recently outlawed, children have been subjected in these exorcisms to often-violent abuse at the hands of self-proclaimed prophets and priests. In 2014, the literacy rate for the population between the ages of 15 and 49 was estimated to be 75.9% (88.1% male and 63.8% female) according to a DHS nationwide survey. The education system is governed by three government ministries: the Ministère de l'Enseignement Primaire, Secondaire et Professionnel (MEPSP ), the Ministère de l'Enseignement Supérieur et Universitaire (MESU) and the Ministère des Affaires Sociales (MAS) . Primary education is not free nor compulsory, [ citation needed ] even though the Congolese constitution says it should be (Article 43 of the 2005 Congolese Constitution). As a result of the First and Second Congo Wars in the late 1990s—early 2000s, over 5.2 million children in the country did not receive any education. Since the end of the civil war, the situation has improved tremendously, with the number of children enrolled in primary schools rising from 5.5 million in 2002 to 16.8 million in 2018, and the number of children enrolled in secondary schools rising from 2.8 million in 2007 to 4.6 million in 2015 according to UNESCO . Actual school attendance has also improved greatly in recent years, with primary school net attendance estimated to be 82.4% in 2014 (82.4% of children ages 6–11 attended school; 83.4% for boys, 80.6% for girls). The hospitals in the Democratic Republic of the Congo (DRC) include the General Hospital of Kinshasa . The DRC has the world's second-highest rate of infant mortality (after Chad). In April 2011, through aid from Global Alliance for Vaccines , a new vaccine to prevent pneumococcal disease was introduced around Kinshasa. In 2012, it was estimated that about 1.1% of adults aged 15–49 were living with HIV/AIDS . Malaria and yellow fever are problems. In May 2019, the death toll from the Ebola outbreak in DRC surpassed 1,000. The incidence of yellow fever-related fatalities in DRC is relatively low. According to the World Health Organization's (WHO) report in 2021, only two individuals died due to yellow fever in DRC. According to the World Bank Group , in 2016, 26,529 people died on the roads in DRC due to traffic accidents. Maternal health is poor in DRC. According to 2010 estimates, DRC has the 17th highest maternal mortality rate in the world. According to UNICEF , 43.5% of children under five are stunted . United Nations emergency food relief agency warned that amid the escalating conflict and worsening situation following COVID-19 in the DRC, millions of lives were at risk as they could die of hunger. According to the data of the World Food Programme , in 2020 four in ten people in Congo lacked food security and about 15.6 million were facing a potential hunger crisis. Air pollution levels in the Democratic Republic of the Congo are very unhealthy. In 2020, annual average air pollution in the DRC stood at 34.2 µg/m³, which is almost 6.8 times the World Health Organization PM2.5 guideline (5 µg/m³: set in September 2021). These pollution levels are estimated to reduce the life expectancy of an average citizen of the DRC by almost 2.9 years. Currently, the DRC does not have a national ambient air quality standard. Given the often unstable situation in the country and the condition of state structures, it is extremely difficult to obtain reliable migration data. However, evidence suggests that DRC continues to be a destination country for immigrants, in spite of recent declines in their numbers. Immigration is very diverse in nature; refugees and asylum-seekers – products of the numerous and violent conflicts in the Great Lakes Region – constitute an important subset of the population. Additionally, the country's large mine operations attract migrant workers from Africa and beyond. There is also considerable migration for commercial activities from other African countries and the rest of the world, but these movements are not well studied. Transit migration towards South Africa and Europe also plays a role. Immigration to the DRC has decreased steadily over the past two decades, most likely as a result of the armed violence that the country has experienced. According to the International Organization for Migration , the number of immigrants in the DRC has fallen from just over one million in 1960, to 754,000 in 1990, to 480,000 in 2005, to an estimated 445,000 in 2010. Official figures are unavailable, partly due to the predominance of the informal economy in the DRC. Data are also lacking on irregular immigrants, however given neighbouring countries' ethnic links to DRC nationals, irregular migration is assumed to be a significant phenomenon. Figures for Congolese nationals abroad vary greatly depending on the source, from three to six million. This discrepancy is due to a lack of official, reliable data. Emigrants from the DRC are above all long-term emigrants, the majority of whom live in Africa and to a lesser extent in Europe; 79.7% and 15.3% respectively, according to estimated 2000 data. New destination countries include South Africa and various points en route to Europe. The DRC has produced a considerable number of refugees and asylum-seekers located in the region and beyond. These numbers peaked in 2004 when, according to UNHCR , there were more than 460,000 refugees from the DRC; in 2008, Congolese refugees numbered 367,995 in total, 68% of whom were living in other African countries. Since 2003, more than 400,000 Congolese migrants have been expelled from Angola . The culture reflects the diversity of its numerous ethnic groups and their differing ways of life throughout the country—from the mouth of the River Congo on the coast, upriver through the rainforest and savanna in its centre, to the more densely populated mountains in the far east. Since the late 19th century, traditional ways of life have undergone changes brought about by colonialism, the struggle for independence, the stagnation of the Mobutu era, and most recently, the First and Second Congo Wars. Despite these pressures, the customs and cultures of the Congo have retained much of their individuality. The country's 81 million inhabitants (2016) are mainly rural. The 30% who live in urban areas have been the most open to Western influences. The DRC has a rich musical heritage rooted in traditional rhythms. The earliest known form of popular partnered dance music in Congo was Maringa , denoting a Kongolese dance practiced within the former Kingdom of Loango , encompassing parts of the present-day Republic of the Congo, Southern Gabon and Cabinda . The style gained popularity in the 1920s-1930s, introducing the "bar-dancing" culture in Léopoldville (now Kinshasa), incorporating unique elements like a bass drum , a bottle as a triangle , and an accordion . In the 1940s and 1950s, the influence of Cuban son bands transformed Maringa into " Congolese rumba ". Imported records by Sexteto Habanero and Trio Matamoros, often mislabeled as "rumba", played a significant role. Artists such as Antoine Kasongo, Paul Kamba, Henri Bowane , Antoine Wendo Kolosoy , Franco Luambo , Le Grand Kallé , Vicky Longomba , Nico Kasanda , Tabu Ley Rochereau , and Papa Noel Nedule authentically popularized the style and made significant contributions to it in the 1940s and 1950s. The 1960s and 1970s saw the emergence of soukous , an urban dance music style that evolved from Congolese rumba. Soukous led to diverse offshoots, such as ekonda saccadé , reflecting the Mongo rhythmic influence, and mokonyonyon , emulating pelvic thrust dance movements from the Otetela ethnic background. The same soukous, under the guidance of " le sapeur ", Papa Wemba , have set the tone for a generation of young men always dressed up in exorbitant designer clothes. They came to be known as the fourth generation of Congolese music and mostly come from the former prominent band Wenge Musica . Political and economic challenges under Mobutu prompted a mass exodus of musicians to Kenya, Tanzania, Uganda, Zambia, Sierra Leone , Liberia , Europe and Asia , expanding the spread of Congolese urban music. Notably, the quartet Ry-Co Jazz played a crucial role in globalizing Congolese music, touring West Africa , the Caribbean , and France. By the 1980s, numerous Congolese musicians were based in Europe, facilitating the global dissemination of their musical prowess. Congolese lead guitarists became a sought-after commodity, attracting bands worldwide eager to infuse a Congolese flavor into their compositions or learn the intricate art of Congolese guitar dexterity. In the late 1980s, Ndombolo emerged as a fast-paced, hip-swaying dance music, drawing inspiration from Congolese rumba and soukous. This genre gained widespread popularity in Africa, Europe, and the Americas , with musicians like Papa Wemba, Koffi Olomide , Werrason , Awilo Longomba , Quartier Latin International , Général Defao , Aurlus Mabélé , Exra Musica, Wenge Musica , Wenge Musica Maison Mére and Fally Ipupa making significant contributions to its evolution and international stage. Many sports are played in the DRC, including football , basketball, baseball, and rugby . The sports are played in numerous stadiums throughout the country, including the Stade Frederic Kibassa Maliba . As Zaire they participated in the 1974 FIFA World Cup . Internationally, the country is especially famous for its professional basketball NBA and football players. Dikembe Mutombo is one of the best African basketball players to ever play the game. Mutombo is well known for humanitarian projects in his home country. Bismack Biyombo , Christian Eyenga , Jonathan Kuminga , and Emmanuel Mudiay are others who gained significant international attention in basketball. Several Congolese players and players of Congolese descent—including strikers Romelu Lukaku , Yannick Bolasie , and Dieumerci Mbokani —have gained prominence in world football. DR Congo has twice won the African Cup of Nations football tournament. DR Congo's women's national volleyball team lastly qualified for the 2021 Women's African Nations Volleyball Championship . The country featured a national team in beach volleyball that competed at the 2018–2020 CAVB Beach Volleyball Continental Cup in both the women's and the men's section. Newspapers of the DRC include L'Avenir , Radion Télévision Mwangaza , La Conscience [ fr ] , L'Observateur [ fr ] , Le Phare , Le Potentiel , Le Soft and LeCongolais.CD , a web-based daily. Radio Télévision Nationale Congolaise (RTNC) is the national broadcaster of the Democratic Republic of the Congo. RTNC currently broadcasts in Lingala , French, and English. Congolese authors use literature as a way to develop a sense of national consciousness amongst the people of the DRC. Frederick Kambemba Yamusangie writes literature for the between generations of those who grew up in the Congo, during the time when they were colonised, fighting for independence and after. Yamusangie in an interview said he felt the distance in literature and wanted to remedy that he wrote the novel, Full Circle, which is a story of a boy named Emanuel who in the beginning of the book feels a difference in culture among the different groups in the Congo and elsewhere. Rais Neza Boneza , an author from the Katanga province, wrote novels and poems to promote artistic expressions as a way to address and deal with conflicts. The DRC has a rich musical heritage rooted in traditional rhythms. The earliest known form of popular partnered dance music in Congo was Maringa , denoting a Kongolese dance practiced within the former Kingdom of Loango , encompassing parts of the present-day Republic of the Congo, Southern Gabon and Cabinda . The style gained popularity in the 1920s-1930s, introducing the "bar-dancing" culture in Léopoldville (now Kinshasa), incorporating unique elements like a bass drum , a bottle as a triangle , and an accordion . In the 1940s and 1950s, the influence of Cuban son bands transformed Maringa into " Congolese rumba ". Imported records by Sexteto Habanero and Trio Matamoros, often mislabeled as "rumba", played a significant role. Artists such as Antoine Kasongo, Paul Kamba, Henri Bowane , Antoine Wendo Kolosoy , Franco Luambo , Le Grand Kallé , Vicky Longomba , Nico Kasanda , Tabu Ley Rochereau , and Papa Noel Nedule authentically popularized the style and made significant contributions to it in the 1940s and 1950s. The 1960s and 1970s saw the emergence of soukous , an urban dance music style that evolved from Congolese rumba. Soukous led to diverse offshoots, such as ekonda saccadé , reflecting the Mongo rhythmic influence, and mokonyonyon , emulating pelvic thrust dance movements from the Otetela ethnic background. The same soukous, under the guidance of " le sapeur ", Papa Wemba , have set the tone for a generation of young men always dressed up in exorbitant designer clothes. They came to be known as the fourth generation of Congolese music and mostly come from the former prominent band Wenge Musica . Political and economic challenges under Mobutu prompted a mass exodus of musicians to Kenya, Tanzania, Uganda, Zambia, Sierra Leone , Liberia , Europe and Asia , expanding the spread of Congolese urban music. Notably, the quartet Ry-Co Jazz played a crucial role in globalizing Congolese music, touring West Africa , the Caribbean , and France. By the 1980s, numerous Congolese musicians were based in Europe, facilitating the global dissemination of their musical prowess. Congolese lead guitarists became a sought-after commodity, attracting bands worldwide eager to infuse a Congolese flavor into their compositions or learn the intricate art of Congolese guitar dexterity. In the late 1980s, Ndombolo emerged as a fast-paced, hip-swaying dance music, drawing inspiration from Congolese rumba and soukous. This genre gained widespread popularity in Africa, Europe, and the Americas , with musicians like Papa Wemba, Koffi Olomide , Werrason , Awilo Longomba , Quartier Latin International , Général Defao , Aurlus Mabélé , Exra Musica, Wenge Musica , Wenge Musica Maison Mére and Fally Ipupa making significant contributions to its evolution and international stage. Many sports are played in the DRC, including football , basketball, baseball, and rugby . The sports are played in numerous stadiums throughout the country, including the Stade Frederic Kibassa Maliba . As Zaire they participated in the 1974 FIFA World Cup . Internationally, the country is especially famous for its professional basketball NBA and football players. Dikembe Mutombo is one of the best African basketball players to ever play the game. Mutombo is well known for humanitarian projects in his home country. Bismack Biyombo , Christian Eyenga , Jonathan Kuminga , and Emmanuel Mudiay are others who gained significant international attention in basketball. Several Congolese players and players of Congolese descent—including strikers Romelu Lukaku , Yannick Bolasie , and Dieumerci Mbokani —have gained prominence in world football. DR Congo has twice won the African Cup of Nations football tournament. DR Congo's women's national volleyball team lastly qualified for the 2021 Women's African Nations Volleyball Championship . The country featured a national team in beach volleyball that competed at the 2018–2020 CAVB Beach Volleyball Continental Cup in both the women's and the men's section. Newspapers of the DRC include L'Avenir , Radion Télévision Mwangaza , La Conscience [ fr ] , L'Observateur [ fr ] , Le Phare , Le Potentiel , Le Soft and LeCongolais.CD , a web-based daily. Radio Télévision Nationale Congolaise (RTNC) is the national broadcaster of the Democratic Republic of the Congo. RTNC currently broadcasts in Lingala , French, and English.Congolese authors use literature as a way to develop a sense of national consciousness amongst the people of the DRC. Frederick Kambemba Yamusangie writes literature for the between generations of those who grew up in the Congo, during the time when they were colonised, fighting for independence and after. Yamusangie in an interview said he felt the distance in literature and wanted to remedy that he wrote the novel, Full Circle, which is a story of a boy named Emanuel who in the beginning of the book feels a difference in culture among the different groups in the Congo and elsewhere. Rais Neza Boneza , an author from the Katanga province, wrote novels and poems to promote artistic expressions as a way to address and deal with conflicts.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/2022–2023_Uganda_Ebola_outbreak/html

2022–2023 Uganda Ebola outbreak

The 2022–2023 Uganda Ebola outbreak was an outbreak of the Sudan ebolavirus , which causes Ebola , from 20 September 2022 until 10 January 2023 in the Western and Central Regions of Uganda . Over 160 people were infected, including 77 people who died. It was Uganda's fifth outbreak with Sudan ebolavirus. The Ugandan Ministry of Health declared the outbreak on 20 September 2022. As of 25 October 2022, there were confirmed cases in the Mubende , Kyegegwa , Kassanda , Kagadi , Bunyanga , Kampala and Wakiso districts. As of 24 October 2022, there were a total of 90 confirmed or probable cases and 44 deaths. On 12 October, the first recorded death in the capital of Kampala occurred; 12 days later on 24 October, there had been a total of 14 infections in the capital in the last two days. On 11 January 2023 after 42 days without new cases the outbreak was declared over. Uganda has previously had four outbreaks of Sudan ebolavirus; one outbreak in 2000 and 2011 and two outbreaks in 2012, as well as an outbreak of Bundibugyo virus disease in 2007 and an Ebola virus disease outbreak in 2019. No human outbreaks of the Sudan ebolavirus have been reported in the last 10 years. Given that this is significantly longer than any reported case of persistent infection in human survivors of ebolavirus infection, this lends weight to the theory expressed by Kyobe Henry Bbosa, Ebola incident commander at Uganda's Ministry of Health, that this outbreak was caused by an unobserved spillover event from a wildlife reservoir. However, this putative spillover remains unidentified. The first cases were detected in the Mubende District among people living around a gold mine . Whilst the mobility of gold traders has been suggested to play a role in onward transmission from the site where the outbreak was first detected, no direct evidence of this has been forthcoming. As of 20 October, the eight most recent Ebola cases had no known contacts with known patients, suggesting incomplete contact tracing and unknown chains of transmission. As of 5 November, a total of 132 confirmed cases had been identified; 39% of confirmed cases died, a total of 61 patients with confirmed Ebola have recovered from illness and been discharged. Cases have been found in seven districts including Mubende, Kassanda District , Kyegegwa District , Bunyangabu District , Kagadi District , Wakiso District , and the capital of Kampala. As of 8 November, 23 Ebola cases had been confirmed among pupils, hence education minister Janet Kataha Museveni announced schools across Uganda would close 25 November, two weeks before the scheduled end of term. On 11 September, the index case of the outbreak, a 24-year-old man in a village of the Mubende District developed symptoms of Ebola and died on 19 September. On 20 September, the Ugandan health authorities declared an outbreak of Sudan ebolavirus in the Mubende District. By 25 September, cases had been confirmed in Kyegegwa District and Kassanda District . On the 29th September Kagadi District confirmed its first case. On 30 September, there were 38 confirmed cases and eight total deaths in confirmed cases. On 1 October, physician Mohammed Ali, one of six infected health workers who treated the index case, died as the first health worker. On 2 October, there were 41 confirmed cases and nine total deaths in confirmed cases. Furthermore, the Bunyanga District had its first confirmed case. On 5 October, there were 43 confirmed cases and 29 reported deaths. On 10 October, there were 63 confirmed or suspected cases and 29 reported deaths. On 12 October, the first confirmed case and death in the capital of Kampala occurred, although he was believed to have fled from an already infected district. On 20 October, there were 60 confirmed cases and 44 reported deaths. On the 22 October Wakiso District had confirmed its first case. On 24 October, there were 90 confirmed cases and 28 confirmed deaths, with 14 confirmed cases reported in Kampala in the previous 48 hours. On 26 October, the Ugandan Ministry of Health confirmed that there were 6 cases in school-aged children who attended classes at 3 different schools in the Rubaga Division of Kampala. One of the children died from the disease and 170 contacts were identified from these cases. On 2 November Masaka District confirmed its first case and death after a 23-year-old woman came to Masaka from Kampala to be looked after by her parents and was admitted to a hospital on the 31 October and later died after being transferred back to Kampala . On 13 November Jinja District confirmed its first case and death after a 45-year-old man died and was linked to a probable case connected to the Rubaga Division of Kampala. On 11 September, the index case of the outbreak, a 24-year-old man in a village of the Mubende District developed symptoms of Ebola and died on 19 September. On 20 September, the Ugandan health authorities declared an outbreak of Sudan ebolavirus in the Mubende District. By 25 September, cases had been confirmed in Kyegegwa District and Kassanda District . On the 29th September Kagadi District confirmed its first case. On 30 September, there were 38 confirmed cases and eight total deaths in confirmed cases. On 1 October, physician Mohammed Ali, one of six infected health workers who treated the index case, died as the first health worker. On 2 October, there were 41 confirmed cases and nine total deaths in confirmed cases. Furthermore, the Bunyanga District had its first confirmed case. On 5 October, there were 43 confirmed cases and 29 reported deaths. On 10 October, there were 63 confirmed or suspected cases and 29 reported deaths. On 12 October, the first confirmed case and death in the capital of Kampala occurred, although he was believed to have fled from an already infected district. On 20 October, there were 60 confirmed cases and 44 reported deaths. On the 22 October Wakiso District had confirmed its first case. On 24 October, there were 90 confirmed cases and 28 confirmed deaths, with 14 confirmed cases reported in Kampala in the previous 48 hours. On 26 October, the Ugandan Ministry of Health confirmed that there were 6 cases in school-aged children who attended classes at 3 different schools in the Rubaga Division of Kampala. One of the children died from the disease and 170 contacts were identified from these cases. On 2 November Masaka District confirmed its first case and death after a 23-year-old woman came to Masaka from Kampala to be looked after by her parents and was admitted to a hospital on the 31 October and later died after being transferred back to Kampala . On 13 November Jinja District confirmed its first case and death after a 45-year-old man died and was linked to a probable case connected to the Rubaga Division of Kampala. According to Jane Aceng , Uganda's health minister, local people initially believed the new Ebola outbreak was caused by witchcraft. Aside from this misinformation , there are also no effective vaccines against the Sudan ebolavirus, and merely early supportive care is the best management option of an infected person, but experts are hopeful that much has been learned about infections with Ebola viruses, including diagnosis, contact tracing and how to improve survival. The World Health Organization (WHO) has been supporting the Ugandan Ministry of Health with surveillance, communication and coordination efforts. Similarly, Médecins Sans Frontières has been supporting the Ministry of Health with deploying initial emergency response. The International Federation of Red Cross and Red Crescent Societies (IFRC) has appealed for emergency aid to Uganda. The European Union has responded to the request with €200,000 in initial emergency funding. On 6 October, the United States announced that they would begin screening air passengers from Uganda for cases of Ebola. According to Ana Maria Henao-Restrepo and her team in WHO's Health Emergencies Program, an adenovirus based vaccine developed by the Sabin Vaccine Institute in a partnership with the Vaccine Research Center at the US National Institute of Allergy and Infectious Diseases will be offered to contacts of known cases as part of a clinical trial . On 15 October, the first lockdown came into effect. The lockdown, affecting the Mubende and Kassandra districts, prevents anyone, except cargo trucks, from leaving or entering the districts for three weeks. Furthermore, bars, nightclubs, places of worship and entertainment venues are closed and a curfew is in place. On 17 October, president Museveni put Kampala under high response alert after two cases from Mubende reached the capital. One of the patients died. Museveni also warned that there had been contacts and risks of infections in the city. The United States has sent the antiviral drug remdesivir and the experimental combination of antibodies MBP134 to Uganda to help protect healthcare workers from the outbreak with CDC-responsible Joel Montgomery saying that if healthcare workers are at risk, then it will negatively impact the response to the outbreak. Supply shortages, for example inadequate PPE, and limited food for those in quarantine have meant that patients and contacts have escaped isolation; interns have only been paid every three months, meaning they were unable to cope with the rising cost of living, all of which are important issues in the response to stem the epidemic. Ebola is mainly spread through contact with bodily fluids . The average case fatality rate of Ebola (all 4 viruses) is 50%. In this outbreak of Sudan Ebolavirus, the case fatality rate has been 39%. Some politicians and other public figures opposed to the 36-year rule of President Yoweri Museveni declared that the Ebola outbreak was fake or exaggerated, and that Ugandans were being used as vaccine "lab rats" to enrich the ruling party. Individuals such as former presidential candidate Joseph Kabuleta further claimed that the Ebola vaccines undergoing clinical trial may have deadly side effects, similar to his earlier claims about COVID-19 vaccines . Other popularized theories have included that Ebola is caused by witchcraft and that burials of Ebola victims are closed so that their organs can be harvested and sold. A contributing factor in misinformation campaigns has been what researchers observed to be uneven application of public health measures during the COVID-19 pandemic , used by the ruling party to stifle dissent and shut down public discourse. An independent fact-checking organization in Uganda has found that a lack of community education regarding disease spread is more widespread than "targeted misinformation", which Ugandan Health Minister Margaret Muhanga had cited, saying opposition politicized the Ebola outbreak. Citizens also expressed fears of heavy-handed lockdowns at a time when the economy was still struggling with the fallout from nationwide COVID-19 lockdowns and ongoing global inflationary pressures. Museveni locked down Mubende and Kassanda districts on 15 October, one month after the first case was reported, but promised no national lockdowns akin to those deployed for COVID-19, even when the virus had spread to Kampala and killed upwards of 77 people in the capital. In the districts undergoing lockdown, markets, bars, and churches were to be closed for the duration of the lockdown, together with travel bans and dawn-to-dusk curfews. Some citizens claimed that the districts placed under lockdown were being deliberately punished for their support of opposition politician Bobi Wine and that police had beaten locals to enforce overnight curfews.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Natural_News/html

Natural News

Natural News (formerly NewsTarget , which is now a separate sister site) is a far-right , anti-vaccination conspiracy theory and fake news website known for promoting alternative medicine , pseudoscience , disinformation , and far-right extremism . The website began publishing articles in 2008 and is based in the United States . The site's founder, Michael Allen " Mike " Adams , gained attention after posting a blog entry implying a call for violence against proponents of GMO foods, and then allegedly creating another website with a list of names of alleged supporters. He has been accused of using "pseudoscience to sell his lies". Adams has described vaccines as "medical child abuse". The website sells various dietary supplements , promotes alternative medicine and climate change denial , makes tendentious nutrition and health claims, disseminates fake news , and espouses various conspiracy theories and pro-Donald Trump propaganda . These conspiracy theories include chemophobic claims about the purported dangers of " chemtrails ", fluoridated drinking water , heavy metals , anti-perspirants , laundry detergent , monosodium glutamate , aspartame , and vaccines . It has also spread conspiracy theories about the Zika virus allegedly being spread by genetically modified mosquitoes and purported adverse effects of genetically modified crops , as well as the farming practices associated with and foods derived from them. As of 2014, Natural News had approximately 7 million unique visitors per month. In May 2020, Facebook banned Natural News content from its platform after discovering that the site was boosting its popularity using content farms in North Macedonia and the Philippines , a form of spamming . Natural News bypassed the ban by republishing its content on a large number of topic-specific domain names , including trump.news, extinction.news, mind.control.news, and veggie.news. The Institute for Strategic Dialogue found 496 domain names associated with Natural News as of June 2020. Michael Allen "Mike" Adams (born 1967 in Lawrence, Kansas ) is the founder and owner of Natural News ; the domain name was registered in 2005 and began publishing articles in 2008. According to Adams' own website, he became interested in alternative nutrition when he developed type II diabetes at the age of 30 and one of his websites asserts "he cured himself of diabetes in a matter of months and transformed himself into the picture of perfect health in mind, body and spirit" himself using natural remedies. However, The Daily Beast found that his recommendation for Amazon Herb Company products in at least eight articles, including a supposed "third-party review...from a truly independent perspective" turn out to be misleading; he has a financial interest in the company, according to non-profit business records in Arizona. He is a raw foods enthusiast and holistic nutritionist . He claims to eat no processed foods, dairy, sugar, meat from mammals or food products containing additives such as monosodium glutamate (MSG). He also says he avoids use of prescription drugs and visits to Western medical doctors. Adams has endorsed conspiracy theories surrounding the Deepwater Horizon oil spill , and those involving Malaysia Airlines Flight 370 . He has endorsed Burzynski: Cancer Is Serious Business , a movie about Stanislaw Burzynski . Steven Novella characterizes Adams as "a dangerous conspiracy-mongering crank". Adams has also endorsed the books of conspiracy theorist Jim Marrs . Adams has made music videos expressing similar viewpoints as the articles posted on his website, such as opposition to the swine flu vaccine . In 2012, after the Sandy Hook Elementary School shooting occurred, Adams called for "medication control" instead of gun control . In March 2018, Adams created Hoggwatch.com , a website Snopes said was "apparently created solely for the purpose of attacking Parkland shooting survivor David Hogg ." Writing in the journal Vaccine , Anna Kata identified Natural News as one of numerous websites spreading "irresponsible health information". According to John Banks, Adams uses "pseudoscience to sell his lies" and is "seen as generally a quack and a shill by science bloggers." One such blogger, David Gorski of ScienceBlogs , called Natural News "one of the most wretched hives of scum and quackery on the Internet," and the most "blatant purveyor of the worst kind of quackery and paranoid anti-physician and anti-medicine conspiracy theories anywhere on the Internet", and a one-stop-shop for "virtually every quackery known to humankind, all slathered with a heaping, helping of unrelenting hostility to science-based medicine and science in general." Peter Bowditch of the website Ratbags commented about the site. Steven Novella of NeuroLogica Blog called NaturalNews "a crank alt med site that promotes every sort of medical nonsense imaginable." Novella continued: "If it is unscientific, antiscientific, conspiracy-mongering, or downright silly, Mike Adams appears to be all for it—whatever sells the "natural" products he hawks on his site." Individuals who commented about Adams' website include astronomer and blogger Phil Plait , PZ Myers , and Mark Hoofnagle. In 2011 and 2015 Brian Dunning listed NaturalNews.com as #1 on his "Top 10 Worst Anti-Science Websites" lists. Adams is listed as a "promoter of questionable methods" by Quackwatch . Robert T. Carroll at The Skeptic's Dictionary said, "Natural News is not a very good source for information. If you don't trust me on this, go to Respectful Insolence or any of the other bloggers on ScienceBlogs and do a search for "Natural News" or "Mike Adams" (who is Natural News). Hundreds of entries will be found and not one of them will have a good word to say about Mike Adams as a source." According to The Atlantic , Natural News is one of the most prominent anti-vaccination websites on Facebook. An article in the journal Vaccine said the site "tend(s) to not only spread irresponsible health information in general (e.g. discouraging chemotherapy or radiation for cancer treatment, antiretrovirals for HIV , and insulin for diabetes), but also have large sections with dubious information on vaccines." After Patrick Swayze died in 2009, Adams posted an article in which he remarked that Swayze, in dying, "joins many other celebrities who have been recently killed by pharmaceuticals or chemotherapy." Commentators of Adams' article on Patrick Swayze included bloggers such as David Gorski and Phil Plait, the latter of whom called Adams' commentary "obnoxious and loathsome." When Angelina Jolie underwent a double mastectomy in May 2013 because she had a mutation in the BRCA1 gene, Adams stated that "Countless millions of women carry the BRCA1 gene and never express breast cancer because they lead healthy, anti-cancer lifestyles based on smart nutrition, exercise, sensible sunlight exposure and avoidance of cancer-causing chemicals." Gorski called the article "vile" and noted that Adams had written similarly themed articles about the death of Michael Jackson , Tony Snow , and Tim Russert . In February 2014, Brian Palmer, writing in the Daily Herald of Arlington Heights, Illinois, criticized the site's promotion of alternative medicine treatments, such as bathing in Himalayan salt and eating Hijiki seaweed, and referred to the claims Natural News made about their efficacy as "preposterous." In August 2014, Nathanael Johnson, writing for Grist , dismissed Natural News as "simply not credible" and as "nothing but a conspiracy-theory site." On August 11, 2014, Natural News published a blog post promoting a homeopathic treatment for Ebola , which was met with harsh criticism from several commentators, and was taken down later that day. In a statement on the article, Natural News said that the blogger who posted the article, Ken Oftedal, was "under review" and that they did not condone anyone interacting with Ebola. However, as of August 20, 2014, the site was still featuring an article written by Adams promoting the use of herbal medicines to treat Ebola. In an article about "fake Ebola cures", Adams was criticized for arguing that herbs could prove effective as an Ebola treatment. [ citation needed ] Natural News was among the pseudoscience platforms which promoted hoaxes about the 2014 Ebola epidemic , including claims that an infected woman was found in Atlanta and that Ebola was a bioweapon. On December 8, 2016, Michael V. LeVine, writing in Business Insider , criticized the site as part of a scientific fake news epidemic: "Snake-oil salesmen have pushed false cures since the dawn of medicine, and now websites like Natural News flood social media with dangerous anti-pharmaceutical, anti-vaccination and anti-GMO pseudoscience that puts millions at risk of contracting preventable illnesses." On February 22, 2017, Google delisted about 140,000 pages on Natural News, removing it from search results. It was returned soon after. The following year, on March 3, 2018, YouTube removed Natural News' video channel for terms of service violations, effectively removing its library of videos from the site. The channel was subsequently reinstated and the videos returned. In June 2019, Facebook removed Natural News from its website for violating its policies against spam. Adams wrote on InfoWars that his site was "permanently banned" from Facebook, and on The Gateway Pundit that the ban was part of a conspiracy against his website. A 2020 study by researchers from Northeastern , Harvard , Northwestern and Rutgers universities found that Natural News was among the top 5 most shared fake news domains in tweets related to COVID-19 , the others being The Gateway Pundit , InfoWars , WorldNetDaily and Judicial Watch . In 2011, Adams posted a report on Natural News which stated that many blueberry food products did not contain real blueberries. In 2013, Adams posted an article describing what he saw when he examined Chicken McNuggets under a microscope. He said in the article that the patterns he saw included "dark black hair-like structures" and a round algae -like object. In July 2014, Adams compared media outlets that wrote positively about GMOs with Nazi Germany's propagandists, calling them, "Monsanto collaborators who have signed on to accelerate heinous crimes being committed against humanity under the false promise of 'feeding the world' with toxic GMOs." He continued with a statement that he set in boldface : "that it is the moral right—and even the obligation—of human beings everywhere to actively plan and carry out the killing of those engaged in heinous crimes against humanity." A day after the post a website called "Monsanto Collaborator" appeared online which listed the names of scientists and journalists who allegedly collaborate with the bio industry; Adams denied creating the website claiming that Monsanto set up the website in order to frame him. In 2019, Natural News falsely claimed that wind turbines contribute more to climate change than fossil fuels .

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Post-Ebola_virus_syndrome/html

Post-Ebola virus syndrome

Post-Ebola virus syndrome (or post-Ebola syndrome ) is a post-viral syndrome affecting those who have recovered from infection with Ebola . Symptoms include joint and muscle pain, eye problems, including blindness, various neurological problems, and other ailments, sometimes so severe that the person is unable to work. Although similar symptoms had been reported following previous outbreaks in the last 20 years, health professionals began using the term in 2014 when referring to a constellation of symptoms seen in people who had recovered from an acute attack of Ebola disease. Researchers have been aware of a group of symptoms that frequently followed Ebola virus disease for 20 years, but it became more widely reported with the large number of survivors of the deadly epidemic in West Africa in 2014. Post Ebola syndrome may manifest as joint pain , muscle pain , chest pain , fatigue , hearing loss , hair loss , cessation of menstruation , and poor long-term health. Some survivors report neurological issues including memory problems and anxiety attacks . Vision loss is also frequently reported, along with eye pain, inflammation , and blurred vision. Two papers published in the New England Journal of Medicine in 2015 report that symptoms include lethargy, joint pains, hair loss, and vision loss, frequently to the point of near blindness, and uveitis . Although, there is some progress that may potentially help Ebola survivors, adequate funding and further research is required to help provide more answers about post-Ebola syndrome. Studies from previous outbreaks reveal that the virus is able to survive for months after recovery in some parts of the body such as the eyes and testes, where the immune system cannot reach. It is not known if the neurologic symptoms seen in survivors are a direct result of the virus or, instead, triggered by the immune system's response to the infection. It is known that Ebola can trigger a massive cytokine storm that can cause bleeding throughout the body, including the brain, which may explain various neurological symptoms that have been reported. In terms of diagnosis, the individual may show sensitivity to light or eye redness when ocular problems are suspected. Neurologically the individual's coordination, gait and frontal release signs should be observed. Management depends on the symptoms displayed, for example, if the individual indicates muscular-skeletal pain then paracetamol may be administered. If the individual presents with ocular problems, then prednisone and cyclopentolate may be used for treatment, according to the WHO. According to a review by Brainard, et al., Ebola virus was identified in almost 3 out of 4 seminal fluid samples (18 survivors) almost 4 months after initial infection, with the last positive samples being more than 6 months (203 days) after infection had occurred. Another aspect of survivors of the Ebola virus, is that it could become sexually transmitted, as the virus is present in semen nine months after the individuals are declared free of Ebola. A 2017 study found the virus in the semen of some men after more than two years following the recovery from the acute infection and in one case, Ebola viral RNA was identified up to 40 months after illness. At the start of 2021 an outbreak of EVD that caused 18 cases and 9 deaths in Guinea is thought to be due to a West Africa Ebola outbreak survivor. This individual apparently infected a woman more than 5 years after he himself had incurred the infection According to a review by Brainard, et al., Ebola virus was identified in almost 3 out of 4 seminal fluid samples (18 survivors) almost 4 months after initial infection, with the last positive samples being more than 6 months (203 days) after infection had occurred. Another aspect of survivors of the Ebola virus, is that it could become sexually transmitted, as the virus is present in semen nine months after the individuals are declared free of Ebola. A 2017 study found the virus in the semen of some men after more than two years following the recovery from the acute infection and in one case, Ebola viral RNA was identified up to 40 months after illness. At the start of 2021 an outbreak of EVD that caused 18 cases and 9 deaths in Guinea is thought to be due to a West Africa Ebola outbreak survivor. This individual apparently infected a woman more than 5 years after he himself had incurred the infection Researchers from the National Institute of Neurological Disorders and Stroke (NINDS) and Liberian research partners are doing a 5-year follow-up study of 1500 Ebola survivors in Liberia. Survivors will be evaluated every 6 months; as of October 2017, two follow-ups have been performed. Researchers will track relapses and viral persistence, characterize sequelae in various bodily systems, and do clinical studies on pharmacologic interventions and vaccines. PREVAIL III (Partnership for Research on Ebola Vaccines in Liberia III), a study of survivors and their contacts, a collaboration between NIAID and Liberia, was planned in late 2014. Early results described abdominal, chest, neurologic, musculoskeletal, and ocular challenges faced by survivors. PREVAIL IV examined if a medication, GS-5734, could help men with persistent Ebola virus RNA in semen to eliminate it, and thereby reduce the potential risk for sexual transmission. PREVAIL VII examined if survivors of Ebola virus disease had evidence of Ebola virus RNA in aqueous humor and outcomes of cataract surgery relative to the local population. In 2018, over two years after the resolution of the Ebola outbreak in Eastern Sierra Leone, a study was conducted of Ebola survivors, with their families used as a control group. The study was published in 2021, Looking at the results, the researchers were able to find an underlying process leading to persistent symptoms in some but not all Ebola survivors. One hypothesis suggests "ongoing inflammation due to persistent infection vs autoimmune phenomena." The authors suggest that more study is needed to come to conclusions about why some survivors continue to experience post syndrome ailments.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Executive_Orders/html

Executive Orders

Executive Orders is a techno-thriller novel, written by Tom Clancy and released on July 1, 1996. It picks up immediately where the final events of Debt of Honor (1994) left off, and features now- U.S. President Jack Ryan as he tries to deal with foreign and domestic threats. The book is dedicated to former U.S. President Ronald Reagan , who helped launch Clancy's worldwide success as a novelist. The book debuted at number one on the New York Times bestseller list . After a terrorist attack kills nearly every U.S. executive, legislative, and judicial figure , previously-confirmed Vice President Jack Ryan is sworn in as President of the United States . As Ryan is left to represent the United States by himself, he must deal with multiple crises: reconstituting his own Cabinet , the House , the Senate , and the entire Supreme Court ; a challenge to the legitimacy of his succession by former Vice President Ed Kealty , leading to press hazing; and a war brewing in the Middle East . When the Iraqi president (implied to be Saddam Hussein ) is assassinated by an Iranian deep-cover agent, Iranian leader Ayatollah Mahmoud Haji Daryaei takes advantage of the power vacuum by launching an unopposed invasion of Iraq and later uniting it with his country, calling the new entity the "United Islamic Republic" (UIR). Daryaei then secretly unleashes a master plan of "weakening" the United States through a series of terrorist attacks: a biological attack in the country using a weaponized strain of Ebola virus, a kidnapping attempt of Ryan's youngest daughter Katie, and an assassination attempt on the President himself by a Secret Service bodyguard who is an Iranian sleeper agent . China and India secretly assist Daryaei, first by causing a diplomatic crisis between the Chinese mainland and Taiwan when a PLAAF aircraft "accidentally" shoots down a Taiwanese airliner. The incident pulls a U.S. Navy carrier group from the Indian Ocean to the South China Sea and allows the Indian Navy's carrier up to move undetected to the Strait of Hormuz , cutting off access to the only sea-bound pathway to the UIR and Saudi Arabia . Daryaei thinks that with the U.S. government and military overwhelmed by a multitude of crises, he is now free to invade Saudi Arabia and claim superpower status for the UIR. The attack on Ryan's daughter as well as the assassination attempt on the President are swiftly averted by the FBI and Secret Service. However, the Ebola epidemic causes Ryan to declare martial law and enforce a travel ban to contain the virus. The epidemic later burns out due to the virus being so fragile that it cannot spread effectively. Meanwhile, CIA operatives John Clark and Domingo Chavez are tasked with investigating the origin of the virus in Africa , where they later discover Daryaei's involvement, connecting the puzzle of seemingly unrelated global crises. Ryan then deploys what is left of the United States military (the virus immobilized almost the entire military apparatus except for one fighter wing , two armored cavalry regiments, and one National Guard armor brigade that had been training at isolated Fort Irwin ) to assist Saudi and Kuwaiti military forces in repelling a UIR invasion of Saudi Arabia. The tide soon turns against the UIR, with its forces obliterated by the combined firepower of the United States, Saudi Arabia, and Kuwait. President Ryan had sent Clark and Chavez into Tehran , the de facto capital of the UIR, to target Daryaei with assistance from Russian intelligence. The Ayatollah is later killed in his residence by precision-guided munitions dropped from F-117 Nighthawks . Ryan then threatens to launch a tactical nuclear strike on Tehran unless those responsible for the attacks are immediately extradited to the U.S. to face charges, and the facility where the weaponized Ebola was cultured is neutralized. He announces a new foreign policy doctrine, the "Ryan Doctrine", under which the United States will hold personally accountable any foreign leader who orders attacks on U.S. citizens, territory, or possessions in the future. Kealty's challenge to Ryan's legitimacy fails in court; due to the way Kealty's legal complaint was worded, the federal judge who hears the case inadvertently confirms that Ryan is the President. In the aftermath of the crisis, public appreciation of the unelected president grows.Jack Ryan : President of the United States Scott Adler : Acting secretary of state George Winston : Acting secretary of the treasury Patrick "Pat" Martin : Acting attorney general Tony Bretano : Acting secretary of defense Arnold van Damm : President Ryan's chief of staff Ben Goodley : National Security Advisor to President Ryan Dan Murray : Acting director of the Federal Bureau of Investigation Pat O'Day : FBI "roving inspector" working under Murray Andrea Price : Chief of the United States Secret Service detail Aref Raman : Special agent for the Secret Service who is an Iranian sleeper agent assigned to assassinate Ryan Bert Vasco : Senior desk officer for Iraq, U.S. State Department Ed Foley : Acting Director of Central Intelligence Mary Pat Foley : Deputy Director of Operations John Clark : Operations officer Domingo "Ding" Chavez : Operations officerJack Ryan : President of the United States Scott Adler : Acting secretary of state George Winston : Acting secretary of the treasury Patrick "Pat" Martin : Acting attorney general Tony Bretano : Acting secretary of defense Arnold van Damm : President Ryan's chief of staff Ben Goodley : National Security Advisor to President Ryan Dan Murray : Acting director of the Federal Bureau of Investigation Pat O'Day : FBI "roving inspector" working under Murray Andrea Price : Chief of the United States Secret Service detail Aref Raman : Special agent for the Secret Service who is an Iranian sleeper agent assigned to assassinate Ryan Bert Vasco : Senior desk officer for Iraq, U.S. State DepartmentEd Foley : Acting Director of Central Intelligence Mary Pat Foley : Deputy Director of Operations John Clark : Operations officer Domingo "Ding" Chavez : Operations officerThe novel is composed of three major storylines. The first part is a realistic portrait about being the President of the United States , with "a near fetishistic pleasure out of detailing the ways in which [the chief executive] is robbed of his private life every minute of the day", according to novelist Marc Cerasini's essay on the book. The second part is about domestic critics and enemies — "venal politicos, fat cats, and corrupt media types", according to Publishers Weekly 's review of the novel — that cause problems for President Ryan as he tries to rebuild the entire U.S. government with his centre-right politics and his grassroots American values. The third part features the United Islamic Republic's quest to become a superpower, which turns the novel into a "taut and harrowing" medical thriller that culminates in a military confrontation on land, sea, and air that is regarded as callback to Clancy's war novel Red Storm Rising (1986). Clancy also discusses whether political outsiders, in this case Jack Ryan himself, are better reformers than those who have worked within the system, a theme explored in movies like Mr. Smith Goes to Washington (1939) and Dave (1993). Promoted by publishing company Putnam in an $800,000 marketing campaign that pitched Jack Ryan as running for president, Executive Orders sold 56,000 copies in its first week at Barnes & Noble . It eventually sold 2.3 million copies. The book received generally positive reviews. Publishers Weekly praised Clancy as "a war-gamer without peer, and his plotting here is masterful, as is his strumming of patriotic heartstrings"; they concluded: "This is heavyweight entertainment, and come pub date it's going to be the world champion of the bestseller lists." The Washington Post hailed the novel as "compelling entertainment", explaining: "[it] shows that, despite the end of the Cold War and the temptation to coast that conventional success may bring, Clancy has lost none of his verve. As cultural artifact, the book suggests a domestic America that is perilous and grim." In a mixed review written by Oliver Stone for The New York Times , Stone praised Clancy's "fiendishly inventive" plotting and "a technically sharp command of the realistic detail"; however, he criticized its length, questioning whether Clancy's works are edited or kept in their place: "Realism comes at the expense of the story's flow, and here I must ask whether anyone actually edits Mr. Clancy, or for that matter whether there is any living workaholic who actually reads every cybernetic paragraph, with its obligatory expressions of grief, anger, fear and that little bit of love that in Mr. Clancy's world can be taken to mean responsibility. "

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Navarro_College/html

Navarro College

Navarro College is a public community college in Texas with its main campus in Corsicana and branches in Mexia , Midlothian , and Waxahachie . The college has an annual student enrollment of more than 9,000 students. The Corsicana campus has strong ties with Texas A&M University–Commerce which has branches at the Navarro College campuses in Corsicana. In spring 1946, a group of local citizens met to form a steering committee for the purpose of establishing a junior college in Navarro County . In a general election held July 16, 1946, voters approved the creation of Navarro Junior College and authorized a county tax to help finance the institution. In that same election, voters chose a seven-member board of trustees to govern the college. The first students began classes in September 1946. Most of the 238 members of that first student body were returning veterans from World War II taking advantage of assistance available under the newly enacted GI Bill of Rights . The first campus of Navarro College was the site of the Air Activities of Texas, a World War II primary flight school located six miles (10 km) south of Corsicana. In 1951, the campus was moved to its present location, a 47-acre (19 ha) tract west of downtown Corsicana on Texas State Highway 31 . In 1974, the college broadened its philosophy and purpose to encompass the comprehensive community-based educational concept, adding occupational education programs and implementing new education concepts including individualized and self-paced instruction and the use of audio-tutorial instructional media. In keeping with the new educational role, the word "junior" was dropped from the institution's name, and the official name Navarro College was adopted by the board of trustees. In an attempt to address the growing needs of its service area, which consists of Navarro, Ellis, Freestone, Limestone, and Leon counties, the college began offering courses in various locations in those areas in the early 1970s and eventually established two permanent centers, Navarro College South at Mexia and the Ellis County Center at Waxahachie. Later, a third and fourth off-campus centers were added in Midlothian and Fairfield. In October 2014, Navarro College received criticism for sending admission rejection letters to two prospective students from Nigeria because the college was "not accepting international students from countries with confirmed Ebola cases." Nigeria was identified by the World Health Organization through the summer of 2014 with multiple confirmed cases of Ebola, but there had been no new Ebola cases (since early September). The rejected applicants lived in Ibadan, Nigeria, approximately 80 miles from Lagos, where the most recent infected cases were identified. The college offered an explanation on October 13, stating that the rejections were not a result of fears of Ebola, but that its international department had recently been restructured to focus on recruiting students from China and Indonesia. On October 16, college Vice-president Dewayne Gragg issued a new statement, contradicting the previous explanation and confirming that there had indeed been a decision to "postpone our recruitment in those nations that the Center for Disease Control and the U.S. State Department have identified as at risk." In October 2014, Navarro College received criticism for sending admission rejection letters to two prospective students from Nigeria because the college was "not accepting international students from countries with confirmed Ebola cases." Nigeria was identified by the World Health Organization through the summer of 2014 with multiple confirmed cases of Ebola, but there had been no new Ebola cases (since early September). The rejected applicants lived in Ibadan, Nigeria, approximately 80 miles from Lagos, where the most recent infected cases were identified. The college offered an explanation on October 13, stating that the rejections were not a result of fears of Ebola, but that its international department had recently been restructured to focus on recruiting students from China and Indonesia. On October 16, college Vice-president Dewayne Gragg issued a new statement, contradicting the previous explanation and confirming that there had indeed been a decision to "postpone our recruitment in those nations that the Center for Disease Control and the U.S. State Department have identified as at risk." The Corsicana campus has expanded to 103 acres (42 ha) with 23 buildings. It is home to the Cook Education Center, which houses a 60-foot-diameter (18 m) dome planetarium with seating for more than two hundred, tied with the University of Texas at Arlington for the largest planetarium in Texas. The Cook Education Center also contains the Pearce Collections Museum , home to many American Civil War artifacts as well as a western art collection. As defined by the Texas Legislature , the official service area of Navarro College includes all of Ellis , Freestone , Leon , Limestone , and Navarro counties. Navarro is accredited by the Southern Association of Colleges and Schools . The accreditation was given in 1954 and reaffirmed in 1964, 1974, 1985, 1995 and again in 2006. Waxahachie Global High School is partnered with Navarro College, and set up in a way that students at Global can take classes at Navarro. Thus they can graduate from high school with an associate degree or transferable credits to a 4-year university along with their high school diploma.Navarro's athletics teams, nicknamed The Bulldogs, compete in the Southwest Junior College Conference of the NJCAA . Navarro offers athletic scholarships in the following sports for men: football, basketball, baseball and for women: soccer, softball, volleyball. In 2011, the baseball team won the NJCAA Junior College World Series in Grand Junction, Colorado . The Bulldogs beat Central Arizona College , 6–4, on J.T. Files' walk-off home run in the tenth inning. The Bulldogs also have a strong reputation for their coed cheer team. Since the year 2000, Coach Monica Aldama has led the program to 16 NCA National Championships in the junior college division, as well as six "Grand National" designations (a status awarded to the team with the highest overall score in competition). In 2020, the squad became the subject of a Netflix docuseries called Cheer . The Bulldogs also have a strong reputation for their coed cheer team. Since the year 2000, Coach Monica Aldama has led the program to 16 NCA National Championships in the junior college division, as well as six "Grand National" designations (a status awarded to the team with the highest overall score in competition). In 2020, the squad became the subject of a Netflix docuseries called Cheer .

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/West_African_Ebola_virus_epidemic_timeline/html

West African Ebola virus epidemic timeline

This article covers the timeline of the 2014 Ebola virus epidemic in West Africa and its outbreaks elsewhere. Flag icons denote the first announcements of confirmed cases by the respective nation-states, their first deaths, and their first secondary transmissions, as well as relevant sessions and announcements of agencies such as the World Health Organization (WHO), the U.S. Centers for Disease Control (CDC), and NGOs such as Doctors Without Borders ; medical evacuations, visa restrictions, border closures, quarantines , court rulings, and possible cases of zoonosis are also included.Take note that the date of the first confirmations of the disease or any event in a country may be before or after the date of the events in local time because of the International Dateline . Guinea Researchers believe that a 2-year-old boy was the index case of the current Ebola virus disease epidemic. He died in December 2013 in the village of Meliandou , Guéckédou Prefecture . His mother, sister, and grandmother then became ill with similar symptoms and also died. Although Ebola represents a significant public health problem in sub-Saharan Africa and was documented in Tai Forest chimpanzees , only one case had been reported in humans in West Africa . With this background and in the context of poor public health systems , the early cases were mis-diagnosed as diseases more common to the area. Thus Ebola virus disease spread for several months before it was recognized as such. In late October 2014, the child was identified as Emile Ouamouno . A tree was later identified in the area where children were known to play with insect-eating Angolan free-tailed bats and hunting and grilling them to eat. Contact with these bats, which are well-known Ebola reservoirs, may have been the immediate cause of the outbreak, though this remains speculative. Guinea On March 18 Guinean health officials announce the outbreak of a mysterious hemorrhagic fever "which strikes like lightning." 35 cases are reported, and at least 23 people died. On March 22, Guinea confirms the fever as Ebola, with 59 possible fatalities. Liberia On March 24, two suspected cases in Liberia are announced by the Liberian Ministries of Information, Culture, Tourism, and Health. The government had also stated that Ebola had 'crossed over into Liberia,' but did not confirm the information. Médecins Sans Frontières On March 24, Médecins Sans Frontières / Doctors Without Borders (MSF) establish an isolation center in Guéckédou Prefecture, Guinea, the first in West Africa to be built expressly for the purpose of halting the epidemic. United Nations On March 25, the World Health Organization (WHO) released its first report concerning Ebola in West Africa, wherein it is stated that thirteen Guinean cases from four districts of the country were confirmed by the Institut Pasteur and the Centre International de Recherche en Infectiologie in Lyon. Mauritania Since 26 March, Mauritania closed all crossings along the Senegal River , the natural border between Mauritania and Senegal, except for the Rosso and Diama points of entry. Liberia On March 27, the government of Liberia revised its statement from March 24 stating that Ebola was not present within the country -a later report from the WHO reversed the country's position a second time. Senegal On March 28 Senegal closed its border with Guinea in an effort to halt the virus from spreading. Liberia On March 31 the first cases of EVD are confirmed in Liberia, in two patients in Lofa and Nimba counties -they had been the subject of a March 24 press report on EVD mentioned previously. The patient in Lofa County died on the day of her diagnosis, becoming the first death in Liberia. United States On March 31, the Centers for Disease Control and Prevention (CDC) sent a five-person team to Guinea for the purpose of aiding the Guinean Ministry of Health and the WHO in containing the outbreak. United Nations By the end of March, the WHO announced that there had been 112 cases and 70 deaths due to Ebola overall (including suspected cases.) Two confirmed cases originated in Liberia, and several suspected cases were reported from Sierra Leone and Liberia. Mali On April 7, six suspected cases were announced by Mali but were later confirmed as not being related to EVD. Liberia On April 12, new cases were reported in Margibi and Montserrado counties, raising the total number of counties holding patients with EVD to four. Guinea On April 30, Guinea's Ministry of Health reported 221 suspected and confirmed cases as well as 146 deaths in Guinea alone. Of the 221, 26 were health workers. United Nations By the end of April, WHO statistics showed 239 cases and 160 deaths overall. Guinea On May 12, cases were reported in Conakry , the capital of Guinea and a city with a population of around two million people. Sierra Leone On May 26 WHO reports the first cases and deaths in Sierra Leone, in Kailahun District . They are traced back to the funeral of a widely respected traditional healer from Kailahun who had contracted the disease after treating Ebola patients from across the border in Guinea. United Nations By the end of May, WHO statistics showed 383 cases and 211 deaths overall. Sierra Leone On June 11, Sierra Leone closed its borders with Liberia and Guinea and closed a number of schools around the country. On 30 July, the government began to deploy troops to enforce quarantines. Liberia On June 17, Liberia reports that EVD has reached its capital, Monrovia . Sierra Leone On June 20, the WHO announces up to 158 cases in Sierra Leone. In addition to Kailahun District , cases were also reported in Kenema , Kambia , Port Loko , and Western Area Rural districts. Médecins Sans Frontières On June 21, Doctors Without Borders declares the second wave of the outbreak "totally out of control" and calls for massive resources. United Nations By the end of June, WHO statistics showed 779 cases and 481 deaths overall. Sierra Leone On July 14, the Bo District of central Sierra Leone reports its first case. Sierra Leone On July 17, the number of EVD cases in Sierra Leone surpasses those of Liberia and Guinea at 442. United Nations On July 18 WHO regards the disease trend in Sierra Leone and Liberia as "serious" with 67 new cases and 19 deaths reported to date. Nigeria On July 25 Nigeria reports its first fatality, a Liberian-American man who died in Lagos . Sierra Leone On July 25, the first case in Freetown , Sierra Leone's capital, is recorded. The city has a population of over one million people. Liberia On July 27, Liberian President Ellen Johnson Sirleaf declared the country's borders to be closed; some exceptions such as Roberts International Airport remain open with the addition of screening centers there. Sirleaf also announced that football events were to be banned, schools and universities closed, and the worst-affected areas of Liberia to be placed under quarantine. Sierra Leone On July 29 Dr. Sheik Umar Khan , who was leading Sierra Leone's fight against the epidemic, dies of the virus, the first health worker to succumb. Liberia On July 30 Liberia shuts schools and orders the quarantining of the worst-affected communities, employing its military. Sierra Leone On 30 July, the government allowed the deployment of troops to maintain quarantines in the country. United States On July 31 the Peace Corps withdraws all volunteers from Liberia, Sierra Leone and Guinea, citing Ebola risks. United Nations By the end of July, WHO statistics showed 1,603 cases and 887 deaths overall. United States On August 2 an American missionary aid worker infected with EVD in Liberia, Dr. Kent Brantly , is medically evacuated to Atlanta, Georgia for treatment at Emory University Hospital . UN On August 4 the World Bank announces up to $200 million in emergency assistance for Liberia, Sierra Leone and Guinea. United States On August 5 a second infected American missionary, Nancy Writebol , is medically evacuated to Emory University Hospital. [ citation needed ] Liberia On August 6, President Sirleaf announced that a state of emergency was to be enforced in Liberia, remarking that "certain rights and privileges" would be sacrificed in doing so. UN On August 7 WHO declares the EVD epidemic a Public Health Emergency of International Concern ( PHEIC ). Ivory Coast On August 11 the Ivory Coast began banning flights from neighboring Liberia. UN On August 12 WHO announces that the death toll has risen above 1,000, and approves the usage of unproven drugs and vaccines. Spain On August 12 Brother Miguel Pajares, a Catholic priest who had been medically evacuated from Liberia where he had been volunteering, dies at Hospital Carlos III in Madrid . UN On August 14 WHO announces that the reports of EVD deaths and cases from the field "vastly underestimate" the scale of the outbreak. Médecins Sans Frontières On August 15 Doctors Without Borders compares the EVD epidemic to "wartime," and estimates that it will take approximately six months to bring under control. Liberia On August 19, the West Point neighborhood of Monrovia is entirely cordoned off in an effort to halt the spread of EVD in one of the country's worst-affected areas. Liberia On August 20 Liberian troops in Monrovia fired tear gas and live rounds at citizens attempting to break out of the quarantine of West Point, Monrovia ; one adolescent dies of gunshot wounds. United States On August 21 the two first medically evacuated cases in the US (missionaries Nancy Writebol and Kent Brantly), having been successfully treated with the experimental therapy ZMapp , are released from Emory University Hospital free of the virus. Kent Brantly's A+ type blood was later used to treat three other cases in the United States: these included the third and fifth medically evacuated cases Rick Sacra and Ashoka Mukpo as well as the second transmitted case Nina Pham. Ivory Coast On August 21, the Ivory Coast closed its borders with both Guinea and Liberia. This action was preceded by a ban on flights between the Ivory Coast and Liberia. Democratic Republic of Congo On August 24 the DRC announces an EVD outbreak in its northern Equateur province of a distinct strain from that of the larger West African outbreak. United Kingdom On August 24 a British man ( William Pooley ) was evacuated from Sierra Leone to an isolation unit at the Royal Free Hospital . Germany On August 27, a Senegalese epidemiologist who was working in Sierra Leone for the WHO was transferred to an isolation ward in Hamburg, marking the first medically evacuated case in Germany. UN On August 28 WHO announces that the death toll has climbed above 1,550, and warns that the outbreak could infect more than 20,000 people. It also announces that $490 million shall be needed over the next six months. US Also on August 28 the journal Science publishes the seminal paper Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak, five of whose co-authors themselves died of EVD before publication. Senegal On August 29 Senegal confirmed its first EVD case, in a Guinean citizen who was travelling to Dakar . UN On August 30 the World Food Program announces that it needs $70 million to feed 1.3 million people at risk in Ebola-quarantined areas. Liberia On August 30, the quarantine of the neighborhood of West Point, Monrovia is lifted after riots on August 20. Liberia On August 31 Liberia began denying sailors from entering or disembarking from vessels at the country's four main seaports. United Nations By the end of August, WHO statistics showed 3,707 cases and 1,808 deaths overall. Ivory Coast On September 1 the Ivory Coast loosens its ban on travel into Liberia by opening several humanitarian corridors between the two countries. Médecins Sans Frontières On September 2 Doctors Without Borders president Joanne Liu warns the U.N. that the world is losing the battle against EVD, and harshly criticizes a "coalition of inaction." Infectious bodies are rotting in the streets in Sierra Leone, and crematoria rather than new Ebola treatment centers are being built in Liberia. UN Also on September 2, the Food and Agriculture Organization (FAO) warns that the epidemic has endangered harvests and sent food prices soaring in West Africa, a problem it expects to intensify in the coming months. UN On September 3 the Director-General of WHO, Margaret Chan , remarks at a Washington, D.C. press conference that the EVD epidemic was "the largest, most complex and most severe we've ever seen," and that it was racing ahead of control efforts. United Kingdom On September 3, the patient previously being isolated at the Royal Free Hospital was released. The patient (who was identified as the British nurse William Pooley) allowed blood to be drawn to treat future patients -the fourth medically evacuated patient in the United States later received his transfusion and successfully recovered. (The transfusion may have contributed). United States On September 4, the United States received its third medically evacuated case -a Massachusetts physician, Rick Sacra, had been working in Liberia for Serving In Mission and had performed Cesarean sections on Ebola patients before revealing symptoms. He was treated at the Nebraska Medical Center in Omaha , where he was given a blood transfusion from the first successfully recovered American patient Kent Brantly. [ citation needed ] Liberia On September 8, the WHO reported that EVD was present in fourteen out of Liberia's fifteen counties. The remaining county without confirmed cases is Grand Gedeh County . The only county free of Ebola as of October 10 was Grand Gedeh County . United States On September 9, a fourth patient was removed from West Africa and placed into the United States. The doctor (whose identity has not been released) was working in Sierra Leone for the WHO and had begun treatment at Emory University Hospital . In order to recover from the virus, the patient was scheduled to receive serum from the British medically evacuated case William Pooley. Australia On September 17, Australia donated 7 million Australian Dollars to the British government, the WHO, and MSF for the purpose of aiding the countries affected by the EVD outbreak. MSF declined the offer, stating that military and medical help were more crucial to their effort than financial support. UN On 18 September the UN General Assembly and the Security Council approve resolutions creating the United Nations Mission for Ebola Emergency Response (UNMEER), the first time in history the UN has created a mission for a health emergency. Guinea Also on September 18 it is reported that eight health workers and journalists were killed by villagers in Womey , Nzérékoré Prefecture ; their bodies were dumped in a septic tank. They disappeared after a riot opposed to their presence broke out—strong animosity had been directed towards health teams advising villagers about EVD previously. France On September 19 the first French national to be infected with EVD, a volunteer nurse for Doctors Without Borders, is medically evacuated from Liberia to the Bégin military hospital on the outskirts of Paris. She later recovered and was released October 4. The death toll in West Africa is nearly 2,400. Spain On September 21, the second medically evacuated case in Spain arrived at Madrid's Hospital Carlos III. Brother Manuel García Viejo, another Spanish citizen who was medical director at the St John of God Hospital Sierra Leone in Lunsar , had been transported to Spain from Sierra Leone after being infected with the virus. Switzerland On September 22 a Swiss health worker was flown out from Sierra Leone to the University Hospital of Geneva after being bitten by an Ebola-infected child. Nigeria On September 22, the WHO reported an overall total of 20 cases and 8 deaths in Nigeria. There have been no new cases since the announcement thus far, and so EVD appears to be contained there. Liberia On September 22, a new 150-bed treatment center was opened in Monrovia , with patients arriving the day of its establishment. United States On September 24, the first EVD case in the United States ( Thomas Eric Duncan ) visits the emergency room of the Presbyterian Hospital of Dallas , where he is diagnosed with a 'low-grade, common viral disease' and sent home with antibiotics . Spain On 25 September it was announced that Brother Manuel García Viejo, the second Spanish citizen infected with the virus, had died at Madrid's Hospital Carlos III . United States On September 25, the third medically evacuated case in the US was released from the Nebraska Medical Center after three weeks of isolation. The patient, Rick Sacra, successfully convalesced with a blood transfusion from another American case. United Nations On September 26, the WHO announces that "The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times. Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long." United States On September 28, Thomas Eric Duncan is isolated at the Presbyterian Hospital of Dallas , where nurses Nina Pham and Amber Vinson are exposed to Duncan's vomit and bodily fluids. Both later become the second and third cases of EVD within the United States. Ivory Coast On September 29, the Ivory Coast concluded its ban on flights from Liberia citing 'West African solidarity.' United States On September 30 the CDC announces the first case of EVD in the Americas, in Dallas, Texas . The anonymous patient (later confirmed as Thomas Eric Duncan ) is "kept in strict isolation" at Texas Health Presbyterian Hospital Dallas . United Nations By the end of September, WHO statistics showed 7,492 cases and 3,439 deaths overall. Guinea On October 2, the Governor of Conakry, Soriba Sorel Camara, decreed that all public festivities for the religious holiday of Tabaski were to be henceforth forbidden after Doctors Without Borders noted a rapid spike of admitted patients in the city. United States On October 2, CDC hosted a Twitter chat to inform the public about Ebola. France On October 3, Health Minister Marisol Touraine announces that the nurse evacuated from Liberia had been cured and had left hospital. She had been treated with Avigan , which had been approved by Japan in March. The death toll in West Africa is more than 3,400. Germany On October 3, a second patient was admitted to an isolation ward in Germany. The patient is a Ugandan doctor who was working in Sierra Leone for an Italian NGO, and is currently being treated in Frankfurt's University Hospital. On the same date, Germany both opened a 48-bed isolation center in Kenema and sent medical supplies to Liberia. United States On October 3, a fourth case was medically evacuated to the United States; the colleagues of the patient were voluntarily isolated upon return from Liberia. The patient, Ashoka Mukpo, was a reporter for an American news network. Germany On October 4, the Senegalese epidemiologist that was the first patient flown to and treated in Germany was released from the University Medical Center Hamburg-Eppendorf after forty days of isolation. Norway On October 6, MSF announced that one of their workers, a Norwegian national, had become infected in Sierra Leone and was to be transported to Norway for treatment as soon as possible. Spain On 6 October María Teresa Romero Ramos , an auxiliary nurse who had cared for Manuel García Viejo at the Hospital Carlos III , tested positive for Ebola at the Hospital Universitario Fundación Alcorcón , marking the first transmission of EVD outside of West Africa. Liberia On October 7, Liberian Ambassador to the United States Jeremiah Sulunteh claimed Liberia may be "close to collapse" in a television interview. United States On October 8 Thomas Eric Duncan , the first case of EVD in the U.S., dies. Liberia On October 8, the WHO announced that EVD was present in fourteen of Liberia's fifteen counties. France On October 9, the International Charter on Space and Major Disasters was activated by the USGS to monitor the outbreak in Sierra Leone, the first time its assorted space assets have been used in an epidemiological role. [ citation needed ] Spain On October 10 María Teresa Romero Ramos's mixed breed dog, Excalibur, is euthanized by regional court order despite public protests due to concerns that it may have been an animal reservoir of the Ebola virus. On Twitter, the hashtag #SalvemosaExcalibur (We'll Save Excalibur) was briefly the second-most popular hashtag worldwide. Ivory Coast On October 10, the Ivory Coast banned the sale of bush meat as part of a series of limitations designed to prevent EVD from spreading to the country. Bush meat has been generally accepted as one of the reservoirs of the virus and has been restricted temporarily in Nigeria as well. United States On October 12, the CDC announces that a caregiver for Thomas Eric Duncan had tested positive for EVD. She is identified two days later as 29-year-old Vietnamese-American nurse Nina Pham . Pham was later moved to the National Institutes of Health in Bethesda, Maryland . France On October 13, France pledges to build several treatment centers in Guinea while also announcing that flights from affected countries may be barred from arrival in France in the near future. Sierra Leone On 14 October, 800 Sierra Leone peacekeepers due to relieve a contingent deployed in Somalia were placed under quarantine when one of the soldiers tested positive for Ebola. Germany On October 14, the first patient in Germany dies from EVD, a 56-year-old Sudanese UN employee who had been the third medical evacuee to Germany, at St Georg Hospital in Leipzig. United States On October 14 anonymous nurses allege that there were no protocols in the treatment of Thomas Eric Duncan at Texas Health Presbyterian Hospital Dallas , that their protective gear was insufficient, and that hazardous waste was allowed to pile up. Also on October 14, Dallas Mayor Mike Rawlings announced that Nina Pham's one-year-old Cavalier King Charles spaniel Bentley would be kept in isolation and monitored at Hensley Field . Also on October 14, 100 members of the American military are sent to Liberia to aid efforts there -the total number of American troops in West Africa stands at 565. United States On October 15 a second caregiver for Thomas Eric Duncan tests positive for EVD, 29-year-old nurse Amber Vinson . The CDC seeks to track fellow airline passengers on a flight she took from Cleveland a day before being diagnosed (her trip was itself cleared by CDC personnel). The U.S. Department of Health and Human Services announced Vinson will be transferred to Emory University Hospital in Atlanta, Georgia. Also on October 15, concerns over Amber Vinson's presence on Frontier Airlines flights 1142 and 1143 prompts school closures (two in Solon, Ohio and three in Belton, Texas ). Furthermore, two pilots and four air stewardesses are put on paid leave "out of an abundance of caution." UN On October 15 the WHO announces that the death toll for EVD is 4,477, mostly in West Africa, and warns that the infection rate there could reach 5,000 to 10,000 new cases a week in two months if efforts are not stepped up. Sierra Leone On October 16, the Emergency Operations Center announced two Ebola cases in the Koinadugu district in the far north. This marks the arrival of cases in every district in the country. United States On October 16, the fourth medically evacuated case in the US was discharged from Emory University Hospital after being administered serum from a British patient that had successfully completed treatment at a hospital in London. Also on October 16, a Maine elementary school teacher who had attended a conference in Dallas is put on 21-day paid leave "out of an abundance of caution." Some 135 people are being monitored in Dallas to some degree. Spain Also on October 16, Air France flight 1300 was isolated at Barajas International Airport in Madrid after a Nigerian passenger fell ill. Senegal On October 17, the EVD outbreak in Senegal is declared over after no new cases were reported in the country for 42 days. Belize On 17 October refused landing of a cruise ship containing a Texas worker who handled blood samples of a now deceased Ebola patient, indicating "This decision was made out of preponderance of caution for the welfare of the citizens and residents of Belize." It also banned travel from Sierra Leone, Liberia, Guinea and Nigeria. UN Also on October 17, a leaked WHO draft document admits systemic mistakes in the handling the early stages of the EVD epidemic in West Africa. Also on October 17, the WHO officially commended Macky Sall , Awa Marie Coll-Seck , the CDC, and MSF for their work in raising public awareness of Ebola in Senegal as well as quickly and effectively preventing the spread of EVD in the country. Senegal was announced 'Ebola-free' on the same day. Médecins Sans Frontières Also on October 17, Doctors Without Borders avers that international pledges of donations have had no impact on the situation in West Africa, and that it was "ridiculous" that MSF was bearing the brunt of care. [ citation needed ] United States Also on October 17, President Barack Obama names Ron Klain as his point man on the Ebola epidemic. Also on October 17, several school closures in Ohio and Texas (connected with the two flights taken by Amber Vinson ) by school district officials are declared by public health officials to be an overreaction. The CDC and Frontier Airlines widen their search, however, to 800 people who afterwards had boarded the same airliner (an Airbus A320, plane number N220FR) before it was taken out of service. The Airbus had flown to Atlanta, Georgia and Ft. Lauderdale, Florida, and back to Cleveland, Ohio. [ citation needed ] Also on October 17, a crowd of parents in Hazelhurst, Mississippi pull their children from their junior high school after learning that its principal had attended a family funeral in Zambia -in southern Africa, 3,000 miles away from the epidemic in West Africa. Egypt On October 18 Egypt delivered three tons of medical equipment to Guinea, consisting of medicine and medical equipment. Democratic Republic of the Congo On October 18, the DRC stated it would train over 1,000 Congolese soldiers in Kinshasa to support the West African countries facing the EVD epidemic there. While facing a concurrent outbreak of its own , the DRC alluded to 'African solidarity' as a reason for its contribution. Portugal On October 18, Portugal announced it would establish a medical base in Bissau , Guinea-Bissau to protect Guinea-Bissau from EVD in the chance that it would enter the country via neighboring Guinea. Guinea-Bissau On October 18 Guinea-Bissau began works on an Ebola treatment center in the Hospital Simão Mendes, which is the primary medical center in the capital, Bissau. The country is bordered by Guinea and Senegal, two nations that had reported cases of EVD during the course of the outbreak. UN On October 19 Tony Banbury, managing director of the recently established UN Mission for Ebola Emergency Response ( UNMEER ), states regarding the logistics of his operation that "I need everything. I need it everywhere. And I need it super-fast." Spain Also on October 19 Teresa Romero, the nurse who was the first person to be infected outside of West Africa, tests negative for Ebola in an initial test. A second test is required for confirmation. Nigeria On October 20, the WHO declared Nigeria to be Ebola-free after over six weeks without new reported cases. The final case and death count stands at 8 deaths and 20 cases. Ghana On October 20, Ghanaian President John Mahama announces that aid is beginning to arrive at the three worst-hit countries (Guinea, Liberia and Sierra Leone). Norway On October 21, the Norwegian national being treated in Oslo after being medically evacuated from Sierra Leone was released from the Oslo University Hospital . The woman, Silje Lehne Michalsen, responded to her discharge by stating: "For three months I saw the total absence of an international response. For three months I became more and more worried and frustrated." UN On October 21 Dr. Marie Paule Kieny of the WHO announces in Geneva that a serum from the blood of recovered EVD patients could be available within weeks in Liberia, and furthermore that target date for a vaccine was January 2015. Sierra Leone On October 21 riots broke out in the Kono district to prevent the quarantine of a 90-year-old woman suspected of having EVD; the youths are reportedly angry that there are no treatment centers in the diamond-rich Kono district. A daytime curfew is imposed. United States On October 22, NBC freelance cameraman and medical evacuee Ashoka Mukpo is released from Nebraska Medical Center free of the Ebola virus, the second patient so treated there. Mukpo is the fifth medically evacuated case in the United States thus far. Furthermore, DHS rules go into effect which route 100% of travellers from Liberia, Sierra Leone, and Guinea to one of five international airports for enhanced screening: JFK , Newark , Dulles , Hartsfield-Jackson , or O'Hare . (These airports had previously served 94% of such passengers arriving in the U.S.) In addition, the CDC announced a plan to monitor for 21 days (the Ebola incubation period) all travelers arriving in the US from Guinea, Liberia or Sierra Leone, beginning on October 27. They will have to report body temperatures and symptoms daily to local and state health departments. And finally, Nina Pham's dog, Bentley, tests negative for Ebola. Spain Also on October 22 Teresa Romero tests negative for Ebola in a second round of tests. Cuba Also on October 22 Cuba sends a medical team to Liberia. Mali On October 23 the first case is confirmed in Mali, a two-year-old girl who had recently visited Guinea. United States Also on October 23 New York City physician Craig Spencer was placed in isolation in Bellevue Hospital after experiencing symptoms of EVD. He subsequently tests positive for the Ebola virus. Spencer had returned recently from Guinea, where he had been working with Ebola patients as part of Doctors Without Borders. The diagnosis was unrelated to the cases of Ebola virus disease in Texas. Spencer completed several activities before arriving at the hospital, including riding the subway, visiting a bowling alley and entering another resident's car via Uber . Mali On October 24 Mali reported its first death; the two-year girl who was the first confirmed case in the country died the day after her case was reported. United States Also on October 24 the two Dallas nurses who had treated Thomas Eric Duncan and contracted EVD, Nina Pham and Amber Vinson, are declared Ebola free; the former meets President Obama in the Oval Office upon release from hospital. Also on the 24th, New York and New Jersey establish mandatory quarantine protocols for those health care workers who have treated EVD patients who arrive from West Africa at their international airports. North Korea Also on October 24, North Korea bars all foreign tourists. United Nations On October 25 the WHO announces that the Ebola outbreak has passed 10,000 cases worldwide; of the 4,922 deaths, Sierra Leone, Liberia and Guinea account for all but ten. United Kingdom Also on October 25, a paper published in The Lancet forecasts that the scale of the current international response is too slow to prevent numerous further deaths in West Africa. United States Also on October 25, nurse Kaci Hickox, who had treated EVD patients in Sierra Leone, expresses frustration at her quarantine after her arrival at Newark International Airport the previous day under a state policy which exceeds the recommendations of the CDC . Mauritania Also on October 25, Mauritania closes its border with Mali . United States On October 26, Illinois Governor Pat Quinn signs an order mandating a 21-day quarantine for those who have had direct contact with EVD patients in Liberia, Guinea, or Sierra Leone. Japan On October 27, a middle aged Canadian journalist was accosted at Tokyo International Airport upon returning from a two-month visit to Liberia and stating he had felt feverish. He was then handed to the Ministry of Health, Labour, and Welfare and was ordered to be quarantined at the National Medical Research Center in Shinjuku , Tokyo . While he was the first suspected EVD case in Asia, tests on the following day proved him negative for EVD. Australia Also on October 27, Australia instigates visa restrictions on travellers from the three countries most affected by the Ebola epidemic. United States On October 28 nurse Kaci Hickox is permitted to undergo quarantine at her home in Maine and leaves her hospital tent in New Jersey. United Nations On October 29 the WHO reports that the rate of infections in Liberia has slowed, due in part in changes in cultural mortuary practices. It warns, however, that the crisis is far from over. The WHO also reports, in its tenth Ebola Roadmap Situation Report, that as of October 27, there are 13,703 EVD cases with 4,920 deaths; that all districts in Liberia and Sierra Leone are affected; and that UNMEER will have been in operation (as of October 30) for thirty days. United States Also on October 29, a Connecticut school is sued for not allowing a seven-year-old student who had attended a wedding in Ebola-free Nigeria with her father to attend until November 3 due to "concerns" expressed by other parents and by teachers. Also on October 29, Louisiana state health officials asked those who had treated EVD patients to not attend the annual meeting of the American Society of Tropical Medicine and Hygiene . North Korea On October 30 North Korea imposes a mandatory 21-day quarantine on all foreign nationals arriving from abroad; furthermore, internal travel and travel abroad are even more tightly restricted. United States Also on October 30, Science and Science Translational Medicine offer their articles on the Ebola epidemic for free for both the public and for researchers given that it is "unprecedented in terms of number of people killed and rapid geographic spread." United States On October 31 Maine Judge Charles C. LaVerdiere ruled that nurse Kaci Hickox (who had previously gone on a defiant bicycle ride, breaking her quarantine) must continue to undergo mandatory monitoring by public health officials, but that her movements were not to be restricted inasmuch as she was asymptomatic . "The court is fully aware that people are acting out of fear and that this fear is not entirely rational,' the judge noted. United Nations By the end of October, WHO statistics showed 13,540 cases and 4,941 deaths overall. France On November 1, the second medically evacuated case was flown out of Sierra Leone to be treated in France. The patient, a United Nations employee, is not a French citizen. United Nations On November 5 UNMEER reports that cases are surging in Sierra Leone due to the lack of treatment centers. "Two-thirds of the new cases recorded in the past three weeks have been in Sierra Leone." United States Also on November 5 the White House requests just over $6 billion in Ebola funding from Congress. France On November 6 France announces the screening of airline passengers arriving from Guinea. United States On November 7 a conference is held at the White House with three leading robotics universities ( Worcester Polytechnic Institute , Texas A&M , and the University of California, Berkeley ) to explore the feasibility of re-purposing non-autonomous robots to further separate health care providers from possible contact with the Ebola virus. Possible roles include the removal of PPE , clinical telepresence , and the burial of the contagious dead. Médecins Sans Frontières Also on November 7, Médecins Sans Frontières / Doctors Without Borders (MSF) announces a significant decline, for reasons which are not fully understood, in Liberian cases. United States On November 10 Dr. Spencer is declared virus-free by the New York City Health Department; he is to be released from Bellevue Hospital the next day. United States On November 11 Dr. Spencer is released from Bellevue Hospital. Mali On November 12, two more cases of Ebola are confirmed, both of whom died; these cases are unrelated to the case of the 2-year-old who died late October. The source of this outbreak is a Guinean imam who was treated at the Pasteur clinic in Bamako (the capital and largest city in Mali); the second case in this outbreak was a nurse at the clinic. Liberia On November 13, Liberia ends its state of emergency . United States On November 15 Dr. Martin Salia, a surgeon working in Sierra Leone, is medically evacuated to the Nebraska Medical Center , the third EVD case to be treated there and the most critical. Mali Also on November 15 Mali has identified and is monitoring 256 contacts (out of as many of 343) of its second batch of EVD cases. United States On November 17 Dr. Martin Salia dies at the Nebraska Medical Center. Germany On November 22, Germany sends 400 specially adapted motorbikes to remote West Africa regions. The bikes are to be used for sample transport in areas that do not have a local testing laboratory. Sierra Leone In early December, Sierra Leone falls behind in efforts to remove and bury the dead, with some workers dumping bodies in the streets to protest not being paid. Bodies are buried without being tested, and less than one in five dead may end up being reported to the WHO as an Ebola casualty. United States On December 10, an American nurse exposed to Ebola while volunteering in Sierra Leone will be admitted to the National Institutes of Health Mark O. Hatfield Clinical Research Center for observation and to enroll in a clinical protocol on Thursday, December 4. United States Also on December 10, Time magazine names The Ebola Fighters its Person of the Year . Sierra Leone On December 12, it is announced that public Christmas and New Year's celebrations are banned. 1,319 new infections have been recorded in the last three weeks. Guinea-Bissau On December 12, shortly after reopening its border (closed since August) with Guinea, a man with a fever was apprehended and quarantined after evading a checkpoint, along with eight other travelers he had joined. (As of eleven days later, on December 23, his name, location and condition remain unknown.) On December 17, confirmed cases top 19,000. On December 22, confirmed deaths exceeded 7,500. Philippines On December 23, two returning OFWs from West Africa evaded quarantine requirements. Taking ill, they were rejected at one hospital and sent to another. (As of a week later, on December 29, their names, locations and condition remain unknown.) United States On December 24, 2014, a CDC technician in Atlanta was potentially exposed to Ebola due to a laboratory error, and has been placed into quarantine. United Kingdom On 29 December, Pauline Cafferkey, a healthcare worker returning from West Africa to Scotland, was diagnosed with Ebola. She was taken to a specialist treatment centre in London the next day. On December 29, confirmed cases exceeded 20,000 and confirmed deaths exceeded 7,800. Iraq On December 31, unnamed health officials in Mosul hospital allegedly maintained that Ebola had stricken "Da'ish gunmen" ( ISIS jihad fighters) of African origin. The reports are not independently confirmed. On January 3, confirmed deaths reach 8,000. [ citation needed ] On January 4, ISIS propaganda claimed several deaths due to Ebola in Mosul . The next day, the Ministry of Health of Iraq and WHO officials debunked the report as untrue. On January 8, confirmed cases reach 21,000. Mali On January 18, Mali is officially Ebola-free. On January 21, Guinea , Sierra Leone , Liberia all reported the lowest weekly infection rates since August 2014. Guinea had re-opened its schools and universities. On January 22, Sierra Leone has cancelled all internal quarantines citing a sharp drop of the Ebola transmission. On January 24, Liberia has reported just 5 confirmed and 21 suspected Ebola cases across the country, indicating a likely termination of the virus transmission. On January 27, confirmed cases exceed 22,000 and deaths 8,800. [ citation needed ] On January 30, in France Dr. Anavaj Sakuntabhai from the Pasteur Institute has reported several asymptomatic Ebola cases, indicating a possible mutation which may enable transmission by carriers without outward signs of the disease. On February 3, confirmed cases topped 22,500 and deaths reached 9,000. On February 16, confirmed cases exceeded 23,000 and deaths were over 9,300. On March 1, confirmed cases neared 24,000 while confirmed deaths exceeded 9,800. [ citation needed ] On March 5, Liberia releases its last confirmed case. On March 11, cases topped 24,300 while deaths surpassed 10,000. On March 20, Liberia records its first case of Ebola in more than two weeks. On April 1, cases exceeded 25,000 while deaths neared 10,500. On May 1, cases were over 26,300 while deaths reached 10,900. The outbreak is nearly over in Liberia (with no new cases in weeks), is averaging ten cases per week in Sierra Leone , and is still fully out of control in Guinea with several score new cases per week. Liberia On May 9, Liberia is officially Ebola-free. On November 10, in Brazil a 46-year-old man coming from Guinea was suspected of Ebola and was hospitalized in Belo Horizonte , Minas Gerais . [ citation needed ] On January 14, West Africa was declared Ebola-free , marking the official end of the epidemic. Guinea Researchers believe that a 2-year-old boy was the index case of the current Ebola virus disease epidemic. He died in December 2013 in the village of Meliandou , Guéckédou Prefecture . His mother, sister, and grandmother then became ill with similar symptoms and also died. Although Ebola represents a significant public health problem in sub-Saharan Africa and was documented in Tai Forest chimpanzees , only one case had been reported in humans in West Africa . With this background and in the context of poor public health systems , the early cases were mis-diagnosed as diseases more common to the area. Thus Ebola virus disease spread for several months before it was recognized as such. In late October 2014, the child was identified as Emile Ouamouno . A tree was later identified in the area where children were known to play with insect-eating Angolan free-tailed bats and hunting and grilling them to eat. Contact with these bats, which are well-known Ebola reservoirs, may have been the immediate cause of the outbreak, though this remains speculative. Guinea On March 18 Guinean health officials announce the outbreak of a mysterious hemorrhagic fever "which strikes like lightning." 35 cases are reported, and at least 23 people died. On March 22, Guinea confirms the fever as Ebola, with 59 possible fatalities. Liberia On March 24, two suspected cases in Liberia are announced by the Liberian Ministries of Information, Culture, Tourism, and Health. The government had also stated that Ebola had 'crossed over into Liberia,' but did not confirm the information. Médecins Sans Frontières On March 24, Médecins Sans Frontières / Doctors Without Borders (MSF) establish an isolation center in Guéckédou Prefecture, Guinea, the first in West Africa to be built expressly for the purpose of halting the epidemic. United Nations On March 25, the World Health Organization (WHO) released its first report concerning Ebola in West Africa, wherein it is stated that thirteen Guinean cases from four districts of the country were confirmed by the Institut Pasteur and the Centre International de Recherche en Infectiologie in Lyon. Mauritania Since 26 March, Mauritania closed all crossings along the Senegal River , the natural border between Mauritania and Senegal, except for the Rosso and Diama points of entry. Liberia On March 27, the government of Liberia revised its statement from March 24 stating that Ebola was not present within the country -a later report from the WHO reversed the country's position a second time. Senegal On March 28 Senegal closed its border with Guinea in an effort to halt the virus from spreading. Liberia On March 31 the first cases of EVD are confirmed in Liberia, in two patients in Lofa and Nimba counties -they had been the subject of a March 24 press report on EVD mentioned previously. The patient in Lofa County died on the day of her diagnosis, becoming the first death in Liberia. United States On March 31, the Centers for Disease Control and Prevention (CDC) sent a five-person team to Guinea for the purpose of aiding the Guinean Ministry of Health and the WHO in containing the outbreak. United Nations By the end of March, the WHO announced that there had been 112 cases and 70 deaths due to Ebola overall (including suspected cases.) Two confirmed cases originated in Liberia, and several suspected cases were reported from Sierra Leone and Liberia. Mali On April 7, six suspected cases were announced by Mali but were later confirmed as not being related to EVD. Liberia On April 12, new cases were reported in Margibi and Montserrado counties, raising the total number of counties holding patients with EVD to four. Guinea On April 30, Guinea's Ministry of Health reported 221 suspected and confirmed cases as well as 146 deaths in Guinea alone. Of the 221, 26 were health workers. United Nations By the end of April, WHO statistics showed 239 cases and 160 deaths overall. Guinea On May 12, cases were reported in Conakry , the capital of Guinea and a city with a population of around two million people. Sierra Leone On May 26 WHO reports the first cases and deaths in Sierra Leone, in Kailahun District . They are traced back to the funeral of a widely respected traditional healer from Kailahun who had contracted the disease after treating Ebola patients from across the border in Guinea. United Nations By the end of May, WHO statistics showed 383 cases and 211 deaths overall. Sierra Leone On June 11, Sierra Leone closed its borders with Liberia and Guinea and closed a number of schools around the country. On 30 July, the government began to deploy troops to enforce quarantines. Liberia On June 17, Liberia reports that EVD has reached its capital, Monrovia . Sierra Leone On June 20, the WHO announces up to 158 cases in Sierra Leone. In addition to Kailahun District , cases were also reported in Kenema , Kambia , Port Loko , and Western Area Rural districts. Médecins Sans Frontières On June 21, Doctors Without Borders declares the second wave of the outbreak "totally out of control" and calls for massive resources. United Nations By the end of June, WHO statistics showed 779 cases and 481 deaths overall. Sierra Leone On July 14, the Bo District of central Sierra Leone reports its first case. Sierra Leone On July 17, the number of EVD cases in Sierra Leone surpasses those of Liberia and Guinea at 442. United Nations On July 18 WHO regards the disease trend in Sierra Leone and Liberia as "serious" with 67 new cases and 19 deaths reported to date. Nigeria On July 25 Nigeria reports its first fatality, a Liberian-American man who died in Lagos . Sierra Leone On July 25, the first case in Freetown , Sierra Leone's capital, is recorded. The city has a population of over one million people. Liberia On July 27, Liberian President Ellen Johnson Sirleaf declared the country's borders to be closed; some exceptions such as Roberts International Airport remain open with the addition of screening centers there. Sirleaf also announced that football events were to be banned, schools and universities closed, and the worst-affected areas of Liberia to be placed under quarantine. Sierra Leone On July 29 Dr. Sheik Umar Khan , who was leading Sierra Leone's fight against the epidemic, dies of the virus, the first health worker to succumb. Liberia On July 30 Liberia shuts schools and orders the quarantining of the worst-affected communities, employing its military. Sierra Leone On 30 July, the government allowed the deployment of troops to maintain quarantines in the country. United States On July 31 the Peace Corps withdraws all volunteers from Liberia, Sierra Leone and Guinea, citing Ebola risks. United Nations By the end of July, WHO statistics showed 1,603 cases and 887 deaths overall. United States On August 2 an American missionary aid worker infected with EVD in Liberia, Dr. Kent Brantly , is medically evacuated to Atlanta, Georgia for treatment at Emory University Hospital . UN On August 4 the World Bank announces up to $200 million in emergency assistance for Liberia, Sierra Leone and Guinea. United States On August 5 a second infected American missionary, Nancy Writebol , is medically evacuated to Emory University Hospital. [ citation needed ] Liberia On August 6, President Sirleaf announced that a state of emergency was to be enforced in Liberia, remarking that "certain rights and privileges" would be sacrificed in doing so. UN On August 7 WHO declares the EVD epidemic a Public Health Emergency of International Concern ( PHEIC ). Ivory Coast On August 11 the Ivory Coast began banning flights from neighboring Liberia. UN On August 12 WHO announces that the death toll has risen above 1,000, and approves the usage of unproven drugs and vaccines. Spain On August 12 Brother Miguel Pajares, a Catholic priest who had been medically evacuated from Liberia where he had been volunteering, dies at Hospital Carlos III in Madrid . UN On August 14 WHO announces that the reports of EVD deaths and cases from the field "vastly underestimate" the scale of the outbreak. Médecins Sans Frontières On August 15 Doctors Without Borders compares the EVD epidemic to "wartime," and estimates that it will take approximately six months to bring under control. Liberia On August 19, the West Point neighborhood of Monrovia is entirely cordoned off in an effort to halt the spread of EVD in one of the country's worst-affected areas. Liberia On August 20 Liberian troops in Monrovia fired tear gas and live rounds at citizens attempting to break out of the quarantine of West Point, Monrovia ; one adolescent dies of gunshot wounds. United States On August 21 the two first medically evacuated cases in the US (missionaries Nancy Writebol and Kent Brantly), having been successfully treated with the experimental therapy ZMapp , are released from Emory University Hospital free of the virus. Kent Brantly's A+ type blood was later used to treat three other cases in the United States: these included the third and fifth medically evacuated cases Rick Sacra and Ashoka Mukpo as well as the second transmitted case Nina Pham. Ivory Coast On August 21, the Ivory Coast closed its borders with both Guinea and Liberia. This action was preceded by a ban on flights between the Ivory Coast and Liberia. Democratic Republic of Congo On August 24 the DRC announces an EVD outbreak in its northern Equateur province of a distinct strain from that of the larger West African outbreak. United Kingdom On August 24 a British man ( William Pooley ) was evacuated from Sierra Leone to an isolation unit at the Royal Free Hospital . Germany On August 27, a Senegalese epidemiologist who was working in Sierra Leone for the WHO was transferred to an isolation ward in Hamburg, marking the first medically evacuated case in Germany. UN On August 28 WHO announces that the death toll has climbed above 1,550, and warns that the outbreak could infect more than 20,000 people. It also announces that $490 million shall be needed over the next six months. US Also on August 28 the journal Science publishes the seminal paper Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak, five of whose co-authors themselves died of EVD before publication. Senegal On August 29 Senegal confirmed its first EVD case, in a Guinean citizen who was travelling to Dakar . UN On August 30 the World Food Program announces that it needs $70 million to feed 1.3 million people at risk in Ebola-quarantined areas. Liberia On August 30, the quarantine of the neighborhood of West Point, Monrovia is lifted after riots on August 20. Liberia On August 31 Liberia began denying sailors from entering or disembarking from vessels at the country's four main seaports. United Nations By the end of August, WHO statistics showed 3,707 cases and 1,808 deaths overall. Ivory Coast On September 1 the Ivory Coast loosens its ban on travel into Liberia by opening several humanitarian corridors between the two countries. Médecins Sans Frontières On September 2 Doctors Without Borders president Joanne Liu warns the U.N. that the world is losing the battle against EVD, and harshly criticizes a "coalition of inaction." Infectious bodies are rotting in the streets in Sierra Leone, and crematoria rather than new Ebola treatment centers are being built in Liberia. UN Also on September 2, the Food and Agriculture Organization (FAO) warns that the epidemic has endangered harvests and sent food prices soaring in West Africa, a problem it expects to intensify in the coming months. UN On September 3 the Director-General of WHO, Margaret Chan , remarks at a Washington, D.C. press conference that the EVD epidemic was "the largest, most complex and most severe we've ever seen," and that it was racing ahead of control efforts. United Kingdom On September 3, the patient previously being isolated at the Royal Free Hospital was released. The patient (who was identified as the British nurse William Pooley) allowed blood to be drawn to treat future patients -the fourth medically evacuated patient in the United States later received his transfusion and successfully recovered. (The transfusion may have contributed). United States On September 4, the United States received its third medically evacuated case -a Massachusetts physician, Rick Sacra, had been working in Liberia for Serving In Mission and had performed Cesarean sections on Ebola patients before revealing symptoms. He was treated at the Nebraska Medical Center in Omaha , where he was given a blood transfusion from the first successfully recovered American patient Kent Brantly. [ citation needed ] Liberia On September 8, the WHO reported that EVD was present in fourteen out of Liberia's fifteen counties. The remaining county without confirmed cases is Grand Gedeh County . The only county free of Ebola as of October 10 was Grand Gedeh County . United States On September 9, a fourth patient was removed from West Africa and placed into the United States. The doctor (whose identity has not been released) was working in Sierra Leone for the WHO and had begun treatment at Emory University Hospital . In order to recover from the virus, the patient was scheduled to receive serum from the British medically evacuated case William Pooley. Australia On September 17, Australia donated 7 million Australian Dollars to the British government, the WHO, and MSF for the purpose of aiding the countries affected by the EVD outbreak. MSF declined the offer, stating that military and medical help were more crucial to their effort than financial support. UN On 18 September the UN General Assembly and the Security Council approve resolutions creating the United Nations Mission for Ebola Emergency Response (UNMEER), the first time in history the UN has created a mission for a health emergency. Guinea Also on September 18 it is reported that eight health workers and journalists were killed by villagers in Womey , Nzérékoré Prefecture ; their bodies were dumped in a septic tank. They disappeared after a riot opposed to their presence broke out—strong animosity had been directed towards health teams advising villagers about EVD previously. France On September 19 the first French national to be infected with EVD, a volunteer nurse for Doctors Without Borders, is medically evacuated from Liberia to the Bégin military hospital on the outskirts of Paris. She later recovered and was released October 4. The death toll in West Africa is nearly 2,400. Spain On September 21, the second medically evacuated case in Spain arrived at Madrid's Hospital Carlos III. Brother Manuel García Viejo, another Spanish citizen who was medical director at the St John of God Hospital Sierra Leone in Lunsar , had been transported to Spain from Sierra Leone after being infected with the virus. Switzerland On September 22 a Swiss health worker was flown out from Sierra Leone to the University Hospital of Geneva after being bitten by an Ebola-infected child. Nigeria On September 22, the WHO reported an overall total of 20 cases and 8 deaths in Nigeria. There have been no new cases since the announcement thus far, and so EVD appears to be contained there. Liberia On September 22, a new 150-bed treatment center was opened in Monrovia , with patients arriving the day of its establishment. United States On September 24, the first EVD case in the United States ( Thomas Eric Duncan ) visits the emergency room of the Presbyterian Hospital of Dallas , where he is diagnosed with a 'low-grade, common viral disease' and sent home with antibiotics . Spain On 25 September it was announced that Brother Manuel García Viejo, the second Spanish citizen infected with the virus, had died at Madrid's Hospital Carlos III . United States On September 25, the third medically evacuated case in the US was released from the Nebraska Medical Center after three weeks of isolation. The patient, Rick Sacra, successfully convalesced with a blood transfusion from another American case. United Nations On September 26, the WHO announces that "The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times. Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long." United States On September 28, Thomas Eric Duncan is isolated at the Presbyterian Hospital of Dallas , where nurses Nina Pham and Amber Vinson are exposed to Duncan's vomit and bodily fluids. Both later become the second and third cases of EVD within the United States. Ivory Coast On September 29, the Ivory Coast concluded its ban on flights from Liberia citing 'West African solidarity.' United States On September 30 the CDC announces the first case of EVD in the Americas, in Dallas, Texas . The anonymous patient (later confirmed as Thomas Eric Duncan ) is "kept in strict isolation" at Texas Health Presbyterian Hospital Dallas . United Nations By the end of September, WHO statistics showed 7,492 cases and 3,439 deaths overall. Guinea On October 2, the Governor of Conakry, Soriba Sorel Camara, decreed that all public festivities for the religious holiday of Tabaski were to be henceforth forbidden after Doctors Without Borders noted a rapid spike of admitted patients in the city. United States On October 2, CDC hosted a Twitter chat to inform the public about Ebola. France On October 3, Health Minister Marisol Touraine announces that the nurse evacuated from Liberia had been cured and had left hospital. She had been treated with Avigan , which had been approved by Japan in March. The death toll in West Africa is more than 3,400. Germany On October 3, a second patient was admitted to an isolation ward in Germany. The patient is a Ugandan doctor who was working in Sierra Leone for an Italian NGO, and is currently being treated in Frankfurt's University Hospital. On the same date, Germany both opened a 48-bed isolation center in Kenema and sent medical supplies to Liberia. United States On October 3, a fourth case was medically evacuated to the United States; the colleagues of the patient were voluntarily isolated upon return from Liberia. The patient, Ashoka Mukpo, was a reporter for an American news network. Germany On October 4, the Senegalese epidemiologist that was the first patient flown to and treated in Germany was released from the University Medical Center Hamburg-Eppendorf after forty days of isolation. Norway On October 6, MSF announced that one of their workers, a Norwegian national, had become infected in Sierra Leone and was to be transported to Norway for treatment as soon as possible. Spain On 6 October María Teresa Romero Ramos , an auxiliary nurse who had cared for Manuel García Viejo at the Hospital Carlos III , tested positive for Ebola at the Hospital Universitario Fundación Alcorcón , marking the first transmission of EVD outside of West Africa. Liberia On October 7, Liberian Ambassador to the United States Jeremiah Sulunteh claimed Liberia may be "close to collapse" in a television interview. United States On October 8 Thomas Eric Duncan , the first case of EVD in the U.S., dies. Liberia On October 8, the WHO announced that EVD was present in fourteen of Liberia's fifteen counties. France On October 9, the International Charter on Space and Major Disasters was activated by the USGS to monitor the outbreak in Sierra Leone, the first time its assorted space assets have been used in an epidemiological role. [ citation needed ] Spain On October 10 María Teresa Romero Ramos's mixed breed dog, Excalibur, is euthanized by regional court order despite public protests due to concerns that it may have been an animal reservoir of the Ebola virus. On Twitter, the hashtag #SalvemosaExcalibur (We'll Save Excalibur) was briefly the second-most popular hashtag worldwide. Ivory Coast On October 10, the Ivory Coast banned the sale of bush meat as part of a series of limitations designed to prevent EVD from spreading to the country. Bush meat has been generally accepted as one of the reservoirs of the virus and has been restricted temporarily in Nigeria as well. United States On October 12, the CDC announces that a caregiver for Thomas Eric Duncan had tested positive for EVD. She is identified two days later as 29-year-old Vietnamese-American nurse Nina Pham . Pham was later moved to the National Institutes of Health in Bethesda, Maryland . France On October 13, France pledges to build several treatment centers in Guinea while also announcing that flights from affected countries may be barred from arrival in France in the near future. Sierra Leone On 14 October, 800 Sierra Leone peacekeepers due to relieve a contingent deployed in Somalia were placed under quarantine when one of the soldiers tested positive for Ebola. Germany On October 14, the first patient in Germany dies from EVD, a 56-year-old Sudanese UN employee who had been the third medical evacuee to Germany, at St Georg Hospital in Leipzig. United States On October 14 anonymous nurses allege that there were no protocols in the treatment of Thomas Eric Duncan at Texas Health Presbyterian Hospital Dallas , that their protective gear was insufficient, and that hazardous waste was allowed to pile up. Also on October 14, Dallas Mayor Mike Rawlings announced that Nina Pham's one-year-old Cavalier King Charles spaniel Bentley would be kept in isolation and monitored at Hensley Field . Also on October 14, 100 members of the American military are sent to Liberia to aid efforts there -the total number of American troops in West Africa stands at 565. United States On October 15 a second caregiver for Thomas Eric Duncan tests positive for EVD, 29-year-old nurse Amber Vinson . The CDC seeks to track fellow airline passengers on a flight she took from Cleveland a day before being diagnosed (her trip was itself cleared by CDC personnel). The U.S. Department of Health and Human Services announced Vinson will be transferred to Emory University Hospital in Atlanta, Georgia. Also on October 15, concerns over Amber Vinson's presence on Frontier Airlines flights 1142 and 1143 prompts school closures (two in Solon, Ohio and three in Belton, Texas ). Furthermore, two pilots and four air stewardesses are put on paid leave "out of an abundance of caution." UN On October 15 the WHO announces that the death toll for EVD is 4,477, mostly in West Africa, and warns that the infection rate there could reach 5,000 to 10,000 new cases a week in two months if efforts are not stepped up. Sierra Leone On October 16, the Emergency Operations Center announced two Ebola cases in the Koinadugu district in the far north. This marks the arrival of cases in every district in the country. United States On October 16, the fourth medically evacuated case in the US was discharged from Emory University Hospital after being administered serum from a British patient that had successfully completed treatment at a hospital in London. Also on October 16, a Maine elementary school teacher who had attended a conference in Dallas is put on 21-day paid leave "out of an abundance of caution." Some 135 people are being monitored in Dallas to some degree. Spain Also on October 16, Air France flight 1300 was isolated at Barajas International Airport in Madrid after a Nigerian passenger fell ill. Senegal On October 17, the EVD outbreak in Senegal is declared over after no new cases were reported in the country for 42 days. Belize On 17 October refused landing of a cruise ship containing a Texas worker who handled blood samples of a now deceased Ebola patient, indicating "This decision was made out of preponderance of caution for the welfare of the citizens and residents of Belize." It also banned travel from Sierra Leone, Liberia, Guinea and Nigeria. UN Also on October 17, a leaked WHO draft document admits systemic mistakes in the handling the early stages of the EVD epidemic in West Africa. Also on October 17, the WHO officially commended Macky Sall , Awa Marie Coll-Seck , the CDC, and MSF for their work in raising public awareness of Ebola in Senegal as well as quickly and effectively preventing the spread of EVD in the country. Senegal was announced 'Ebola-free' on the same day. Médecins Sans Frontières Also on October 17, Doctors Without Borders avers that international pledges of donations have had no impact on the situation in West Africa, and that it was "ridiculous" that MSF was bearing the brunt of care. [ citation needed ] United States Also on October 17, President Barack Obama names Ron Klain as his point man on the Ebola epidemic. Also on October 17, several school closures in Ohio and Texas (connected with the two flights taken by Amber Vinson ) by school district officials are declared by public health officials to be an overreaction. The CDC and Frontier Airlines widen their search, however, to 800 people who afterwards had boarded the same airliner (an Airbus A320, plane number N220FR) before it was taken out of service. The Airbus had flown to Atlanta, Georgia and Ft. Lauderdale, Florida, and back to Cleveland, Ohio. [ citation needed ] Also on October 17, a crowd of parents in Hazelhurst, Mississippi pull their children from their junior high school after learning that its principal had attended a family funeral in Zambia -in southern Africa, 3,000 miles away from the epidemic in West Africa. Egypt On October 18 Egypt delivered three tons of medical equipment to Guinea, consisting of medicine and medical equipment. Democratic Republic of the Congo On October 18, the DRC stated it would train over 1,000 Congolese soldiers in Kinshasa to support the West African countries facing the EVD epidemic there. While facing a concurrent outbreak of its own , the DRC alluded to 'African solidarity' as a reason for its contribution. Portugal On October 18, Portugal announced it would establish a medical base in Bissau , Guinea-Bissau to protect Guinea-Bissau from EVD in the chance that it would enter the country via neighboring Guinea. Guinea-Bissau On October 18 Guinea-Bissau began works on an Ebola treatment center in the Hospital Simão Mendes, which is the primary medical center in the capital, Bissau. The country is bordered by Guinea and Senegal, two nations that had reported cases of EVD during the course of the outbreak. UN On October 19 Tony Banbury, managing director of the recently established UN Mission for Ebola Emergency Response ( UNMEER ), states regarding the logistics of his operation that "I need everything. I need it everywhere. And I need it super-fast." Spain Also on October 19 Teresa Romero, the nurse who was the first person to be infected outside of West Africa, tests negative for Ebola in an initial test. A second test is required for confirmation. Nigeria On October 20, the WHO declared Nigeria to be Ebola-free after over six weeks without new reported cases. The final case and death count stands at 8 deaths and 20 cases. Ghana On October 20, Ghanaian President John Mahama announces that aid is beginning to arrive at the three worst-hit countries (Guinea, Liberia and Sierra Leone). Norway On October 21, the Norwegian national being treated in Oslo after being medically evacuated from Sierra Leone was released from the Oslo University Hospital . The woman, Silje Lehne Michalsen, responded to her discharge by stating: "For three months I saw the total absence of an international response. For three months I became more and more worried and frustrated." UN On October 21 Dr. Marie Paule Kieny of the WHO announces in Geneva that a serum from the blood of recovered EVD patients could be available within weeks in Liberia, and furthermore that target date for a vaccine was January 2015. Sierra Leone On October 21 riots broke out in the Kono district to prevent the quarantine of a 90-year-old woman suspected of having EVD; the youths are reportedly angry that there are no treatment centers in the diamond-rich Kono district. A daytime curfew is imposed. United States On October 22, NBC freelance cameraman and medical evacuee Ashoka Mukpo is released from Nebraska Medical Center free of the Ebola virus, the second patient so treated there. Mukpo is the fifth medically evacuated case in the United States thus far. Furthermore, DHS rules go into effect which route 100% of travellers from Liberia, Sierra Leone, and Guinea to one of five international airports for enhanced screening: JFK , Newark , Dulles , Hartsfield-Jackson , or O'Hare . (These airports had previously served 94% of such passengers arriving in the U.S.) In addition, the CDC announced a plan to monitor for 21 days (the Ebola incubation period) all travelers arriving in the US from Guinea, Liberia or Sierra Leone, beginning on October 27. They will have to report body temperatures and symptoms daily to local and state health departments. And finally, Nina Pham's dog, Bentley, tests negative for Ebola. Spain Also on October 22 Teresa Romero tests negative for Ebola in a second round of tests. Cuba Also on October 22 Cuba sends a medical team to Liberia. Mali On October 23 the first case is confirmed in Mali, a two-year-old girl who had recently visited Guinea. United States Also on October 23 New York City physician Craig Spencer was placed in isolation in Bellevue Hospital after experiencing symptoms of EVD. He subsequently tests positive for the Ebola virus. Spencer had returned recently from Guinea, where he had been working with Ebola patients as part of Doctors Without Borders. The diagnosis was unrelated to the cases of Ebola virus disease in Texas. Spencer completed several activities before arriving at the hospital, including riding the subway, visiting a bowling alley and entering another resident's car via Uber . Mali On October 24 Mali reported its first death; the two-year girl who was the first confirmed case in the country died the day after her case was reported. United States Also on October 24 the two Dallas nurses who had treated Thomas Eric Duncan and contracted EVD, Nina Pham and Amber Vinson, are declared Ebola free; the former meets President Obama in the Oval Office upon release from hospital. Also on the 24th, New York and New Jersey establish mandatory quarantine protocols for those health care workers who have treated EVD patients who arrive from West Africa at their international airports. North Korea Also on October 24, North Korea bars all foreign tourists. United Nations On October 25 the WHO announces that the Ebola outbreak has passed 10,000 cases worldwide; of the 4,922 deaths, Sierra Leone, Liberia and Guinea account for all but ten. United Kingdom Also on October 25, a paper published in The Lancet forecasts that the scale of the current international response is too slow to prevent numerous further deaths in West Africa. United States Also on October 25, nurse Kaci Hickox, who had treated EVD patients in Sierra Leone, expresses frustration at her quarantine after her arrival at Newark International Airport the previous day under a state policy which exceeds the recommendations of the CDC . Mauritania Also on October 25, Mauritania closes its border with Mali . United States On October 26, Illinois Governor Pat Quinn signs an order mandating a 21-day quarantine for those who have had direct contact with EVD patients in Liberia, Guinea, or Sierra Leone. Japan On October 27, a middle aged Canadian journalist was accosted at Tokyo International Airport upon returning from a two-month visit to Liberia and stating he had felt feverish. He was then handed to the Ministry of Health, Labour, and Welfare and was ordered to be quarantined at the National Medical Research Center in Shinjuku , Tokyo . While he was the first suspected EVD case in Asia, tests on the following day proved him negative for EVD. Australia Also on October 27, Australia instigates visa restrictions on travellers from the three countries most affected by the Ebola epidemic. United States On October 28 nurse Kaci Hickox is permitted to undergo quarantine at her home in Maine and leaves her hospital tent in New Jersey. United Nations On October 29 the WHO reports that the rate of infections in Liberia has slowed, due in part in changes in cultural mortuary practices. It warns, however, that the crisis is far from over. The WHO also reports, in its tenth Ebola Roadmap Situation Report, that as of October 27, there are 13,703 EVD cases with 4,920 deaths; that all districts in Liberia and Sierra Leone are affected; and that UNMEER will have been in operation (as of October 30) for thirty days. United States Also on October 29, a Connecticut school is sued for not allowing a seven-year-old student who had attended a wedding in Ebola-free Nigeria with her father to attend until November 3 due to "concerns" expressed by other parents and by teachers. Also on October 29, Louisiana state health officials asked those who had treated EVD patients to not attend the annual meeting of the American Society of Tropical Medicine and Hygiene . North Korea On October 30 North Korea imposes a mandatory 21-day quarantine on all foreign nationals arriving from abroad; furthermore, internal travel and travel abroad are even more tightly restricted. United States Also on October 30, Science and Science Translational Medicine offer their articles on the Ebola epidemic for free for both the public and for researchers given that it is "unprecedented in terms of number of people killed and rapid geographic spread." United States On October 31 Maine Judge Charles C. LaVerdiere ruled that nurse Kaci Hickox (who had previously gone on a defiant bicycle ride, breaking her quarantine) must continue to undergo mandatory monitoring by public health officials, but that her movements were not to be restricted inasmuch as she was asymptomatic . "The court is fully aware that people are acting out of fear and that this fear is not entirely rational,' the judge noted. United Nations By the end of October, WHO statistics showed 13,540 cases and 4,941 deaths overall. France On November 1, the second medically evacuated case was flown out of Sierra Leone to be treated in France. The patient, a United Nations employee, is not a French citizen. United Nations On November 5 UNMEER reports that cases are surging in Sierra Leone due to the lack of treatment centers. "Two-thirds of the new cases recorded in the past three weeks have been in Sierra Leone." United States Also on November 5 the White House requests just over $6 billion in Ebola funding from Congress. France On November 6 France announces the screening of airline passengers arriving from Guinea. United States On November 7 a conference is held at the White House with three leading robotics universities ( Worcester Polytechnic Institute , Texas A&M , and the University of California, Berkeley ) to explore the feasibility of re-purposing non-autonomous robots to further separate health care providers from possible contact with the Ebola virus. Possible roles include the removal of PPE , clinical telepresence , and the burial of the contagious dead. Médecins Sans Frontières Also on November 7, Médecins Sans Frontières / Doctors Without Borders (MSF) announces a significant decline, for reasons which are not fully understood, in Liberian cases. United States On November 10 Dr. Spencer is declared virus-free by the New York City Health Department; he is to be released from Bellevue Hospital the next day. United States On November 11 Dr. Spencer is released from Bellevue Hospital. Mali On November 12, two more cases of Ebola are confirmed, both of whom died; these cases are unrelated to the case of the 2-year-old who died late October. The source of this outbreak is a Guinean imam who was treated at the Pasteur clinic in Bamako (the capital and largest city in Mali); the second case in this outbreak was a nurse at the clinic. Liberia On November 13, Liberia ends its state of emergency . United States On November 15 Dr. Martin Salia, a surgeon working in Sierra Leone, is medically evacuated to the Nebraska Medical Center , the third EVD case to be treated there and the most critical. Mali Also on November 15 Mali has identified and is monitoring 256 contacts (out of as many of 343) of its second batch of EVD cases. United States On November 17 Dr. Martin Salia dies at the Nebraska Medical Center. Germany On November 22, Germany sends 400 specially adapted motorbikes to remote West Africa regions. The bikes are to be used for sample transport in areas that do not have a local testing laboratory. Sierra Leone In early December, Sierra Leone falls behind in efforts to remove and bury the dead, with some workers dumping bodies in the streets to protest not being paid. Bodies are buried without being tested, and less than one in five dead may end up being reported to the WHO as an Ebola casualty. United States On December 10, an American nurse exposed to Ebola while volunteering in Sierra Leone will be admitted to the National Institutes of Health Mark O. Hatfield Clinical Research Center for observation and to enroll in a clinical protocol on Thursday, December 4. United States Also on December 10, Time magazine names The Ebola Fighters its Person of the Year . Sierra Leone On December 12, it is announced that public Christmas and New Year's celebrations are banned. 1,319 new infections have been recorded in the last three weeks. Guinea-Bissau On December 12, shortly after reopening its border (closed since August) with Guinea, a man with a fever was apprehended and quarantined after evading a checkpoint, along with eight other travelers he had joined. (As of eleven days later, on December 23, his name, location and condition remain unknown.) On December 17, confirmed cases top 19,000. On December 22, confirmed deaths exceeded 7,500. Philippines On December 23, two returning OFWs from West Africa evaded quarantine requirements. Taking ill, they were rejected at one hospital and sent to another. (As of a week later, on December 29, their names, locations and condition remain unknown.) United States On December 24, 2014, a CDC technician in Atlanta was potentially exposed to Ebola due to a laboratory error, and has been placed into quarantine. United Kingdom On 29 December, Pauline Cafferkey, a healthcare worker returning from West Africa to Scotland, was diagnosed with Ebola. She was taken to a specialist treatment centre in London the next day. On December 29, confirmed cases exceeded 20,000 and confirmed deaths exceeded 7,800. Iraq On December 31, unnamed health officials in Mosul hospital allegedly maintained that Ebola had stricken "Da'ish gunmen" ( ISIS jihad fighters) of African origin. The reports are not independently confirmed. On January 3, confirmed deaths reach 8,000. [ citation needed ] On January 4, ISIS propaganda claimed several deaths due to Ebola in Mosul . The next day, the Ministry of Health of Iraq and WHO officials debunked the report as untrue. On January 8, confirmed cases reach 21,000. Mali On January 18, Mali is officially Ebola-free. On January 21, Guinea , Sierra Leone , Liberia all reported the lowest weekly infection rates since August 2014. Guinea had re-opened its schools and universities. On January 22, Sierra Leone has cancelled all internal quarantines citing a sharp drop of the Ebola transmission. On January 24, Liberia has reported just 5 confirmed and 21 suspected Ebola cases across the country, indicating a likely termination of the virus transmission. On January 27, confirmed cases exceed 22,000 and deaths 8,800. [ citation needed ] On January 30, in France Dr. Anavaj Sakuntabhai from the Pasteur Institute has reported several asymptomatic Ebola cases, indicating a possible mutation which may enable transmission by carriers without outward signs of the disease. On February 3, confirmed cases topped 22,500 and deaths reached 9,000. On February 16, confirmed cases exceeded 23,000 and deaths were over 9,300. On March 1, confirmed cases neared 24,000 while confirmed deaths exceeded 9,800. [ citation needed ] On March 5, Liberia releases its last confirmed case. On March 11, cases topped 24,300 while deaths surpassed 10,000. On March 20, Liberia records its first case of Ebola in more than two weeks. On April 1, cases exceeded 25,000 while deaths neared 10,500. On May 1, cases were over 26,300 while deaths reached 10,900. The outbreak is nearly over in Liberia (with no new cases in weeks), is averaging ten cases per week in Sierra Leone , and is still fully out of control in Guinea with several score new cases per week. Liberia On May 9, Liberia is officially Ebola-free. On November 10, in Brazil a 46-year-old man coming from Guinea was suspected of Ebola and was hospitalized in Belo Horizonte , Minas Gerais . [ citation needed ]On January 14, West Africa was declared Ebola-free , marking the official end of the epidemic.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Soviet_Union/html

Soviet Union

The Soviet Union , [lower-alpha 18] officially the Union of Soviet Socialist Republics [lower-alpha 19] ( USSR ), [lower-alpha 20] was a transcontinental country that spanned much of Eurasia from 1922 to 1991. It was a successor state to the Russian Empire that was nominally organized as a federal union of fifteen national republics , the largest and most populous of which was the Russian SFSR ; [lower-alpha 21] in practice both its government and economy were highly centralized until its final years. As a one-party state governed by the Communist Party of the Soviet Union , it was a flagship communist state . The Soviet Union's roots lay in the October Revolution of 1917, which saw the Bolsheviks overthrow the Russian Provisional Government that formed earlier that year following the February Revolution that had dissolved the Russian Empire . The new government, led by Vladimir Lenin , established the Russian Soviet Federative Socialist Republic (RSFSR), [lower-alpha 22] the world's first constitutionally socialist state . The revolution was not accepted by all within the Russian Republic , resulting in the Russian Civil War between the Bolsheviks and the anti-communist Whites . As the war progressed in the Bolsheviks' favor, the RSFSR began to incorporate land acquired from the war into various puppet states, which were merged into the Soviet Union in December 1922. Following Lenin's death in 1924, Joseph Stalin came to power, inaugurating a period of rapid industrialization and forced collectivization that led to significant economic growth, but also contributed to a famine in 1930 to 1933 that killed millions. The forced labour camp system of the Gulag was also expanded in this period. During the late 1930s, Stalin conducted the Great Purge to remove actual and perceived opponents, resulting in mass death, imprisonment, and deportation. In 1939, the USSR and Nazi Germany signed a nonaggression pact despite their ideological incongruence; nonetheless, in 1941, Nazi Germany invaded the Soviet Union in the largest land invasion in history, opening the Eastern Front of World War II . The Soviets played a decisive role in defeating the Axis powers in 1945, suffering an estimated 27 million casualties , which accounted for the majority of Allied losses. In the aftermath of the war , the Soviet Union consolidated the territory occupied by the Red Army , forming various satellite states , and undertook rapid economic development which cemented its status as a superpower . Following World War II, ideological tensions with the United States eventually led to the Cold War . The American-led Western Bloc coalesced into NATO in 1949, prompting the Soviet Union to form its own military alliance, commonly known as the Warsaw Pact , in 1955. Neither side ever engaged in direct military confrontation, and instead fought on an ideological basis and through proxy wars . In 1953, following Stalin's death , the Soviet Union undertook a campaign of de-Stalinization under the leadership of Nikita Khrushchev , which saw reversals and rejections of Stalinist policies. This campaign caused tensions with Communist China . During the 1950s, the Soviet Union rapidly expanded its efforts in space exploration and took an early lead in the Space Race with the first artificial satellite , the first human spaceflight , the first space station , and the first probe to land on another planet ( Venus ). The Cuban Missile Crisis of October 1962 was the closest the Cold War came to escalating into full-scale nuclear war . The 1970s saw a brief détente in the Soviet Union's relationship with the United States , but tensions emerged again following the Soviet invasion of Afghanistan in 1979. In the mid-1980s, the last Soviet leader, Mikhail Gorbachev , sought to reform the country through his policies of glasnost and perestroika . In 1989, various countries of the Warsaw Pact overthrew their Soviet-backed regimes , and nationalist and separatist movements erupted across the entire Soviet Union. In 1991, amid efforts to reform and preserve the country as a renewed federation , an attempted coup d'état against Gorbachev by hardline communists prompted the three most populous and economically developed republics—Ukraine, Russia, and Belarus—to secede from the Union. On December 26, Gorbachev officially recognized the dissolution of the Soviet Union . Boris Yeltsin , the leader of the RSFSR, oversaw its reconstitution into the Russian Federation , which became the Soviet Union's successor state; all other republics emerged as fully independent post-Soviet states . During its existence, the Soviet Union produced many significant social and technological achievements and innovations . It had the world's second-largest economy and largest standing military. An NPT-designated state , it housed the largest arsenal of nuclear weapons in the world . As an Allied nation, it was a founding member of the United Nations as well as one of the five permanent members of the United Nations Security Council . Before its dissolution, the USSR was one of the world's two superpowers through its hegemony in Eastern Europe, global diplomatic and ideological influence (particularly in the Global South ), military and economic strengths, and scientific accomplishments.The word soviet is derived from the Russian word sovet ( Russian: совет ), meaning 'council', 'assembly', 'advice', [lower-alpha 23] ultimately deriving from the proto-Slavic verbal stem of * vět-iti ('to inform'), related to Slavic věst ('news'), English wise . The word sovietnik means 'councillor'. Some organizations in Russian history were called council ( Russian: совет ). In the Russian Empire , the State Council , which functioned from 1810 to 1917, was referred to as a Council of Ministers. The Soviets as workers' councils first appeared during the 1905 Russian Revolution . Although they were quickly suppressed by the Imperial army, after the February Revolution of 1917 , workers' and soldiers' Soviets emerged throughout the country, and shared power with the Russian Provisional Government . The Bolsheviks, led by Vladimir Lenin , demanded that all power be transferred to the Soviets, and gained support from the workers and soldiers. After the October Revolution , in which the Bolsheviks seized power from the Provisional Government in the name of the Soviets, Lenin proclaimed the formation of the Russian Socialist Federal Soviet Republic (RSFSR). During the Georgian Affair of 1922, Lenin called for the Russian SFSR and other national Soviet republics to form a greater union which he initially named as the Union of Soviet Republics of Europe and Asia ( Russian : Союз Ð¡Ð¾Ð²ÐµÑ‚ÑÐºÐ¸Ñ Ð ÐµÑÐ¿ÑƒÐ±Ð»Ð¸Ðº Европы и Азии , tr. Sojuz Sovjetskih Respublik Evropy i Azii ). Joseph Stalin initially resisted Lenin's proposal but ultimately accepted it, and with Lenin's agreement he changed the name to the Union of Soviet Socialist Republics (USSR), although all republics began as socialist soviet and did not change to the other order until 1936 . In addition, in the regional languages of several republics, the word council or conciliar in the respective language was only quite late changed to an adaptation of the Russian soviet and never in others, e.g. Ukrainian SSR . СССР(in the Latin alphabet: SSSR ) is the abbreviation of the Russian-language cognate of USSR, as written in Cyrillic letters . The Soviets used this abbreviation so frequently that audiences worldwide became familiar with its meaning. After this, the most common Russian initialization is Союз ССР(transliteration: Soyuz SSR ) which essentially translates to Union of SSRs in English. In addition, the Russian short form name Советский Союз (transliteration: Sovjetskij Sojuz , which literally means Soviet Union ) is also commonly used, but only in its unabbreviated form. Since the start of the Great Patriotic War at the latest, abbreviating the Russian name of the Soviet Union as СС has been taboo, the reason being that СС as a Russian Cyrillic abbreviation is associated with the infamous Schutzstaffel of Nazi Germany , just as SS is in English. In English-language media, the state was referred to as the Soviet Union or the USSR. The Russian SFSR dominated the Soviet Union to such an extent that for most of the Soviet Union's existence, it was commonly, but incorrectly, referred to as Russia. According to historian Matthew White, it was an open secret that the country's federal structure was "window dressing" for Russian dominance. For that reason, the people of the USSR were almost always called "Russians", not "Soviets", since "everyone knew who really ran the show". Modern revolutionary activity in the Russian Empire began with the 1825 Decembrist revolt . Although serfdom was abolished in 1861, it was done on terms unfavourable to the peasants and served to encourage revolutionaries. A parliament—the State Duma —was established in 1906 after the Russian Revolution of 1905 , but Emperor Nicholas II resisted attempts to move from absolute to a constitutional monarchy . Social unrest continued and was aggravated during World War I by military defeat and food shortages in major cities. A spontaneous popular demonstration in Petrograd on 8 March 1917, demanding peace and bread, culminated in the February Revolution and the abdication of Nicholas II and the imperial government. The tsarist autocracy was replaced by the social-democratic Russian Provisional Government , which intended to conduct elections to the Russian Constituent Assembly and to continue fighting on the side of the Entente in World War I . At the same time, workers' councils , known in Russian as ' Soviets ', sprang up across the country, and the most influential of them, the Petrograd Soviet of Workers' and Soldiers' Deputies , shared power with the Provisional Government. Membership of the Bolsehevik party had risen from 24,000 members in February 1917 to 200,000 members by September 1917. 50,000 workers had passed a resolution in favour of Bolshevik demand for transfer of power to the soviets . The Bolsheviks , led by Vladimir Lenin , pushed for communist revolution in the Soviets and on the streets, adopting the slogan of "All Power to the Soviets" and urging the overthrow of the Provisional Government. On 7 November 1917, Bolshevik Red Guards stormed the Winter Palace in Petrograd, arresting the Provisional Government leaders and Lenin declared that all power was now transferred to the Soviets. This event would later be officially known in Soviet bibliographies as the " Great October Socialist Revolution ". Lenin's government instituted a number of progressive measures such as universal education , universal healthcare and equal rights for women . Conversely, the bloody Red Terror was initiated to shut down all opposition, both perceived and real. In December, the Bolsheviks signed an armistice with the Central Powers , though by February 1918, fighting had resumed. In March, the Soviets ended involvement in the war and signed the separate peace Treaty of Brest-Litovsk . A long and bloody Civil War ensued between the Reds and the Whites , starting in 1917 and ending in 1923 with the Reds' victory. It included foreign intervention , the murder of the former Emperor and his family , and the famine of 1921–1922 , which killed about five million people. In March 1921, during a related war against Poland , the Peace of Riga was signed, splitting disputed territories in Belarus and Ukraine between the Republic of Poland and Soviet Russia . Soviet Russia sought to re-conquer all newly independent nations of the former Empire, although their success was limited. Estonia , Finland , Latvia , and Lithuania all repelled Soviet invasions, while Ukraine , Belarus (as a result of the Polish–Soviet War ), Armenia , Azerbaijan and Georgia were occupied by the Red Army. Additionally, forced requisition of food by the Soviet government led to substantial resistance, of which the most notable was the Tambov Rebellion , ultimately put down by the Red Army. The Civil War had a devastating impact on the economy. A black market emerged in Russia, despite the threat of martial law against profiteering. The ruble collapsed, with barter increasingly replacing money as a medium of exchange and, by 1921, heavy industry output had fallen to 20% of 1913 levels. 90% of wages were paid with goods rather than money. 70% of locomotives were in need of repair [ citation needed ] , and food requisitioning, combined with the effects of seven years of war and a severe drought, contributed to a famine that caused between 3 and 10 million deaths. Coal production decreased from 27.5 million tons (1913) to 7 million tons (1920), while overall factory production also declined from 10,000 million roubles to 1,000 million roubles. According to the noted historian David Christian, the grain harvest was also slashed from 80.1 million tons (1913) to 46.5 million tons (1920). On 28 December 1922, a conference of plenipotentiary delegations from the Russian SFSR , the Transcaucasian SFSR , the Ukrainian SSR and the Byelorussian SSR approved the Treaty on the Creation of the USSR and the Declaration of the Creation of the USSR , forming the Union of Soviet Socialist Republics. These two documents were confirmed by the first Congress of Soviets of the USSR and signed by the heads of the delegations, Mikhail Kalinin , Mikhail Tskhakaya , Mikhail Frunze , Grigory Petrovsky and Alexander Chervyakov , on 30 December 1922. The formal proclamation was made from the stage of the Bolshoi Theatre in Moscow. An intensive restructuring of the economy, industry and politics of the country began in the early days of Soviet power in 1917. A large part of this was done according to the Bolshevik Initial Decrees , government documents signed by Vladimir Lenin. One of the most prominent breakthroughs was the GOELRO plan , which envisioned a major restructuring of the Soviet economy based on total electrification of Russia. The plan became the prototype for subsequent Five-Year Plans and was fulfilled by 1931. After the economic policy of ' War communism ' during the Russian Civil War, as a prelude to fully developing socialism in the country, the Soviet government permitted some private enterprise to coexist alongside nationalized industry in the 1920s, and total food requisition in the countryside was replaced by a food tax. From its creation, the government in the Soviet Union was based on the one-party rule of the Communist Party (Bolsheviks) . [lower-alpha 24] The stated purpose was to prevent the return of capitalist exploitation, and that the principles of democratic centralism would be the most effective in representing the people's will in a practical manner. The debate over the future of the economy provided the background for a power struggle in the years after Lenin's death in 1924. Initially, Lenin was to be replaced by a ' troika ' consisting of Grigory Zinoviev of the Ukrainian SSR , Lev Kamenev of the Russian SFSR , and Joseph Stalin of the Transcaucasian SFSR . On 1 February 1924, the USSR was recognized by the United Kingdom. [ citation needed ] The same year, a Soviet Constitution was approved, legitimizing the December 1922 union. According to Archie Brown the constitution was never an accurate guide to political reality in the USSR. For example, the fact that the Party played the leading role in making and enforcing policy was not mentioned in it until 1977. The USSR was a federative entity of many constituent republics, each with its own political and administrative entities. However, the term 'Soviet Russia' – formally applicable only to the Russian Federative Socialist Republic – was often applied to the entire country by non-Soviet writers due to its domination by the Russian SFSR. On 3 April 1922, Stalin was named the General Secretary of the Communist Party of the Soviet Union . Lenin had appointed Stalin the head of the Workers' and Peasants' Inspectorate , which gave Stalin considerable power. By gradually consolidating his influence and isolating and outmaneuvering his rivals within the party , Stalin became the undisputed leader of the country and, by the end of the 1920s, established a totalitarian rule. In October 1927, Zinoviev and Leon Trotsky were expelled from the Central Committee and forced into exile. In 1928, Stalin introduced the first five-year plan for building a socialist economy . In place of the internationalism expressed by Lenin throughout the revolution, it aimed to build Socialism in One Country . In industry, the state assumed control over all existing enterprises and undertook an intensive program of industrialization . In agriculture , rather than adhering to the 'lead by example' policy advocated by Lenin, forced collectivization of farms was implemented all over the country. Famines ensued as a result, causing deaths estimated at three to seven million; surviving kulaks (wealthy or middle-class peasants) were persecuted, and many were sent to Gulags to do forced labor . Social upheaval continued in the mid-1930s. Despite the turmoil of the mid-to-late 1930s, the country developed a robust industrial economy in the years preceding World War II . Closer cooperation between the USSR and the West developed in the early 1930s. From 1932 to 1934, the country participated in the World Disarmament Conference . In 1933, diplomatic relations between the United States and the USSR were established when in November, the newly elected President of the United States, Franklin D. Roosevelt, chose to recognize Stalin's Communist government formally and negotiated a new trade agreement between the two countries. In September 1934, the country joined the League of Nations . After the Spanish Civil War broke out in 1936, the USSR actively supported the Republican forces against the Nationalists , who were supported by Fascist Italy and Nazi Germany . In December 1936, Stalin unveiled a new constitution that was praised by supporters around the world as the most democratic constitution imaginable, though there was some skepticism. American historian J. Arch Getty concludes: "Many who lauded Stalin's Soviet Union as the most democratic country on earth lived to regret their words. After all, the Soviet Constitution of 1936 was adopted on the eve of the Great Terror of the late 1930s; the "thoroughly democratic" elections to the first Supreme Soviet permitted only uncontested candidates and took place at the height of the savage violence in 1937. The civil rights, personal freedoms, and democratic forms promised in the Stalin constitution were trampled almost immediately and remained dead letters until long after Stalin's death." Stalin's Great Purge resulted in the detainment or execution of many ' Old Bolsheviks ' who had participated in the October Revolution. According to declassified Soviet archives, the NKVD arrested more than one and a half million people in 1937 and 1938, of whom 681,692 were shot. Over those two years, there were an average of over one thousand executions a day. [lower-alpha 25] In 1939, after attempts to form a military alliance with Britain and France against Germany failed, the Soviet Union made a dramatic shift towards Nazi Germany. Almost a year after Britain and France had concluded the Munich Agreement with Germany, the Soviet Union made agreements with Germany as well, both militarily and economically during extensive talks . Unlike the case of Britain and France, the Soviet Union's agreement with Germany, the Molotov–Ribbentrop Pact (signed on 23 August 1939), included a secret protocol that paved the way for the Soviet invasion of Eastern European states and occupation of their territories . The pact made possible the Soviet occupation of Lithuania, Latvia, Estonia , Bessarabia, northern Bukovina , and eastern Poland . On 1 September, Germany invaded Poland and on the 17th the Soviet Union invaded Poland as well. On 6 October, Poland fell and part of the Soviet occupation zone was then handed over to Germany. On 10 October, the Soviet Union and Lithuania signed an agreement whereby the Soviet Union transferred Polish sovereignty over the Vilna region to Lithuania, and on 28 October the boundary between the Soviet occupation zone and the new territory of Lithuania was officially demarcated. On 1 November, the Soviet Union annexed Western Ukraine , followed by Western Belarus on the 2nd. In late November, unable to coerce the Republic of Finland by diplomatic means into moving its border 25 kilometres (16 mi) back from Leningrad , Stalin ordered the invasion of Finland . On 14 December 1939, the Soviet Union was expelled from the League of Nations for invading Finland. In the east, the Soviet military won several decisive victories during border clashes with the Empire of Japan in 1938 and 1939. However, in April 1941, the USSR signed the Soviet–Japanese Neutrality Pact with Japan, which the Soviets would unilaterally break in 1945, recognizing the territorial integrity of Manchukuo , a Japanese puppet state . The pact ensured Japan would not enter the war against the USSR on the side of Germany later. Germany broke the Molotov–Ribbentrop Pact and invaded the Soviet Union on 22 June 1941 starting what is known in Russia and some other post-Soviet states as the Great Patriotic War . The Red Army stopped the seemingly invincible German Army at the Battle of Moscow . The Battle of Stalingrad , which lasted from late 1942 to early 1943, dealt a severe blow to Germany from which they never fully recovered and became a turning point in the war. After Stalingrad, Soviet forces drove through Eastern Europe to Berlin before Germany surrendered in 1945 . The German Army suffered 80% of its military deaths in the Eastern Front. Harry Hopkins , a close foreign policy advisor to Franklin D. Roosevelt, spoke on 10 August 1943 of the USSR's decisive role in the war, saying that "While in Sicily the forces of Great Britain and the United States are being opposed by 2 German divisions, the Russian front is receiving attention of approximately 200 German divisions." [lower-alpha 26] Up to 34 million soldiers served in the Red Army during World War II, 8 million of which were non-Slavic minorities . The USSR suffered greatly in the war, losing around 20 million people (modern Russian sources put the number at 26.6 million). This includes 8.7 million military deaths. The majority of the losses were ethnic Russians , followed by ethnic Ukrainians . Approximately 2.8 million Soviet POWs died of starvation, mistreatment, or executions in just eight months of 1941–42. More than 2 million people were killed in Belarus during the three years of German occupation , almost a quarter of the region's population, including around 550,000 Jews in the Holocaust in Belarus . During the war, the country together with the United States, the United Kingdom and China were considered the Big Four Allied powers, and later became the Four Policemen that formed the basis of the United Nations Security Council . It emerged as a superpower in the post-war period. Once denied diplomatic recognition by the Western world, the USSR had official relations with practically every country by the late 1940s. A member of the United Nations at its foundation in 1945, the country became one of the five permanent members of the United Nations Security Council , which gave it the right to veto any of its resolutions. The USSR, in fulfillment of its agreement with the Allies at the Yalta Conference , broke the Soviet–Japanese Neutrality Pact in April 1945 which Japan had been honoring despite their alliance with Germany, and invaded Manchukuo and other Japan-controlled territories on 9 August 1945. This conflict ended with a decisive Soviet victory, contributing to the unconditional surrender of Japan and the end of World War II. Soviet soldiers committed mass rapes in occupied territories, especially in Germany . The wartime rapes were followed by decades of silence. According to historian Antony Beevor , whose books were banned in 2015 from some Russian schools and colleges, NKVD (Soviet secret police) files have revealed that the leadership knew what was happening, but did little to stop it. It was often rear echelon units who committed the rapes. According to professor Oleg Rzheshevsky, "4,148 Red Army officers and many privates were punished for committing atrocities". The exact number of German women and girls raped by Soviet troops during the war and occupation is uncertain, but historians estimate their numbers are likely in the hundreds of thousands, and possibly as many as two million. The Soviet Union was greatly assisted in its wartime effort by the United States via Lend Lease . In total, the U.S. deliveries to the USSR through Lend-Lease amounted to $11 billion in materials: over 400,000 jeeps and trucks; 12,000 armored vehicles (including 7,000 tanks, about 1,386 of which were M3 Lees and 4,102 M4 Shermans ); 11,400 aircraft (of which 4,719 were Bell P-39 Airacobras , 3,414 were Douglas A-20 Havocs and 2,397 were Bell P-63 Kingcobras ) and 1.75 million tons of food. As Soviet soldiers were bearing the brunt of the war, Roosevelt's advisor Harry Hopkins felt that American aid to the Soviets would hasten the war's conclusion. Roughly 17.5 million tons of military equipment, vehicles, industrial supplies, and food were shipped from the Western Hemisphere to the USSR, 94% coming from the US. For comparison, a total of 22 million tons landed in Europe to supply American forces from January 1942 to May 1945. It has been estimated that American deliveries to the USSR through the Persian Corridor alone were sufficient, by US Army standards, to maintain sixty combat divisions in the line. During the immediate post-war period, the Soviet Union rebuilt and expanded its economy, while maintaining its strictly centralized control . It took effective control over most of the countries of Eastern Europe (except Yugoslavia and later Albania ), turning them into satellite states . The USSR bound its satellite states in a military alliance, the Warsaw Pact , in 1955, and an economic organization, Council for Mutual Economic Assistance or Comecon , a counterpart to the European Economic Community (EEC), from 1949 to 1991. Although nominally a "defensive" alliance, the Warsaw Pact's primary function was to safeguard the Soviet Union's hegemony over its Eastern European satellites, with the Pact's only direct military actions having been the invasions of its own member states to keep them from breaking away. The USSR concentrated on its own recovery, seizing and transferring most of Germany's industrial plants, and it exacted war reparations from East Germany , Hungary , Romania , and Bulgaria using Soviet-dominated joint enterprises. It also instituted trading arrangements deliberately designed to favour the country. Moscow controlled the Communist parties that ruled the satellite states, and they followed orders from the Kremlin. Historian Mark Kramer concludes: "The net outflow of resources from eastern Europe to the Soviet Union was approximately $15 billion to $20 billion in the first decade after World War II, an amount roughly equal to the total aid provided by the United States to western Europe under the Marshall Plan ." Later, the Comecon supplied aid to the eventually victorious Chinese Communist Party , and its influence grew elsewhere in the world. Fearing its ambitions, the Soviet Union's wartime allies, the United Kingdom and the United States, became its enemies. In the ensuing Cold War, the two sides clashed indirectly in proxy wars . Stalin died on 5 March 1953. Without a mutually agreeable successor, the highest Communist Party officials initially opted to rule the Soviet Union jointly through a troika headed by Georgy Malenkov . This did not last, however, and Nikita Khrushchev eventually won the ensuing power struggle by the mid-1950s. In 1956, he denounced Joseph Stalin and proceeded to ease controls over the party and society. This was known as de-Stalinization . Moscow considered Eastern Europe to be a critically vital buffer zone for the forward defence of its western borders, in case of another major invasion such as the German invasion of 1941. For this reason, the USSR sought to cement its control of the region by transforming the Eastern European countries into satellite states, dependent upon and subservient to its leadership. As a result, Soviet military forces were used to suppress an anti-communist uprising in Hungary in 1956. In the late 1950s, a confrontation with China regarding the Soviet rapprochement with the West, and what Mao Zedong perceived as Khrushchev's revisionism , led to the Sino–Soviet split . This resulted in a break throughout the global Marxist–Leninist movement, with the governments in Albania , Cambodia and Somalia choosing to ally with China. During this period of the late 1950s and early 1960s, the USSR continued to realize scientific and technological exploits in the Space Race , rivaling the United States: launching the first artificial satellite, Sputnik 1 in 1957; a living dog named Laika in 1957; the first human being, Yuri Gagarin in 1961; the first woman in space, Valentina Tereshkova in 1963; Alexei Leonov , the first person to walk in space in 1965; the first soft landing on the Moon by spacecraft Luna 9 in 1966; and the first Moon rovers, Lunokhod 1 and Lunokhod 2 . Khrushchev initiated ' The Thaw ', a complex shift in political, cultural and economic life in the country. This included some openness and contact with other nations and new social and economic policies with more emphasis on commodity goods, allowing a dramatic rise in living standards while maintaining high levels of economic growth. Censorship was relaxed as well. Khrushchev's reforms in agriculture and administration, however, were generally unproductive. In 1962, he precipitated a crisis with the United States over the Soviet deployment of nuclear missiles in Cuba . An agreement was made with the United States to remove nuclear missiles from both Cuba and Turkey , concluding the crisis. This event caused Khrushchev much embarrassment and loss of prestige, resulting in his removal from power in 1964. Following the ousting of Khrushchev, another period of collective leadership ensued, consisting of Leonid Brezhnev as general secretary, Alexei Kosygin as Premier and Nikolai Podgorny as Chairman of the Presidium, lasting until Brezhnev established himself in the early 1970s as the preeminent Soviet leader. In 1968, the Soviet Union and Warsaw Pact allies invaded Czechoslovakia to crush the Prague Spring reforms. In the aftermath, Brezhnev justified the invasion and previous military interventions, as well as any potential military interventions in the future, by introducing the Brezhnev Doctrine , which proclaimed any threat to Soviet rule in a Warsaw Pact state as a threat to all Warsaw Pact states, therefore justifying military intervention. Brezhnev presided throughout détente with the West that resulted in treaties on armament control ( SALT I , SALT II , Anti-Ballistic Missile Treaty ) while at the same time building up Soviet military might. In October 1977, the third Soviet Constitution was unanimously adopted. The prevailing mood of the Soviet leadership at the time of Brezhnev's death in 1982 was one of aversion to change. The long period of Brezhnev's rule had come to be dubbed one of 'standstill' , with an ageing and ossified top political leadership. This period is also known as the Era of Stagnation, a period of adverse economic, political, and social effects in the country, which began during the rule of Brezhnev and continued under his successors Yuri Andropov and Konstantin Chernenko . In late 1979, the Soviet Union's military intervened in the ongoing civil war in neighboring Afghanistan , effectively ending a détente with the West. Two developments dominated the decade that followed: the increasingly apparent crumbling of the Soviet Union's economic and political structures, and the patchwork attempts at reforms to reverse that process. Kenneth S. Deffeyes argued in Beyond Oil that the Reagan administration encouraged Saudi Arabia to lower the price of oil to the point where the Soviets could not make a profit selling their oil, and resulted in the depletion of the country's hard currency reserves. Brezhnev's next two successors, transitional figures with deep roots in his tradition, did not last long. Yuri Andropov was 68 years old and Konstantin Chernenko 72 when they assumed power; both died in less than two years. In an attempt to avoid a third short-lived leader, in 1985, the Soviets turned to the next generation and selected Mikhail Gorbachev . In addition to the failing economy, the prolonged war in Afghanistan led to increased public dissatisfaction with the Communist regime. Also, the Chernobyl disaster in 1986 added motive force to Gorbachev's reforms. He made significant changes in the economy and party leadership, called perestroika . His policy of glasnost freed public access to information after decades of heavy government censorship. Gorbachev also moved to end the Cold War. In 1988, the USSR abandoned its war in Afghanistan and began to withdraw its forces. In the following year, Gorbachev refused to interfere in the internal affairs of the Soviet satellite states , which paved the way for the Revolutions of 1989 . In particular, the standstill of the Soviet Union at the Pan-European Picnic in August 1989 then set a peaceful chain reaction in motion, at the end of which the Eastern Bloc collapsed. With the tearing down of the Berlin Wall and with East and West Germany pursuing re-unification, the Iron Curtain between the West and Soviet-occupied regions came down. At the same time, the Soviet republics started legal moves towards potentially declaring sovereignty over their territories, citing the freedom to secede in Article 72 of the USSR constitution. On 7 April 1990, a law was passed allowing a republic to secede if more than two-thirds of its residents voted for it in a referendum. Many held their first free elections in the Soviet era for their own national legislatures in 1990. Many of these legislatures proceeded to produce legislation contradicting the Union laws in what was known as the ' War of Laws '. In 1989, the Russian SFSR convened a newly elected Congress of People's Deputies. Boris Yeltsin was elected its chairman. On 12 June 1990, the Congress declared Russia's sovereignty over its territory and proceeded to pass laws that attempted to supersede some of the Soviet laws. After a landslide victory of SÄ jÅ«dis in Lithuania, that country declared its independence restored on 11 March 1990, citing the illegality of the Soviet occupation of the Baltic states . Soviet forces attempted to halt the secession by crushing popular demonstrations in Lithuania ( Bloody Sunday ) and Latvia ( The Barricades ), as a result of which numerous civilians were killed or wounded. However, these actions only bolstered international support for the secessionists. A referendum for the preservation of the USSR was held on 17 March 1991 in nine republics (the remainder having boycotted the vote), with the majority of the population in those republics voting for preservation of the Union in the form of a new federation. The referendum gave Gorbachev a minor boost. In the summer of 1991, the New Union Treaty , which would have turned the country into a much looser Union, was agreed upon by eight republics. The signing of the treaty, however, was interrupted by the August Coup —an attempted coup d'état by hardline members of the government and the KGB who sought to reverse Gorbachev's reforms and reassert the central government's control over the republics. After the coup collapsed, Russian president Yeltsin was seen as a hero for his decisive actions, while Gorbachev's power was effectively ended. The balance of power tipped significantly towards the republics. In August 1991, Latvia and Estonia immediately declared the restoration of their full independence (following Lithuania's 1990 example). Gorbachev resigned as general secretary in late August, and soon afterwards, the party's activities were indefinitely suspended—effectively ending its rule. By the fall, Gorbachev could no longer influence events outside Moscow, and he was being challenged even there by Yeltsin, who had been elected President of Russia in July 1991. The remaining 12 republics continued discussing new, increasingly looser, models of the Union. However, by December all except Russia and Kazakhstan had formally declared independence. During this time, Yeltsin took over what remained of the Soviet government, including the Moscow Kremlin . The final blow was struck on 1 December when Ukraine, the second-most powerful republic, voted overwhelmingly for independence . Ukraine's secession ended any realistic chance of the country staying together even on a limited scale. On 8 December 1991, the presidents of Russia, Ukraine and Belarus (formerly Byelorussia), signed the Belavezha Accords , which declared the Soviet Union dissolved and established the Commonwealth of Independent States (CIS) in its place. While doubts remained over the authority of the accords to do this, on 21 December 1991, the representatives of all Soviet republics except Georgia signed the Alma-Ata Protocol , which confirmed the accords. On 25 December 1991, Gorbachev resigned as the President of the USSR, declaring the office extinct. He turned the powers that had been vested in the presidency over to Yeltsin. That night, the Soviet flag was lowered for the last time, and the Russian tricolour was raised in its place. The following day, the Supreme Soviet , the highest governmental body, voted both itself and the country out of existence. This is generally recognized as marking the official, final dissolution of the Soviet Union as a functioning state, and the end of the Cold War. The Soviet Army initially remained under overall CIS command but was soon absorbed into the different military forces of the newly independent states. The few remaining Soviet institutions that had not been taken over by Russia ceased to function by the end of 1991. Following the dissolution, Russia was internationally recognized as the USSR's legal successor on the international stage. To that end, Russia voluntarily accepted all Soviet foreign debt and claimed Soviet overseas properties as its own. Under the 1992 Lisbon Protocol , Russia also agreed to receive all nuclear weapons remaining in the territory of other former Soviet republics. Since then, the Russian Federation has assumed the Soviet Union's rights and obligations , and is widely viewed as the USSR's successor state. Ukraine has refused to recognize exclusive Russian claims to succession of the USSR and claimed such status for Ukraine as well, which was codified in Articles 7 and 8 of its 1991 law On Legal Succession of Ukraine . Since its independence in 1991, Ukraine has continued to pursue claims against Russia in foreign courts, seeking to recover its share of the foreign property that was owned by the USSR. In summing up the international ramifications of these events, Vladislav Zubok stated: 'The collapse of the Soviet empire was an event of epochal geopolitical, military, ideological, and economic significance.' Before the dissolution, the country had maintained its status as one of the world's two superpowers for four decades after World War II through its hegemony in Eastern Europe, military strength, economic strength and scientific research, especially in space technology and weaponry. The analysis of the succession of states for the 15 post-Soviet states is complex. The Russian Federation is widely seen as the legal continuator state and is for most purposes the heir to the Soviet Union. It retained ownership of all former Soviet embassy properties, inheriting the full Soviet nuclear arsenal , and also inherited the Soviet Union's UN membership , with its permanent seat on the Security Council . Of the two other co-founding states of the USSR at the time of the dissolution, Ukraine was the only one that had passed laws, similar to Russia, claiming it is a state-successor of both the Ukrainian SSR and the USSR. Soviet treaties laid groundwork for Ukraine's future foreign agreements as well as leading to the country agreeing to undertake 16.37% of debts of the Soviet Union for which it was going to receive its share of the USSR's foreign property. Russia's position as the 'only continuation of the USSR' that became widely accepted in the West, as well as constant pressure from the Western countries, allowed Russia to inherit Soviet state property abroad and conceal information about it. Due to that Ukraine never ratified 'zero option' agreement that Russian Federation had signed with other former Soviet republics, as it denied disclosing of information about Soviet Gold Reserves and its Diamond Fund. The dispute over former Soviet property and assets between the two former republics is still ongoing: The conflict is unsolvable. We can continue to poke Kiev handouts in the calculation of 'solve the problem', only it won't be solved. Going to a trial is also pointless: for a number of European countries this is a political issue, and they will make a decision clearly in whose favor. What to do in this situation is an open question. Search for non-trivial solutions. But we must remember that in 2014, with the filing of the then Ukrainian Prime Minister Yatsenyuk, litigation with Russia resumed in 32 countries. Similar situation occurred with restitution of cultural property. Although on 14 February 1992 Russia and other former Soviet republics signed agreement 'On the return of cultural and historic property to the origin states' in Minsk , it was halted by the Russian State Duma that eventually passed ' Federal Law on Cultural Valuables Displaced to the USSR as a Result of the Second World War and Located on the Territory of the Russian Federation ' which made restitution currently impossible, effectively barring the return of looted cultural heritage by Soviet troops during the Second World War to its original owners. Estonia, Latvia, and Lithuania consider themselves as revivals of the three independent countries that existed prior to their occupation and annexation by the Soviet Union in 1940. They maintain that the process by which they were incorporated into the Soviet Union violated both international law and their own law, and that in 1990–1991 they were reasserting an independence that still legally existed. Nearly all of the post-Soviet states suffered deep and prolonged recessions after shock therapy , with poverty increasing more than tenfold. In a 2001 study by the economist Steven Rosefielde , he calculated that there were 3.4 million premature deaths in Russia from 1990 to 1998, which he partly blames on the "shock therapy" that came with the Washington Consensus . In 2011, The Guardian published an analysis of the former Soviet countries twenty years after the fall of the USSR. They found that "GDP fell as much as 50 percent in the 1990s in some republics... as capital flight, industrial collapse, hyperinflation and tax avoidance took their toll," but that there was a rebound in the 2000s, and by 2010 "some economies were five times as big as they were in 1991." Life expectancy has grown since 1991 in some of the countries, but fallen in others; likewise, some held free and fair elections, while others remained authoritarian. There are additionally six states that claim independence from the other internationally recognized post-Soviet states but possess limited international recognition : Abkhazia , Artsakh , Donetsk , Luhansk , South Ossetia and Transnistria . The Chechen separatist movement of the Chechen Republic of Ichkeria , the Gagauz separatist movement of the Gagauz Republic and the Talysh separatist movement of the Talysh-Mughan Autonomous Republic are other such cases which have already been resolved.Modern revolutionary activity in the Russian Empire began with the 1825 Decembrist revolt . Although serfdom was abolished in 1861, it was done on terms unfavourable to the peasants and served to encourage revolutionaries. A parliament—the State Duma —was established in 1906 after the Russian Revolution of 1905 , but Emperor Nicholas II resisted attempts to move from absolute to a constitutional monarchy . Social unrest continued and was aggravated during World War I by military defeat and food shortages in major cities. A spontaneous popular demonstration in Petrograd on 8 March 1917, demanding peace and bread, culminated in the February Revolution and the abdication of Nicholas II and the imperial government. The tsarist autocracy was replaced by the social-democratic Russian Provisional Government , which intended to conduct elections to the Russian Constituent Assembly and to continue fighting on the side of the Entente in World War I . At the same time, workers' councils , known in Russian as ' Soviets ', sprang up across the country, and the most influential of them, the Petrograd Soviet of Workers' and Soldiers' Deputies , shared power with the Provisional Government. Membership of the Bolsehevik party had risen from 24,000 members in February 1917 to 200,000 members by September 1917. 50,000 workers had passed a resolution in favour of Bolshevik demand for transfer of power to the soviets . The Bolsheviks , led by Vladimir Lenin , pushed for communist revolution in the Soviets and on the streets, adopting the slogan of "All Power to the Soviets" and urging the overthrow of the Provisional Government. On 7 November 1917, Bolshevik Red Guards stormed the Winter Palace in Petrograd, arresting the Provisional Government leaders and Lenin declared that all power was now transferred to the Soviets. This event would later be officially known in Soviet bibliographies as the " Great October Socialist Revolution ". Lenin's government instituted a number of progressive measures such as universal education , universal healthcare and equal rights for women . Conversely, the bloody Red Terror was initiated to shut down all opposition, both perceived and real. In December, the Bolsheviks signed an armistice with the Central Powers , though by February 1918, fighting had resumed. In March, the Soviets ended involvement in the war and signed the separate peace Treaty of Brest-Litovsk . A long and bloody Civil War ensued between the Reds and the Whites , starting in 1917 and ending in 1923 with the Reds' victory. It included foreign intervention , the murder of the former Emperor and his family , and the famine of 1921–1922 , which killed about five million people. In March 1921, during a related war against Poland , the Peace of Riga was signed, splitting disputed territories in Belarus and Ukraine between the Republic of Poland and Soviet Russia . Soviet Russia sought to re-conquer all newly independent nations of the former Empire, although their success was limited. Estonia , Finland , Latvia , and Lithuania all repelled Soviet invasions, while Ukraine , Belarus (as a result of the Polish–Soviet War ), Armenia , Azerbaijan and Georgia were occupied by the Red Army. Additionally, forced requisition of food by the Soviet government led to substantial resistance, of which the most notable was the Tambov Rebellion , ultimately put down by the Red Army. The Civil War had a devastating impact on the economy. A black market emerged in Russia, despite the threat of martial law against profiteering. The ruble collapsed, with barter increasingly replacing money as a medium of exchange and, by 1921, heavy industry output had fallen to 20% of 1913 levels. 90% of wages were paid with goods rather than money. 70% of locomotives were in need of repair [ citation needed ] , and food requisitioning, combined with the effects of seven years of war and a severe drought, contributed to a famine that caused between 3 and 10 million deaths. Coal production decreased from 27.5 million tons (1913) to 7 million tons (1920), while overall factory production also declined from 10,000 million roubles to 1,000 million roubles. According to the noted historian David Christian, the grain harvest was also slashed from 80.1 million tons (1913) to 46.5 million tons (1920). On 28 December 1922, a conference of plenipotentiary delegations from the Russian SFSR , the Transcaucasian SFSR , the Ukrainian SSR and the Byelorussian SSR approved the Treaty on the Creation of the USSR and the Declaration of the Creation of the USSR , forming the Union of Soviet Socialist Republics. These two documents were confirmed by the first Congress of Soviets of the USSR and signed by the heads of the delegations, Mikhail Kalinin , Mikhail Tskhakaya , Mikhail Frunze , Grigory Petrovsky and Alexander Chervyakov , on 30 December 1922. The formal proclamation was made from the stage of the Bolshoi Theatre in Moscow. An intensive restructuring of the economy, industry and politics of the country began in the early days of Soviet power in 1917. A large part of this was done according to the Bolshevik Initial Decrees , government documents signed by Vladimir Lenin. One of the most prominent breakthroughs was the GOELRO plan , which envisioned a major restructuring of the Soviet economy based on total electrification of Russia. The plan became the prototype for subsequent Five-Year Plans and was fulfilled by 1931. After the economic policy of ' War communism ' during the Russian Civil War, as a prelude to fully developing socialism in the country, the Soviet government permitted some private enterprise to coexist alongside nationalized industry in the 1920s, and total food requisition in the countryside was replaced by a food tax. From its creation, the government in the Soviet Union was based on the one-party rule of the Communist Party (Bolsheviks) . [lower-alpha 24] The stated purpose was to prevent the return of capitalist exploitation, and that the principles of democratic centralism would be the most effective in representing the people's will in a practical manner. The debate over the future of the economy provided the background for a power struggle in the years after Lenin's death in 1924. Initially, Lenin was to be replaced by a ' troika ' consisting of Grigory Zinoviev of the Ukrainian SSR , Lev Kamenev of the Russian SFSR , and Joseph Stalin of the Transcaucasian SFSR . On 1 February 1924, the USSR was recognized by the United Kingdom. [ citation needed ] The same year, a Soviet Constitution was approved, legitimizing the December 1922 union. According to Archie Brown the constitution was never an accurate guide to political reality in the USSR. For example, the fact that the Party played the leading role in making and enforcing policy was not mentioned in it until 1977. The USSR was a federative entity of many constituent republics, each with its own political and administrative entities. However, the term 'Soviet Russia' – formally applicable only to the Russian Federative Socialist Republic – was often applied to the entire country by non-Soviet writers due to its domination by the Russian SFSR.On 3 April 1922, Stalin was named the General Secretary of the Communist Party of the Soviet Union . Lenin had appointed Stalin the head of the Workers' and Peasants' Inspectorate , which gave Stalin considerable power. By gradually consolidating his influence and isolating and outmaneuvering his rivals within the party , Stalin became the undisputed leader of the country and, by the end of the 1920s, established a totalitarian rule. In October 1927, Zinoviev and Leon Trotsky were expelled from the Central Committee and forced into exile. In 1928, Stalin introduced the first five-year plan for building a socialist economy . In place of the internationalism expressed by Lenin throughout the revolution, it aimed to build Socialism in One Country . In industry, the state assumed control over all existing enterprises and undertook an intensive program of industrialization . In agriculture , rather than adhering to the 'lead by example' policy advocated by Lenin, forced collectivization of farms was implemented all over the country. Famines ensued as a result, causing deaths estimated at three to seven million; surviving kulaks (wealthy or middle-class peasants) were persecuted, and many were sent to Gulags to do forced labor . Social upheaval continued in the mid-1930s. Despite the turmoil of the mid-to-late 1930s, the country developed a robust industrial economy in the years preceding World War II . Closer cooperation between the USSR and the West developed in the early 1930s. From 1932 to 1934, the country participated in the World Disarmament Conference . In 1933, diplomatic relations between the United States and the USSR were established when in November, the newly elected President of the United States, Franklin D. Roosevelt, chose to recognize Stalin's Communist government formally and negotiated a new trade agreement between the two countries. In September 1934, the country joined the League of Nations . After the Spanish Civil War broke out in 1936, the USSR actively supported the Republican forces against the Nationalists , who were supported by Fascist Italy and Nazi Germany . In December 1936, Stalin unveiled a new constitution that was praised by supporters around the world as the most democratic constitution imaginable, though there was some skepticism. American historian J. Arch Getty concludes: "Many who lauded Stalin's Soviet Union as the most democratic country on earth lived to regret their words. After all, the Soviet Constitution of 1936 was adopted on the eve of the Great Terror of the late 1930s; the "thoroughly democratic" elections to the first Supreme Soviet permitted only uncontested candidates and took place at the height of the savage violence in 1937. The civil rights, personal freedoms, and democratic forms promised in the Stalin constitution were trampled almost immediately and remained dead letters until long after Stalin's death." Stalin's Great Purge resulted in the detainment or execution of many ' Old Bolsheviks ' who had participated in the October Revolution. According to declassified Soviet archives, the NKVD arrested more than one and a half million people in 1937 and 1938, of whom 681,692 were shot. Over those two years, there were an average of over one thousand executions a day. [lower-alpha 25] In 1939, after attempts to form a military alliance with Britain and France against Germany failed, the Soviet Union made a dramatic shift towards Nazi Germany. Almost a year after Britain and France had concluded the Munich Agreement with Germany, the Soviet Union made agreements with Germany as well, both militarily and economically during extensive talks . Unlike the case of Britain and France, the Soviet Union's agreement with Germany, the Molotov–Ribbentrop Pact (signed on 23 August 1939), included a secret protocol that paved the way for the Soviet invasion of Eastern European states and occupation of their territories . The pact made possible the Soviet occupation of Lithuania, Latvia, Estonia , Bessarabia, northern Bukovina , and eastern Poland . On 1 September, Germany invaded Poland and on the 17th the Soviet Union invaded Poland as well. On 6 October, Poland fell and part of the Soviet occupation zone was then handed over to Germany. On 10 October, the Soviet Union and Lithuania signed an agreement whereby the Soviet Union transferred Polish sovereignty over the Vilna region to Lithuania, and on 28 October the boundary between the Soviet occupation zone and the new territory of Lithuania was officially demarcated. On 1 November, the Soviet Union annexed Western Ukraine , followed by Western Belarus on the 2nd. In late November, unable to coerce the Republic of Finland by diplomatic means into moving its border 25 kilometres (16 mi) back from Leningrad , Stalin ordered the invasion of Finland . On 14 December 1939, the Soviet Union was expelled from the League of Nations for invading Finland. In the east, the Soviet military won several decisive victories during border clashes with the Empire of Japan in 1938 and 1939. However, in April 1941, the USSR signed the Soviet–Japanese Neutrality Pact with Japan, which the Soviets would unilaterally break in 1945, recognizing the territorial integrity of Manchukuo , a Japanese puppet state . The pact ensured Japan would not enter the war against the USSR on the side of Germany later. Germany broke the Molotov–Ribbentrop Pact and invaded the Soviet Union on 22 June 1941 starting what is known in Russia and some other post-Soviet states as the Great Patriotic War . The Red Army stopped the seemingly invincible German Army at the Battle of Moscow . The Battle of Stalingrad , which lasted from late 1942 to early 1943, dealt a severe blow to Germany from which they never fully recovered and became a turning point in the war. After Stalingrad, Soviet forces drove through Eastern Europe to Berlin before Germany surrendered in 1945 . The German Army suffered 80% of its military deaths in the Eastern Front. Harry Hopkins , a close foreign policy advisor to Franklin D. Roosevelt, spoke on 10 August 1943 of the USSR's decisive role in the war, saying that "While in Sicily the forces of Great Britain and the United States are being opposed by 2 German divisions, the Russian front is receiving attention of approximately 200 German divisions." [lower-alpha 26] Up to 34 million soldiers served in the Red Army during World War II, 8 million of which were non-Slavic minorities . The USSR suffered greatly in the war, losing around 20 million people (modern Russian sources put the number at 26.6 million). This includes 8.7 million military deaths. The majority of the losses were ethnic Russians , followed by ethnic Ukrainians . Approximately 2.8 million Soviet POWs died of starvation, mistreatment, or executions in just eight months of 1941–42. More than 2 million people were killed in Belarus during the three years of German occupation , almost a quarter of the region's population, including around 550,000 Jews in the Holocaust in Belarus . During the war, the country together with the United States, the United Kingdom and China were considered the Big Four Allied powers, and later became the Four Policemen that formed the basis of the United Nations Security Council . It emerged as a superpower in the post-war period. Once denied diplomatic recognition by the Western world, the USSR had official relations with practically every country by the late 1940s. A member of the United Nations at its foundation in 1945, the country became one of the five permanent members of the United Nations Security Council , which gave it the right to veto any of its resolutions. The USSR, in fulfillment of its agreement with the Allies at the Yalta Conference , broke the Soviet–Japanese Neutrality Pact in April 1945 which Japan had been honoring despite their alliance with Germany, and invaded Manchukuo and other Japan-controlled territories on 9 August 1945. This conflict ended with a decisive Soviet victory, contributing to the unconditional surrender of Japan and the end of World War II. Soviet soldiers committed mass rapes in occupied territories, especially in Germany . The wartime rapes were followed by decades of silence. According to historian Antony Beevor , whose books were banned in 2015 from some Russian schools and colleges, NKVD (Soviet secret police) files have revealed that the leadership knew what was happening, but did little to stop it. It was often rear echelon units who committed the rapes. According to professor Oleg Rzheshevsky, "4,148 Red Army officers and many privates were punished for committing atrocities". The exact number of German women and girls raped by Soviet troops during the war and occupation is uncertain, but historians estimate their numbers are likely in the hundreds of thousands, and possibly as many as two million. The Soviet Union was greatly assisted in its wartime effort by the United States via Lend Lease . In total, the U.S. deliveries to the USSR through Lend-Lease amounted to $11 billion in materials: over 400,000 jeeps and trucks; 12,000 armored vehicles (including 7,000 tanks, about 1,386 of which were M3 Lees and 4,102 M4 Shermans ); 11,400 aircraft (of which 4,719 were Bell P-39 Airacobras , 3,414 were Douglas A-20 Havocs and 2,397 were Bell P-63 Kingcobras ) and 1.75 million tons of food. As Soviet soldiers were bearing the brunt of the war, Roosevelt's advisor Harry Hopkins felt that American aid to the Soviets would hasten the war's conclusion. Roughly 17.5 million tons of military equipment, vehicles, industrial supplies, and food were shipped from the Western Hemisphere to the USSR, 94% coming from the US. For comparison, a total of 22 million tons landed in Europe to supply American forces from January 1942 to May 1945. It has been estimated that American deliveries to the USSR through the Persian Corridor alone were sufficient, by US Army standards, to maintain sixty combat divisions in the line. During the immediate post-war period, the Soviet Union rebuilt and expanded its economy, while maintaining its strictly centralized control . It took effective control over most of the countries of Eastern Europe (except Yugoslavia and later Albania ), turning them into satellite states . The USSR bound its satellite states in a military alliance, the Warsaw Pact , in 1955, and an economic organization, Council for Mutual Economic Assistance or Comecon , a counterpart to the European Economic Community (EEC), from 1949 to 1991. Although nominally a "defensive" alliance, the Warsaw Pact's primary function was to safeguard the Soviet Union's hegemony over its Eastern European satellites, with the Pact's only direct military actions having been the invasions of its own member states to keep them from breaking away. The USSR concentrated on its own recovery, seizing and transferring most of Germany's industrial plants, and it exacted war reparations from East Germany , Hungary , Romania , and Bulgaria using Soviet-dominated joint enterprises. It also instituted trading arrangements deliberately designed to favour the country. Moscow controlled the Communist parties that ruled the satellite states, and they followed orders from the Kremlin. Historian Mark Kramer concludes: "The net outflow of resources from eastern Europe to the Soviet Union was approximately $15 billion to $20 billion in the first decade after World War II, an amount roughly equal to the total aid provided by the United States to western Europe under the Marshall Plan ." Later, the Comecon supplied aid to the eventually victorious Chinese Communist Party , and its influence grew elsewhere in the world. Fearing its ambitions, the Soviet Union's wartime allies, the United Kingdom and the United States, became its enemies. In the ensuing Cold War, the two sides clashed indirectly in proxy wars .Germany broke the Molotov–Ribbentrop Pact and invaded the Soviet Union on 22 June 1941 starting what is known in Russia and some other post-Soviet states as the Great Patriotic War . The Red Army stopped the seemingly invincible German Army at the Battle of Moscow . The Battle of Stalingrad , which lasted from late 1942 to early 1943, dealt a severe blow to Germany from which they never fully recovered and became a turning point in the war. After Stalingrad, Soviet forces drove through Eastern Europe to Berlin before Germany surrendered in 1945 . The German Army suffered 80% of its military deaths in the Eastern Front. Harry Hopkins , a close foreign policy advisor to Franklin D. Roosevelt, spoke on 10 August 1943 of the USSR's decisive role in the war, saying that "While in Sicily the forces of Great Britain and the United States are being opposed by 2 German divisions, the Russian front is receiving attention of approximately 200 German divisions." [lower-alpha 26] Up to 34 million soldiers served in the Red Army during World War II, 8 million of which were non-Slavic minorities . The USSR suffered greatly in the war, losing around 20 million people (modern Russian sources put the number at 26.6 million). This includes 8.7 million military deaths. The majority of the losses were ethnic Russians , followed by ethnic Ukrainians . Approximately 2.8 million Soviet POWs died of starvation, mistreatment, or executions in just eight months of 1941–42. More than 2 million people were killed in Belarus during the three years of German occupation , almost a quarter of the region's population, including around 550,000 Jews in the Holocaust in Belarus . During the war, the country together with the United States, the United Kingdom and China were considered the Big Four Allied powers, and later became the Four Policemen that formed the basis of the United Nations Security Council . It emerged as a superpower in the post-war period. Once denied diplomatic recognition by the Western world, the USSR had official relations with practically every country by the late 1940s. A member of the United Nations at its foundation in 1945, the country became one of the five permanent members of the United Nations Security Council , which gave it the right to veto any of its resolutions. The USSR, in fulfillment of its agreement with the Allies at the Yalta Conference , broke the Soviet–Japanese Neutrality Pact in April 1945 which Japan had been honoring despite their alliance with Germany, and invaded Manchukuo and other Japan-controlled territories on 9 August 1945. This conflict ended with a decisive Soviet victory, contributing to the unconditional surrender of Japan and the end of World War II. Soviet soldiers committed mass rapes in occupied territories, especially in Germany . The wartime rapes were followed by decades of silence. According to historian Antony Beevor , whose books were banned in 2015 from some Russian schools and colleges, NKVD (Soviet secret police) files have revealed that the leadership knew what was happening, but did little to stop it. It was often rear echelon units who committed the rapes. According to professor Oleg Rzheshevsky, "4,148 Red Army officers and many privates were punished for committing atrocities". The exact number of German women and girls raped by Soviet troops during the war and occupation is uncertain, but historians estimate their numbers are likely in the hundreds of thousands, and possibly as many as two million. The Soviet Union was greatly assisted in its wartime effort by the United States via Lend Lease . In total, the U.S. deliveries to the USSR through Lend-Lease amounted to $11 billion in materials: over 400,000 jeeps and trucks; 12,000 armored vehicles (including 7,000 tanks, about 1,386 of which were M3 Lees and 4,102 M4 Shermans ); 11,400 aircraft (of which 4,719 were Bell P-39 Airacobras , 3,414 were Douglas A-20 Havocs and 2,397 were Bell P-63 Kingcobras ) and 1.75 million tons of food. As Soviet soldiers were bearing the brunt of the war, Roosevelt's advisor Harry Hopkins felt that American aid to the Soviets would hasten the war's conclusion. Roughly 17.5 million tons of military equipment, vehicles, industrial supplies, and food were shipped from the Western Hemisphere to the USSR, 94% coming from the US. For comparison, a total of 22 million tons landed in Europe to supply American forces from January 1942 to May 1945. It has been estimated that American deliveries to the USSR through the Persian Corridor alone were sufficient, by US Army standards, to maintain sixty combat divisions in the line. During the immediate post-war period, the Soviet Union rebuilt and expanded its economy, while maintaining its strictly centralized control . It took effective control over most of the countries of Eastern Europe (except Yugoslavia and later Albania ), turning them into satellite states . The USSR bound its satellite states in a military alliance, the Warsaw Pact , in 1955, and an economic organization, Council for Mutual Economic Assistance or Comecon , a counterpart to the European Economic Community (EEC), from 1949 to 1991. Although nominally a "defensive" alliance, the Warsaw Pact's primary function was to safeguard the Soviet Union's hegemony over its Eastern European satellites, with the Pact's only direct military actions having been the invasions of its own member states to keep them from breaking away. The USSR concentrated on its own recovery, seizing and transferring most of Germany's industrial plants, and it exacted war reparations from East Germany , Hungary , Romania , and Bulgaria using Soviet-dominated joint enterprises. It also instituted trading arrangements deliberately designed to favour the country. Moscow controlled the Communist parties that ruled the satellite states, and they followed orders from the Kremlin. Historian Mark Kramer concludes: "The net outflow of resources from eastern Europe to the Soviet Union was approximately $15 billion to $20 billion in the first decade after World War II, an amount roughly equal to the total aid provided by the United States to western Europe under the Marshall Plan ." Later, the Comecon supplied aid to the eventually victorious Chinese Communist Party , and its influence grew elsewhere in the world. Fearing its ambitions, the Soviet Union's wartime allies, the United Kingdom and the United States, became its enemies. In the ensuing Cold War, the two sides clashed indirectly in proxy wars .Stalin died on 5 March 1953. Without a mutually agreeable successor, the highest Communist Party officials initially opted to rule the Soviet Union jointly through a troika headed by Georgy Malenkov . This did not last, however, and Nikita Khrushchev eventually won the ensuing power struggle by the mid-1950s. In 1956, he denounced Joseph Stalin and proceeded to ease controls over the party and society. This was known as de-Stalinization . Moscow considered Eastern Europe to be a critically vital buffer zone for the forward defence of its western borders, in case of another major invasion such as the German invasion of 1941. For this reason, the USSR sought to cement its control of the region by transforming the Eastern European countries into satellite states, dependent upon and subservient to its leadership. As a result, Soviet military forces were used to suppress an anti-communist uprising in Hungary in 1956. In the late 1950s, a confrontation with China regarding the Soviet rapprochement with the West, and what Mao Zedong perceived as Khrushchev's revisionism , led to the Sino–Soviet split . This resulted in a break throughout the global Marxist–Leninist movement, with the governments in Albania , Cambodia and Somalia choosing to ally with China. During this period of the late 1950s and early 1960s, the USSR continued to realize scientific and technological exploits in the Space Race , rivaling the United States: launching the first artificial satellite, Sputnik 1 in 1957; a living dog named Laika in 1957; the first human being, Yuri Gagarin in 1961; the first woman in space, Valentina Tereshkova in 1963; Alexei Leonov , the first person to walk in space in 1965; the first soft landing on the Moon by spacecraft Luna 9 in 1966; and the first Moon rovers, Lunokhod 1 and Lunokhod 2 . Khrushchev initiated ' The Thaw ', a complex shift in political, cultural and economic life in the country. This included some openness and contact with other nations and new social and economic policies with more emphasis on commodity goods, allowing a dramatic rise in living standards while maintaining high levels of economic growth. Censorship was relaxed as well. Khrushchev's reforms in agriculture and administration, however, were generally unproductive. In 1962, he precipitated a crisis with the United States over the Soviet deployment of nuclear missiles in Cuba . An agreement was made with the United States to remove nuclear missiles from both Cuba and Turkey , concluding the crisis. This event caused Khrushchev much embarrassment and loss of prestige, resulting in his removal from power in 1964.Following the ousting of Khrushchev, another period of collective leadership ensued, consisting of Leonid Brezhnev as general secretary, Alexei Kosygin as Premier and Nikolai Podgorny as Chairman of the Presidium, lasting until Brezhnev established himself in the early 1970s as the preeminent Soviet leader. In 1968, the Soviet Union and Warsaw Pact allies invaded Czechoslovakia to crush the Prague Spring reforms. In the aftermath, Brezhnev justified the invasion and previous military interventions, as well as any potential military interventions in the future, by introducing the Brezhnev Doctrine , which proclaimed any threat to Soviet rule in a Warsaw Pact state as a threat to all Warsaw Pact states, therefore justifying military intervention. Brezhnev presided throughout détente with the West that resulted in treaties on armament control ( SALT I , SALT II , Anti-Ballistic Missile Treaty ) while at the same time building up Soviet military might. In October 1977, the third Soviet Constitution was unanimously adopted. The prevailing mood of the Soviet leadership at the time of Brezhnev's death in 1982 was one of aversion to change. The long period of Brezhnev's rule had come to be dubbed one of 'standstill' , with an ageing and ossified top political leadership. This period is also known as the Era of Stagnation, a period of adverse economic, political, and social effects in the country, which began during the rule of Brezhnev and continued under his successors Yuri Andropov and Konstantin Chernenko . In late 1979, the Soviet Union's military intervened in the ongoing civil war in neighboring Afghanistan , effectively ending a détente with the West.Two developments dominated the decade that followed: the increasingly apparent crumbling of the Soviet Union's economic and political structures, and the patchwork attempts at reforms to reverse that process. Kenneth S. Deffeyes argued in Beyond Oil that the Reagan administration encouraged Saudi Arabia to lower the price of oil to the point where the Soviets could not make a profit selling their oil, and resulted in the depletion of the country's hard currency reserves. Brezhnev's next two successors, transitional figures with deep roots in his tradition, did not last long. Yuri Andropov was 68 years old and Konstantin Chernenko 72 when they assumed power; both died in less than two years. In an attempt to avoid a third short-lived leader, in 1985, the Soviets turned to the next generation and selected Mikhail Gorbachev . In addition to the failing economy, the prolonged war in Afghanistan led to increased public dissatisfaction with the Communist regime. Also, the Chernobyl disaster in 1986 added motive force to Gorbachev's reforms. He made significant changes in the economy and party leadership, called perestroika . His policy of glasnost freed public access to information after decades of heavy government censorship. Gorbachev also moved to end the Cold War. In 1988, the USSR abandoned its war in Afghanistan and began to withdraw its forces. In the following year, Gorbachev refused to interfere in the internal affairs of the Soviet satellite states , which paved the way for the Revolutions of 1989 . In particular, the standstill of the Soviet Union at the Pan-European Picnic in August 1989 then set a peaceful chain reaction in motion, at the end of which the Eastern Bloc collapsed. With the tearing down of the Berlin Wall and with East and West Germany pursuing re-unification, the Iron Curtain between the West and Soviet-occupied regions came down. At the same time, the Soviet republics started legal moves towards potentially declaring sovereignty over their territories, citing the freedom to secede in Article 72 of the USSR constitution. On 7 April 1990, a law was passed allowing a republic to secede if more than two-thirds of its residents voted for it in a referendum. Many held their first free elections in the Soviet era for their own national legislatures in 1990. Many of these legislatures proceeded to produce legislation contradicting the Union laws in what was known as the ' War of Laws '. In 1989, the Russian SFSR convened a newly elected Congress of People's Deputies. Boris Yeltsin was elected its chairman. On 12 June 1990, the Congress declared Russia's sovereignty over its territory and proceeded to pass laws that attempted to supersede some of the Soviet laws. After a landslide victory of SÄ jÅ«dis in Lithuania, that country declared its independence restored on 11 March 1990, citing the illegality of the Soviet occupation of the Baltic states . Soviet forces attempted to halt the secession by crushing popular demonstrations in Lithuania ( Bloody Sunday ) and Latvia ( The Barricades ), as a result of which numerous civilians were killed or wounded. However, these actions only bolstered international support for the secessionists. A referendum for the preservation of the USSR was held on 17 March 1991 in nine republics (the remainder having boycotted the vote), with the majority of the population in those republics voting for preservation of the Union in the form of a new federation. The referendum gave Gorbachev a minor boost. In the summer of 1991, the New Union Treaty , which would have turned the country into a much looser Union, was agreed upon by eight republics. The signing of the treaty, however, was interrupted by the August Coup —an attempted coup d'état by hardline members of the government and the KGB who sought to reverse Gorbachev's reforms and reassert the central government's control over the republics. After the coup collapsed, Russian president Yeltsin was seen as a hero for his decisive actions, while Gorbachev's power was effectively ended. The balance of power tipped significantly towards the republics. In August 1991, Latvia and Estonia immediately declared the restoration of their full independence (following Lithuania's 1990 example). Gorbachev resigned as general secretary in late August, and soon afterwards, the party's activities were indefinitely suspended—effectively ending its rule. By the fall, Gorbachev could no longer influence events outside Moscow, and he was being challenged even there by Yeltsin, who had been elected President of Russia in July 1991.The remaining 12 republics continued discussing new, increasingly looser, models of the Union. However, by December all except Russia and Kazakhstan had formally declared independence. During this time, Yeltsin took over what remained of the Soviet government, including the Moscow Kremlin . The final blow was struck on 1 December when Ukraine, the second-most powerful republic, voted overwhelmingly for independence . Ukraine's secession ended any realistic chance of the country staying together even on a limited scale. On 8 December 1991, the presidents of Russia, Ukraine and Belarus (formerly Byelorussia), signed the Belavezha Accords , which declared the Soviet Union dissolved and established the Commonwealth of Independent States (CIS) in its place. While doubts remained over the authority of the accords to do this, on 21 December 1991, the representatives of all Soviet republics except Georgia signed the Alma-Ata Protocol , which confirmed the accords. On 25 December 1991, Gorbachev resigned as the President of the USSR, declaring the office extinct. He turned the powers that had been vested in the presidency over to Yeltsin. That night, the Soviet flag was lowered for the last time, and the Russian tricolour was raised in its place. The following day, the Supreme Soviet , the highest governmental body, voted both itself and the country out of existence. This is generally recognized as marking the official, final dissolution of the Soviet Union as a functioning state, and the end of the Cold War. The Soviet Army initially remained under overall CIS command but was soon absorbed into the different military forces of the newly independent states. The few remaining Soviet institutions that had not been taken over by Russia ceased to function by the end of 1991. Following the dissolution, Russia was internationally recognized as the USSR's legal successor on the international stage. To that end, Russia voluntarily accepted all Soviet foreign debt and claimed Soviet overseas properties as its own. Under the 1992 Lisbon Protocol , Russia also agreed to receive all nuclear weapons remaining in the territory of other former Soviet republics. Since then, the Russian Federation has assumed the Soviet Union's rights and obligations , and is widely viewed as the USSR's successor state. Ukraine has refused to recognize exclusive Russian claims to succession of the USSR and claimed such status for Ukraine as well, which was codified in Articles 7 and 8 of its 1991 law On Legal Succession of Ukraine . Since its independence in 1991, Ukraine has continued to pursue claims against Russia in foreign courts, seeking to recover its share of the foreign property that was owned by the USSR. In summing up the international ramifications of these events, Vladislav Zubok stated: 'The collapse of the Soviet empire was an event of epochal geopolitical, military, ideological, and economic significance.' Before the dissolution, the country had maintained its status as one of the world's two superpowers for four decades after World War II through its hegemony in Eastern Europe, military strength, economic strength and scientific research, especially in space technology and weaponry. The analysis of the succession of states for the 15 post-Soviet states is complex. The Russian Federation is widely seen as the legal continuator state and is for most purposes the heir to the Soviet Union. It retained ownership of all former Soviet embassy properties, inheriting the full Soviet nuclear arsenal , and also inherited the Soviet Union's UN membership , with its permanent seat on the Security Council . Of the two other co-founding states of the USSR at the time of the dissolution, Ukraine was the only one that had passed laws, similar to Russia, claiming it is a state-successor of both the Ukrainian SSR and the USSR. Soviet treaties laid groundwork for Ukraine's future foreign agreements as well as leading to the country agreeing to undertake 16.37% of debts of the Soviet Union for which it was going to receive its share of the USSR's foreign property. Russia's position as the 'only continuation of the USSR' that became widely accepted in the West, as well as constant pressure from the Western countries, allowed Russia to inherit Soviet state property abroad and conceal information about it. Due to that Ukraine never ratified 'zero option' agreement that Russian Federation had signed with other former Soviet republics, as it denied disclosing of information about Soviet Gold Reserves and its Diamond Fund. The dispute over former Soviet property and assets between the two former republics is still ongoing: The conflict is unsolvable. We can continue to poke Kiev handouts in the calculation of 'solve the problem', only it won't be solved. Going to a trial is also pointless: for a number of European countries this is a political issue, and they will make a decision clearly in whose favor. What to do in this situation is an open question. Search for non-trivial solutions. But we must remember that in 2014, with the filing of the then Ukrainian Prime Minister Yatsenyuk, litigation with Russia resumed in 32 countries. Similar situation occurred with restitution of cultural property. Although on 14 February 1992 Russia and other former Soviet republics signed agreement 'On the return of cultural and historic property to the origin states' in Minsk , it was halted by the Russian State Duma that eventually passed ' Federal Law on Cultural Valuables Displaced to the USSR as a Result of the Second World War and Located on the Territory of the Russian Federation ' which made restitution currently impossible, effectively barring the return of looted cultural heritage by Soviet troops during the Second World War to its original owners. Estonia, Latvia, and Lithuania consider themselves as revivals of the three independent countries that existed prior to their occupation and annexation by the Soviet Union in 1940. They maintain that the process by which they were incorporated into the Soviet Union violated both international law and their own law, and that in 1990–1991 they were reasserting an independence that still legally existed. Nearly all of the post-Soviet states suffered deep and prolonged recessions after shock therapy , with poverty increasing more than tenfold. In a 2001 study by the economist Steven Rosefielde , he calculated that there were 3.4 million premature deaths in Russia from 1990 to 1998, which he partly blames on the "shock therapy" that came with the Washington Consensus . In 2011, The Guardian published an analysis of the former Soviet countries twenty years after the fall of the USSR. They found that "GDP fell as much as 50 percent in the 1990s in some republics... as capital flight, industrial collapse, hyperinflation and tax avoidance took their toll," but that there was a rebound in the 2000s, and by 2010 "some economies were five times as big as they were in 1991." Life expectancy has grown since 1991 in some of the countries, but fallen in others; likewise, some held free and fair elections, while others remained authoritarian. There are additionally six states that claim independence from the other internationally recognized post-Soviet states but possess limited international recognition : Abkhazia , Artsakh , Donetsk , Luhansk , South Ossetia and Transnistria . The Chechen separatist movement of the Chechen Republic of Ichkeria , the Gagauz separatist movement of the Gagauz Republic and the Talysh separatist movement of the Talysh-Mughan Autonomous Republic are other such cases which have already been resolved.The analysis of the succession of states for the 15 post-Soviet states is complex. The Russian Federation is widely seen as the legal continuator state and is for most purposes the heir to the Soviet Union. It retained ownership of all former Soviet embassy properties, inheriting the full Soviet nuclear arsenal , and also inherited the Soviet Union's UN membership , with its permanent seat on the Security Council . Of the two other co-founding states of the USSR at the time of the dissolution, Ukraine was the only one that had passed laws, similar to Russia, claiming it is a state-successor of both the Ukrainian SSR and the USSR. Soviet treaties laid groundwork for Ukraine's future foreign agreements as well as leading to the country agreeing to undertake 16.37% of debts of the Soviet Union for which it was going to receive its share of the USSR's foreign property. Russia's position as the 'only continuation of the USSR' that became widely accepted in the West, as well as constant pressure from the Western countries, allowed Russia to inherit Soviet state property abroad and conceal information about it. Due to that Ukraine never ratified 'zero option' agreement that Russian Federation had signed with other former Soviet republics, as it denied disclosing of information about Soviet Gold Reserves and its Diamond Fund. The dispute over former Soviet property and assets between the two former republics is still ongoing: The conflict is unsolvable. We can continue to poke Kiev handouts in the calculation of 'solve the problem', only it won't be solved. Going to a trial is also pointless: for a number of European countries this is a political issue, and they will make a decision clearly in whose favor. What to do in this situation is an open question. Search for non-trivial solutions. But we must remember that in 2014, with the filing of the then Ukrainian Prime Minister Yatsenyuk, litigation with Russia resumed in 32 countries. Similar situation occurred with restitution of cultural property. Although on 14 February 1992 Russia and other former Soviet republics signed agreement 'On the return of cultural and historic property to the origin states' in Minsk , it was halted by the Russian State Duma that eventually passed ' Federal Law on Cultural Valuables Displaced to the USSR as a Result of the Second World War and Located on the Territory of the Russian Federation ' which made restitution currently impossible, effectively barring the return of looted cultural heritage by Soviet troops during the Second World War to its original owners. Estonia, Latvia, and Lithuania consider themselves as revivals of the three independent countries that existed prior to their occupation and annexation by the Soviet Union in 1940. They maintain that the process by which they were incorporated into the Soviet Union violated both international law and their own law, and that in 1990–1991 they were reasserting an independence that still legally existed. Nearly all of the post-Soviet states suffered deep and prolonged recessions after shock therapy , with poverty increasing more than tenfold. In a 2001 study by the economist Steven Rosefielde , he calculated that there were 3.4 million premature deaths in Russia from 1990 to 1998, which he partly blames on the "shock therapy" that came with the Washington Consensus . In 2011, The Guardian published an analysis of the former Soviet countries twenty years after the fall of the USSR. They found that "GDP fell as much as 50 percent in the 1990s in some republics... as capital flight, industrial collapse, hyperinflation and tax avoidance took their toll," but that there was a rebound in the 2000s, and by 2010 "some economies were five times as big as they were in 1991." Life expectancy has grown since 1991 in some of the countries, but fallen in others; likewise, some held free and fair elections, while others remained authoritarian. There are additionally six states that claim independence from the other internationally recognized post-Soviet states but possess limited international recognition : Abkhazia , Artsakh , Donetsk , Luhansk , South Ossetia and Transnistria . The Chechen separatist movement of the Chechen Republic of Ichkeria , the Gagauz separatist movement of the Gagauz Republic and the Talysh separatist movement of the Talysh-Mughan Autonomous Republic are other such cases which have already been resolved.With an area of 22,402,200 square kilometres (8,649,500 sq mi) , the Soviet Union was the world's largest country, a status that is retained by the Russian Federation . Covering a sixth of Earth's land surface, its size was comparable to that of North America . Two other successor states, Kazakhstan and Ukraine , rank among the top 10 countries by land area, and the largest country entirely in Europe, respectively. The European portion accounted for a quarter of the country's area and was the cultural and economic center. The eastern part in Asia extended to the Pacific Ocean to the east and Afghanistan to the south, and, except some areas in Central Asia , was much less populous. It spanned over 10,000 kilometres (6,200 mi) east to west across 11 time zones , and over 7,200 kilometres (4,500 mi) north to south. It had five climate zones: tundra , taiga , steppes , desert and mountains . The USSR, like Russia , had the world's longest border , measuring over 60,000 kilometres (37,000 mi) , or 1 + 1 ⁄ 2 circumferences of Earth. Two-thirds of it was a coastline . The country bordered Afghanistan , the People's Republic of China , Czechoslovakia , Finland , Hungary , Iran , Mongolia , North Korea , Norway , Poland , Romania , and Turkey from 1945 to 1991. The Bering Strait separated the USSR from the United States . The country's highest mountain was Communism Peak (now Ismoil Somoni Peak ) in Tajikistan , at 7,495 metres (24,590 ft) . The USSR also included most of the world's largest lakes; the Caspian Sea (shared with Iran ), and Lake Baikal , the world's largest (by volume) and deepest freshwater lake that is also an internal body of water in Russia. Neighbouring countries were aware of the high levels of pollution in the Soviet Union but after the dissolution of the Soviet Union it was discovered that its environmental problems were greater than what the Soviet authorities admitted. The Soviet Union was the world's second largest producer of harmful emissions. In 1988, total emissions in the Soviet Union were about 79% of those in the United States. But since the Soviet GNP was only 54% of that of the United States, this means that the Soviet Union generated 1.5 times more pollution than the United States per unit of GNP. The Soviet Chernobyl disaster in 1986 was the first major accident at a civilian nuclear power plant . Unparalleled in the world, it resulted in a large number of radioactive isotopes being released into the atmosphere. Radioactive doses were scattered relatively far. Although long-term effects of the accident were unknown, 4,000 new cases of thyroid cancer which resulted from the accident's contamination were reported at the time of the accident, but this led to a relatively low number of deaths (WHO data, 2005). Another major radioactive accident was the Kyshtym disaster . The Kola Peninsula was one of the places with major problems. Around the industrial cities of Monchegorsk and Norilsk , where nickel , for example, is mined, all forests have been destroyed by contamination, while the northern and other parts of Russia have been affected by emissions. During the 1990s, people in the West were also interested in the radioactive hazards of nuclear facilities, decommissioned nuclear submarines , and the processing of nuclear waste or spent nuclear fuel . It was also known in the early 1990s that the USSR had transported radioactive material to the Barents Sea and Kara Sea , which was later confirmed by the Russian parliament. The crash of the K-141 Kursk submarine in 2000 in the west further raised concerns. In the past, there were accidents involving submarines K-19 , K-8 , a K-129 , K-27 , K-219 and K-278 Komsomolets . There were three power hierarchies in the Soviet Union: the legislature represented by the Supreme Soviet of the Soviet Union , the government represented by the Council of Ministers , and the Communist Party of the Soviet Union (CPSU), the only legal party and the final policymaker in the country. At the top of the Communist Party was the Central Committee , elected at Party Congresses and Conferences. In turn, the Central Committee voted for a Politburo (called the Presidium between 1952 and 1966), Secretariat and the general secretary (First Secretary from 1953 to 1966), the de facto highest office in the Soviet Union. Depending on the degree of power consolidation, it was either the Politburo as a collective body or the General Secretary, who always was one of the Politburo members, that effectively led the party and the country (except for the period of the highly personalized authority of Stalin, exercised directly through his position in the Council of Ministers rather than the Politburo after 1941). They were not controlled by the general party membership, as the key principle of the party organization was democratic centralism , demanding strict subordination to higher bodies, and elections went uncontested, endorsing the candidates proposed from above. The Communist Party maintained its dominance over the state mainly through its control over the system of appointments . All senior government officials and most deputies of the Supreme Soviet were members of the CPSU. Of the party heads themselves, Stalin (1941–1953) and Khrushchev (1958–1964) were Premiers. Upon the forced retirement of Khrushchev, the party leader was prohibited from this kind of double membership, but the later General Secretaries for at least some part of their tenure occupied the mostly ceremonial position of Chairman of the Presidium of the Supreme Soviet , the nominal head of state . The institutions at lower levels were overseen and at times supplanted by primary party organizations . However, in practice the degree of control the party was able to exercise over the state bureaucracy, particularly after the death of Stalin, was far from total, with the bureaucracy pursuing different interests that were at times in conflict with the party, nor was the party itself monolithic from top to bottom, although factions were officially banned . The Supreme Soviet (successor of the Congress of Soviets ) was nominally the highest state body for most of the Soviet history, at first acting as a rubber stamp institution, approving and implementing all decisions made by the party. However, its powers and functions were extended in the late 1950s, 1960s and 1970s, including the creation of new state commissions and committees. It gained additional powers relating to the approval of the Five-Year Plans and the government budget . The Supreme Soviet elected a Presidium (successor of the Central Executive Committee ) to wield its power between plenary sessions, ordinarily held twice a year, and appointed the Supreme Court , the Procurator General and the Council of Ministers (known before 1946 as the Council of People's Commissars ), headed by the Chairman (Premier) and managing an enormous bureaucracy responsible for the administration of the economy and society. State and party structures of the constituent republics largely emulated the structure of the central institutions, although the Russian SFSR, unlike the other constituent republics, for most of its history had no republican branch of the CPSU, being ruled directly by the union-wide party until 1990. Local authorities were organized likewise into party committees , local Soviets and executive committees . While the state system was nominally federal, the party was unitary. The state security police (the KGB and its predecessor agencies ) played an important role in Soviet politics. It was instrumental in the Red Terror and Great Purge , but was brought under strict party control after Stalin's death. Under Yuri Andropov , the KGB engaged in the suppression of political dissent and maintained an extensive network of informers, reasserting itself as a political actor to some extent independent of the party-state structure, culminating in the anti-corruption campaign targeting high-ranking party officials in the late 1970s and early 1980s. The constitution , which was promulgated in 1924 , 1936 and 1977 , did not limit state power. No formal separation of powers existed between the Party, Supreme Soviet and Council of Ministers that represented executive and legislative branches of the government. The system was governed less by statute than by informal conventions, and no settled mechanism of leadership succession existed. Bitter and at times deadly power struggles took place in the Politburo after the deaths of Lenin and Stalin, as well as after Khrushchev's dismissal, itself due to a decision by both the Politburo and the Central Committee. All leaders of the Communist Party before Gorbachev died in office, except Georgy Malenkov and Khrushchev, both dismissed from the party leadership amid internal struggle within the party. Between 1988 and 1990, facing considerable opposition, Mikhail Gorbachev enacted reforms shifting power away from the highest bodies of the party and making the Supreme Soviet less dependent on them. The Congress of People's Deputies was established, the majority of whose members were directly elected in competitive elections held in March 1989, the first in Soviet history. The Congress now elected the Supreme Soviet, which became a full-time parliament, and much stronger than before. For the first time since the 1920s, it refused to rubber stamp proposals from the party and Council of Ministers. In 1990, Gorbachev introduced and assumed the position of the President of the Soviet Union , concentrated power in his executive office, independent of the party, and subordinated the government, now renamed the Cabinet of Ministers of the USSR , to himself. Tensions grew between the Union-wide authorities under Gorbachev, reformists led in Russia by Boris Yeltsin and controlling the newly elected Supreme Soviet of the Russian SFSR , and communist hardliners. On 19–21 August 1991, a group of hardliners staged a coup attempt . The coup failed, and the State Council of the Soviet Union became the highest organ of state power 'in the period of transition'. Gorbachev resigned as General Secretary, only remaining President for the final months of the existence of the USSR. The judiciary was not independent of the other branches of government. The Supreme Court supervised the lower courts ( People's Court ) and applied the law as established by the constitution or as interpreted by the Supreme Soviet. The Constitutional Oversight Committee reviewed the constitutionality of laws and acts. The Soviet Union used the inquisitorial system of Roman law , where the judge, procurator , and defence attorney collaborate to "establish the truth". Human rights in the Soviet Union were severely limited. The Soviet Union was a totalitarian state from 1927 until 1953 and a one-party state until 1990. Freedom of speech was suppressed and dissent was punished. Independent political activities were not tolerated, whether these involved participation in free labor unions , private corporations , independent churches or opposition political parties . The freedom of movement within and especially outside the country was limited. The state restricted rights of citizens to private property . The Soviet conception of human rights was very different from international law . According to Soviet legal theory , "it is the government who is the beneficiary of human rights which are to be asserted against the individual". The Soviet state was considered as the source of human rights. Therefore, the Soviet legal system regarded law as an arm of politics and courts as agencies of the government. Extensive extrajudicial powers were given to the Soviet secret police agencies . The Soviet government in practice significantly curbed the rule of law , civil liberties , protection of law , freedom of movement and guarantees of property , which were considered as examples of "bourgeois morality" by Soviet law theorists such as Andrey Vyshinsky . According to Vladimir Lenin , the purpose of socialist courts was "not to eliminate terror ... but to substantiate it and legitimize it in principle". The Soviet Union signed legally-binding human rights documents, such as the International Covenant on Civil and Political Rights in 1973, but they were neither widely known or accessible to people living under Communist rule, nor were they taken seriously by the Communist authorities. : 117 During his rule, Stalin always made the final policy decisions. Otherwise, Soviet foreign policy was set by the commission on the Foreign Policy of the Central Committee of the Communist Party of the Soviet Union , or by the party's highest body the Politburo . Operations were handled by the separate Ministry of Foreign Affairs . It was known as the People's Commissariat for Foreign Affairs (or Narkomindel), until 1946. The most influential spokesmen were Georgy Chicherin (1872–1936), Maxim Litvinov (1876–1951), Vyacheslav Molotov (1890–1986), Andrey Vyshinsky (1883–1954) and Andrei Gromyko (1909–1989). Intellectuals were based in the Moscow State Institute of International Relations . The Marxist-Leninist leadership of the Soviet Union intensely debated foreign policy issues and changed directions several times. Even after Stalin assumed dictatorial control in the late 1920s, there were debates, and he frequently changed positions. During the country's early period, it was assumed that Communist revolutions would break out soon in every major industrial country, and it was the Russian responsibility to assist them. The Comintern was the weapon of choice. A few revolutions did break out, but they were quickly suppressed (the longest lasting one was in Hungary)—the Hungarian Soviet Republic —lasted only from 21 March 1919 to 1 August 1919. The Russian Bolsheviks were in no position to give any help. By 1921, Lenin, Trotsky, and Stalin realized that capitalism had stabilized itself in Europe and there would not be any widespread revolutions anytime soon. It became the duty of the Russian Bolsheviks to protect what they had in Russia, and avoid military confrontations that might destroy their bridgehead. Russia was now a pariah state, along with Germany. The two came to terms in 1922 with the Treaty of Rapallo that settled long-standing grievances. At the same time, the two countries secretly set up training programs for the illegal German army and air force operations at hidden camps in the USSR. Moscow eventually stopped threatening other states, and instead worked to open peaceful relationships in terms of trade, and diplomatic recognition. The United Kingdom dismissed the warnings of Winston Churchill and a few others about a continuing Marxist-Leninist threat, and opened trade relations and de facto diplomatic recognition in 1922. There was hope for a settlement of the pre-war Tsarist debts, but it was repeatedly postponed. Formal recognition came when the new Labour Party came to power in 1924. All the other countries followed suit in opening trade relations. Henry Ford opened large-scale business relations with the Soviets in the late 1920s, hoping that it would lead to long-term peace. Finally, in 1933, the United States officially recognized the USSR, a decision backed by the public opinion and especially by US business interests that expected an opening of a new profitable market. In the late 1920s and early 1930s, Stalin ordered Marxist-Leninist parties across the world to strongly oppose non-Marxist political parties, labor unions or other organizations on the left, which they labelled social fascists . In the usage of the Soviet Union, and of the Comintern and its affiliated parties in this period, the epithet fascist was used to describe capitalist society in general and virtually any anti-Soviet or anti-Stalinist activity or opinion. Stalin reversed himself in 1934 with the Popular Front program that called on all Marxist parties to join with all anti-Fascist political, labor, and organizational forces that were opposed to fascism , especially of the Nazi variety. The rapid growth of power in Nazi Germany encouraged both Paris and Moscow to form a military alliance, and the Franco-Soviet Treaty of Mutual Assistance was signed in May 1935. A firm believer in collective security, Stalin's foreign minister Maxim Litvinov worked very hard to form a closer relationship with France and Britain. In 1939, half a year after the Munich Agreement , the USSR attempted to form an anti-Nazi alliance with France and Britain. Adolf Hitler proposed a better deal, which would give the USSR control over much of Eastern Europe through the Molotov–Ribbentrop Pact . In September, Germany invaded Poland, and the USSR also invaded later that month, resulting in the partition of Poland. In response, Britain and France declared war on Germany, marking the beginning of World War II . Up until his death in 1953, Joseph Stalin controlled all foreign relations of the Soviet Union during the interwar period . Despite the increasing build-up of Germany 's war machine and the outbreak of the Second Sino-Japanese War , the Soviet Union did not cooperate with any other nation, choosing to follow its own path. However, after Operation Barbarossa , the Soviet Union's priorities changed. Despite previous conflict with the United Kingdom , Vyacheslav Molotov dropped his post war border demands. The Cold War was a period of geopolitical tension between the United States and the Soviet Union and their respective allies, the Western Bloc and the Eastern Bloc , which began following World War II in 1945. The term cold war is used because there was no large-scale fighting directly between the two superpowers , but they each supported major regional conflicts known as proxy wars . The conflict was based around the ideological and geopolitical struggle for global influence by these two superpowers, following their temporary alliance and victory against Nazi Germany in 1945. Aside from the nuclear arsenal development and conventional military deployment, the struggle for dominance was expressed via indirect means such as psychological warfare , propaganda campaigns, espionage , far-reaching embargoes , rivalry at sports events and technological competitions such as the Space Race . Constitutionally, the USSR was a federation of constituent Union Republics, which were either unitary states, such as Ukraine or Byelorussia (SSRs), or federations, such as Russia or Transcaucasia (SFSRs), all four being the founding republics who signed the Treaty on the Creation of the USSR in December 1922. In 1924, during the national delimitation in Central Asia, Uzbekistan and Turkmenistan were formed from parts of Russia's Turkestan ASSR and two Soviet dependencies, the Khorezm and Bukharan PSPs . In 1929, Tajikistan was split off from the Uzbekistan SSR. With the constitution of 1936, the Transcaucasian SFSR was dissolved, resulting in its constituent republics of Armenia , Georgia and Azerbaijan being elevated to Union Republics, while Kazakhstan and Kirghizia were split off from the Russian SFSR, resulting in the same status. In August 1940, Moldavia was formed from parts of Ukraine and Soviet-occupied Bessarabia , and Ukrainian SSR. Estonia , Latvia and Lithuania were also annexed by the Soviet Union and turned into SSRs, which was not recognized by most of the international community and was considered an illegal occupation . After the Soviet invasion of Finland , the Karelo-Finnish SSR was formed on annexed territory as a Union Republic in March 1940 and then incorporated into Russia as the Karelian ASSR in 1956. Between July 1956 and September 1991, there were 15 union republics (see map below). While nominally a union of equals, in practice the Soviet Union was dominated by Russians . The domination was so absolute that for most of its existence, the country was commonly (but incorrectly) referred to as 'Russia'. While the Russian SFSR was technically only one republic within the larger union, it was by far the largest (both in terms of population and area), most powerful, and most highly developed. The Russian SFSR was also the industrial center of the Soviet Union. Historian Matthew White wrote that it was an open secret that the country's federal structure was 'window dressing' for Russian dominance. For that reason, the people of the USSR were usually called 'Russians', not 'Soviets', since 'everyone knew who really ran the show'. At the top of the Communist Party was the Central Committee , elected at Party Congresses and Conferences. In turn, the Central Committee voted for a Politburo (called the Presidium between 1952 and 1966), Secretariat and the general secretary (First Secretary from 1953 to 1966), the de facto highest office in the Soviet Union. Depending on the degree of power consolidation, it was either the Politburo as a collective body or the General Secretary, who always was one of the Politburo members, that effectively led the party and the country (except for the period of the highly personalized authority of Stalin, exercised directly through his position in the Council of Ministers rather than the Politburo after 1941). They were not controlled by the general party membership, as the key principle of the party organization was democratic centralism , demanding strict subordination to higher bodies, and elections went uncontested, endorsing the candidates proposed from above. The Communist Party maintained its dominance over the state mainly through its control over the system of appointments . All senior government officials and most deputies of the Supreme Soviet were members of the CPSU. Of the party heads themselves, Stalin (1941–1953) and Khrushchev (1958–1964) were Premiers. Upon the forced retirement of Khrushchev, the party leader was prohibited from this kind of double membership, but the later General Secretaries for at least some part of their tenure occupied the mostly ceremonial position of Chairman of the Presidium of the Supreme Soviet , the nominal head of state . The institutions at lower levels were overseen and at times supplanted by primary party organizations . However, in practice the degree of control the party was able to exercise over the state bureaucracy, particularly after the death of Stalin, was far from total, with the bureaucracy pursuing different interests that were at times in conflict with the party, nor was the party itself monolithic from top to bottom, although factions were officially banned . The Supreme Soviet (successor of the Congress of Soviets ) was nominally the highest state body for most of the Soviet history, at first acting as a rubber stamp institution, approving and implementing all decisions made by the party. However, its powers and functions were extended in the late 1950s, 1960s and 1970s, including the creation of new state commissions and committees. It gained additional powers relating to the approval of the Five-Year Plans and the government budget . The Supreme Soviet elected a Presidium (successor of the Central Executive Committee ) to wield its power between plenary sessions, ordinarily held twice a year, and appointed the Supreme Court , the Procurator General and the Council of Ministers (known before 1946 as the Council of People's Commissars ), headed by the Chairman (Premier) and managing an enormous bureaucracy responsible for the administration of the economy and society. State and party structures of the constituent republics largely emulated the structure of the central institutions, although the Russian SFSR, unlike the other constituent republics, for most of its history had no republican branch of the CPSU, being ruled directly by the union-wide party until 1990. Local authorities were organized likewise into party committees , local Soviets and executive committees . While the state system was nominally federal, the party was unitary. The state security police (the KGB and its predecessor agencies ) played an important role in Soviet politics. It was instrumental in the Red Terror and Great Purge , but was brought under strict party control after Stalin's death. Under Yuri Andropov , the KGB engaged in the suppression of political dissent and maintained an extensive network of informers, reasserting itself as a political actor to some extent independent of the party-state structure, culminating in the anti-corruption campaign targeting high-ranking party officials in the late 1970s and early 1980s. The constitution , which was promulgated in 1924 , 1936 and 1977 , did not limit state power. No formal separation of powers existed between the Party, Supreme Soviet and Council of Ministers that represented executive and legislative branches of the government. The system was governed less by statute than by informal conventions, and no settled mechanism of leadership succession existed. Bitter and at times deadly power struggles took place in the Politburo after the deaths of Lenin and Stalin, as well as after Khrushchev's dismissal, itself due to a decision by both the Politburo and the Central Committee. All leaders of the Communist Party before Gorbachev died in office, except Georgy Malenkov and Khrushchev, both dismissed from the party leadership amid internal struggle within the party. Between 1988 and 1990, facing considerable opposition, Mikhail Gorbachev enacted reforms shifting power away from the highest bodies of the party and making the Supreme Soviet less dependent on them. The Congress of People's Deputies was established, the majority of whose members were directly elected in competitive elections held in March 1989, the first in Soviet history. The Congress now elected the Supreme Soviet, which became a full-time parliament, and much stronger than before. For the first time since the 1920s, it refused to rubber stamp proposals from the party and Council of Ministers. In 1990, Gorbachev introduced and assumed the position of the President of the Soviet Union , concentrated power in his executive office, independent of the party, and subordinated the government, now renamed the Cabinet of Ministers of the USSR , to himself. Tensions grew between the Union-wide authorities under Gorbachev, reformists led in Russia by Boris Yeltsin and controlling the newly elected Supreme Soviet of the Russian SFSR , and communist hardliners. On 19–21 August 1991, a group of hardliners staged a coup attempt . The coup failed, and the State Council of the Soviet Union became the highest organ of state power 'in the period of transition'. Gorbachev resigned as General Secretary, only remaining President for the final months of the existence of the USSR. The judiciary was not independent of the other branches of government. The Supreme Court supervised the lower courts ( People's Court ) and applied the law as established by the constitution or as interpreted by the Supreme Soviet. The Constitutional Oversight Committee reviewed the constitutionality of laws and acts. The Soviet Union used the inquisitorial system of Roman law , where the judge, procurator , and defence attorney collaborate to "establish the truth". Human rights in the Soviet Union were severely limited. The Soviet Union was a totalitarian state from 1927 until 1953 and a one-party state until 1990. Freedom of speech was suppressed and dissent was punished. Independent political activities were not tolerated, whether these involved participation in free labor unions , private corporations , independent churches or opposition political parties . The freedom of movement within and especially outside the country was limited. The state restricted rights of citizens to private property . The Soviet conception of human rights was very different from international law . According to Soviet legal theory , "it is the government who is the beneficiary of human rights which are to be asserted against the individual". The Soviet state was considered as the source of human rights. Therefore, the Soviet legal system regarded law as an arm of politics and courts as agencies of the government. Extensive extrajudicial powers were given to the Soviet secret police agencies . The Soviet government in practice significantly curbed the rule of law , civil liberties , protection of law , freedom of movement and guarantees of property , which were considered as examples of "bourgeois morality" by Soviet law theorists such as Andrey Vyshinsky . According to Vladimir Lenin , the purpose of socialist courts was "not to eliminate terror ... but to substantiate it and legitimize it in principle". The Soviet Union signed legally-binding human rights documents, such as the International Covenant on Civil and Political Rights in 1973, but they were neither widely known or accessible to people living under Communist rule, nor were they taken seriously by the Communist authorities. : 117During his rule, Stalin always made the final policy decisions. Otherwise, Soviet foreign policy was set by the commission on the Foreign Policy of the Central Committee of the Communist Party of the Soviet Union , or by the party's highest body the Politburo . Operations were handled by the separate Ministry of Foreign Affairs . It was known as the People's Commissariat for Foreign Affairs (or Narkomindel), until 1946. The most influential spokesmen were Georgy Chicherin (1872–1936), Maxim Litvinov (1876–1951), Vyacheslav Molotov (1890–1986), Andrey Vyshinsky (1883–1954) and Andrei Gromyko (1909–1989). Intellectuals were based in the Moscow State Institute of International Relations . The Marxist-Leninist leadership of the Soviet Union intensely debated foreign policy issues and changed directions several times. Even after Stalin assumed dictatorial control in the late 1920s, there were debates, and he frequently changed positions. During the country's early period, it was assumed that Communist revolutions would break out soon in every major industrial country, and it was the Russian responsibility to assist them. The Comintern was the weapon of choice. A few revolutions did break out, but they were quickly suppressed (the longest lasting one was in Hungary)—the Hungarian Soviet Republic —lasted only from 21 March 1919 to 1 August 1919. The Russian Bolsheviks were in no position to give any help. By 1921, Lenin, Trotsky, and Stalin realized that capitalism had stabilized itself in Europe and there would not be any widespread revolutions anytime soon. It became the duty of the Russian Bolsheviks to protect what they had in Russia, and avoid military confrontations that might destroy their bridgehead. Russia was now a pariah state, along with Germany. The two came to terms in 1922 with the Treaty of Rapallo that settled long-standing grievances. At the same time, the two countries secretly set up training programs for the illegal German army and air force operations at hidden camps in the USSR. Moscow eventually stopped threatening other states, and instead worked to open peaceful relationships in terms of trade, and diplomatic recognition. The United Kingdom dismissed the warnings of Winston Churchill and a few others about a continuing Marxist-Leninist threat, and opened trade relations and de facto diplomatic recognition in 1922. There was hope for a settlement of the pre-war Tsarist debts, but it was repeatedly postponed. Formal recognition came when the new Labour Party came to power in 1924. All the other countries followed suit in opening trade relations. Henry Ford opened large-scale business relations with the Soviets in the late 1920s, hoping that it would lead to long-term peace. Finally, in 1933, the United States officially recognized the USSR, a decision backed by the public opinion and especially by US business interests that expected an opening of a new profitable market. In the late 1920s and early 1930s, Stalin ordered Marxist-Leninist parties across the world to strongly oppose non-Marxist political parties, labor unions or other organizations on the left, which they labelled social fascists . In the usage of the Soviet Union, and of the Comintern and its affiliated parties in this period, the epithet fascist was used to describe capitalist society in general and virtually any anti-Soviet or anti-Stalinist activity or opinion. Stalin reversed himself in 1934 with the Popular Front program that called on all Marxist parties to join with all anti-Fascist political, labor, and organizational forces that were opposed to fascism , especially of the Nazi variety. The rapid growth of power in Nazi Germany encouraged both Paris and Moscow to form a military alliance, and the Franco-Soviet Treaty of Mutual Assistance was signed in May 1935. A firm believer in collective security, Stalin's foreign minister Maxim Litvinov worked very hard to form a closer relationship with France and Britain. In 1939, half a year after the Munich Agreement , the USSR attempted to form an anti-Nazi alliance with France and Britain. Adolf Hitler proposed a better deal, which would give the USSR control over much of Eastern Europe through the Molotov–Ribbentrop Pact . In September, Germany invaded Poland, and the USSR also invaded later that month, resulting in the partition of Poland. In response, Britain and France declared war on Germany, marking the beginning of World War II . Up until his death in 1953, Joseph Stalin controlled all foreign relations of the Soviet Union during the interwar period . Despite the increasing build-up of Germany 's war machine and the outbreak of the Second Sino-Japanese War , the Soviet Union did not cooperate with any other nation, choosing to follow its own path. However, after Operation Barbarossa , the Soviet Union's priorities changed. Despite previous conflict with the United Kingdom , Vyacheslav Molotov dropped his post war border demands. The Cold War was a period of geopolitical tension between the United States and the Soviet Union and their respective allies, the Western Bloc and the Eastern Bloc , which began following World War II in 1945. The term cold war is used because there was no large-scale fighting directly between the two superpowers , but they each supported major regional conflicts known as proxy wars . The conflict was based around the ideological and geopolitical struggle for global influence by these two superpowers, following their temporary alliance and victory against Nazi Germany in 1945. Aside from the nuclear arsenal development and conventional military deployment, the struggle for dominance was expressed via indirect means such as psychological warfare , propaganda campaigns, espionage , far-reaching embargoes , rivalry at sports events and technological competitions such as the Space Race .The Marxist-Leninist leadership of the Soviet Union intensely debated foreign policy issues and changed directions several times. Even after Stalin assumed dictatorial control in the late 1920s, there were debates, and he frequently changed positions. During the country's early period, it was assumed that Communist revolutions would break out soon in every major industrial country, and it was the Russian responsibility to assist them. The Comintern was the weapon of choice. A few revolutions did break out, but they were quickly suppressed (the longest lasting one was in Hungary)—the Hungarian Soviet Republic —lasted only from 21 March 1919 to 1 August 1919. The Russian Bolsheviks were in no position to give any help. By 1921, Lenin, Trotsky, and Stalin realized that capitalism had stabilized itself in Europe and there would not be any widespread revolutions anytime soon. It became the duty of the Russian Bolsheviks to protect what they had in Russia, and avoid military confrontations that might destroy their bridgehead. Russia was now a pariah state, along with Germany. The two came to terms in 1922 with the Treaty of Rapallo that settled long-standing grievances. At the same time, the two countries secretly set up training programs for the illegal German army and air force operations at hidden camps in the USSR. Moscow eventually stopped threatening other states, and instead worked to open peaceful relationships in terms of trade, and diplomatic recognition. The United Kingdom dismissed the warnings of Winston Churchill and a few others about a continuing Marxist-Leninist threat, and opened trade relations and de facto diplomatic recognition in 1922. There was hope for a settlement of the pre-war Tsarist debts, but it was repeatedly postponed. Formal recognition came when the new Labour Party came to power in 1924. All the other countries followed suit in opening trade relations. Henry Ford opened large-scale business relations with the Soviets in the late 1920s, hoping that it would lead to long-term peace. Finally, in 1933, the United States officially recognized the USSR, a decision backed by the public opinion and especially by US business interests that expected an opening of a new profitable market. In the late 1920s and early 1930s, Stalin ordered Marxist-Leninist parties across the world to strongly oppose non-Marxist political parties, labor unions or other organizations on the left, which they labelled social fascists . In the usage of the Soviet Union, and of the Comintern and its affiliated parties in this period, the epithet fascist was used to describe capitalist society in general and virtually any anti-Soviet or anti-Stalinist activity or opinion. Stalin reversed himself in 1934 with the Popular Front program that called on all Marxist parties to join with all anti-Fascist political, labor, and organizational forces that were opposed to fascism , especially of the Nazi variety. The rapid growth of power in Nazi Germany encouraged both Paris and Moscow to form a military alliance, and the Franco-Soviet Treaty of Mutual Assistance was signed in May 1935. A firm believer in collective security, Stalin's foreign minister Maxim Litvinov worked very hard to form a closer relationship with France and Britain. In 1939, half a year after the Munich Agreement , the USSR attempted to form an anti-Nazi alliance with France and Britain. Adolf Hitler proposed a better deal, which would give the USSR control over much of Eastern Europe through the Molotov–Ribbentrop Pact . In September, Germany invaded Poland, and the USSR also invaded later that month, resulting in the partition of Poland. In response, Britain and France declared war on Germany, marking the beginning of World War II . Up until his death in 1953, Joseph Stalin controlled all foreign relations of the Soviet Union during the interwar period . Despite the increasing build-up of Germany 's war machine and the outbreak of the Second Sino-Japanese War , the Soviet Union did not cooperate with any other nation, choosing to follow its own path. However, after Operation Barbarossa , the Soviet Union's priorities changed. Despite previous conflict with the United Kingdom , Vyacheslav Molotov dropped his post war border demands. The Cold War was a period of geopolitical tension between the United States and the Soviet Union and their respective allies, the Western Bloc and the Eastern Bloc , which began following World War II in 1945. The term cold war is used because there was no large-scale fighting directly between the two superpowers , but they each supported major regional conflicts known as proxy wars . The conflict was based around the ideological and geopolitical struggle for global influence by these two superpowers, following their temporary alliance and victory against Nazi Germany in 1945. Aside from the nuclear arsenal development and conventional military deployment, the struggle for dominance was expressed via indirect means such as psychological warfare , propaganda campaigns, espionage , far-reaching embargoes , rivalry at sports events and technological competitions such as the Space Race .Constitutionally, the USSR was a federation of constituent Union Republics, which were either unitary states, such as Ukraine or Byelorussia (SSRs), or federations, such as Russia or Transcaucasia (SFSRs), all four being the founding republics who signed the Treaty on the Creation of the USSR in December 1922. In 1924, during the national delimitation in Central Asia, Uzbekistan and Turkmenistan were formed from parts of Russia's Turkestan ASSR and two Soviet dependencies, the Khorezm and Bukharan PSPs . In 1929, Tajikistan was split off from the Uzbekistan SSR. With the constitution of 1936, the Transcaucasian SFSR was dissolved, resulting in its constituent republics of Armenia , Georgia and Azerbaijan being elevated to Union Republics, while Kazakhstan and Kirghizia were split off from the Russian SFSR, resulting in the same status. In August 1940, Moldavia was formed from parts of Ukraine and Soviet-occupied Bessarabia , and Ukrainian SSR. Estonia , Latvia and Lithuania were also annexed by the Soviet Union and turned into SSRs, which was not recognized by most of the international community and was considered an illegal occupation . After the Soviet invasion of Finland , the Karelo-Finnish SSR was formed on annexed territory as a Union Republic in March 1940 and then incorporated into Russia as the Karelian ASSR in 1956. Between July 1956 and September 1991, there were 15 union republics (see map below). While nominally a union of equals, in practice the Soviet Union was dominated by Russians . The domination was so absolute that for most of its existence, the country was commonly (but incorrectly) referred to as 'Russia'. While the Russian SFSR was technically only one republic within the larger union, it was by far the largest (both in terms of population and area), most powerful, and most highly developed. The Russian SFSR was also the industrial center of the Soviet Union. Historian Matthew White wrote that it was an open secret that the country's federal structure was 'window dressing' for Russian dominance. For that reason, the people of the USSR were usually called 'Russians', not 'Soviets', since 'everyone knew who really ran the show'. Under the Military Law of September 1925, the Soviet Armed Forces consisted of the Land Forces , the Air Force , the Navy , Joint State Political Directorate (OGPU) and the Internal Troops . The OGPU later became independent and in 1934 joined the NKVD secret police, and so its internal troops were under the joint leadership of the defense and internal commissariats. After World War II, Strategic Missile Forces (1959), Air Defense Forces (1948) and National Civil Defense Forces (1970) were formed, which ranked first, third, and sixth in the official Soviet system of importance (ground forces were second, Air Force fourth, and Navy fifth). The army had the greatest political influence. In 1989, there served two million soldiers divided between 150 motorized and 52 armored divisions. Until the early 1960s, the Soviet navy was a rather small military branch, but after the Caribbean crisis , under the leadership of Sergei Gorshkov , it expanded significantly. It became known for battlecruisers and submarines. In 1989, there served 500 000 men. The Soviet Air Force focused on a fleet of strategic bombers and during war situation was to eradicate enemy infrastructure and nuclear capacity. The air force also had a number of fighters and tactical bombers to support the army in the war. Strategic missile forces had more than 1,400 intercontinental ballistic missiles (ICBMs), deployed between 28 bases and 300 command centers. In the post-war period, the Soviet Army was directly involved in several military operations abroad. These included the suppression of the uprising in East Germany (1953), Hungarian revolution (1956) and the invasion of Czechoslovakia (1968). The Soviet Union also participated in the war in Afghanistan between 1979 and 1989 . In the Soviet Union, general conscription applied, meaning all able-bodied males aged 18 and older were drafted in the armed forces. The Soviet Union adopted a command economy , whereby production and distribution of goods were centralized and directed by the government. The first Bolshevik experience with a command economy was the policy of war communism , which involved the nationalization of industry, centralized distribution of output, coercive or forced requisition of agricultural production, and attempts to eliminate money circulation, private enterprises and free trade . The barrier troops were also used to enforce Bolshevik control over food supplies in areas controlled by the Red Army, a role which soon earned them the hatred of the Russian civilian population. After the severe economic collapse, Lenin replaced war communism by the New Economic Policy (NEP) in 1921, legalizing free trade and private ownership of small businesses. The economy steadily recovered as a result. After a long debate among the members of the Politburo about the course of economic development, by 1928–1929, upon gaining control of the country, Stalin abandoned the NEP and pushed for full central planning, starting forced collectivization of agriculture and enacting draconian labor legislation. Resources were mobilized for rapid industrialization , which significantly expanded Soviet capacity in heavy industry and capital goods during the 1930s. The primary motivation for industrialization was preparation for war, mostly due to distrust of the outside capitalist world. As a result, the USSR was transformed from a largely agrarian economy into a great industrial power, leading the way for its emergence as a superpower after World War II . The war caused extensive devastation of the Soviet economy and infrastructure, which required massive reconstruction. By the early 1940s, the Soviet economy had become relatively self-sufficient ; for most of the period until the creation of Comecon , only a tiny share of domestic products was traded internationally. After the creation of the Eastern Bloc, external trade rose rapidly. However, the influence of the world economy on the USSR was limited by fixed domestic prices and a state monopoly on foreign trade . Grain and sophisticated consumer manufactures became major import articles from around the 1960s. During the arms race of the Cold War, the Soviet economy was burdened by military expenditures, heavily lobbied for by a powerful bureaucracy dependent on the arms industry. At the same time, the USSR became the largest arms exporter to the Third World . A portion of Soviet resources during the Cold War were allocated in aid to the Soviet-aligned states. The Soviet Union's military budget in the 1970s was gigantic, forming 40–60% of the entire federal budget and accounting to 15% of the USSR's GDP (13% in the 1980s). From the 1930s until its dissolution in late 1991, the way the Soviet economy operated remained essentially unchanged. The economy was formally directed by central planning , carried out by Gosplan and organized in five-year plans . However, in practice, the plans were highly aggregated and provisional, subject to ad hoc intervention by superiors. All critical economic decisions were taken by the political leadership. Allocated resources and plan targets were usually denominated in rubles rather than in physical goods. Credit was discouraged, but widespread. The final allocation of output was achieved through relatively decentralized, unplanned contracting. Although in theory prices were legally set from above, in practice they were often negotiated, and informal horizontal links (e.g. between producer factories) were widespread. A number of basic services were state-funded, such as education and health care. In the manufacturing sector, heavy industry and defence were prioritized over consumer goods . Consumer goods, particularly outside large cities, were often scarce, of poor quality and limited variety. Under the command economy, consumers had almost no influence on production, and the changing demands of a population with growing incomes could not be satisfied by supplies at rigidly fixed prices. A massive unplanned second economy grew up at low levels alongside the planned one, providing some of the goods and services that the planners could not. The legalization of some elements of the decentralized economy was attempted with the reform of 1965 . Although statistics of the Soviet economy are notoriously unreliable and its economic growth difficult to estimate precisely, by most accounts, the economy continued to expand until the mid-1980s. During the 1950s and 1960s, it had comparatively high growth and was catching up to the West. However, after 1970, the growth, while still positive, steadily declined much more quickly and consistently than in other countries, despite a rapid increase in the capital stock (the rate of capital increase was only surpassed by Japan). Overall, the growth rate of per capita income in the Soviet Union between 1960 and 1989 was slightly above the world average (based on 102 countries). A 1986 study published in the American Journal of Public Health claimed that, citing World Bank data, the Soviet model provided a better quality of life and human development than market economies at the same level of economic development in most cases. According to Stanley Fischer and William Easterly , growth could have been faster. By their calculation, per capita income in 1989 should have been twice higher than it was, considering the amount of investment, education and population. The authors attribute this poor performance to the low productivity of capital. Steven Rosefielde states that the standard of living declined due to Stalin's despotism. While there was a brief improvement after his death, it lapsed into stagnation. In 1987, Mikhail Gorbachev attempted to reform and revitalize the economy with his program of perestroika . His policies relaxed state control over enterprises but did not replace it by market incentives, resulting in a sharp decline in output. The economy, already suffering from reduced petroleum export revenues , started to collapse. Prices were still fixed, and the property was still largely state-owned until after the country's dissolution. For most of the period after World War II until its collapse, Soviet GDP ( PPP ) was the second-largest in the world , and third during the second half of the 1980s, although on a per-capita basis, it was behind that of First World countries. Compared to countries with similar per-capita GDP in 1928, the Soviet Union experienced significant growth. [ citation needed ] In 1990, the country had a Human Development Index of 0.920, placing it in the 'high' category of human development. It was the third-highest in the Eastern Bloc, behind Czechoslovakia and East Germany , and the 25th in the world of 130 countries. The need for fuel declined in the Soviet Union from the 1970s to the 1980s, both per ruble of gross social product and per ruble of industrial product. At the start, this decline grew very rapidly but gradually slowed down between 1970 and 1975. From 1975 and 1980, it grew even slower, [ clarification needed ] only 2.6%. David Wilson, a historian, believed that the gas industry would account for 40% of Soviet fuel production by the end of the century. His theory did not come to fruition because of the USSR's collapse. The USSR, in theory, would have continued to have an economic growth rate of 2–2.5% during the 1990s because of Soviet energy fields. [ clarification needed ] However, the energy sector faced many difficulties, among them the country's high military expenditure and hostile relations with the First World . In 1991, the Soviet Union had a pipeline network of 82,000 kilometres (51,000 mi) for crude oil and another 206,500 kilometres (128,300 mi) for natural gas. Petroleum and petroleum-based products, natural gas, metals, wood, agricultural products, and a variety of manufactured goods, primarily machinery, arms and military equipment, were exported. In the 1970s and 1980s, the USSR heavily relied on fossil fuel exports to earn hard currency . At its peak in 1988, it was the largest producer and second-largest exporter of crude oil, surpassed only by Saudi Arabia . The Soviet Union placed great emphasis on science and technology within its economy, however, the most remarkable Soviet successes in technology, such as producing the world's first space satellite , typically were the responsibility of the military. Lenin believed that the USSR would never overtake the developed world if it remained as technologically backward as it was upon its founding. Soviet authorities proved their commitment to Lenin's belief by developing massive networks, research and development organizations. In the early 1960s, the Soviets awarded 40% of chemistry PhDs to women, compared to only 5% in the United States. By 1989, Soviet scientists were among the world's best-trained specialists in several areas, such as Energy physics, selected areas of medicine, mathematics, welding and military technologies. Due to rigid state planning and bureaucracy , the Soviets remained far behind technologically in chemistry, biology, and computers when compared to the First World . The Soviet government opposed and persecuted geneticists in favour of Lysenkoism , a pseudoscience rejected by the scientific community in the Soviet Union and abroad but supported by Stalin's inner circles. Implemented in the USSR and China, it resulted in reduced crop yields and is widely believed to have contributed to the Great Chinese Famine . The Soviet Union also had more scientists and engineers , relative to the world population, than any other major country due to the strong levels of state support for scientific developments by the 1980s. Under the Reagan administration , Project Socrates determined that the Soviet Union addressed the acquisition of science and technology in a manner that was radically different from what the US was using. In the case of the US, economic prioritization was being used for indigenous research and development as the means to acquire science and technology in both the private and public sectors. In contrast, the USSR was offensively and defensively maneuvering in the acquisition and use of the worldwide technology, to increase the competitive advantage that they acquired from the technology while preventing the US from acquiring a competitive advantage. However, technology-based planning was executed in a centralized, government-centric manner that greatly hindered its flexibility. This was exploited by the US to undermine the strength of the Soviet Union and thus foster its reform. At the end of the 1950s, the USSR constructed the first satellite — Sputnik 1 , which marked the beginning of the Space Race —a competition to achieve superior spaceflight capability with the United States. This was followed by other successful satellites, most notably Sputnik 5 , where test dogs were sent to space. On 12 April 1961, the USSR launched Vostok 1 , which carried Yuri Gagarin , making him the first human to ever be launched into space and complete a space journey. The first plans for space shuttles and orbital stations were drawn up in Soviet design offices, but personal disputes between designers and management prevented their development. In terms of the Luna program , the USSR only had automated spacecraft launches with no crewed spacecraft, passing on the 'Moon' part of Space Race , which was won by the Americans . The Soviet public's reaction to the American moon-landing was mixed. The Soviet government limited the release of information about it, which affected the reaction. A portion of the populace did not give it attention, and another portion was angered. In the 1970s, specific proposals for the design of a space shuttle emerged, but shortcomings, especially in the electronics industry (rapid overheating of electronics), postponed it till the end of the 1980s. The first shuttle, the Buran , flew in 1988, but without a human crew. Another, Ptichka , endured prolonged construction and was canceled in 1991. For their launch into space, there is today an unused superpower rocket, Energia , which is the most powerful in the world. In the late 1980s, the Soviet Union built the Mir orbital station. It was built on the construction of Salyut stations and its only role was civilian-grade research tasks. Mir was the only orbital station in operation from 1986 to 1998. Gradually, other modules were added to it, including American modules. However, the station deteriorated rapidly after a fire on board, so in 2001 it was decided to bring it into the atmosphere where it burned down. Transport was a vital component of the country's economy. The economic centralization of the late 1920s and 1930s led to the development of infrastructure on a massive scale, most notably the establishment of Aeroflot , an aviation enterprise . The country had a wide variety of modes of transport by land, water and air. However, due to inadequate maintenance, much of the road, water and Soviet civil aviation transport were outdated and technologically backward compared to the First World. Soviet rail transport was the largest and most intensively used in the world; it was also better developed than most of its Western counterparts. By the late 1970s and early 1980s, Soviet economists were calling for the construction of more roads to alleviate some of the burdens from the railways and to improve the Soviet government budget . The street network and automotive industry remained underdeveloped, and dirt roads were common outside major cities. Soviet maintenance projects proved unable to take care of even the few roads the country had. By the early-to-mid-1980s, the Soviet authorities tried to solve the road problem by ordering the construction of new ones. Meanwhile, the automobile industry was growing at a faster rate than road construction. The underdeveloped road network led to a growing demand for public transport. Despite improvements, several aspects of the transport sector were still [ when? ] riddled with problems due to outdated infrastructure, lack of investment, corruption and bad decision-making. Soviet authorities were unable to meet the growing demand for transport infrastructure and services. The Soviet merchant navy was one of the largest in the world. The need for fuel declined in the Soviet Union from the 1970s to the 1980s, both per ruble of gross social product and per ruble of industrial product. At the start, this decline grew very rapidly but gradually slowed down between 1970 and 1975. From 1975 and 1980, it grew even slower, [ clarification needed ] only 2.6%. David Wilson, a historian, believed that the gas industry would account for 40% of Soviet fuel production by the end of the century. His theory did not come to fruition because of the USSR's collapse. The USSR, in theory, would have continued to have an economic growth rate of 2–2.5% during the 1990s because of Soviet energy fields. [ clarification needed ] However, the energy sector faced many difficulties, among them the country's high military expenditure and hostile relations with the First World . In 1991, the Soviet Union had a pipeline network of 82,000 kilometres (51,000 mi) for crude oil and another 206,500 kilometres (128,300 mi) for natural gas. Petroleum and petroleum-based products, natural gas, metals, wood, agricultural products, and a variety of manufactured goods, primarily machinery, arms and military equipment, were exported. In the 1970s and 1980s, the USSR heavily relied on fossil fuel exports to earn hard currency . At its peak in 1988, it was the largest producer and second-largest exporter of crude oil, surpassed only by Saudi Arabia . The Soviet Union placed great emphasis on science and technology within its economy, however, the most remarkable Soviet successes in technology, such as producing the world's first space satellite , typically were the responsibility of the military. Lenin believed that the USSR would never overtake the developed world if it remained as technologically backward as it was upon its founding. Soviet authorities proved their commitment to Lenin's belief by developing massive networks, research and development organizations. In the early 1960s, the Soviets awarded 40% of chemistry PhDs to women, compared to only 5% in the United States. By 1989, Soviet scientists were among the world's best-trained specialists in several areas, such as Energy physics, selected areas of medicine, mathematics, welding and military technologies. Due to rigid state planning and bureaucracy , the Soviets remained far behind technologically in chemistry, biology, and computers when compared to the First World . The Soviet government opposed and persecuted geneticists in favour of Lysenkoism , a pseudoscience rejected by the scientific community in the Soviet Union and abroad but supported by Stalin's inner circles. Implemented in the USSR and China, it resulted in reduced crop yields and is widely believed to have contributed to the Great Chinese Famine . The Soviet Union also had more scientists and engineers , relative to the world population, than any other major country due to the strong levels of state support for scientific developments by the 1980s. Under the Reagan administration , Project Socrates determined that the Soviet Union addressed the acquisition of science and technology in a manner that was radically different from what the US was using. In the case of the US, economic prioritization was being used for indigenous research and development as the means to acquire science and technology in both the private and public sectors. In contrast, the USSR was offensively and defensively maneuvering in the acquisition and use of the worldwide technology, to increase the competitive advantage that they acquired from the technology while preventing the US from acquiring a competitive advantage. However, technology-based planning was executed in a centralized, government-centric manner that greatly hindered its flexibility. This was exploited by the US to undermine the strength of the Soviet Union and thus foster its reform. At the end of the 1950s, the USSR constructed the first satellite — Sputnik 1 , which marked the beginning of the Space Race —a competition to achieve superior spaceflight capability with the United States. This was followed by other successful satellites, most notably Sputnik 5 , where test dogs were sent to space. On 12 April 1961, the USSR launched Vostok 1 , which carried Yuri Gagarin , making him the first human to ever be launched into space and complete a space journey. The first plans for space shuttles and orbital stations were drawn up in Soviet design offices, but personal disputes between designers and management prevented their development. In terms of the Luna program , the USSR only had automated spacecraft launches with no crewed spacecraft, passing on the 'Moon' part of Space Race , which was won by the Americans . The Soviet public's reaction to the American moon-landing was mixed. The Soviet government limited the release of information about it, which affected the reaction. A portion of the populace did not give it attention, and another portion was angered. In the 1970s, specific proposals for the design of a space shuttle emerged, but shortcomings, especially in the electronics industry (rapid overheating of electronics), postponed it till the end of the 1980s. The first shuttle, the Buran , flew in 1988, but without a human crew. Another, Ptichka , endured prolonged construction and was canceled in 1991. For their launch into space, there is today an unused superpower rocket, Energia , which is the most powerful in the world. In the late 1980s, the Soviet Union built the Mir orbital station. It was built on the construction of Salyut stations and its only role was civilian-grade research tasks. Mir was the only orbital station in operation from 1986 to 1998. Gradually, other modules were added to it, including American modules. However, the station deteriorated rapidly after a fire on board, so in 2001 it was decided to bring it into the atmosphere where it burned down. Transport was a vital component of the country's economy. The economic centralization of the late 1920s and 1930s led to the development of infrastructure on a massive scale, most notably the establishment of Aeroflot , an aviation enterprise . The country had a wide variety of modes of transport by land, water and air. However, due to inadequate maintenance, much of the road, water and Soviet civil aviation transport were outdated and technologically backward compared to the First World. Soviet rail transport was the largest and most intensively used in the world; it was also better developed than most of its Western counterparts. By the late 1970s and early 1980s, Soviet economists were calling for the construction of more roads to alleviate some of the burdens from the railways and to improve the Soviet government budget . The street network and automotive industry remained underdeveloped, and dirt roads were common outside major cities. Soviet maintenance projects proved unable to take care of even the few roads the country had. By the early-to-mid-1980s, the Soviet authorities tried to solve the road problem by ordering the construction of new ones. Meanwhile, the automobile industry was growing at a faster rate than road construction. The underdeveloped road network led to a growing demand for public transport. Despite improvements, several aspects of the transport sector were still [ when? ] riddled with problems due to outdated infrastructure, lack of investment, corruption and bad decision-making. Soviet authorities were unable to meet the growing demand for transport infrastructure and services. The Soviet merchant navy was one of the largest in the world. Excess deaths throughout World War I and the Russian Civil War (including the famine of 1921–1922 that was triggered by Lenin's war communism policies) amounted to a combined total of 18 million, some 10 million in the 1930s, and more than 20 million in 1941–1945. The postwar Soviet population was 45 to 50 million smaller than it would have been if pre-war demographic growth had continued. According to Catherine Merridale , '... reasonable estimate would place the total number of excess deaths for the whole period somewhere around 60 million.' The birth rate of the USSR decreased from 44.0 per thousand in 1926 to 18.0 in 1974, mainly due to increasing urbanization and the rising average age of marriages. The mortality rate demonstrated a gradual decrease as well—from 23.7 per thousand in 1926 to 8.7 in 1974. In general, the birth rates of the southern republics in Transcaucasia and Central Asia were considerably higher than those in the northern parts of the Soviet Union, and in some cases even increased in the post–World War II period, a phenomenon partly attributed to slower rates of urbanization and traditionally earlier marriages in the southern republics. Soviet Europe moved towards sub-replacement fertility , while Soviet Central Asia continued to exhibit population growth well above replacement-level fertility. The late 1960s and the 1970s witnessed a reversal of the declining trajectory of the rate of mortality in the USSR, and was especially notable among men of working age, but was also prevalent in Russia and other predominantly Slavic areas of the country. An analysis of the official data from the late 1980s showed that after worsening in the late-1970s and the early 1980s, adult mortality began to improve again. The infant mortality rate increased from 24.7 in 1970 to 27.9 in 1974. Some researchers regarded the rise as mostly real, a consequence of worsening health conditions and services. The rises in both adult and infant mortality were not explained or defended by Soviet officials, and the Soviet government stopped publishing all mortality statistics for ten years. Soviet demographers and health specialists remained silent about the mortality increases until the late-1980s, when the publication of mortality data resumed, and researchers could delve into the real causes. The Soviet Union imposed heavy control on city growth, preventing some cities from reaching their full potential while promoting others. For the entirety of its existence, the most populous cities were Moscow and Leningrad (both in Russian SFSR ), with the third far place taken by Kiev ( Ukrainian SSR ). At its inception, the Top 5 was completed by Kharkov (Ukrainian SSR) and Baku ( Azerbaijan SSR ), but, by the end of the century, Tashkent ( Uzbek SSSR ), which had assumed the position of capital of Soviet Central Asia, had risen to fourth place. Another city worth mentioning is Minsk ( Byelorussian SSR ), which saw rapid growth during the 20th century, rising from the 32nd most populous in the union to the 7th. Under Lenin, the state made explicit commitments to promote the equality of men and women. Many early Russian feminists and ordinary Russian working women actively participated in the Revolution, and many more were affected by the events of that period and the new policies. Beginning in October 1918, Lenin's government liberalized divorce and abortion laws, decriminalized homosexuality (re-criminalized in 1932), permitted cohabitation, and ushered in a host of reforms. However, without birth control , the new system produced many broken marriages, as well as countless out-of-wedlock children. The epidemic of divorces and extramarital affairs created social hardships when Soviet leaders wanted people to concentrate their efforts on growing the economy. Giving women control over their fertility also led to a precipitous decline in the birth rate, perceived as a threat to their country's military power. By 1936, Stalin reversed most of the liberal laws, ushering in a pronatalist era that lasted for decades. By 1917, Russia became the first great power to grant women the right to vote. After heavy casualties in World War I and II, women outnumbered men in Russia by a 4:3 ratio. This contributed to the larger role women played in Russian society compared to other great powers at the time. Anatoly Lunacharsky became the first People's Commissar for Education of Soviet Russia. In the beginning, the Soviet authorities placed great emphasis on the elimination of illiteracy . All left-handed children were forced to write with their right hand in the Soviet school system. Literate people were automatically hired as teachers. [ citation needed ] For a short period, quality was sacrificed for quantity. By 1940, Stalin could announce that illiteracy had been eliminated. Throughout the 1930s, social mobility rose sharply, which has been attributed to reforms in education. In the aftermath of World War II, the country's educational system expanded dramatically, which had a tremendous effect. In the 1960s, nearly all children had access to education, the only exception being those living in remote areas. Nikita Khrushchev tried to make education more accessible, making it clear to children that education was closely linked to the needs of society. Education also became important in giving rise to the New Man . Citizens directly entering the workforce had the constitutional right to a job and to free vocational training . The education system was highly centralized and universally accessible to all citizens, with affirmative action for applicants from nations associated with cultural backwardness . However, as part of a general antisemitic policy , an unofficial Jewish quota was applied [ when? ] in the leading institutions of higher education by subjecting Jewish applicants to harsher entrance examinations. The Brezhnev era also introduced a rule that required all university applicants to present a reference from the local Komsomol party secretary. According to statistics from 1986, the number of higher education students per the population of 10,000 was 181 for the USSR, compared to 517 for the US. The Soviet Union was an ethnically diverse country, with more than 100 distinct ethnic groups. The total population of the country was estimated at 293 million in 1991. According to a 1990 estimate, the majority of the population were Russians (50.78%), followed by Ukrainians (15.45%) and Uzbeks (5.84%). Overall, in 1989 the ethnic demography of the country showed that 69.8% was East Slavic , 17.5% was Turkic , 1.6% were Armenians , 1.6% were Balts , 1.5% were Finnic , 1.5% were Tajik , 1.4% were Georgian , 1.2% were Moldovan and 4.1% were of other various ethnic groups. All citizens of the USSR had their own ethnic affiliation. The ethnicity of a person was chosen at the age of sixteen by the child's parents. If the parents did not agree, the child was automatically assigned the ethnicity of the father. Partly due to Soviet policies, some of the smaller minority ethnic groups were considered part of larger ones, such as the Mingrelians of Georgia , who were classified with the linguistically related Georgians . Some ethnic groups voluntarily assimilated, while others were brought in by force. Russians, Belarusians , and Ukrainians, who were all East Slavic and Orthodox, shared close cultural, ethnic, and religious ties, while other groups did not. With multiple nationalities living in the same territory, ethnic antagonisms developed over the years. [ neutrality is disputed ] Members of various ethnicities participated in legislative bodies. Organs of power like the Politburo, the Secretariat of the Central Committee etc., were formally ethnically neutral, but in reality, ethnic Russians were overrepresented, although there were also non-Russian leaders in the Soviet leadership , such as Joseph Stalin , Grigory Zinoviev , Nikolai Podgorny or Andrei Gromyko . During the Soviet era, a significant number of ethnic Russians and Ukrainians migrated to other Soviet republics, and many of them settled there. According to the last census in 1989, the Russian 'diaspora' in the Soviet republics had reached 25 million. In 1917, before the revolution, health conditions were significantly behind those of developed countries. As Lenin later noted, "Either the lice will defeat socialism, or socialism will defeat the lice". The Soviet health care system was conceived by the People's Commissariat for Health in 1918. Under the Semashko model , health care was to be controlled by the state and would be provided to its citizens free of charge, a revolutionary concept at the time. Article 42 of the 1977 Soviet Constitution gave all citizens the right to health protection and free access to any health institutions in the USSR. Before Leonid Brezhnev became general secretary, the Soviet healthcare system was held in high esteem by many foreign specialists. This changed, however, from Brezhnev's accession and Mikhail Gorbachev 's tenure as leader, during which the health care system was heavily criticized for many basic faults, such as the quality of service and the unevenness in its provision. Minister of Health Yevgeniy Chazov , during the 19th Congress of the Communist Party of the Soviet Union , while highlighting such successes as having the most doctors and hospitals in the world, recognized the system's areas for improvement and felt that billions of rubles were squandered. After the revolution, life expectancy for all age groups went up. This statistic in itself was seen by some that the socialist system was superior to the capitalist system . These improvements continued into the 1960s when statistics indicated that the life expectancy briefly surpassed that of the United States. Life expectancy started to decline in the 1970s, possibly because of alcohol abuse . At the same time, infant mortality began to rise. After 1974, the government stopped publishing statistics on the matter. This trend can be partly explained by the number of pregnancies rising drastically in the Asian part of the country where infant mortality was the highest while declining markedly in the more developed European part of the Soviet Union. Soviet dental technology and dental health were considered notoriously bad. In 1991, the average 35-year-old had 12 to 14 cavities, fillings or missing teeth. Toothpaste was often not available, and toothbrushes did not conform to standards of modern dentistry. Under Lenin, the government gave small language groups their own writing systems. The development of these writing systems was highly successful, even though some flaws were detected. During the later days of the USSR, countries with the same multilingual situation implemented similar policies. A serious problem when creating these writing systems was that the languages differed dialectally greatly from each other. When a language had been given a writing system and appeared in a notable publication, it would attain 'official language' status. There were many minority languages which never received their own writing system; therefore, their speakers were forced to have a second language . There are examples where the government retreated from this policy, most notably under Stalin where education was discontinued in languages that were not widespread. These languages were then assimilated into another language, mostly Russian. During World War II, some minority languages were banned, and their speakers accused of collaborating with the enemy. As the most widely spoken of the Soviet Union's many languages, Russian de facto functioned as an official language, as the 'language of interethnic communication' ( Russian: язык межнационального общения ), but only assumed the de jure status as the official national language in 1990. Christianity and Islam had the highest number of adherents among the religious citizens. Eastern Christianity predominated among Christians, with Russia's traditional Russian Orthodox Church being the largest Christian denomination . About 90% of the Soviet Union's Muslims were Sunnis , with Shias being concentrated in the Azerbaijan SSR . Smaller groups included Roman Catholics , Jews, Buddhists , and a variety of Protestant denominations (especially Baptists and Lutherans ). Religious influence had been strong in the Russian Empire. The Russian Orthodox Church enjoyed a privileged status as the church of the monarchy and took part in carrying out official state functions. The immediate period following the establishment of the Soviet state included a struggle against the Orthodox Church, which the revolutionaries considered an ally of the former ruling classes . In Soviet law, the 'freedom to hold religious services' was constitutionally guaranteed, although the ruling Communist Party regarded religion as incompatible with the Marxist spirit of scientific materialism . In practice, the Soviet system subscribed to a narrow interpretation of this right, and in fact used a range of official measures to discourage religion and curb the activities of religious groups. The 1918 Council of People's Commissars decree establishing the Russian SFSR as a secular state also decreed that 'the teaching of religion in all [places] where subjects of general instruction are taught, is forbidden. Citizens may teach and may be taught religion privately.' Among further restrictions, those adopted in 1929 included express prohibitions on a range of church activities, including meetings for organized Bible study . Both Christian and non-Christian establishments were shut down by the thousands in the 1920s and 1930s. By 1940, as many as 90% of the churches, synagogues, and mosques that had been operating in 1917 were closed; the majority of them were demolished or re-purposed for state needs with little concern for their historic and cultural value. More than 85,000 Orthodox priests were shot in 1937 alone. Only a twelfth of the Russian Orthodox Church's priests were left functioning in their parishes by 1941. In the period between 1927 and 1940, the number of Orthodox Churches in Russia fell from 29,584 to less than 500 (1.7%). The Soviet Union was officially a secular state , but a 'government-sponsored program of forced conversion to atheism ' was conducted under the doctrine of state atheism . The government targeted religions based on state interests, and while most organized religions were never outlawed, religious property was confiscated, believers were harassed, and religion was ridiculed while atheism was propagated in schools. In 1925, the government founded the League of Militant Atheists to intensify the propaganda campaign. Accordingly, although personal expressions of religious faith were not explicitly banned, a strong sense of social stigma was imposed on them by the formal structures and mass media, and it was generally considered unacceptable for members of certain professions (teachers, state bureaucrats, soldiers) to be openly religious. While persecution accelerated following Stalin's rise to power, a revival of Orthodoxy was fostered by the government during World War II and the Soviet authorities sought to control the Russian Orthodox Church rather than liquidate it. During the first five years of Soviet power, the Bolsheviks executed 28 Russian Orthodox bishops and over 1,200 Russian Orthodox priests. Many others were imprisoned or exiled. Believers were harassed and persecuted. Most seminaries were closed, and the publication of most religious material was prohibited. By 1941, only 500 churches remained open out of about 54,000 in existence before World War I. Convinced that religious anti-Sovietism had become a thing of the past, and with the looming threat of war, the Stalin regime began shifting to a more moderate religion policy in the late 1930s. Soviet religious establishments overwhelmingly rallied to support the war effort during World War II. Amid other accommodations to religious faith after the German invasion, churches were reopened. Radio Moscow began broadcasting a religious hour, and a historic meeting between Stalin and Orthodox Church leader Patriarch Sergius of Moscow was held in 1943. Stalin had the support of the majority of the religious people in the USSR even through the late 1980s. The general tendency of this period was an increase in religious activity among believers of all faiths. Under Nikita Khrushchev , the state leadership clashed with the churches in 1958–1964, a period when atheism was emphasized in the educational curriculum, and numerous state publications promoted atheistic views. During this period, the number of churches fell from 20,000 to 10,000 from 1959 to 1965, and the number of synagogues dropped from 500 to 97. The number of working mosques also declined, falling from 1,500 to 500 within a decade. Religious institutions remained monitored by the Soviet government, but churches, synagogues, temples, and mosques were all given more leeway in the Brezhnev era . Official relations between the Orthodox Church and the government again warmed to the point that the Brezhnev government twice honored Orthodox Patriarch Alexy I with the Order of the Red Banner of Labour . A poll conducted by Soviet authorities in 1982 recorded 20% of the Soviet population as 'active religious believers.' The Soviet Union imposed heavy control on city growth, preventing some cities from reaching their full potential while promoting others. For the entirety of its existence, the most populous cities were Moscow and Leningrad (both in Russian SFSR ), with the third far place taken by Kiev ( Ukrainian SSR ). At its inception, the Top 5 was completed by Kharkov (Ukrainian SSR) and Baku ( Azerbaijan SSR ), but, by the end of the century, Tashkent ( Uzbek SSSR ), which had assumed the position of capital of Soviet Central Asia, had risen to fourth place. Another city worth mentioning is Minsk ( Byelorussian SSR ), which saw rapid growth during the 20th century, rising from the 32nd most populous in the union to the 7th. Under Lenin, the state made explicit commitments to promote the equality of men and women. Many early Russian feminists and ordinary Russian working women actively participated in the Revolution, and many more were affected by the events of that period and the new policies. Beginning in October 1918, Lenin's government liberalized divorce and abortion laws, decriminalized homosexuality (re-criminalized in 1932), permitted cohabitation, and ushered in a host of reforms. However, without birth control , the new system produced many broken marriages, as well as countless out-of-wedlock children. The epidemic of divorces and extramarital affairs created social hardships when Soviet leaders wanted people to concentrate their efforts on growing the economy. Giving women control over their fertility also led to a precipitous decline in the birth rate, perceived as a threat to their country's military power. By 1936, Stalin reversed most of the liberal laws, ushering in a pronatalist era that lasted for decades. By 1917, Russia became the first great power to grant women the right to vote. After heavy casualties in World War I and II, women outnumbered men in Russia by a 4:3 ratio. This contributed to the larger role women played in Russian society compared to other great powers at the time.Anatoly Lunacharsky became the first People's Commissar for Education of Soviet Russia. In the beginning, the Soviet authorities placed great emphasis on the elimination of illiteracy . All left-handed children were forced to write with their right hand in the Soviet school system. Literate people were automatically hired as teachers. [ citation needed ] For a short period, quality was sacrificed for quantity. By 1940, Stalin could announce that illiteracy had been eliminated. Throughout the 1930s, social mobility rose sharply, which has been attributed to reforms in education. In the aftermath of World War II, the country's educational system expanded dramatically, which had a tremendous effect. In the 1960s, nearly all children had access to education, the only exception being those living in remote areas. Nikita Khrushchev tried to make education more accessible, making it clear to children that education was closely linked to the needs of society. Education also became important in giving rise to the New Man . Citizens directly entering the workforce had the constitutional right to a job and to free vocational training . The education system was highly centralized and universally accessible to all citizens, with affirmative action for applicants from nations associated with cultural backwardness . However, as part of a general antisemitic policy , an unofficial Jewish quota was applied [ when? ] in the leading institutions of higher education by subjecting Jewish applicants to harsher entrance examinations. The Brezhnev era also introduced a rule that required all university applicants to present a reference from the local Komsomol party secretary. According to statistics from 1986, the number of higher education students per the population of 10,000 was 181 for the USSR, compared to 517 for the US. The Soviet Union was an ethnically diverse country, with more than 100 distinct ethnic groups. The total population of the country was estimated at 293 million in 1991. According to a 1990 estimate, the majority of the population were Russians (50.78%), followed by Ukrainians (15.45%) and Uzbeks (5.84%). Overall, in 1989 the ethnic demography of the country showed that 69.8% was East Slavic , 17.5% was Turkic , 1.6% were Armenians , 1.6% were Balts , 1.5% were Finnic , 1.5% were Tajik , 1.4% were Georgian , 1.2% were Moldovan and 4.1% were of other various ethnic groups. All citizens of the USSR had their own ethnic affiliation. The ethnicity of a person was chosen at the age of sixteen by the child's parents. If the parents did not agree, the child was automatically assigned the ethnicity of the father. Partly due to Soviet policies, some of the smaller minority ethnic groups were considered part of larger ones, such as the Mingrelians of Georgia , who were classified with the linguistically related Georgians . Some ethnic groups voluntarily assimilated, while others were brought in by force. Russians, Belarusians , and Ukrainians, who were all East Slavic and Orthodox, shared close cultural, ethnic, and religious ties, while other groups did not. With multiple nationalities living in the same territory, ethnic antagonisms developed over the years. [ neutrality is disputed ] Members of various ethnicities participated in legislative bodies. Organs of power like the Politburo, the Secretariat of the Central Committee etc., were formally ethnically neutral, but in reality, ethnic Russians were overrepresented, although there were also non-Russian leaders in the Soviet leadership , such as Joseph Stalin , Grigory Zinoviev , Nikolai Podgorny or Andrei Gromyko . During the Soviet era, a significant number of ethnic Russians and Ukrainians migrated to other Soviet republics, and many of them settled there. According to the last census in 1989, the Russian 'diaspora' in the Soviet republics had reached 25 million. In 1917, before the revolution, health conditions were significantly behind those of developed countries. As Lenin later noted, "Either the lice will defeat socialism, or socialism will defeat the lice". The Soviet health care system was conceived by the People's Commissariat for Health in 1918. Under the Semashko model , health care was to be controlled by the state and would be provided to its citizens free of charge, a revolutionary concept at the time. Article 42 of the 1977 Soviet Constitution gave all citizens the right to health protection and free access to any health institutions in the USSR. Before Leonid Brezhnev became general secretary, the Soviet healthcare system was held in high esteem by many foreign specialists. This changed, however, from Brezhnev's accession and Mikhail Gorbachev 's tenure as leader, during which the health care system was heavily criticized for many basic faults, such as the quality of service and the unevenness in its provision. Minister of Health Yevgeniy Chazov , during the 19th Congress of the Communist Party of the Soviet Union , while highlighting such successes as having the most doctors and hospitals in the world, recognized the system's areas for improvement and felt that billions of rubles were squandered. After the revolution, life expectancy for all age groups went up. This statistic in itself was seen by some that the socialist system was superior to the capitalist system . These improvements continued into the 1960s when statistics indicated that the life expectancy briefly surpassed that of the United States. Life expectancy started to decline in the 1970s, possibly because of alcohol abuse . At the same time, infant mortality began to rise. After 1974, the government stopped publishing statistics on the matter. This trend can be partly explained by the number of pregnancies rising drastically in the Asian part of the country where infant mortality was the highest while declining markedly in the more developed European part of the Soviet Union. Soviet dental technology and dental health were considered notoriously bad. In 1991, the average 35-year-old had 12 to 14 cavities, fillings or missing teeth. Toothpaste was often not available, and toothbrushes did not conform to standards of modern dentistry. Soviet dental technology and dental health were considered notoriously bad. In 1991, the average 35-year-old had 12 to 14 cavities, fillings or missing teeth. Toothpaste was often not available, and toothbrushes did not conform to standards of modern dentistry. Under Lenin, the government gave small language groups their own writing systems. The development of these writing systems was highly successful, even though some flaws were detected. During the later days of the USSR, countries with the same multilingual situation implemented similar policies. A serious problem when creating these writing systems was that the languages differed dialectally greatly from each other. When a language had been given a writing system and appeared in a notable publication, it would attain 'official language' status. There were many minority languages which never received their own writing system; therefore, their speakers were forced to have a second language . There are examples where the government retreated from this policy, most notably under Stalin where education was discontinued in languages that were not widespread. These languages were then assimilated into another language, mostly Russian. During World War II, some minority languages were banned, and their speakers accused of collaborating with the enemy. As the most widely spoken of the Soviet Union's many languages, Russian de facto functioned as an official language, as the 'language of interethnic communication' ( Russian: язык межнационального общения ), but only assumed the de jure status as the official national language in 1990. Christianity and Islam had the highest number of adherents among the religious citizens. Eastern Christianity predominated among Christians, with Russia's traditional Russian Orthodox Church being the largest Christian denomination . About 90% of the Soviet Union's Muslims were Sunnis , with Shias being concentrated in the Azerbaijan SSR . Smaller groups included Roman Catholics , Jews, Buddhists , and a variety of Protestant denominations (especially Baptists and Lutherans ). Religious influence had been strong in the Russian Empire. The Russian Orthodox Church enjoyed a privileged status as the church of the monarchy and took part in carrying out official state functions. The immediate period following the establishment of the Soviet state included a struggle against the Orthodox Church, which the revolutionaries considered an ally of the former ruling classes . In Soviet law, the 'freedom to hold religious services' was constitutionally guaranteed, although the ruling Communist Party regarded religion as incompatible with the Marxist spirit of scientific materialism . In practice, the Soviet system subscribed to a narrow interpretation of this right, and in fact used a range of official measures to discourage religion and curb the activities of religious groups. The 1918 Council of People's Commissars decree establishing the Russian SFSR as a secular state also decreed that 'the teaching of religion in all [places] where subjects of general instruction are taught, is forbidden. Citizens may teach and may be taught religion privately.' Among further restrictions, those adopted in 1929 included express prohibitions on a range of church activities, including meetings for organized Bible study . Both Christian and non-Christian establishments were shut down by the thousands in the 1920s and 1930s. By 1940, as many as 90% of the churches, synagogues, and mosques that had been operating in 1917 were closed; the majority of them were demolished or re-purposed for state needs with little concern for their historic and cultural value. More than 85,000 Orthodox priests were shot in 1937 alone. Only a twelfth of the Russian Orthodox Church's priests were left functioning in their parishes by 1941. In the period between 1927 and 1940, the number of Orthodox Churches in Russia fell from 29,584 to less than 500 (1.7%). The Soviet Union was officially a secular state , but a 'government-sponsored program of forced conversion to atheism ' was conducted under the doctrine of state atheism . The government targeted religions based on state interests, and while most organized religions were never outlawed, religious property was confiscated, believers were harassed, and religion was ridiculed while atheism was propagated in schools. In 1925, the government founded the League of Militant Atheists to intensify the propaganda campaign. Accordingly, although personal expressions of religious faith were not explicitly banned, a strong sense of social stigma was imposed on them by the formal structures and mass media, and it was generally considered unacceptable for members of certain professions (teachers, state bureaucrats, soldiers) to be openly religious. While persecution accelerated following Stalin's rise to power, a revival of Orthodoxy was fostered by the government during World War II and the Soviet authorities sought to control the Russian Orthodox Church rather than liquidate it. During the first five years of Soviet power, the Bolsheviks executed 28 Russian Orthodox bishops and over 1,200 Russian Orthodox priests. Many others were imprisoned or exiled. Believers were harassed and persecuted. Most seminaries were closed, and the publication of most religious material was prohibited. By 1941, only 500 churches remained open out of about 54,000 in existence before World War I. Convinced that religious anti-Sovietism had become a thing of the past, and with the looming threat of war, the Stalin regime began shifting to a more moderate religion policy in the late 1930s. Soviet religious establishments overwhelmingly rallied to support the war effort during World War II. Amid other accommodations to religious faith after the German invasion, churches were reopened. Radio Moscow began broadcasting a religious hour, and a historic meeting between Stalin and Orthodox Church leader Patriarch Sergius of Moscow was held in 1943. Stalin had the support of the majority of the religious people in the USSR even through the late 1980s. The general tendency of this period was an increase in religious activity among believers of all faiths. Under Nikita Khrushchev , the state leadership clashed with the churches in 1958–1964, a period when atheism was emphasized in the educational curriculum, and numerous state publications promoted atheistic views. During this period, the number of churches fell from 20,000 to 10,000 from 1959 to 1965, and the number of synagogues dropped from 500 to 97. The number of working mosques also declined, falling from 1,500 to 500 within a decade. Religious institutions remained monitored by the Soviet government, but churches, synagogues, temples, and mosques were all given more leeway in the Brezhnev era . Official relations between the Orthodox Church and the government again warmed to the point that the Brezhnev government twice honored Orthodox Patriarch Alexy I with the Order of the Red Banner of Labour . A poll conducted by Soviet authorities in 1982 recorded 20% of the Soviet population as 'active religious believers.' The culture of the Soviet Union passed through several stages during the USSR's existence. During the first decade following the revolution, there was relative freedom and artists experimented with several different styles to find a distinctive Soviet style of art. Lenin wanted art to be accessible to the Russian people. On the other hand, hundreds of intellectuals, writers, and artists were exiled or executed, and their work banned, such as Nikolay Gumilyov who was shot for alleged conspiracy against the Bolshevik regime, and Yevgeny Zamyatin . The government encouraged a variety of trends. In art and literature, numerous schools, some traditional and others radically experimental, proliferated. Communist writers Maxim Gorky and Vladimir Mayakovsky were active during this time. As a means of influencing a largely illiterate society, films received encouragement from the state, and much of director Sergei Eisenstein 's best work dates from this period. During Stalin's rule, the Soviet culture was characterized by the rise and domination of the government-imposed style of socialist realism , with all other trends being severely repressed, with rare exceptions, such as Mikhail Bulgakov 's works. Many writers were imprisoned and killed. Following the Khrushchev Thaw , censorship was diminished. During this time, a distinctive period of Soviet culture developed, characterized by conformist public life and an intense focus on personal life. Greater experimentation in art forms was again permissible, resulting in the production of more sophisticated and subtly critical work. The regime loosened its emphasis on socialist realism; thus, for instance, many protagonists of the novels of author Yury Trifonov concerned themselves with problems of daily life rather than with building socialism. Underground dissident literature, known as samizdat , developed during this late period. In architecture, the Khrushchev era mostly focused on functional design as opposed to the highly decorated style of Stalin's epoch. In music, in response to the increasing popularity of forms of popular music like jazz in the West, many jazz orchestras were permitted throughout the USSR, notably the Melodiya Ensemble, named after the principle record label in the USSR. In the second half of the 1980s, Gorbachev's policies of perestroika and glasnost significantly expanded freedom of expression throughout the country in the media and the press. In summer of 1923 in Moscow was established the Proletarian Sports Society "Dynamo" as a sports organization of Soviet secret police Cheka . On 13 July 1925 the Central Committee of the Russian Communist Party (Bolsheviks) adopted a statement "About the party's tasks in sphere of physical culture". In the statement was determined the role of physical culture in Soviet society and the party's tasks in political leadership of physical culture movement in the country. The Soviet Olympic Committee formed on 21 April 1951, and the IOC recognized the new body in its 45th session . In the same year, when the Soviet representative Konstantin Andrianov became an IOC member, the USSR officially joined the Olympic Movement . The 1952 Summer Olympics in Helsinki thus became first Olympic Games for Soviet athletes. The Soviet Union was the biggest rival to the United States at the Summer Olympics, winning six of its nine appearances at the games and also topping the medal tally at the Winter Olympics six times. The Soviet Union's Olympics success has been attributed to its large investment in sports to demonstrate its superpower image and political influence on a global stage. The Soviet Union national ice hockey team won nearly every world championship and Olympic tournament between 1954 and 1991 and never failed to medal in any International Ice Hockey Federation (IIHF) tournament in which they competed. Soviet Olympic team was notorious for skirting the edge of amateur rules. All Soviet athletes held some nominal jobs, but were in fact state-sponsored and trained full-time. According to many experts, that gave the Soviet Union a huge advantage over the United States and other Western countries, whose athletes were students or real amateurs. Indeed, the Soviet Union monopolized the top place in the medal standings after 1968, and, until its collapse, placed second only once, in the 1984 Winter games , after another Eastern bloc nation, the GDR . Amateur rules were relaxed only in the late 1980s and were almost completely abolished in the 1990s, after the fall of the USSR . According to British journalist Andrew Jennings , a KGB colonel stated that the agency's officers had posed as anti-doping authorities from the International Olympic Committee (IOC) to undermine doping tests and that Soviet athletes were "rescued with [these] tremendous efforts". Documents obtained in 2016 revealed the Soviet Union's plans for a statewide doping system in track and field in preparation for the 1984 Summer Olympics in Los Angeles. Dated prior to the country's decision to boycott the Games, the document detailed the existing steroids operations of the program, along with suggestions for further enhancements. The legacy of the USSR remains a controversial topic. The socio-economic nature of communist states such as the USSR, especially under Stalin, has also been much debated, varyingly being labelled a form of bureaucratic collectivism , state capitalism , state socialism , or a totally unique mode of production . The USSR implemented a broad range of policies over a long period of time, with a large amount of conflicting policies being implemented by different leaders. Some have a positive view of it whilst others are critical towards the country, calling it a repressive oligarchy . The opinions on the USSR are complex and have changed over time, with different generations having different views on the matter as well as on Soviet policies corresponding to separate time periods during its history. Western academicians published various analyses of the post-Soviet states' development, claiming that the dissolution was followed by a severe drop in economic and social conditions in these countries, including a rapid increase in poverty, crime, corruption, unemployment, homelessness, rates of disease, infant mortality and domestic violence, as well as demographic losses, income inequality and the rise of an oligarchical class , along with decreases in calorie intake, life expectancy, adult literacy, and income. Between 1988 and 1989 and 1993–1995, the Gini ratio increased by an average of 9 points for all former Soviet republics. According to Western analysis, the economic shocks that accompanied wholesale privatization were associated with sharp increases in mortality, Russia, Kazakhstan, Latvia, Lithuania and Estonia saw a tripling of unemployment and a 42% increase in male death rates between 1991 and 1994, and in the following decades, only five or six of the post-communist states are on a path to joining the wealthy capitalist West while most are falling behind, some to such an extent that it will take over fifty years to catch up to where they were before the fall of the Soviet Bloc. However, virtually all the former Soviet republics were able to turn their economies around and increase GDP to multiple times what it was under the USSR, though with large wealth disparities, and many post-soviet economies described as oligarchic. Since the dissolution of the Soviet Union , annual polling by the Levada Center has shown that over 50% of Russia's population regretted this event, with the only exception to this being in the year 2012 when support for the Soviet Union dipped below 50 percent. A 2018 poll showed that 66% of Russians regretted the fall of the Soviet Union, setting a 15-year record, and the majority of these regretting opinions came from people older than 55. In 2020, polls conducted by the Levada Center found that 75% of Russians agreed that the Soviet era was the greatest era in their country's history. According to the New Russia Barometer (NRB) polls by the Centre for the Study of Public Policy, 50% of Russian respondents reported a positive impression of the Soviet Union in 1991. This increased to about 75% of NRB respondents in 2000, dropping slightly to 71% in 2009. Throughout the 2000s, an average of 32% of NRB respondents supported the restoration of the Soviet Union. In a 2021 poll, a record 70% of Russians indicated they had a mostly/very favourable view of Joseph Stalin . In Armenia , 12% of respondents said the USSR collapse did good, while 66% said it did harm. In Kyrgyzstan , 16% of respondents said the collapse of the USSR did good, while 61% said it did harm. In a 2018 Rating Sociological Group poll, 47% of Ukrainian respondents had a positive opinion of Soviet leader Leonid Brezhnev , who ruled the Soviet Union from 1964 to 1982, while viewing Lenin , Stalin and Gorbachev very negatively. A 2021 poll conducted by the Levada Center found that 49% of Russians prefer the USSR's political system, while 18% prefer the current political system and 16% would prefer a Western democracy . A further 62% of people polled preferred the Soviet system of central planning, while 24% prefer a market-based system. According to the Levada Center's polls, the primary reasons cited for Soviet nostalgia are the advantages of the shared economic union between the Soviet republics, including perceived financial stability. This was referenced by up to 53% of respondents in 2016. At least 43% also lamented the loss of the Soviet Union's global political superpower status. About 31% cited the loss of social trust and capital. The remainder of the respondents cited a mix of reasons ranging from practical travel difficulties to a sense of national displacement. The 1941–1945 period of World War II is still known in Russia as the ' Great Patriotic War '. The war became a topic of great importance in cinema, literature, history lessons at school, the mass media, and the arts. As a result of the massive losses suffered by the military and civilians during the conflict, Victory Day celebrated on 9 May is still one of the most important and emotional dates in Russia. Catherine Wanner asserts that Victory Day commemorations are a vehicle for Soviet nostalgia, as they "kept alive a mythology of Soviet grandeur, of solidarity among the Sovietskii narod , and of a sense of self as citizen of a superpower state". Russian Victory Day parades are organized annually in most cities, with the central military parade taking place in Moscow (just as during the Soviet times). Additionally, the recently introduced Immortal Regiment on May 9 sees millions of Russians carry the portraits of their relatives who fought in the war. Russia also retains other Soviet holidays , such as the Defender of the Fatherland Day (February 23), International Women's Day (March 8), and International Workers' Day . In some post-Soviet republics, there is a more negative view of the USSR, although there is no unanimity on the matter. In large part due to the Holodomor , ethnic Ukrainians have a negative view of the Soviet Union. Russian -speaking Ukrainians of Ukraine's southern and eastern regions have a more positive view of the USSR. In some countries with internal conflict, there is also nostalgia for the USSR, especially for refugees of the post-Soviet conflicts who have been forced to flee their homes and have been displaced. The many Russian enclaves in the former USSR republics such as Transnistria have in a general a positive remembrance of it. The left's view of the USSR is complex. While some leftists regard the USSR as an example of state capitalism or that it was an oligarchical state, other leftists admire Vladimir Lenin and the Russian Revolution . Council communists generally view the USSR as failing to create class consciousness , turning into a corrupt state in which the elite controlled society. Many anti-Stalinist leftists such as anarchists are extremely critical of Soviet authoritarianism and repression . Much of the criticism it receives is centered around massacres in the Soviet Union , the centralized hierarchy present in the USSR and mass political repression as well as violence towards government critics and political dissidents such as other leftists. Critics also point towards its failure to implement any substantial worker cooperatives or implementing worker liberation, as well as corruption and the Soviet authoritarian nature. [ citation needed ] Anarchists are also critical of the country, labeling the Soviet system as red fascism . Factors contributing to the anarchist animosity towards the USSR included the Soviet destruction of the Makhnovist movement after an initial alliance, the suppression of the anarchist Kronstadt rebellion , and the defeat of the rival anarchist factions by the Soviet-supported Communist faction during the Spanish Civil War . Maoists also have a mixed opinion on the USSR, viewing it negatively during the Sino-Soviet Split and denouncing it as revisionist and reverted to capitalism. The Chinese government in 1963 articulated its criticism of the USSR's system and promoted China's ideological line as an alternative. After the dissolution of the Soviet Union, the Japanese Communist Party (JCP) released a press statement titled "We welcome the end of a party which embodied the historical evil of great power chauvinism and hegemonism ". Noam Chomsky called the collapse of the Soviet Union "a small victory for socialism, not only because of the fall of one of the most anti-socialist states in the world, where working people had fewer rights than in the West, but also because it freed the term 'socialism' from the burden of being associated in the propaganda systems of East and West with Soviet tyranny — for the East, in order to benefit from the aura of authentic socialism, for the West, in order to demonize the concept." In some post-Soviet republics, there is a more negative view of the USSR, although there is no unanimity on the matter. In large part due to the Holodomor , ethnic Ukrainians have a negative view of the Soviet Union. Russian -speaking Ukrainians of Ukraine's southern and eastern regions have a more positive view of the USSR. In some countries with internal conflict, there is also nostalgia for the USSR, especially for refugees of the post-Soviet conflicts who have been forced to flee their homes and have been displaced. The many Russian enclaves in the former USSR republics such as Transnistria have in a general a positive remembrance of it. The left's view of the USSR is complex. While some leftists regard the USSR as an example of state capitalism or that it was an oligarchical state, other leftists admire Vladimir Lenin and the Russian Revolution . Council communists generally view the USSR as failing to create class consciousness , turning into a corrupt state in which the elite controlled society. Many anti-Stalinist leftists such as anarchists are extremely critical of Soviet authoritarianism and repression . Much of the criticism it receives is centered around massacres in the Soviet Union , the centralized hierarchy present in the USSR and mass political repression as well as violence towards government critics and political dissidents such as other leftists. Critics also point towards its failure to implement any substantial worker cooperatives or implementing worker liberation, as well as corruption and the Soviet authoritarian nature. [ citation needed ] Anarchists are also critical of the country, labeling the Soviet system as red fascism . Factors contributing to the anarchist animosity towards the USSR included the Soviet destruction of the Makhnovist movement after an initial alliance, the suppression of the anarchist Kronstadt rebellion , and the defeat of the rival anarchist factions by the Soviet-supported Communist faction during the Spanish Civil War . Maoists also have a mixed opinion on the USSR, viewing it negatively during the Sino-Soviet Split and denouncing it as revisionist and reverted to capitalism. The Chinese government in 1963 articulated its criticism of the USSR's system and promoted China's ideological line as an alternative. After the dissolution of the Soviet Union, the Japanese Communist Party (JCP) released a press statement titled "We welcome the end of a party which embodied the historical evil of great power chauvinism and hegemonism ". Noam Chomsky called the collapse of the Soviet Union "a small victory for socialism, not only because of the fall of one of the most anti-socialist states in the world, where working people had fewer rights than in the West, but also because it freed the term 'socialism' from the burden of being associated in the propaganda systems of East and West with Soviet tyranny — for the East, in order to benefit from the aura of authentic socialism, for the West, in order to demonize the concept."

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/2018_Équateur_province_Ebola_outbreak/html

2018 Équateur province Ebola outbreak

The 2018 Équateur province Ebola outbreak occurred in the north-west of the Democratic Republic of the Congo (DRC) from May to July 2018. It was contained entirely within Équateur province , and was the first time that vaccination with the rVSV-ZEBOV Ebola vaccine had been attempted in the early stages of an Ebola outbreak, with a total of 3,481 people vaccinated. It was the ninth recorded Ebola outbreak in the DRC. The outbreak began on 8 May 2018, when it was reported that 17 people were suspected of having died from EVD near the town of Bikoro in the Province of Équateur . The World Health Organization declared the outbreak after two people were confirmed as having the disease. On 17 May, the virus was confirmed to have spread to the inland port city of Mbandaka , causing the WHO to raise its assessment of the national risk level to "very high", but not yet to constitute an international public health emergency . The WHO declared the outbreak over on 24 July 2018, with 33 confirmed deaths. Subsequent to the end of this outbreak, the Kivu Ebola epidemic commenced in the eastern region of the country on 1 August 2018; it was declared over on 25 June 2020 with 2,280 deaths recorded. A further separate outbreak in the Province of Équateur was announced on 1 June 2020 by the Congolese health ministry, described as the eleventh Ebola outbreak since records began. This eleventh outbreak was declared over as of 18 November following no reported cases for 42 days, having caused 130 cases and 55 deaths. The earliest cases are believed to have occurred in early April 2018. The suspected index case was a police officer, who died in a health center in the village of Ikoko-Impenge , near the market town of Bikoro in Équateur province, according to the International Federation of the Red Cross and Red Crescent Societies . After his funeral, eleven family members became ill, and seven of them died. All of the seven deceased had attended the man's funeral or cared for him while he was sick. The identification of this individual as the index case has not yet been confirmed. Équateur province's Provincial Health Division reported 21 cases with symptoms consistent with Ebola virus disease , of whom 17 had died, on 3 May 2018. Of these, eight cases were subsequently shown not to have been Ebola-related. The outbreak was declared on 8 May after samples from two of five patients in Bikoro tested positive for the Zaire strain of the Ebola virus. On 10 May, the World Health Organization (WHO) stated that the Democratic Republic of the Congo had a total of 32 cases of EVD, and a further two suspected cases were announced on the following day, bringing the total cases to 34, all located in the Bikoro area of DRC. * numbers are subject to revision both up, when new cases are discovered, and down, when tests show cases were not Ebola-related. In the eight previous Ebola outbreaks in DRC since 1976, the virus had never before reached a major city. In May 2018, for the first time, four cases were confirmed in the city of Mbandaka. On 14 May, suspected cases were reported in the Iboko and Wangata areas in Équateur province , in addition to Bikoro. The WHO reported on 17 May 2018 that the first case of this outbreak in an urban area had been confirmed in the Wangata district of Mbandaka city, the capital of Équateur province, about 100 miles north of Bikoro. Mbandaka is a busy, densely populated port on the Congo River with a population of 1.2 million, leading to a high risk of contagion. The following day, the WHO raised the health risk in DRC to "very high" due to the presence of the virus in an urban area. The DRC government was particularly concerned about the virus spreading by boat transport along the Congo between Mbandaka and the capital, Kinshasa . The WHO also considered that there was a high risk of the outbreak spreading to nine other countries in the region, including the bordering Republic of the Congo and Central African Republic . As of 23 May 2018 [ update ] , the focus of the outbreak was split between Bikoro and Iboko; Iboko had 55% of the confirmed cases of EVD and Bikoro had 81.5% of the fatalities. The cases in the Bikoro health zone were located in Ikoko Impenge (12), Bikoro (6), Momboyo (1) and Moheli (1); those in the Iboko health zone were located in Itipo (13), Mpangi (2), Wenga (1) and Loongo (1). According to the fifth situation report released by the WHO, the case fatality rate (CFR) was 42.3%. Demographics had been reported for 44 cases as of 22 May; there were 26 cases of EVD in men and 18 in women; 7 cases were in children 14 years and under, and 9 were in those over 60 years. By 23 May, there had been 5 reported cases in health-care workers, including two who died. Contact tracing was being employed to identify contacts with infected individuals. On 29 May, it was reported that 800 contacts had been identified in the city of Mbandaka; the next day it was reported that 500 people in the city had been vaccinated. On 29 May, the WHO indicated that nine neighbouring countries had been alerted for being at high risk of spread of EVD, On 4 June, it was reported that Angola had closed its border with the DRC due to the outbreak. This outbreak in the Democratic Republic of the Congo was declared over on 24 July 2018 after 42 days passed without any new confirmed cases. Although it was noted that a new outbreak occurred only one week later in the eastern region of Kivu ; and it has been established that they are not linked. The earliest cases are believed to have occurred in early April 2018. The suspected index case was a police officer, who died in a health center in the village of Ikoko-Impenge , near the market town of Bikoro in Équateur province, according to the International Federation of the Red Cross and Red Crescent Societies . After his funeral, eleven family members became ill, and seven of them died. All of the seven deceased had attended the man's funeral or cared for him while he was sick. The identification of this individual as the index case has not yet been confirmed. Équateur province's Provincial Health Division reported 21 cases with symptoms consistent with Ebola virus disease , of whom 17 had died, on 3 May 2018. Of these, eight cases were subsequently shown not to have been Ebola-related. The outbreak was declared on 8 May after samples from two of five patients in Bikoro tested positive for the Zaire strain of the Ebola virus. On 10 May, the World Health Organization (WHO) stated that the Democratic Republic of the Congo had a total of 32 cases of EVD, and a further two suspected cases were announced on the following day, bringing the total cases to 34, all located in the Bikoro area of DRC. * numbers are subject to revision both up, when new cases are discovered, and down, when tests show cases were not Ebola-related.In the eight previous Ebola outbreaks in DRC since 1976, the virus had never before reached a major city. In May 2018, for the first time, four cases were confirmed in the city of Mbandaka. On 14 May, suspected cases were reported in the Iboko and Wangata areas in Équateur province , in addition to Bikoro. The WHO reported on 17 May 2018 that the first case of this outbreak in an urban area had been confirmed in the Wangata district of Mbandaka city, the capital of Équateur province, about 100 miles north of Bikoro. Mbandaka is a busy, densely populated port on the Congo River with a population of 1.2 million, leading to a high risk of contagion. The following day, the WHO raised the health risk in DRC to "very high" due to the presence of the virus in an urban area. The DRC government was particularly concerned about the virus spreading by boat transport along the Congo between Mbandaka and the capital, Kinshasa . The WHO also considered that there was a high risk of the outbreak spreading to nine other countries in the region, including the bordering Republic of the Congo and Central African Republic . As of 23 May 2018 [ update ] , the focus of the outbreak was split between Bikoro and Iboko; Iboko had 55% of the confirmed cases of EVD and Bikoro had 81.5% of the fatalities. The cases in the Bikoro health zone were located in Ikoko Impenge (12), Bikoro (6), Momboyo (1) and Moheli (1); those in the Iboko health zone were located in Itipo (13), Mpangi (2), Wenga (1) and Loongo (1). According to the fifth situation report released by the WHO, the case fatality rate (CFR) was 42.3%. Demographics had been reported for 44 cases as of 22 May; there were 26 cases of EVD in men and 18 in women; 7 cases were in children 14 years and under, and 9 were in those over 60 years. By 23 May, there had been 5 reported cases in health-care workers, including two who died. Contact tracing was being employed to identify contacts with infected individuals. On 29 May, it was reported that 800 contacts had been identified in the city of Mbandaka; the next day it was reported that 500 people in the city had been vaccinated. On 29 May, the WHO indicated that nine neighbouring countries had been alerted for being at high risk of spread of EVD, On 4 June, it was reported that Angola had closed its border with the DRC due to the outbreak. This outbreak in the Democratic Republic of the Congo was declared over on 24 July 2018 after 42 days passed without any new confirmed cases. Although it was noted that a new outbreak occurred only one week later in the eastern region of Kivu ; and it has been established that they are not linked. The Bikoro area had three hospitals, but the area's health services were described by WHO as predominantly having "limited functionality"; they received supplies from international bodies but experienced frequent shortages. More than half of the Bikoro area cases were in Ikoko-Impenge , a village not connected to the road system. Bikoro lies in dense rain forest , and the area's remoteness and inadequate infrastructure hindered treatment of EVD patients, as well as surveillance and vaccination efforts. Adherence was another challenge: on 20–21 May, three individuals with EVD in an isolation ward of a treatment center in Mbandaka fled; two later died after attending a prayer meeting, at which they may have exposed 50 other attendees to the virus. Bushmeat was believed to be one vector of infection, but bushmeat vendors at the Mbandaka market told reporters that they did not believe Ebola was real or serious. Hostility towards health workers trying to offer medical assistance was also reported. On 29 May, the WHO forecast that there would be 100–300 cases by the end of July. Zaire ebolavirus , which was identified in this outbreak, is included in genus Ebolavirus , family Filoviridae , The virus was named for the Ebola River , which runs as a tributary of the Congo River in the Democratic Republic of the Congo; the Zaire strain was first identified in 1976 in Yambuku . Médecins Sans Frontières (MSF) established treatment centers in Bikoro, Ikoko and Wangata. WHO sent an expert team to Bikoro on 8 May, and on 13 May, WHO Director-General Tedros Adhanom Ghebreyesus visited the town. On 18 May, the WHO IHR committee met and decided against declaring a Public Health Emergency of International Concern . As of 24 May 2018 [ update ] , WHO had sent 138 technical personnel to the three affected areas; the Red Cross sent more than 150 people, and UNICEF personnel were also active. Other international agencies sending teams included the UK Public Health Rapid Support Team and the Africa Centres for Disease Control and Prevention. The Wellcome Trust donated £2 million towards the DRC outbreak. Merck donated its experimental vaccine and the GAVI international vaccination alliance helped to support vaccination operations. Several tons of supplies were shipped to the DRC, including protection and disinfection kits and palliative drugs. After the virus spread to the city of Mbandaka, DRC health minister Oly Ilunga Kalenga announced that healthcare would be provided free for those affected. US President Donald Trump has advocated rescinding Ebola funding and most financing for State Department emergency responses. National Security Advisor John Bolton removed the National Security Council's health security chief on the day that the Ebola outbreak was declared, shutting down the entire epidemic prevention office. The U.S. Centers for Disease Control and Prevention says "about five" of its staff advise the Congolese government. CDC presence appears to be smaller than West African countries'. The U.S. Agency for International Development promised $1 million to WHO for Ebola efforts. Germany has promised $5.8 million. Surveillance of travelers at Mbandaka's port and airport was performed. The DRC Ministry of Public Health identified 115 areas where movement of people increased the risk of virus transmission, including 83 river ports, nine airports and seven bus stations, as well as 16 markets. José Makila , the DRC minister of transport, stated that the Navy would be used to surveil river traffic on the Congo. On 10 May, the Nigerian Ministry of Health reported it would start screening at its borders, and on 18 May 2018, a total of 20 countries had instituted screening of travelers coming from the DRC. WHO sent teams to 8/9 of the neighboring countries to assess their capability to deal with EVD spread and facilitate their surveillance. The DRC Ministry of Public Health worked with surveyors and cartographers from UCLA and OpenStreetMap DRC to improve mapping of the affected area. A laboratory commenced operations in Bikoro on 16 May, enabling local testing of patient samples for Ebola virus. Burials were organized by MSF and the Red Cross of the Democratic Republic of the Congo to minimize the risk of transmission. The United Nations Radio broadcast EVD awareness information, and posters and leaflets were prepared and distributed. UNICEF warned 143 churches across Mbandaka of the risks of prayer meetings. Surveillance of travelers at Mbandaka's port and airport was performed. The DRC Ministry of Public Health identified 115 areas where movement of people increased the risk of virus transmission, including 83 river ports, nine airports and seven bus stations, as well as 16 markets. José Makila , the DRC minister of transport, stated that the Navy would be used to surveil river traffic on the Congo. On 10 May, the Nigerian Ministry of Health reported it would start screening at its borders, and on 18 May 2018, a total of 20 countries had instituted screening of travelers coming from the DRC. WHO sent teams to 8/9 of the neighboring countries to assess their capability to deal with EVD spread and facilitate their surveillance. The DRC Ministry of Public Health worked with surveyors and cartographers from UCLA and OpenStreetMap DRC to improve mapping of the affected area. A laboratory commenced operations in Bikoro on 16 May, enabling local testing of patient samples for Ebola virus. Burials were organized by MSF and the Red Cross of the Democratic Republic of the Congo to minimize the risk of transmission. The United Nations Radio broadcast EVD awareness information, and posters and leaflets were prepared and distributed. UNICEF warned 143 churches across Mbandaka of the risks of prayer meetings. Health authorities including DRC's Ministry of Public Health used recombinant vesicular stomatitis virus – Zaire Ebola virus ( rVSV-ZEBOV ) vaccine – a recently developed experimental Ebola vaccine , produced by Merck – to try to suppress the outbreak. This live-attenuated vaccine expresses the surface glycoprotein of the Kikwit 1995 strain of Zaire ebolavirus in a recombinant vesicular stomatitis virus vector . rVSV-ZEBOV was trialed in Guinea and Sierra Leone during the West African epidemic of 2013–16, with 5837 people receiving the vaccine; the trial authors concluded that rVSV-ZEBOV provided "substantial protection" against EVD, but subsequent commentators have questioned the degree of protection obtained and the degree of long-term protection conferred is unknown. As the vaccine had not been approved by any regulatory authority, it was used in DRC under a compassionate use trial protocol. A ring vaccination strategy was used, which involves vaccinating only those most likely to be infected: direct contacts of infected individuals, and contacts of those contacts. Other groups targeted included health workers, laboratory personnel, surveillance workers and people involved with burials. People who were vaccinated were followed up for 84 days to assess whether they were protected from infection and to monitor any adverse events. A total of 4,320 doses of the rVSV-ZEBOV vaccine were delivered to DRC's capital Kinshasa by WHO on 16 May, and a further 3,240 doses arrived three days later; with another 8,000 doses to be made available. The vaccine must be transported and stored at between −60 and −80 °C. A cold chain was established in Kinshasa by 18 May and has been extended to Mbandaka. WHO planned to concentrate on vaccinating three sets of contacts of confirmed EVD cases, two in Bikoro and one in Mbandaka. Vaccination started on 21 May among health workers in Mbandaka, with 7,560 vaccine doses ready for immediate use, according to WHO. The DRC health minister Oly Ilunga Kalenga stated that vaccination of health workers and Ebola case contacts in the Wangata and Bolenge areas of Mbandaka would take five days, after which vaccination would start in Bikoro and Iboko. As of 24 May 2018 [ update ] , 154 people in Mbandaka had been vaccinated, and preparations were started for vaccinating in Bikoro and Iboko. Up to 1,000 people were expected to have been vaccinated by 26 May, according to WHO. It was the first time that vaccination had been attempted in the early stages of an Ebola outbreak. The rVSV-ZEBOV vaccine proved effective for the strain of the Ebola virus in this outbreak, having via ring vaccination protected some 3,481 individuals. Health officials considered trialing experimental treatments, including the antiviral agents favipiravir and GS-5734 , and the antibody ZMapp . All three agents were given to patients during the West African epidemic, but none has yet been proved to be effective. The DRC Ministry of Public Health also requested that the US trial mAb114 treatment during the outbreak. The mAb114 monoclonal antibody was developed by the National Institutes of Health and Jean-Jacques Muyembe at the National Institute for Biomedical Research, and is derived from an EVD survivor of the 1995 Kikwit outbreak who still had circulating anti-Ebola antibodies eleven years later; it has been tested in macaques but not in humans. The ZMapp cocktail was assessed by the World Health Organization for emergency use under the MEURI ethical protocol. The panel agreed that "the benefits of ZMapp outweigh its risks" while noting that it presented logistical challenges, particularly that of requiring a cold chain for distribution and storage. Despite being at earlier stages of development, three other therapies, mAb114 , remdesivir and REGN3470-3471-3479, were also approved for emergency use under MEURI and the Ministry of Health in the DRC. Health authorities including DRC's Ministry of Public Health used recombinant vesicular stomatitis virus – Zaire Ebola virus ( rVSV-ZEBOV ) vaccine – a recently developed experimental Ebola vaccine , produced by Merck – to try to suppress the outbreak. This live-attenuated vaccine expresses the surface glycoprotein of the Kikwit 1995 strain of Zaire ebolavirus in a recombinant vesicular stomatitis virus vector . rVSV-ZEBOV was trialed in Guinea and Sierra Leone during the West African epidemic of 2013–16, with 5837 people receiving the vaccine; the trial authors concluded that rVSV-ZEBOV provided "substantial protection" against EVD, but subsequent commentators have questioned the degree of protection obtained and the degree of long-term protection conferred is unknown. As the vaccine had not been approved by any regulatory authority, it was used in DRC under a compassionate use trial protocol. A ring vaccination strategy was used, which involves vaccinating only those most likely to be infected: direct contacts of infected individuals, and contacts of those contacts. Other groups targeted included health workers, laboratory personnel, surveillance workers and people involved with burials. People who were vaccinated were followed up for 84 days to assess whether they were protected from infection and to monitor any adverse events. A total of 4,320 doses of the rVSV-ZEBOV vaccine were delivered to DRC's capital Kinshasa by WHO on 16 May, and a further 3,240 doses arrived three days later; with another 8,000 doses to be made available. The vaccine must be transported and stored at between −60 and −80 °C. A cold chain was established in Kinshasa by 18 May and has been extended to Mbandaka. WHO planned to concentrate on vaccinating three sets of contacts of confirmed EVD cases, two in Bikoro and one in Mbandaka. Vaccination started on 21 May among health workers in Mbandaka, with 7,560 vaccine doses ready for immediate use, according to WHO. The DRC health minister Oly Ilunga Kalenga stated that vaccination of health workers and Ebola case contacts in the Wangata and Bolenge areas of Mbandaka would take five days, after which vaccination would start in Bikoro and Iboko. As of 24 May 2018 [ update ] , 154 people in Mbandaka had been vaccinated, and preparations were started for vaccinating in Bikoro and Iboko. Up to 1,000 people were expected to have been vaccinated by 26 May, according to WHO. It was the first time that vaccination had been attempted in the early stages of an Ebola outbreak. The rVSV-ZEBOV vaccine proved effective for the strain of the Ebola virus in this outbreak, having via ring vaccination protected some 3,481 individuals. Health officials considered trialing experimental treatments, including the antiviral agents favipiravir and GS-5734 , and the antibody ZMapp . All three agents were given to patients during the West African epidemic, but none has yet been proved to be effective. The DRC Ministry of Public Health also requested that the US trial mAb114 treatment during the outbreak. The mAb114 monoclonal antibody was developed by the National Institutes of Health and Jean-Jacques Muyembe at the National Institute for Biomedical Research, and is derived from an EVD survivor of the 1995 Kikwit outbreak who still had circulating anti-Ebola antibodies eleven years later; it has been tested in macaques but not in humans. The ZMapp cocktail was assessed by the World Health Organization for emergency use under the MEURI ethical protocol. The panel agreed that "the benefits of ZMapp outweigh its risks" while noting that it presented logistical challenges, particularly that of requiring a cold chain for distribution and storage. Despite being at earlier stages of development, three other therapies, mAb114 , remdesivir and REGN3470-3471-3479, were also approved for emergency use under MEURI and the Ministry of Health in the DRC. Post-Ebola virus syndrome affects those who have survived EVD infection; the resulting signs and symptoms can include muscle pain, eye problems and neurological problems. The Democratic Republic of the Congo (formerly Zaire) has had several previous EVD outbreaks since 1976, which are summarised in the Table below. All have been located in the west or north of the country. Three previous outbreaks (in 1976, 1977 and 2014) occurring in former province of Équateur , of which the current Équateur province forms part. In 2014, the WHO considered that the DRC was lagging behind the rest of Africa in health expenditures , at the relative rate of Intl$ 32 per head. For the 2017 Democratic Republic of the Congo Ebola virus outbreak , the DRC regulatory authorities approved the use of the experimental rVSV-ZEBOV vaccine, but logistical issues delayed its implementation until the outbreak was already under control. Shortly before the first cases of the 2018 Ebola outbreak, the country experienced a widespread cholera epidemic (June 2017 – spring 2018), which was the most serious in the country since 1994.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Defense_Threat_Reduction_Agency/html

Defense Threat Reduction Agency

•Defense Special Weapons Agency, (1996–1998) •Defense Nuclear Agency, (1971–1996) •Defense Atomic Support Agency, (1959–1971) • Armed Forces Special Weapons Project , (1947–1959) • Manhattan Project (1942–1946) The Defense Threat Reduction Agency ( DTRA ) is both a defense agency and a combat support agency within the United States Department of Defense (DoD) for countering weapons of mass destruction (WMD; chemical , biological , radiological , nuclear , and high explosives ) and supporting the nuclear enterprise. Its stated mission is to provide "cross-cutting solutions to enable the Department of Defense, the United States Government, and international partners to Deter strategic attack against the United States and its allies; Prevent, reduce, and counter WMD and emerging threats; and Prevail against WMD-armed adversaries in crisis and conflict." DTRA is headquartered in Fort Belvoir, Virginia . The DTRA mission, organization and management, responsibilities and functions, relationships, authorities, and administration are defined in DoD Directive 5105.62, Defense Threat Reduction Agency (DTRA) .DTRA was officially established on October 1, 1998, as a result of the 1997 Defense Reform Initiative by consolidating several DoD organizations, including the Defense Special Weapons Agency (successor to the Defense Nuclear Agency) and the On-Site Inspection Agency. The Defense Technology Security Administration and the Nunn–Lugar Cooperative Threat Reduction program office in the Office of the Secretary of Defense were also incorporated into the new agency. In 2002, DTRA published a detailed history of its predecessor agencies, Defense's Nuclear Agency, 1947–1997 , the first paragraph of which makes a brief statement about the agencies which led up to the formation of DTRA: Defense's Nuclear Agency, 1947–1997 , traces the development of the Armed Forces Special Weapons Project (AFSWP), and its descendant government organizations, from its original founding in 1947 to 1997. After the disestablishment of the Manhattan Engineering District (MED) in 1947, AFSWP was formed to provide military training in nuclear weapons' operations. Over the years, its sequential descendant organizations have been the Defense Atomic Support Agency (DASA) from 1959 to 1971, the Defense Nuclear Agency (DNA) from 1971 to 1996, and the Defense Special Weapons Agency (DSWA) from 1996 to 1998. In 1998, DSWA, the On-Site Inspection Agency, the Defense Technology Security Administration, and selected elements of the Office of Secretary of Defense were combined to form the Defense Threat Reduction Agency (DTRA). DTRA employs approximately 1,400 DoD civilians and 800 uniformed service members at more than a dozen permanent locations worldwide. Most personnel are at DTRA headquarters at Fort Belvoir. Approximately 15% of the workforce is split between Kirtland Air Force Base and the White Sands Missile Range in New Mexico , and the Nevada National Security Site (formerly the Nevada Test Site), where they test and support the U.S. military's nuclear mission. The remaining 15% of the workforce is stationed in Germany , Kazakhstan , Azerbaijan , Uzbekistan , Georgia , Ukraine , Armenia , Kenya , South Korea , Japan , and Singapore . DTRA also has liaisons with the U.S. military's Combatant Commands , the National Guard Bureau , the FBI and other U.S. government interagency partners. In 2005, the United States Strategic Command (USSTRATCOM) was designated as the lead Combatant Command for the integration and synchronization of DoD's efforts in support of the government's "Combating WMD" objectives. It was at this time that the SCC-WMD was co-located with DTRA. The Combat Command designation was changed again in 2017 when responsibility was moved to U.S. Special Operations Command (USSOCOM). In 2012, the Standing Joint Force Headquarters for Elimination (SJFHQ-E) was relocated to the DTRA/SCC-WMD headquarters at Fort Belvoir. This centralized the DoD's Combating Weapons of Mass Destruction operations, a move recommended in the 2010 Quadrennial Defense Review . On September 30, 2016, the Joint Improvised-Threat Defeat Agency (JIDA) became part of DTRA and was renamed the Joint Improvised-Threat Defeat Organization (JIDO) in accordance with the 2016 National Defense Authorization Act (NDAA). In Section 1532 of the NDAA, Congress directed the DoD to move JIDA to a military department or under an existing defense agency. DTRA requested a base budget of $2.0 billion for fiscal year 2023 (FY23), including $998 million for Operation and Maintenance, $654 million for Research, Development, Test and Evaluation, $342 million for Cooperative Threat Reduction, and $14 million for Procurement. After the end of the Cold War , DTRA and its predecessor agencies implemented the DoD aspects of several treaties that assist former Eastern Bloc countries in the destruction of Soviet era nuclear weapons sites (such as missile silos and plutonium production facilities), biological weapons sites (such as the Soviet biological weapons program ), and chemical weapons sites (such as the GosNIIOKhT ) in an attempt to avert potential weapons proliferation in the post-Soviet era as part of the Nunn–Lugar Cooperative Threat Reduction program. The Nuclear Test Personnel Review (NTPR) program is the DoD program that confirms veteran participation in U.S. nuclear tests from 1945 to 1992, and the occupation forces of Hiroshima and Nagasaki , Japan. Members of this group are sometimes referred to as atomic veterans or atomic vets. If a veteran is a confirmed participant in these events, NTPR may provide either an actual or estimated radiation dose received by the veteran. The Department of Veterans Affairs (VA) and the Department of Justice (DOJ) may request this information from DTRA as required. DTRA is responsible for US reporting under the New START Treaty and the Intermediate-Range Nuclear Forces Treaty . DTRA is also responsible for reducing the threat of conventional war , especially in Europe , by participating in various arms control treaties to which the United States is a party, such as the Conventional Forces in Europe treaty , the Transparency in Armaments activity of the United Nations , and the Wassenaar Arrangement , as well as the Chemical Weapons Convention , the Plutonium Production Reactor Agreement, the Dayton Peace Accords , the Vienna Document and the Global Exchange of Military Information program under the auspices of the Organization for Security and Co-operation in Europe . DTRA has the responsibility to manage and integrate the Department of Defense chemical and biological defense science and technology programs. In accordance with the Recommendation 174 (h) of the 2005 Base Closure and Realignment Commission, part of the Chemical Biological Defense Research component of the DTRA was relocated to Edgewood Chemical Biological Center, Aberdeen Proving Ground , Maryland in 2011. This represented a move of about ten percent of the staff of the Chemical Biological Defense Research component of DTRA to Aberdeen Proving Ground; the rest of the staff remain at Fort Belvoir.After the end of the Cold War , DTRA and its predecessor agencies implemented the DoD aspects of several treaties that assist former Eastern Bloc countries in the destruction of Soviet era nuclear weapons sites (such as missile silos and plutonium production facilities), biological weapons sites (such as the Soviet biological weapons program ), and chemical weapons sites (such as the GosNIIOKhT ) in an attempt to avert potential weapons proliferation in the post-Soviet era as part of the Nunn–Lugar Cooperative Threat Reduction program.The Nuclear Test Personnel Review (NTPR) program is the DoD program that confirms veteran participation in U.S. nuclear tests from 1945 to 1992, and the occupation forces of Hiroshima and Nagasaki , Japan. Members of this group are sometimes referred to as atomic veterans or atomic vets. If a veteran is a confirmed participant in these events, NTPR may provide either an actual or estimated radiation dose received by the veteran. The Department of Veterans Affairs (VA) and the Department of Justice (DOJ) may request this information from DTRA as required.DTRA is responsible for US reporting under the New START Treaty and the Intermediate-Range Nuclear Forces Treaty . DTRA is also responsible for reducing the threat of conventional war , especially in Europe , by participating in various arms control treaties to which the United States is a party, such as the Conventional Forces in Europe treaty , the Transparency in Armaments activity of the United Nations , and the Wassenaar Arrangement , as well as the Chemical Weapons Convention , the Plutonium Production Reactor Agreement, the Dayton Peace Accords , the Vienna Document and the Global Exchange of Military Information program under the auspices of the Organization for Security and Co-operation in Europe .DTRA has the responsibility to manage and integrate the Department of Defense chemical and biological defense science and technology programs. In accordance with the Recommendation 174 (h) of the 2005 Base Closure and Realignment Commission, part of the Chemical Biological Defense Research component of the DTRA was relocated to Edgewood Chemical Biological Center, Aberdeen Proving Ground , Maryland in 2011. This represented a move of about ten percent of the staff of the Chemical Biological Defense Research component of DTRA to Aberdeen Proving Ground; the rest of the staff remain at Fort Belvoir.DTRA has spent approximately $300 million on scientific R&D efforts since 2003, developing vaccines and therapeutic treatments against viral hemorrhagic fever , including Ebola . Starting in 2007, DTRA partnered with the National Institute of Allergy and Infectious Diseases (NIAID) of the United States Department of Health and Human Services and the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) to fund research on the drug now called ZMapp , which has since been used on several patients. DTRA also funded and managed the research on the EZ1 assay used to detect and diagnose the presence of the Ebola Zaire virus in humans. EZ1 was given Emergency Use Authorization by the Food and Drug Administration (FDA) in August 2014. DTRA first developed EZ1 as part of a 2011 "bio-preparedness initiative" for the United States Department of Defense to prepare for a possible Ebola outbreak. EZ1 was used to identify infected patients in West Africa . The Nunn-Lugar Cooperative Threat Reduction program provided for the DTRA to award a $4 million contract to MRIGlobal to "configure, equip, deploy and staff two quick response mobile laboratory systems (MLS) to support the ongoing Ebola outbreak in West Africa ." The labs were deployed to Sierra Leone . DTRA was the program manager for designing, testing, contracting, and producing the Transport Isolation System (TIS), This sealed, self-contained patient containment system can be loaded into United States Air Force (USAF) C-17 Globemaster and C-130 Hercules cargo planes for aeromedical evacuation. The TIS was designed to deal with any U.S. troops exposed to or infected with Ebola while serving in Operation United Assistance , but it is for transporting anyone exposed to or infected with any highly contagious disease. It can hold eight patients lying down, 12 sitting, or a combination of the two. DTRA worked with the Air Force Life Cycle Management Center (AFLCMC) and United States Transportation Command (USTRANSCOM) on the TIS; St. Louis -based Production Products was awarded a sole-source contract to produce 25 TIS units. DTRA was one of the key United States Department of Defense agencies that developed the Field Deployable Hydrolysis System (FDHS) used to destroy Syria's chemical weapons aboard the U.S.-flagged container ship MV Cape Ray in the summer of 2014 after Syria agreed to give up its chemical weapons stockpile under international pressure and in accordance with United Nations Security Council Resolution 2118 . DTRA partnered with the United States Army Edgewood Chemical Biological Center (ECBC) to develop the FDHS and then modify it for ship-borne operations after Syrian President Bashar al-Assad agreed to turn over his country's poison gas arsenal and chemical weapon production equipment to the Organisation for the Prohibition of Chemical Weapons (OPCW), but no country volunteered to host the destruction process. Two FDHS units destroyed more than 600 tons of Sarin and mustard agents, completing the task several weeks ahead of schedule. The remaining materials were then taken to Finland and Germany for final disposal. DTRA was awarded its third Joint Meritorious Unit Award for successfully destroying Syria's declared chemical weapons. DTRA funded, managed, and tested the Massive Ordnance Penetrator (MOP) bomb until February 2010, when the program was turned over to the USAF. DTRA developed the MOP to fulfill a long-standing Air Force requirement for a weapon that could destroy hard and deeply buried targets. The MOP is a 30,000-pound, 20.5-foot-long bomb dropped from B-52 and B-2 bombers at high altitude that can reportedly penetrate 200 feet of reinforced concrete. The MOP contains a 5,300-pound explosive charge, more than ten times the explosive power of its predecessor, the BLU-109 "bunker buster." In 2003, a DTRA task force was identifying, collecting, and securing radiological material in Iraq as part of Operation Iraqi Freedom , including almost two tons of low-enriched uranium (LEU), several hundred tons of yellowcake (a type of uranium powder), and other radioactive sources. Code-named Project MAXIMUS, DTRA, and the United States Department of Energy moved 1.77 metric tons of LEU and approximately 1,000 highly radioactive sources out of Iraq by the summer of 2004. DTRA task force members also secured the yellowcake in a bunker in Tuwaitha , Iraq , which was turned over to the Iraqi Ministry of Science and Technology; the remaining 550 tons of yellowcake were sold in 2008 to Cameco , a uranium producer in Canada . In late 2019, DTRA established the Discovery of Medical Countermeasures Against Novel Entities (DOMANE) program. Shortly afterwards, the COVID-19 pandemic began, and DOMANE started researching existing, pre-approved medications like Pepcid (famotidine) for potential cost-effective treatments for COVID-19 . DTRA has spent approximately $300 million on scientific R&D efforts since 2003, developing vaccines and therapeutic treatments against viral hemorrhagic fever , including Ebola . Starting in 2007, DTRA partnered with the National Institute of Allergy and Infectious Diseases (NIAID) of the United States Department of Health and Human Services and the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) to fund research on the drug now called ZMapp , which has since been used on several patients. DTRA also funded and managed the research on the EZ1 assay used to detect and diagnose the presence of the Ebola Zaire virus in humans. EZ1 was given Emergency Use Authorization by the Food and Drug Administration (FDA) in August 2014. DTRA first developed EZ1 as part of a 2011 "bio-preparedness initiative" for the United States Department of Defense to prepare for a possible Ebola outbreak. EZ1 was used to identify infected patients in West Africa . The Nunn-Lugar Cooperative Threat Reduction program provided for the DTRA to award a $4 million contract to MRIGlobal to "configure, equip, deploy and staff two quick response mobile laboratory systems (MLS) to support the ongoing Ebola outbreak in West Africa ." The labs were deployed to Sierra Leone . DTRA was the program manager for designing, testing, contracting, and producing the Transport Isolation System (TIS), This sealed, self-contained patient containment system can be loaded into United States Air Force (USAF) C-17 Globemaster and C-130 Hercules cargo planes for aeromedical evacuation. The TIS was designed to deal with any U.S. troops exposed to or infected with Ebola while serving in Operation United Assistance , but it is for transporting anyone exposed to or infected with any highly contagious disease. It can hold eight patients lying down, 12 sitting, or a combination of the two. DTRA worked with the Air Force Life Cycle Management Center (AFLCMC) and United States Transportation Command (USTRANSCOM) on the TIS; St. Louis -based Production Products was awarded a sole-source contract to produce 25 TIS units. DTRA was one of the key United States Department of Defense agencies that developed the Field Deployable Hydrolysis System (FDHS) used to destroy Syria's chemical weapons aboard the U.S.-flagged container ship MV Cape Ray in the summer of 2014 after Syria agreed to give up its chemical weapons stockpile under international pressure and in accordance with United Nations Security Council Resolution 2118 . DTRA partnered with the United States Army Edgewood Chemical Biological Center (ECBC) to develop the FDHS and then modify it for ship-borne operations after Syrian President Bashar al-Assad agreed to turn over his country's poison gas arsenal and chemical weapon production equipment to the Organisation for the Prohibition of Chemical Weapons (OPCW), but no country volunteered to host the destruction process. Two FDHS units destroyed more than 600 tons of Sarin and mustard agents, completing the task several weeks ahead of schedule. The remaining materials were then taken to Finland and Germany for final disposal. DTRA was awarded its third Joint Meritorious Unit Award for successfully destroying Syria's declared chemical weapons. DTRA funded, managed, and tested the Massive Ordnance Penetrator (MOP) bomb until February 2010, when the program was turned over to the USAF. DTRA developed the MOP to fulfill a long-standing Air Force requirement for a weapon that could destroy hard and deeply buried targets. The MOP is a 30,000-pound, 20.5-foot-long bomb dropped from B-52 and B-2 bombers at high altitude that can reportedly penetrate 200 feet of reinforced concrete. The MOP contains a 5,300-pound explosive charge, more than ten times the explosive power of its predecessor, the BLU-109 "bunker buster." In 2003, a DTRA task force was identifying, collecting, and securing radiological material in Iraq as part of Operation Iraqi Freedom , including almost two tons of low-enriched uranium (LEU), several hundred tons of yellowcake (a type of uranium powder), and other radioactive sources. Code-named Project MAXIMUS, DTRA, and the United States Department of Energy moved 1.77 metric tons of LEU and approximately 1,000 highly radioactive sources out of Iraq by the summer of 2004. DTRA task force members also secured the yellowcake in a bunker in Tuwaitha , Iraq , which was turned over to the Iraqi Ministry of Science and Technology; the remaining 550 tons of yellowcake were sold in 2008 to Cameco , a uranium producer in Canada . In late 2019, DTRA established the Discovery of Medical Countermeasures Against Novel Entities (DOMANE) program. Shortly afterwards, the COVID-19 pandemic began, and DOMANE started researching existing, pre-approved medications like Pepcid (famotidine) for potential cost-effective treatments for COVID-19 . DTRA and its legacy agencies have been awarded numerous Joint Meritorious Unit Awards (JMUA) since the JMUA was implemented in 1982 (made retroactive to 1979): Defense Nuclear Agency 1st JMUA: 1 July 1981 – 20 June 1984 2nd JMUA: 1 January 1993 – 31 May 1995 On-Site Inspection Agency 1st JMUA: 15 January 1988 – 31 December 1988 2nd JMUA: 1 January 1989 – 30 July 1993 3rd JMUA: 1 August 1993 – 31 July 1996 4th JMUA: 1998 Defense Special Weapons Agency 1st JMUA: 1 June 1995 – 30 September 1998 Defense Threat Reduction Agency 1st JMUA: 1 October 1998 – 5 March 2000 2nd JMUA: 6 March 2000 – 30 June 2003 3rd JMUA: 1 October 2009 – 20 September 2011 4th JMUA: 1 May 2012 – 1 November 2014DTRA and its legacy agencies have been awarded numerous Joint Meritorious Unit Awards (JMUA) since the JMUA was implemented in 1982 (made retroactive to 1979): Defense Nuclear Agency 1st JMUA: 1 July 1981 – 20 June 1984 2nd JMUA: 1 January 1993 – 31 May 1995 On-Site Inspection Agency 1st JMUA: 15 January 1988 – 31 December 1988 2nd JMUA: 1 January 1989 – 30 July 1993 3rd JMUA: 1 August 1993 – 31 July 1996 4th JMUA: 1998 Defense Special Weapons Agency 1st JMUA: 1 June 1995 – 30 September 1998 Defense Threat Reduction Agency 1st JMUA: 1 October 1998 – 5 March 2000 2nd JMUA: 6 March 2000 – 30 June 2003 3rd JMUA: 1 October 2009 – 20 September 2011 4th JMUA: 1 May 2012 – 1 November 2014

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Taï_Forest_ebolavirus/html

Taï Forest ebolavirus

Taï Forest virus (TAFV) The species Taï Forest ebolavirus ( / t ɑː ˈ iː / ) is a virological taxon included in the genus Ebolavirus , family Filoviridae , order Mononegavirales . The species has a single virus member, Taï Forest virus (TAFV). The members of the species are called Taï Forest ebolaviruses. Tai Forest ebolavirus has been seen in a single human infection due to contact with chimpanzees from the Tai Forest in Côte d'Ivoire . The name Taï Forest ebolavirus is derived from Parc National de Taï (the name of a national park in Côte d'Ivoire , where Taï Forest virus was first discovered) and the taxonomic suffix ebolavirus (which denotes an ebolavirus species). According to the rules for taxon naming established by the International Committee on Taxonomy of Viruses (ICTV), the name Taï Forest ebolavirus is always to be capitalized , italicized , never abbreviated, and to be preceded by the word "species". The names of its members (Taï Forest ebolaviruses) are to be capitalized, are not italicized, and used without articles . The species was introduced in 1998 as Cote d'Ivoire Ebola virus . In 2002, the name was changed to Cote d'Ivoire ebolavirus . The name was proposed to be changed to Taï Forest ebolavirus in 2010, and this proposal was immediately accepted by the ICTV. [ citation needed ] A virus of the genus Ebolavirus is a member of the species Taï Forest ebolavirus if: it is endemic in Côte d'Ivoire it has a genome with three gene overlaps ( VP35 / VP40 , GP / VP30 , VP24 / L ) it has a genomic sequence different from Ebola virus by ≥30% but different from that of Taï Forest virus by <30%. Taï Forest virus ( / t ɑː ˈ iː / ; TAFV) is a close relative of the much more commonly known Ebola virus (EBOV). TAFV causes severe disease in primates , the Ebola hemorrhagic fever . TAFV is a Select Agent , World Health Organization Risk Group 4 Pathogen (requiring Biosafety Level 4-equivalent containment ), National Institutes of Health / National Institute of Allergy and Infectious Diseases Category A Priority Pathogen, Centers for Disease Control and Prevention Category A Bioterrorism Agent , and listed as a Biological Agent for Export Control by the Australia Group . [ citation needed ]Taï Forest virus (abbreviated TAFV) was first described in 1995 as a new "strain" of Ebola virus . It is the single member of the species Taï Forest ebolavirus , which is included into the genus Ebolavirus , family Filoviridae , order Mononegavirales . The name Taï Forest virus is derived from Parc National de Taï (the name of a national park in Côte d'Ivoire , where it was first discovered) and the taxonomic suffix virus . According to the rules for taxon naming established by the International Committee on Taxonomy of Viruses (ICTV), the name Taï Forest virus is always to be capitalized , but (in contrast to taxon names, e. g. genus and species names) is never italicized , and may be abbreviated (with TAFV being the official abbreviation). Taï Forest virus was first introduced as a new "strain" of Ebola virus in 1995. In 2000, it received the designation Côte d'Ivoire Ebola virus, and in 2002 the name was changed to Côte d'Ivoire ebolavirus. (both times misspelling "Côte"). Other names circulating in the literature were the correct Côte d'Ivoire Ebola virus and Côte d'Ivoire ebolavirus, and the jargon terms Ivory Coast Ebola virus and Ivory Coast ebolavirus. Previous abbreviations for the virus were EBOV-CI (for Ebola virus Côte d'Ivoire or Ebola virus Côte d'Ivoire), EBOV-IC (for Ebola virus Ivory Coast), ICEBOV (for Ivory Coast Ebola virus or Ivory Coast ebolavirus) and most recently CIEBOV (for Cote d;Ivoire Ebola virus, Côte d'Ivoire Ebola virus, Côte d'Ivoire ebolavirus or Côte d'Ivoire ebolavirus). The virus received its final designation in 2010, when it was renamed Taï Forest virus (TAFV). A virus of the species Taï Forest ebolavirus is a Taï Forest virus (TAFV) if it has the properties of Taï Forest ebolaviruses and if its genome diverges from that of the prototype Taï Forest virus, Taï Forest virus variant Côte d'Ivoire (TAFV/CI), by ≤10% at the nucleotide level. TAFV is one of four ebolaviruses that causes Ebola virus disease (EVD) in humans (in the literature also often referred to as Ebola hemorrhagic fever, EHF). EVD due to TAFV infection cannot be differentiated from EVD caused by other ebolaviruses by clinical observation alone, which is why the clinical presentation and pathology of infections by all ebolaviruses is presented together on a separate page (see Ebola virus disease ). TAFV made its first and thus far only known appearance in 1994 during a viral hemorrhagic fever epizootic among western chimpanzees (Pan troglodytes verus) in Taï National Park , Côte d'Ivoire . As more dead western chimpanzees were discovered, many tested positive for infection with an ebolavirus distinct from those already known. One of the scientists performing the necropsies on the infected western chimpanzees contracted TAFV. She developed symptoms similar to those of dengue fever approximately a week after the necropsy, and was transported to Switzerland for treatment. She was discharged from hospital after two weeks and had fully recovered six weeks after the infection. [ citation needed ]The ecology of TAFV is currently unclear and no reservoir host has yet been identified. Therefore, it remains unclear how TAFV was introduced into the western chimpanzee population. Bats are suspected to harbor the virus because infectious Marburg virus (MARV), a distantly related filovirus, has been isolated from bats, and because traces (but no infectious particles) of the more closely related Ebola virus (EBOV) were found in bats as well. TAFV is basically uncharacterized on a molecular level. However, its genomic sequence, and with it the genomic organization and the conservation of individual open reading frames , is similar to that of the other four known ebolaviruses. It is therefore currently assumed that the knowledge obtained for EBOV can be extrapolated to TAFV and that all TAFV proteins behave analogous to those of EBOV. [ citation needed ]

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/List_of_The_Rookie_episodes/html

List of The Rookie episodes

The Rookie is an American police procedural television series created for ABC by Alexi Hawley. The series follows John Nolan, a man in his forties, who becomes the oldest rookie at the Los Angeles Police Department . The series is produced by ABC Studios and Entertainment One ; it is based on real-life Los Angeles Police Department officer William Norcross, who moved to Los Angeles in 2015 and joined the department in his mid-40s. In May 2021, the series was renewed for a fourth season which premiered on September 26, 2021. On March 30, 2022, ABC renewed the series for a fifth season which premiered on September 25, 2022. On April 17, 2023, ABC renewed the series for a sixth season which premiered on February 20, 2024. On April 15, 2024, ABC renewed the series for a seventh season. As of April 9, 2024 , [ update ] 104 episodes of The Rookie have aired, currently in its sixth season.In the midst of Lopez's kidnapping, Jackson is killed by La Fiera's men while trying to save her. Grey and Wesley enlist the help of the DEA, but they are bound by the political ramifications of the case. Nolan, Tim and Harper enlist Max, who gives them a helicopter and arms to rescue Lopez, who has been brought to Guatemala . Wesley receives help from a criminal, Elijah Stone, in exchange for future favors before travelling there himself to make a deal with La Fiera. La Fiera threatens to kill Lopez once her baby is born. Nolan and the others resort to their backup plan. Wesley is separated from Lopez as she is brought to the hospital in a staged labor. Tim and Harper ambush La Fiera at the hospital and save Lopez, who shoots La Fiera dead as they're about to escape in the helicopter, avenging Jackson. Nolan saves Wesley from La Fiera's remaining goons. Three months later, Lopez has given birth to her and Wesley's son, who they name Jackson in honor of Jackson West. Nolan and Lucy respond to a call of a suspicious person near a power station, which they quickly realize has a bomb in before they escape before it detonates. The FBI's Los Angeles division is called in when it is suspected that the bomber belongs to a terrorist cell. When the FBI learns that the suspect, Zeke Freemont, has a connection to FBI trainee Simone Clark ( Niecy Nash ), they call her in to assist, but is soon dismissed. Nolan encourages her to stand up for herself and they find common grounds with both having been the oldest trainees in their respective agencies, both the LAPD and FBI. Lead agent Matt Garza calls her in to question Zeke as he only wants to speak to her. He reveals that he built bombs for the bomber, but did not know what they were for. Lopez and Harper investigate a supposed break in at a professor's house, and with Simone's help, discover that it was the same suspect as with the bombing, who is later identified as Trevor Gurin, with a classified connection to Groom Lake . With reluctance, Garza takes Simone on to his team. Through map evidence at the suspect' house and the codeword "Enervo", they deduce that Trevor was former military. He steals further bombs from the National Guard 's weapon storage, and initiates his plan to take down the city's infrastructure, starting with the roads. This episode and Enervo serve as the backdoor pilot episodes for the spin-off show, "The Rookie: Feds". One month later, Nolan has finished his TO certification, Lucy has finished her undercover course and Harper has returned to work. Nolan is assigned rookie Celina Juarez, and the two come off to a rocky start after a traffic stop gone awry. The vehicle is revealed to contain a blood stained carpet, but since the evidence was obtained illegally, it can't hold up in court. The carpet is also revealed to be linked to the disappearance of Jill Baskin, whose case Harper has taken on. Together with Lopez and Harper, Nolan and Celina work undercover to follow Jill's suspected abductor Tyler Harvin, but he escapes. While looking through evidence, Celina has a dream about where Jill could possibly be held. Nolan decides to give her a chance after refreshing their working relationship, and the two search a property in the woods, where they find Jill. Celina pursues Tyler and ends up in a fight with him before Nolan locates her and arrests Tyler. Lucy patrols solo and is locked inside an old warehouse while conducting a welfare check. She has an epiphany after looking through a document from the Dye Hards, an online group Chris joined looking into Rosalind Dyer. After Tim and Aaron finds her, she and Chris approach the FBI with the suspicion of Rosalind being a user in the group, which they track to an address in Seattle . Lucy joins the team to the city and find a blood written message from Rosalind on a wall at the address, saying "Better luck next time". Tim and Lucy go out on their first date, but find themselves tackling a dispute between a cook and chef. Grey warns them against a relationship, and has them separated on duty. While taking out money at a bank, Harper and James find themselves in a middle of a robbery committed by serial robber Todd Shelf and three associates. Harper has an employee trigger the silent alarm and the police arrive. Todd and Roger Armistead escape, but Todd leaves him behind. The FBI are called in, and the LAPD works with Simone Clark ( Niecy Nash ) and her superior/training FBI Special Agent Carter Hope ( James Lesure ). They track an unusual money wiring to Taylor Barnes, who reveals he hacked the FBI's undercover agents and informant list to sell to the highest bidder. Taylor is shot by a sniper before he can reveal the buyer's identity. Tim and Lucy and their reinforcements surround Roger taking a hostage in a neighborhood. Bradford hatches a plan to distract him and Roger is subsequently arrested. At a hospital, Todd's third associate, Amy Wright, escapes and reunites with Todd. They push Tim and Aaron's patrol car off a parking garage roof, but the two narrowly escape. Shortly after, Nolan and Celina finds Todd dead in the truck he and Amy stole. With help from Matthew Garza's team at the FBI, Lopez puts everything on the line to help Elijah Stone take down Abril Rodas in exchange for her safety as part of an elaborate operation. Garza's team moves to utilise Abril's girlfriend Daylin as bait for Elijah. But the night he arrives to execute her, he withdraws at the last minute due to a unintended distraction caused by Aaron. Unbeknown to both the LAPD and FBI, Elijah approaches Abril and offers to work with her. Nolan and Bailey travel to Nolan's mother's now-vacant home in Foxburg, Pennsylvania , and must deal with the secrets and shady dealings his late mother left behind including someone masquerading as Nolan, drug dealers, and a foreclosed mortgage. Britt Robertson (Laura Stenson), Felix Solis (Matthew Garza) and Kevin Zegers (Brendon Acres) are credited as Special Guest Stars. Elijah begins to question Monica's loyalty, but is convinced after she forms a plan to double play the LAPD on his trail. She approaches them under the guise of finally helping, but Grey and Harper quickly deduce her play. The second time Monica reports on Elijah moves, the police manage to decode the real location at the Port of Los Angeles. A shootout ensues and Elijah subdues Harper, but Lopez wounds him and she and Harper arrest him. Monica contacts Abril and offers her assistance. Nolan re-opens Celina's sister Blanca and with Celina discovers a new lead which fractures the previous alibi. Nolan learns from a witness that Celina's mother that they were taking opioids together while Blanca and Celina were left home alone, during which Blanca disappeared. Her mother is eventually brought in for questioning, and admits the truth to Celina. Lucy goes undercover as a sales agent in order to gain Frank Tesca's interest following his release from prison. Once he approaches her, he asks her to take some under payment in favor for products from her company. Frank learns that his brother's crew is after him, while some of his own men has also turned on him. After a drive-by shooting, he determines a close associate was behind it, but Lucy stops him from killing him as Tim and the police descend on their location. Frank concedes that he has lost control over his crew after his prison time and wishes to reconcile with his daughter, which Lucy encourages him to do. Aaron assists Lopez with detective work while she is at home, and questions a reluctant witness of a robbery, which leads to a vehicle with a dead body and workshop with a decreased suspect. He manages to solve the case in addition to seven other tie-ins. Harper, Nolan and Celina tackle a cold case favor which involves a severed torso. Further searching wounds up a arm belonging to it and two friends of the victim. Video footage in their possession reveals that they accidentally shot their friend and cut his body up and hid the parts.In the midst of Lopez's kidnapping, Jackson is killed by La Fiera's men while trying to save her. Grey and Wesley enlist the help of the DEA, but they are bound by the political ramifications of the case. Nolan, Tim and Harper enlist Max, who gives them a helicopter and arms to rescue Lopez, who has been brought to Guatemala . Wesley receives help from a criminal, Elijah Stone, in exchange for future favors before travelling there himself to make a deal with La Fiera. La Fiera threatens to kill Lopez once her baby is born. Nolan and the others resort to their backup plan. Wesley is separated from Lopez as she is brought to the hospital in a staged labor. Tim and Harper ambush La Fiera at the hospital and save Lopez, who shoots La Fiera dead as they're about to escape in the helicopter, avenging Jackson. Nolan saves Wesley from La Fiera's remaining goons. Three months later, Lopez has given birth to her and Wesley's son, who they name Jackson in honor of Jackson West. Nolan and Lucy respond to a call of a suspicious person near a power station, which they quickly realize has a bomb in before they escape before it detonates. The FBI's Los Angeles division is called in when it is suspected that the bomber belongs to a terrorist cell. When the FBI learns that the suspect, Zeke Freemont, has a connection to FBI trainee Simone Clark ( Niecy Nash ), they call her in to assist, but is soon dismissed. Nolan encourages her to stand up for herself and they find common grounds with both having been the oldest trainees in their respective agencies, both the LAPD and FBI. Lead agent Matt Garza calls her in to question Zeke as he only wants to speak to her. He reveals that he built bombs for the bomber, but did not know what they were for. Lopez and Harper investigate a supposed break in at a professor's house, and with Simone's help, discover that it was the same suspect as with the bombing, who is later identified as Trevor Gurin, with a classified connection to Groom Lake . With reluctance, Garza takes Simone on to his team. Through map evidence at the suspect' house and the codeword "Enervo", they deduce that Trevor was former military. He steals further bombs from the National Guard 's weapon storage, and initiates his plan to take down the city's infrastructure, starting with the roads. This episode and Enervo serve as the backdoor pilot episodes for the spin-off show, "The Rookie: Feds".One month later, Nolan has finished his TO certification, Lucy has finished her undercover course and Harper has returned to work. Nolan is assigned rookie Celina Juarez, and the two come off to a rocky start after a traffic stop gone awry. The vehicle is revealed to contain a blood stained carpet, but since the evidence was obtained illegally, it can't hold up in court. The carpet is also revealed to be linked to the disappearance of Jill Baskin, whose case Harper has taken on. Together with Lopez and Harper, Nolan and Celina work undercover to follow Jill's suspected abductor Tyler Harvin, but he escapes. While looking through evidence, Celina has a dream about where Jill could possibly be held. Nolan decides to give her a chance after refreshing their working relationship, and the two search a property in the woods, where they find Jill. Celina pursues Tyler and ends up in a fight with him before Nolan locates her and arrests Tyler. Lucy patrols solo and is locked inside an old warehouse while conducting a welfare check. She has an epiphany after looking through a document from the Dye Hards, an online group Chris joined looking into Rosalind Dyer. After Tim and Aaron finds her, she and Chris approach the FBI with the suspicion of Rosalind being a user in the group, which they track to an address in Seattle . Lucy joins the team to the city and find a blood written message from Rosalind on a wall at the address, saying "Better luck next time". Tim and Lucy go out on their first date, but find themselves tackling a dispute between a cook and chef. Grey warns them against a relationship, and has them separated on duty. While taking out money at a bank, Harper and James find themselves in a middle of a robbery committed by serial robber Todd Shelf and three associates. Harper has an employee trigger the silent alarm and the police arrive. Todd and Roger Armistead escape, but Todd leaves him behind. The FBI are called in, and the LAPD works with Simone Clark ( Niecy Nash ) and her superior/training FBI Special Agent Carter Hope ( James Lesure ). They track an unusual money wiring to Taylor Barnes, who reveals he hacked the FBI's undercover agents and informant list to sell to the highest bidder. Taylor is shot by a sniper before he can reveal the buyer's identity. Tim and Lucy and their reinforcements surround Roger taking a hostage in a neighborhood. Bradford hatches a plan to distract him and Roger is subsequently arrested. At a hospital, Todd's third associate, Amy Wright, escapes and reunites with Todd. They push Tim and Aaron's patrol car off a parking garage roof, but the two narrowly escape. Shortly after, Nolan and Celina finds Todd dead in the truck he and Amy stole. With help from Matthew Garza's team at the FBI, Lopez puts everything on the line to help Elijah Stone take down Abril Rodas in exchange for her safety as part of an elaborate operation. Garza's team moves to utilise Abril's girlfriend Daylin as bait for Elijah. But the night he arrives to execute her, he withdraws at the last minute due to a unintended distraction caused by Aaron. Unbeknown to both the LAPD and FBI, Elijah approaches Abril and offers to work with her. Nolan and Bailey travel to Nolan's mother's now-vacant home in Foxburg, Pennsylvania , and must deal with the secrets and shady dealings his late mother left behind including someone masquerading as Nolan, drug dealers, and a foreclosed mortgage. Britt Robertson (Laura Stenson), Felix Solis (Matthew Garza) and Kevin Zegers (Brendon Acres) are credited as Special Guest Stars. Elijah begins to question Monica's loyalty, but is convinced after she forms a plan to double play the LAPD on his trail. She approaches them under the guise of finally helping, but Grey and Harper quickly deduce her play. The second time Monica reports on Elijah moves, the police manage to decode the real location at the Port of Los Angeles. A shootout ensues and Elijah subdues Harper, but Lopez wounds him and she and Harper arrest him. Monica contacts Abril and offers her assistance. Nolan re-opens Celina's sister Blanca and with Celina discovers a new lead which fractures the previous alibi. Nolan learns from a witness that Celina's mother that they were taking opioids together while Blanca and Celina were left home alone, during which Blanca disappeared. Her mother is eventually brought in for questioning, and admits the truth to Celina. Lucy goes undercover as a sales agent in order to gain Frank Tesca's interest following his release from prison. Once he approaches her, he asks her to take some under payment in favor for products from her company. Frank learns that his brother's crew is after him, while some of his own men has also turned on him. After a drive-by shooting, he determines a close associate was behind it, but Lucy stops him from killing him as Tim and the police descend on their location. Frank concedes that he has lost control over his crew after his prison time and wishes to reconcile with his daughter, which Lucy encourages him to do. Aaron assists Lopez with detective work while she is at home, and questions a reluctant witness of a robbery, which leads to a vehicle with a dead body and workshop with a decreased suspect. He manages to solve the case in addition to seven other tie-ins. Harper, Nolan and Celina tackle a cold case favor which involves a severed torso. Further searching wounds up a arm belonging to it and two friends of the victim. Video footage in their possession reveals that they accidentally shot their friend and cut his body up and hid the parts.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/IUCN_Red_List/html

IUCN Red List

The International Union for Conservation of Nature (IUCN) Red List of Threatened Species , also known as the IUCN Red List or Red Data Book , founded in 1964, is an inventory of the global conservation status and extinction risk of biological species . A series of Regional Red Lists , which assess the risk of extinction to species within a political management unit, are also produced by countries and organizations. The goals of the Red List are to provide scientifically based information on the status of species and subspecies at a global level, to draw attention to the magnitude and importance of threatened biodiversity, to influence national and international policy and decision-making, and to provide information to guide actions to conserve biological diversity. Major species assessors include BirdLife International , the Institute of Zoology (the research division of the Zoological Society of London ), the World Conservation Monitoring Centre , and many Specialist Groups within the IUCN Species Survival Commission (SSC). Collectively, assessments by these organizations and groups account for nearly half the species on the Red List. The IUCN aims to have the category of every species re-evaluated at least every ten years, and every five years if possible. This is done in a peer reviewed manner through IUCN Species Survival Commission Specialist Groups (SSC), which are Red List Authorities (RLA) responsible for a species, group of species or specific geographic area, or in the case of BirdLife International, an entire class ( Aves ). The red list unit works with staff from the IUCN Global Species Programme as well as current program partners to recommend new partners or networks to join as new Red List Authorities. The number of species which have been assessed for the Red List has been increasing over time. As of 2023 , [ update ] of 150,388 species surveyed, 42,108 are considered at risk of extinction because of human activity, in particular overfishing , hunting , and land development . The idea for a Red Data Book was suggested by Peter Scott in 1963. Initially the Red Data Lists were designed for specialists and were issued in a loose-leaf format that could be easily changed. The first two volumes of Red Lists were published in 1966 by conservationist Noel Simon, one for mammals and one for birds. The third volume that appeared covered reptiles and amphibians. It was created by René E. Honegger in 1968. In 1970 the IUCN published its fifth volume in this series. This was the first Red Data List which focused on plants ( angiosperms only), compiled by Ronald Melville . The final volume of Red Data List created in the older, loose leaf style was volume 4 on freshwater fishes. This was published in 1979 by Robert Rush Miller . The first attempt to create a Red Data Book for a nonspecialist public came in 1969 with The Red Book: Wildlife in Danger. This book covered varies groups but was predominantly about mammals and birds, with smaller sections on reptiles, amphibians, fishes, and plants. The 2006 Red List, released on 4 May 2006 evaluated 40,168 species as a whole, plus an additional 2,160 subspecies , varieties , aquatic stocks , and subpopulations . [ citation needed ] On 12 September 2007, the World Conservation Union (IUCN) released the 2007 IUCN Red List of Threatened Species . In this release, they have raised their classification of both the western lowland gorilla ( Gorilla gorilla gorilla ) and the Cross River gorilla ( Gorilla gorilla diehli ) from endangered to critically endangered , which is the last category before extinct in the wild , due to Ebola virus and poaching , along with other factors. Russ Mittermeier , chief of Swiss -based IUCN's Primate Specialist Group, stated that 16,306 species are endangered with extinction, 188 more than in 2006 (total of 41,415 species on the Red List). The Red List includes the Sumatran orangutan ( Pongo abelii ) in the Critically Endangered category and the Bornean orangutan ( Pongo pygmaeus ) in the Endangered category. The 2008 Red List was released on 6 October 2008 at the IUCN World Conservation Congress in Barcelona and "confirmed an extinction crisis, with almost one in four [mammals] at risk of disappearing forever". The study shows at least 1,141 of the 5,487 mammals on Earth are known to be threatened with extinction, and 836 are listed as Data Deficient . The Red List of 2012 was released 19 July 2012 at Rio+20 Earth Summit ; nearly 2,000 species were added, with 4 species to the extinct list, 2 to the rediscovered list. The IUCN assessed a total of 63,837 species which revealed 19,817 are threatened with extinction. 3,947 were described as "critically endangered" and 5,766 as "endangered", while more than 10,000 species are listed as "vulnerable". At threat are 41% of amphibian species, 33% of reef-building corals, 30% of conifers, 25% of mammals, and 13% of birds. The IUCN Red List has listed 132 species of plants and animals from India as "Critically Endangered". Initially the Red Data Lists were designed for specialists and were issued in a loose-leaf format that could be easily changed. The first two volumes of Red Lists were published in 1966 by conservationist Noel Simon, one for mammals and one for birds. The third volume that appeared covered reptiles and amphibians. It was created by René E. Honegger in 1968. In 1970 the IUCN published its fifth volume in this series. This was the first Red Data List which focused on plants ( angiosperms only), compiled by Ronald Melville . The final volume of Red Data List created in the older, loose leaf style was volume 4 on freshwater fishes. This was published in 1979 by Robert Rush Miller . The first attempt to create a Red Data Book for a nonspecialist public came in 1969 with The Red Book: Wildlife in Danger. This book covered varies groups but was predominantly about mammals and birds, with smaller sections on reptiles, amphibians, fishes, and plants.The 2006 Red List, released on 4 May 2006 evaluated 40,168 species as a whole, plus an additional 2,160 subspecies , varieties , aquatic stocks , and subpopulations . [ citation needed ]On 12 September 2007, the World Conservation Union (IUCN) released the 2007 IUCN Red List of Threatened Species . In this release, they have raised their classification of both the western lowland gorilla ( Gorilla gorilla gorilla ) and the Cross River gorilla ( Gorilla gorilla diehli ) from endangered to critically endangered , which is the last category before extinct in the wild , due to Ebola virus and poaching , along with other factors. Russ Mittermeier , chief of Swiss -based IUCN's Primate Specialist Group, stated that 16,306 species are endangered with extinction, 188 more than in 2006 (total of 41,415 species on the Red List). The Red List includes the Sumatran orangutan ( Pongo abelii ) in the Critically Endangered category and the Bornean orangutan ( Pongo pygmaeus ) in the Endangered category. The 2008 Red List was released on 6 October 2008 at the IUCN World Conservation Congress in Barcelona and "confirmed an extinction crisis, with almost one in four [mammals] at risk of disappearing forever". The study shows at least 1,141 of the 5,487 mammals on Earth are known to be threatened with extinction, and 836 are listed as Data Deficient . The Red List of 2012 was released 19 July 2012 at Rio+20 Earth Summit ; nearly 2,000 species were added, with 4 species to the extinct list, 2 to the rediscovered list. The IUCN assessed a total of 63,837 species which revealed 19,817 are threatened with extinction. 3,947 were described as "critically endangered" and 5,766 as "endangered", while more than 10,000 species are listed as "vulnerable". At threat are 41% of amphibian species, 33% of reef-building corals, 30% of conifers, 25% of mammals, and 13% of birds. The IUCN Red List has listed 132 species of plants and animals from India as "Critically Endangered". Species are classified by the IUCN Red List into nine groups, specified through criteria such as rate of decline, population size, area of geographic distribution, and degree of population and distribution fragmentation. There is an emphasis on the acceptability of applying any criteria in the absence of high quality data including suspicion and potential future threats, "so long as these can reasonably be supported". : 6 In the IUCN Red List, " threatened " embraces the categories of Critically Endangered, Endangered, and Vulnerable. The older 1994 list has only a single "Lower Risk" category which contained three subcategories: In the 2001 framework, Near Threatened and Least Concern became their own categories, while Conservation Dependent was removed and its contents merged into Near Threatened . The tag of "possibly extinct" (PE) is used by Birdlife International , the Red List Authority for birds for the IUCN Red List. BirdLife International has recommended PE become an official tag for Critically Endangered species, and this has now been adopted, along with a "Possibly Extinct in the Wild" tag for species with populations surviving in captivity but likely to be extinct in the wild. [ citation needed ]The older 1994 list has only a single "Lower Risk" category which contained three subcategories: In the 2001 framework, Near Threatened and Least Concern became their own categories, while Conservation Dependent was removed and its contents merged into Near Threatened .The tag of "possibly extinct" (PE) is used by Birdlife International , the Red List Authority for birds for the IUCN Red List. BirdLife International has recommended PE become an official tag for Critically Endangered species, and this has now been adopted, along with a "Possibly Extinct in the Wild" tag for species with populations surviving in captivity but likely to be extinct in the wild. [ citation needed ]There have been a number of versions, dating from 1991, including: Version 1.0 (1991) Version 2.0 (1992) Version 2.1 (1993) Version 2.2 (1994) Version 2.3 (1994) Version 3.0 (1999) Version 3.1 (2001) All new IUCN assessments since 2001 have used version 3.1 of the categories and criteria.In 1997, the IUCN Red List received criticism on the grounds of secrecy (or at least poor documentation) surrounding the sources of its data. These allegations have led to efforts by the IUCN to improve its documentation and data quality, and to include peer reviews of taxa on the Red List. The list is also open to petitions against its classifications, on the basis of documentation or criteria. In the November 2002 issue of Trends in Ecology & Evolution , an article suggested that the IUCN Red List and similar works are prone to misuse by governments and other groups that draw possibly inappropriate conclusions on the state of the environment or to affect exploitation of natural resources . In the November 2016 issue of Science Advances , a research article claims there are serious inconsistencies in the way species are classified by the IUCN. The researchers contend that the IUCN's process of categorization is "out-dated, and leaves room for improvement", and further emphasize the importance of readily available and easy-to-include geospatial data, such as satellite and aerial imaging. Their conclusion questioned not only the IUCN's method but also the validity of where certain species fall on the List. They believe that combining geographical data can significantly increase the number of species that need to be reclassified to a higher risk category.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Hammer-headed_bat/html

Hammer-headed bat

Sphyrocephalus labrosus Murray , 1862 Zygaenocephalus labrosus (Murray, 1862) The hammer-headed bat ( Hypsignathus monstrosus ), also known as hammer-headed fruit bat , big-lipped bat , and hammerhead bat , is a megabat widely distributed in West and Central Africa. It is the only member of the genus Hypsignathus , which is part of the tribe Epomophorini along with four other genera. It is the largest bat in continental Africa, with wingspans approaching 1 m (3.3 ft) , and males almost twice as heavy as females. Males and females also greatly differ in appearance, making it the most sexually dimorphic bat species in the world. These differences include several adaptations that help males produce and amplify vocalizations: the males' larynges (vocal cords) are about three times as large as those of females, and they have large resonating chambers on their faces. Females appear more like a typical megabat, with foxlike faces. The hammer-headed bat is frugivorous , consuming a variety of fruits such as figs, bananas, and mangoes, though a few instances of carnivory have been noted. Females tend to travel a consistent route to find predictable fruits, whereas males travel more to find the highest quality fruit. It forages at night, sleeping during the day in tree roosts. Individuals may roost alone or in small groups. Unlike many other bat species that segregate based on sex, males and females will roost together during the day. It has two mating seasons each year during the dry seasons. It is believed to be the only bat species with a classical lek mating system, wherein males gather on a "lek", which in this case is a long and thin stretch of land, such as along a river. There, they produce loud, honking vocalizations to attract females. Females visit the lek and select a male to mate with; the most successful 6% of males are involved in 79% of matings. Offspring are born five or six months later, typically a singleton, though twins have been documented. Its predators are not well-known, but may include hawks. Adults are commonly affected by parasites such as flies and mites . The hammer-headed bat is sometimes considered a pest due to its frugivorous diet and its extremely loud honking noises at night. In Nigeria and the Democratic Republic of the Congo, it is consumed as bushmeat . It has been investigated as a potential reservoir of the Ebola virus , with several testing positive for antibodies against the virus. It is not considered a species of conservation concern due to its large range and presumably large population size.Hypsignathus Epomops Nanonycteris Epomophorus Micropteropus Megaloglossus Myonycteris Lissonycteris The hammer-headed bat was described as a new species in 1861 by American scientist Harrison Allen . Allen placed the species into a newly-created genus, Hypsignathus . The holotype had been collected by French-American zoologist Paul Du Chaillu in Gabon . The genus name Hypsignathus comes from the Ancient Greek húpsos , meaning "high", and gnáthos , meaning "jaw". T. S. Palmer speculated that Allen chose the name Hypsignathus to allude to the "deeply arched mouth" of the species. The species name monstrosus is Latin for "having the qualities of a monster". A 2011 study found that Hypsignathus was the most basal member of the tribe Epomophorini, which also includes Epomops , Micropteropus , Epomophorus , and Nanonycteris . Initially, Allen identified the hammer-headed bat as a member of the subfamily Pteropodinae of the megabats . However, in 1997, Epomophorini was recognized as part of the subfamily Epomophorinae . Some taxonomists do not recognize Epomophorinae as a valid subfamily and include its taxa, including the Epomophorini, within Rousettinae . The hammer-headed bat is the largest bat in mainland Africa. Males have wingspans up to 90.1 cm (2.96 ft) , and all individuals have forearm lengths exceeding 112 mm (4.4 in) . It has pronounced sexual dimorphism , more so than any other bat species in the world, with males up to twice as heavy as females. The average weight of males is 420 g (15 oz) , compared to 234 g (8.3 oz) for females. Other differences between the sexes relate to their social system, in which males produce loud, honking vocalizations. Therefore, males have greatly enlarged larynges , about three times the size of females', extending through most of the thoracic cavity, and measuring half the length of the spine. The larynx is so large, it displaces other organs, including the heart, lungs, and gastrointestinal tract. Males also have resonating chambers to increase the volume of sound production. These chambers are pharyngeal air sacs connected to a large sinus in the humped snout. These numerous adaptations caused scientists Herbert Lang and James Chapin to remark, "In no other mammal is everything so entirely subordinated to the organs of voice". Males overall have boxy heads with enormous lips, while the females, with their narrower snouts, have more foxlike faces. Males and females both have dark brown fur, with a paler mantle (sides and back of neck). It has patches of white fur at the base of the ears, though sometimes indistinct. The fur is long and smooth, though somewhat woolly in texture on the mantle. The ears are triangular and blackish-brown, and the eyes are very large. The dental formula is 2.1.2.1 2.1.3.2 for a total of 28 teeth; very occasionally, individuals have been found with an additional upper premolar on each side of the mouth, for a total of 30 teeth. The skull is larger and more robust than any other megabat in Africa, with a pronounced, massive snout. The tongue is large and powerful, with an expanded, tridentate tip. The tongue has backwards-facing papillae used to extract juice from fruits. The wings are characterized by low aspect ratio , meaning that it has a smaller wingspan relative to the wing area. The wing loading is considered exceptionally high, meaning that it has a large body weight relative to the wing area. The wings are blackish brown in color. The thumb is approximately 128–137 mm (5.0–5.4 in) long. The wings attach to the hindlimbs at the second toe. It lacks a tail. Instead of the typical mammalian karyotype where females have two X chromosomes and males have one each of X and Y , males have a single X chromosome and no Y chromosome, known as X0 sex-determination system . Thus, females have 36 chromosomes (34 autosomes and two sex chromosomes ), and males have 35 chromosomes (34 autosomes but only one sex chromosome). This is seen in a few other bat genera, including Epomophorus and Epomops . Hammer-headed bats are frugivores . Figs make up much of their diet, but mangos , bananas and guavas may also be consumed. There are some complications inherent in a fruit diet such as insufficient protein intake. It is suggested that fruit bats compensate for this by possessing a proportionally longer intestine compared to insectivorous species. Males and females rely on different strategies for foraging. Females use trap-lining , in which they travel an established route with dependable and predictable food sources, even if the food is lower quality. Males, in contrast, search for areas rich with food, traveling up to 10 km (6.2 mi) to reach particularly good food patches. Upon finding suitable fruit, the hammer-headed bat may eat at the tree or pick the fruit and carry it away to another site for consumption. It chews the fruit, swallowing the juice and soft pulp, before spitting out the rest. The guano (feces) typically contains seeds from ingested fruits, indicating that it may be an important seed disperser . Van Deusan (1968) reports H. monstrosus showing some carnivorous behavior by attacking chickens to drink their blood and scavenging for meat. Little is known about reproduction in hammer-headed bats. In some populations, breeding is thought to take place semi-annually during the dry seasons. The timing of the dry season varies depending on the locality, but in general the first breeding season is from June to August and the second is from December to February. Females may become pregnant up to twice per year, giving birth after five or six months gestation to one offspring at a time, though twins have been reported. Newborns weigh approximately 40 g (1.4 oz) at birth. Females reach sexual maturity faster than males, and can reproduce at six months. Females reach adult size by nine months of age. In contrast, males are not sexually mature until eighteen months. Males and females are similar in size for their first year of life. This species is often cited as an example of classical lek mating , and is perhaps the only bat species with such. The classical lek is defined by four criteria: Males gather in a particular region, known as a lek; here, they establish "display territories" Display territories offer no beneficial resources to females beyond access to males Mate choice is up to females to decide; all copulation occurs at the lek Males do not assist females in caring for offspring Males form these leks along streams or riverbeds during the mating season, which lasts 1 – 3 months. Leks consist of 20 – 135 males in an area about 40 m (130 ft) wide and 400–1,600 m (1,300–5,200 ft) long. Each male claims a display territory of about 10 m (33 ft) in diameter, in which he honks repeatedly and flaps his wings while hanging from a branch. Typically, 60 – 120 honks are produced per minute. Males display for around four hours before foraging, with peaks in lekking activity in the early evening and before dawn. The early evening peak is when the majority of copulation occurs. Females will fly through the lek, selecting a male by landing on a branch next to him. The chosen male emits a "staccato buzz" call, followed immediately by copulation, which lasts 30 – 60 seconds. After copulation, the female immediately departs, and the male resumes displaying. The males at the center of the lek have the most success, and are responsible for the majority of matings: the top 6% of males have 79% of the total matings. In the before-dawn peak in activity, copulation is less frequent, and males spend time jockeying with each other for the best display territory. As the mating season progresses, the importance of the before-dawn peak lessens. However, some populations of hammer-headed bats in West Africa do not use leks. Instead, they have a harem system. During the day, the hammer-headed bat roosts in trees, typically 20–30 m (66–98 ft) above the ground in the forest canopy . Various trees are used for roosting, with no preference for a particular species. It has low fidelity to its roost and will move to a new roost after 5 – 9 days. It relies on camouflage to hide from predators. It displays a mix of solitary and social behavior. Individuals of both sexes are frequently found roosting alone, though they may roost in small groups of around four individuals. Occasionally, groups of up to twenty-five have been documented. Groups are of mixed sex and age, unlike other bat species which segregate based on sex. While roosting, individuals in a group are approximately 10–15 cm (3.9–5.9 in) apart, with males on the periphery and females nearer the center. During most of the day, individuals sleep with their noses covered by their wings. Members of the same group show little interaction with each other: they do not "squabble", vocalize, or groom each other. Instead, at sunset, individuals groom themselves then set off independently to forage. Its predators are not well-documented, but may include avian species such as the long-tailed hawk . It has a diverse array of parasites, including such ectoparasites as the bat fly ( Nycteribiidae ) Dipseliopoda arcuata , the spinturnicid mite Ancystropus aethiopicus , the gastronyssid mite Mycteronyssus polli , and the teinocoptid mite Teinocopties auricularis . Internally, it is known to be affected by the liver parasite Hepatocystis carpenteri . Adults commonly host parasites. Hammer-headed bats are frugivores . Figs make up much of their diet, but mangos , bananas and guavas may also be consumed. There are some complications inherent in a fruit diet such as insufficient protein intake. It is suggested that fruit bats compensate for this by possessing a proportionally longer intestine compared to insectivorous species. Males and females rely on different strategies for foraging. Females use trap-lining , in which they travel an established route with dependable and predictable food sources, even if the food is lower quality. Males, in contrast, search for areas rich with food, traveling up to 10 km (6.2 mi) to reach particularly good food patches. Upon finding suitable fruit, the hammer-headed bat may eat at the tree or pick the fruit and carry it away to another site for consumption. It chews the fruit, swallowing the juice and soft pulp, before spitting out the rest. The guano (feces) typically contains seeds from ingested fruits, indicating that it may be an important seed disperser . Van Deusan (1968) reports H. monstrosus showing some carnivorous behavior by attacking chickens to drink their blood and scavenging for meat. Little is known about reproduction in hammer-headed bats. In some populations, breeding is thought to take place semi-annually during the dry seasons. The timing of the dry season varies depending on the locality, but in general the first breeding season is from June to August and the second is from December to February. Females may become pregnant up to twice per year, giving birth after five or six months gestation to one offspring at a time, though twins have been reported. Newborns weigh approximately 40 g (1.4 oz) at birth. Females reach sexual maturity faster than males, and can reproduce at six months. Females reach adult size by nine months of age. In contrast, males are not sexually mature until eighteen months. Males and females are similar in size for their first year of life. This species is often cited as an example of classical lek mating , and is perhaps the only bat species with such. The classical lek is defined by four criteria: Males gather in a particular region, known as a lek; here, they establish "display territories" Display territories offer no beneficial resources to females beyond access to males Mate choice is up to females to decide; all copulation occurs at the lek Males do not assist females in caring for offspring Males form these leks along streams or riverbeds during the mating season, which lasts 1 – 3 months. Leks consist of 20 – 135 males in an area about 40 m (130 ft) wide and 400–1,600 m (1,300–5,200 ft) long. Each male claims a display territory of about 10 m (33 ft) in diameter, in which he honks repeatedly and flaps his wings while hanging from a branch. Typically, 60 – 120 honks are produced per minute. Males display for around four hours before foraging, with peaks in lekking activity in the early evening and before dawn. The early evening peak is when the majority of copulation occurs. Females will fly through the lek, selecting a male by landing on a branch next to him. The chosen male emits a "staccato buzz" call, followed immediately by copulation, which lasts 30 – 60 seconds. After copulation, the female immediately departs, and the male resumes displaying. The males at the center of the lek have the most success, and are responsible for the majority of matings: the top 6% of males have 79% of the total matings. In the before-dawn peak in activity, copulation is less frequent, and males spend time jockeying with each other for the best display territory. As the mating season progresses, the importance of the before-dawn peak lessens. However, some populations of hammer-headed bats in West Africa do not use leks. Instead, they have a harem system. During the day, the hammer-headed bat roosts in trees, typically 20–30 m (66–98 ft) above the ground in the forest canopy . Various trees are used for roosting, with no preference for a particular species. It has low fidelity to its roost and will move to a new roost after 5 – 9 days. It relies on camouflage to hide from predators. It displays a mix of solitary and social behavior. Individuals of both sexes are frequently found roosting alone, though they may roost in small groups of around four individuals. Occasionally, groups of up to twenty-five have been documented. Groups are of mixed sex and age, unlike other bat species which segregate based on sex. While roosting, individuals in a group are approximately 10–15 cm (3.9–5.9 in) apart, with males on the periphery and females nearer the center. During most of the day, individuals sleep with their noses covered by their wings. Members of the same group show little interaction with each other: they do not "squabble", vocalize, or groom each other. Instead, at sunset, individuals groom themselves then set off independently to forage. Its predators are not well-documented, but may include avian species such as the long-tailed hawk . It has a diverse array of parasites, including such ectoparasites as the bat fly ( Nycteribiidae ) Dipseliopoda arcuata , the spinturnicid mite Ancystropus aethiopicus , the gastronyssid mite Mycteronyssus polli , and the teinocoptid mite Teinocopties auricularis . Internally, it is known to be affected by the liver parasite Hepatocystis carpenteri . Adults commonly host parasites. The hammer-headed bat is a lowland species, always occurring below 1,800 m (5,900 ft) above sea level. Most records of this species occur in rainforest habitat, including lowland rainforest, swamp forest, riverine forests, and mosaics of forest and grassland. While it has been documented in savanna habitats, these records are rare, and it has been speculated that these individuals are vagrants . It has a wide range in West and Central Africa , including the following countries: Angola , Benin , Burkina Faso , Cameroon , Central African Republic , Republic of the Congo , Democratic Republic of the Congo , Ivory Coast , Equatorial Guinea , Ethiopia , Gabon , Ghana , Guinea , Guinea-Bissau , Kenya , Liberia , Nigeria , Sierra Leone , Sudan , Togo , and Uganda . As a frugivorous species, the hammer-headed bat is sometimes considered a pest of fruit crops. Its ability to produce extremely loud vocalizations means that some consider it one of Africa's most significant nocturnal pests. Humans hunt this large bat and consume it as bushmeat. It is eaten in Nigeria, as well as seasonally in the Democratic Republic of the Congo . The hammer-headed bat has been investigated as a potential reservoir of the Ebola virus . Some individuals have tested seropositive for the virus, meaning that they had antibodies against the virus, though the virus itself was not detected. Additionally, nucleic acid sequences associated with the virus have been isolated from its tissues. However, the natural reservoirs of ebolaviruses are still unknown as of 2019. Megabats like the hammer-headed bat tend to be over-sampled relative to other potential Ebola virus hosts, meaning that they may have an unwarranted amount of research attention, and as of 2015 [ update ] , no bat hunter or researcher is known to be the index case ("patient zero") in an Ebola outbreak. As of 2016 [ update ] , the hammer-headed bat is evaluated as a least-concern species by the IUCN — its lowest conservation priority. It meets the criteria for this classification because it has a wide geographic range; its population is presumably large; and it is not thought to be experiencing rapid population decline. It is not a common bat species in captivity, though it is kept at the Wrocław Zoo in Poland as of 2020, and was kept at the Bronx Zoo and San Diego Zoo Safari Park in the 1970s and 1980s. In captivity, hammer-headed bats, particularly males, are vulnerable to stress-related illness, especially when moved or placed in new enclosures. As a frugivorous species, the hammer-headed bat is sometimes considered a pest of fruit crops. Its ability to produce extremely loud vocalizations means that some consider it one of Africa's most significant nocturnal pests. Humans hunt this large bat and consume it as bushmeat. It is eaten in Nigeria, as well as seasonally in the Democratic Republic of the Congo . The hammer-headed bat has been investigated as a potential reservoir of the Ebola virus . Some individuals have tested seropositive for the virus, meaning that they had antibodies against the virus, though the virus itself was not detected. Additionally, nucleic acid sequences associated with the virus have been isolated from its tissues. However, the natural reservoirs of ebolaviruses are still unknown as of 2019. Megabats like the hammer-headed bat tend to be over-sampled relative to other potential Ebola virus hosts, meaning that they may have an unwarranted amount of research attention, and as of 2015 [ update ] , no bat hunter or researcher is known to be the index case ("patient zero") in an Ebola outbreak. As of 2016 [ update ] , the hammer-headed bat is evaluated as a least-concern species by the IUCN — its lowest conservation priority. It meets the criteria for this classification because it has a wide geographic range; its population is presumably large; and it is not thought to be experiencing rapid population decline. It is not a common bat species in captivity, though it is kept at the Wrocław Zoo in Poland as of 2020, and was kept at the Bronx Zoo and San Diego Zoo Safari Park in the 1970s and 1980s. In captivity, hammer-headed bats, particularly males, are vulnerable to stress-related illness, especially when moved or placed in new enclosures.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Morocco/html

Morocco

Morocco , [lower-alpha 5] officially the Kingdom of Morocco , [lower-alpha 6] is a country in the Maghreb region of North Africa . It overlooks the Mediterranean Sea to the north and the Atlantic Ocean to the west, and has land borders with Algeria to the east , and the disputed territory of Western Sahara to the south . Morocco also claims the Spanish exclaves of Ceuta , Melilla and Peñón de Vélez de la Gomera , and several small Spanish-controlled islands off its coast. It has a population of roughly 37 million, the official and predominant religion is Islam , and the official languages are Arabic and Berber ; French and the Moroccan dialect of Arabic are also widely spoken. Moroccan identity and culture is a mix of Arab , Berber , African and European cultures. Its capital is Rabat , while its largest city is Casablanca . The region constituting Morocco has been inhabited since the Paleolithic era over 300,000 years ago. The Idrisid dynasty was established by Idris I in 788 and was subsequently ruled by a series of other independent dynasties, reaching its zenith as a regional power in the 11th and 12th centuries, under the Almoravid and Almohad dynasties, when it controlled most of the Iberian Peninsula and the Maghreb. Centuries of Arab migration to the Maghreb since the 7th century shifted the demographic scope of the region. In the 15th and 16th centuries, Morocco faced external threats to its sovereignty, with Portugal seizing some territory and the Ottoman Empire encroaching from the east. The Marinid and Saadi dynasties otherwise resisted foreign domination, and Morocco was the only North African nation to escape Ottoman dominion. The 'Alawi dynasty , which rules the country to this day, seized power in 1631, and over the next two centuries expanded diplomatic and commercial relations with the Western world . Morocco's strategic location near the mouth of the Mediterranean drew renewed European interest; in 1912, France and Spain divided the country into respective protectorates , reserving an international zone in Tangier . Following intermittent riots and revolts against colonial rule, in 1956, Morocco regained its independence and reunified. Since independence, Morocco has remained relatively stable. It has the fifth-largest economy in Africa and wields significant influence in both Africa and the Arab world ; it is considered a middle power in global affairs and holds membership in the Arab League , the Arab Maghreb Union , the Union for the Mediterranean , and the African Union . Morocco is a unitary semi- constitutional monarchy with an elected parliament. The executive branch is led by the King of Morocco and the prime minister , while legislative power is vested in the two chambers of parliament: the House of Representatives and the House of Councillors . Judicial power rests with the Constitutional Court, which may review the validity of laws, elections, and referendums. The king holds vast executive and legislative powers, especially over the military , foreign policy and religious affairs; he can issue decrees called dahirs , which have the force of law, and can also dissolve the parliament after consulting the prime minister and the president of the constitutional court. Morocco claims ownership of the non-self-governing territory of Western Sahara , which it has designated its Southern Provinces . In 1975, after Spain agreed to decolonise the territory and cede its control to Morocco and Mauritania , a guerrilla war broke out between those powers and some of the local inhabitants . In 1979, Mauritania relinquished its claim to the area, but the war continued to rage. In 1991, a ceasefire agreement was reached, but the issue of sovereignty remained unresolved. Today, Morocco occupies two-thirds of the territory, and efforts to resolve the dispute have thus far failed to break the political deadlock.The English Morocco is an anglicisation of the Spanish name for the country, Marruecos , derived from the name of the city of Marrakesh , which was the capital of the Almoravid dynasty , the Almohad Caliphate , and the Saadian dynasty . During the Almoravid dynasty, the city of Marrakesh was established under the name of Tāmurākušt , derived from the city's ancient Berber name of amūr n Yakuš ( lit. ' land/country of God ' ). Historically, the territory has been part of what Muslim geographers referred to as al-Maghrib al-Aqṣā [ ar ] ( ال٠غرب الأقصى , 'the Farthest West [of the Islamic world]' designating roughly the area from Tiaret to the Atlantic ) in contrast with neighbouring regions of al-Maghrib al-Awsaṭ [ ar ] ( ال٠غرب الأوسط , 'the Middle West': Tripoli to Béjaïa ) and al-Maghrib al-Adnā [ ar ] ( ال٠غرب الأدنى , 'the Nearest West': Alexandria to Tripoli ). Morocco's modern Arabic name is al-Maghrib ( ال٠غرب , transl. the land of the sunset; the west ), with the Kingdom's official Arabic name being al-Mamlakah al-Maghribīyah ( ال٠٠لكة ال٠غربية ; transl. the kingdom of sunset/the west ). In Turkish , Morocco is known as Fas , a name derived from its medieval capital of Fes which is derived from the Arabic word Faʾs ( فأس ; transl. pickaxe ), as the city's founder Idris I ibn Abd Allah reputedly used a silver and gold pickaxe to trace the outlines of the city. In other parts of the Islamic world, for example in Egyptian and Middle Eastern Arabic literature before the mid-20th century, Morocco was commonly referred to as Murrakush ( ٠راكش ). The term is still used to refer to Morocco today in several Indo-Iranian languages, including Persian , Urdu , and Punjabi . Morocco has also been referred to politically by a variety of terms denoting the Sharifi heritage of the Alawi dynasty , such as al-Mamlakah ash-Sharīfah ( ال٠٠لكة الشريفة ), al-Iyālah ash-Sharīfah ( الإيالة الشريفة ) and al-Imbarāṭūriyyah ash-Sharīfah ( الإ٠براطورية الشريفة ), rendered in French as l'Empire chérifien and in English as the 'Sharifian Empire'. The area of present-day Morocco has been inhabited since at least Paleolithic times , beginning sometime between 190,000 and 90,000 BC. A recent publication has suggested that there is evidence for even earlier human habitation of the area: Homo sapiens fossils that had been discovered in the late 2000s near the Atlantic coast in Jebel Irhoud were recently dated to roughly 315,000 years ago. During the Upper Paleolithic , the Maghreb was more fertile than it is today, resembling a savanna , in contrast to its modern arid landscape. Twenty-two thousand years ago, the Aterian culture was succeeded by the Iberomaurusian culture, which shared similarities with Iberian cultures. Skeletal similarities have been suggested between the human remains found at Iberomaurusian " Mechta-Afalou " burial sites and European Cro-Magnon remains. The Iberomaurusian culture was succeeded by the Beaker culture in Morocco. Mitochondrial DNA studies have discovered a close ancestral link between Berbers and the Saami of Scandinavia. This evidence supports the theory that some of the peoples who had been living in the Franco-Cantabrian refuge area of southwestern Europe during the late-glacial period migrated to northern Europe, contributing to its repopulation after the last ice age . In the early part of Classical Antiquity , Northwest Africa and Morocco were slowly drawn into the wider emerging Mediterranean world by the Phoenicians , who established trading colonies and settlements there, the most substantial of which were Chellah , Lixus , and Mogador . Mogador was established as a Phoenician colony as early as the 6th century BC. [ page needed ] Morocco later became a realm of the Northwest African civilisation of ancient Carthage , and part of the Carthaginian empire. The earliest known independent Moroccan state was the Berber kingdom of Mauretania , under King Baga . This ancient kingdom (not to be confused with the modern state of Mauritania ) flourished around 225 BC or earlier. Mauretania became a client kingdom of the Roman Empire in 33 BC. Emperor Claudius annexed Mauretania directly in 44 AD, making it a Roman province ruled by an imperial governor (either a procurator Augusti , or a legatus Augusti pro praetore ). During the Crisis of the Third Century , parts of Mauretania were reconquered by Berbers. By the late 3rd century, direct Roman rule had become confined to a few coastal cities, such as Septum ( Ceuta ) in Mauretania Tingitana and Cherchell in Mauretania Caesariensis . When, in 429 AD, the area was devastated by the Vandals , the Roman Empire lost its remaining possessions in Mauretania, and local Mauro-Roman kings assumed control of them. In the 530s, the Eastern Roman Empire , under Byzantine control, re-established direct imperial rule of Septum and Tingi , fortified Tingis and erected a church. The Muslim conquest of the Maghreb that had begun during the mid-7th century was completed under the Umayyad Caliphate by 709. The caliphate introduced both Islam and the Arabic language to the area; this period also saw the beginning of a trend of Arab migration to the Maghreb which would last for centuries and effect a demographic shift in the region. While constituting part of the larger empire, Morocco was initially organised as a subsidiary province of Ifriqiya , with the local governors appointed by the Muslim governor in Kairouan . The indigenous Berber tribes adopted Islam, but retained their customary laws . They also paid taxes and tribute to the new Muslim administration. The first independent Muslim state in the area of modern Morocco was the Kingdom of Nekor , an emirate in the Rif Mountains . It was founded by Salih I ibn Mansur in 710, as a client state to the Umayyad Caliphate. After the outbreak of the Berber Revolt in 739, the Berbers formed other independent states such as the Miknasa of Sijilmasa and the Barghawata . The founder of the Idrisid dynasty and the great-grandson of Hasan ibn Ali , Idris ibn Abdallah , had fled to Morocco after the massacre of his family by the Abbasids in the Hejaz . He convinced the Awraba Berber tribes to break their allegiance to the distant Abbasid caliphs and he founded the Idrisid dynasty in 788. The Idrisids established Fes as their capital and Morocco became a centre of Muslim learning and a major regional power . The Idrisids were ousted in 927 by the Fatimid Caliphate and their Miknasa allies. After Miknasa broke off relations with the Fatimids in 932, they were removed from power by the Maghrawa of Sijilmasa in 980. From the 11th century onward, a series of Berber dynasties arose. Under the Sanhaja Almoravid dynasty and the Masmuda Almohad dynasty , Morocco dominated the Maghreb, al-Andalus in Iberia , and the western Mediterranean region. From the 13th century onward the country saw a massive migration of the Banu Hilal Arab tribes. In the 13th and 14th centuries the Zenata Berber Marinids held power in Morocco and strove to replicate the successes of the Almohads through military campaigns in Algeria and Spain. They were followed by the Wattasids . In the 15th century, the Reconquista ended Muslim rule in Iberia and many Muslims and Jews fled to Morocco. Portuguese efforts to control the Atlantic sea trade in the 15th century did not greatly affect the interior of Morocco even though they managed to control some possessions on the Moroccan coast but not venturing further afield inland. In 1549, the region fell to successive Arab dynasties claiming descent from the Islamic prophet Muhammad : first the Saadi dynasty who ruled from 1549 to 1659, and then the Alawi dynasty , who have remained in power since the 17th century. Morocco faced aggression from Spain in the north, and the Ottoman Empire's allies pressing westward. Under the Saadis, the sultanate ended the Portuguese Aviz dynasty in 1578 at the Battle of Alcácer Quibir . The reign of Ahmad al-Mansur brought new wealth and prestige to the Sultanate, and a large expedition to West Africa inflicted a crushing defeat on the Songhay Empire in 1591. However, managing the territories across the Sahara proved too difficult. [ citation needed ] Upon the death of al-Mansur, the country was divided among his sons. After a period of political fragmentation and conflict during the decline of the Saadi dynasty, Morocco was finally reunited by the Alawi sultan al-Rashid in the late 1660s, who took Fez in 1666 and Marrakesh in 1668. : 230 : 225 The 'Alawis succeeded in stabilising their position, and while the kingdom was smaller than previous ones in the region, it remained quite wealthy. Against the opposition of local tribes Ismail Ibn Sharif (1672–1727) began to create a unified state. With his Riffian army, he re-occupied Tangier from the English who had abandoned it in 1684 and drove the Spanish from Larache in 1689. Portuguese abandoned Mazagão , their last territory in Morocco, in 1769. However, the siege of Melilla against the Spanish ended in defeat in 1775. Morocco was the first nation to recognise the fledgling United States as an independent nation in 1777. In the beginning of the American Revolution , American merchant ships in the Atlantic Ocean were subject to attacks by other fleets. On 20 December 1777, Morocco's Sultan Mohammed III declared that American merchant ships would be under the protection of the sultanate and could thus enjoy safe passage. The 1786 Moroccan–American Treaty of Friendship stands as the United States' oldest unbroken friendship treaty. As Europe industrialised, Northwest Africa was increasingly prized for its potential for colonisation. France showed a strong interest in Morocco as early as 1830, not only to protect the border of its Algerian territory, but also because of the strategic position of Morocco with coasts on the Mediterranean and the open Atlantic. In 1860, a dispute over Spain's Ceuta enclave led Spain to declare war. Victorious Spain won a further enclave and an enlarged Ceuta in the settlement. In 1884, Spain created a protectorate in the coastal areas of Morocco. In 1904, France and Spain carved out zones of influence in Morocco. Recognition by the United Kingdom of France's sphere of influence provoked a strong reaction from the German Empire ; and a crisis loomed in 1905. The matter was resolved at the Algeciras Conference in 1906. The Agadir Crisis of 1911 increased tensions between European powers. The 1912 Treaty of Fez made Morocco a protectorate of France, and triggered the 1912 Fez riots . Spain continued to operate its coastal protectorate. By the same treaty, Spain assumed the role of protecting power over the northern coastal and southern Saharan zones. Tens of thousands of colonists entered Morocco. Some bought up large amounts of rich agricultural land, while others organised the exploitation and modernisation of mines and harbours. Interest groups that formed among these elements continually pressured France to increase its control over Morocco – a control which was also made necessary by the continuous wars among Moroccan tribes, part of which had taken sides with the French since the beginning of the conquest. The French colonial administrator, Governor general Marshal Hubert Lyautey , sincerely admired Moroccan culture and succeeded in imposing a joint Moroccan-French administration, while creating a modern school system. Several divisions of Moroccan soldiers ( Goumiers or regular troops and officers) served in the French army in both World War I and World War II , and in the Spanish Nationalist Army in the Spanish Civil War and after ( Regulares ). The institution of slavery was abolished in 1925. Between 1921 and 1926, an uprising in the Rif Mountains, led by Abd el-Krim , led to the establishment of the Republic of the Rif . The Spanish used anti-civilian bombing raids and mustard gas to prevent the Rif republic from independence. They lost more than 13,000 soldiers at Annual in July–August 1921 alone. The Riffi were eventually suppressed by 1927 by the Franco-Spanish military. The casualties on the Spanish-French side were 52,000 and from the Riffi 10,000 died. In 1943, the Istiqlal Party (Independence Party) was founded to press for independence, with discreet US support. Moroccan nationalists drew heavily on transnational activist networks for lobbying to end colonial rule, primarily at the United Nations. The Istiqlal Party subsequently provided most of the leadership for the nationalist movement. France's exile of Sultan Mohammed V in 1953 to Madagascar and his replacement by the unpopular Mohammed Ben Aarafa sparked active opposition to the French and Spanish protectorates. [ citation needed ] The most notable violence occurred in Oujda where Moroccans attacked French and other European residents in the streets. [ citation needed ] France allowed Mohammed V to return in 1955, and the negotiations that led to Moroccan independence began the following year. In March 1956 Morocco regained its independence from France as the Kingdom of Morocco. A month later Spain forsook its protectorate in Northern Morocco to the new state but kept its two coastal enclaves ( Ceuta and Melilla ) on the Mediterranean coast which dated from earlier conquests, but on which Morocco still claims sovereignty to this day. Sultan Mohammed became King in 1957. Upon the death of Mohammed V, Hassan II became King of Morocco on 3 March 1961. Morocco held its first general elections in 1963 . However, Hassan declared a state of emergency and suspended parliament in 1965. In 1971 and 1972, there were two failed attempts to depose the king and establish a republic. A truth commission set up in 2005 to investigate human rights abuses during his reign confirmed nearly 10,000 cases, ranging from death in detention to forced exile. Some 592 people were recorded killed during Hassan's rule according to the truth commission. In 1963, the Sand War was fought between Algerian and Moroccan troops over Moroccan claims to parts of Algerian territory. A formal peace agreement was signed in February 1964; however, relations remained strained between the two countries following the conflict. The Spanish enclave of Ifni in the south was returned to Morocco in 1969. The Polisario movement was formed in 1973, with the aim of establishing an independent state in the Spanish Sahara. On 6 November 1975, King Hassan asked for volunteers to cross into the Spanish Sahara. Some 350,000 civilians were reported as being involved in the " Green March ". A month later, Spain agreed to leave the Spanish Sahara, soon to become Western Sahara, and to transfer it to joint Moroccan-Mauritanian control, despite the objections and threats of military intervention by Algeria. Moroccan forces occupied the territory. Moroccan and Algerian troops soon clashed in Western Sahara . Morocco and Mauritania divided up Western Sahara. Fighting between the Moroccan military and Polisario forces continued for many years. The prolonged war was a considerable financial drain on Morocco. In 1983, Hassan cancelled planned elections amid political unrest and economic crisis. In 1984, Morocco left the Organisation of African Unity in protest at the SADR 's admission to the body. Polisario claimed to have killed more than 5,000 Moroccan soldiers between 1982 and 1985. Algerian authorities have estimated the number of Sahrawi refugees in Algeria to be 165,000. Diplomatic relations with Algeria were restored in 1988. In 1991, a UN-monitored ceasefire began in Western Sahara, but the territory's status remains undecided and ceasefire violations are reported. The following decade saw much wrangling over a proposed referendum on the future of the territory but the deadlock was not broken. [ citation needed ] Political reforms in the 1990s resulted in the establishment of a bicameral legislature with Morocco's first opposition-led government coming to power. King Hassan II died in 1999 and was succeeded by his son, Mohammed VI . He is a cautious moderniser who has introduced some economic and social liberalisation. Mohammed VI paid a controversial visit to the Western Sahara in 2002. Morocco unveiled an autonomy blueprint for Western Sahara to the United Nations in 2007. The Polisario rejected the plan and put forward its own proposal. Morocco and the Polisario Front held UN-sponsored talks in New York City but failed to come to any agreement. In 2010, security forces stormed a protest camp in the Western Sahara, triggering violent demonstrations in the regional capital El Aaiún . In 2002, Morocco and Spain agreed to a US-brokered resolution over the disputed island of Perejil . Spanish troops had taken the normally uninhabited island after Moroccan soldiers landed on it and set up tents and a flag. There were renewed tensions in 2005, as dozens of African migrants stormed the borders of the Spanish enclaves of Melilla and Ceuta. In response, Spain deported dozens of the illegal migrants to Morocco from Melilla. In 2006, the Spanish Premier Zapatero visited Spanish enclaves. He was the first Spanish leader in 25 years to make an official visit to the territories. The following year, Spanish King Juan Carlos I visited Ceuta and Melilla, further angering Morocco which demanded control of the enclaves. During the 2011–2012 Moroccan protests , thousands of people rallied in Rabat and other cities calling for political reform and a new constitution curbing the powers of the king. In July 2011, the King won a landslide victory in a referendum on a reformed constitution he had proposed to placate the Arab Spring protests. In the first general elections that followed, the moderate Islamist Justice and Development Party won a plurality of seats, with Abdelilah Benkirane being designated as head of government per the new constitution. Despite the reforms made by Mohammed VI, demonstrators continued to call for deeper reforms. Hundreds took part in a trade union rally in Casablanca in May 2012. Participants accused the government of failing to deliver on reforms. On 10 December 2020, Israel–Morocco normalisation agreement was announced and Morocco announced its intention to resume diplomatic relations with Israel. Joint Declaration of the Kingdom of Morocco, the United States of America and the State of Israel was signed on 22 December 2020. On 24 August 2021, neighbouring Algeria cut diplomatic relations with Morocco, accusing Morocco of supporting a separatist group and hostile actions against Algeria. Morocco called the decision unjustified. On 8 September 2023, a 6.8 magnitude earthquake hit Morocco killing more than 2,800 people and injuring thousands. The epicentre of the quake was around 70 km southwest of city of Marrakech. The area of present-day Morocco has been inhabited since at least Paleolithic times , beginning sometime between 190,000 and 90,000 BC. A recent publication has suggested that there is evidence for even earlier human habitation of the area: Homo sapiens fossils that had been discovered in the late 2000s near the Atlantic coast in Jebel Irhoud were recently dated to roughly 315,000 years ago. During the Upper Paleolithic , the Maghreb was more fertile than it is today, resembling a savanna , in contrast to its modern arid landscape. Twenty-two thousand years ago, the Aterian culture was succeeded by the Iberomaurusian culture, which shared similarities with Iberian cultures. Skeletal similarities have been suggested between the human remains found at Iberomaurusian " Mechta-Afalou " burial sites and European Cro-Magnon remains. The Iberomaurusian culture was succeeded by the Beaker culture in Morocco. Mitochondrial DNA studies have discovered a close ancestral link between Berbers and the Saami of Scandinavia. This evidence supports the theory that some of the peoples who had been living in the Franco-Cantabrian refuge area of southwestern Europe during the late-glacial period migrated to northern Europe, contributing to its repopulation after the last ice age . In the early part of Classical Antiquity , Northwest Africa and Morocco were slowly drawn into the wider emerging Mediterranean world by the Phoenicians , who established trading colonies and settlements there, the most substantial of which were Chellah , Lixus , and Mogador . Mogador was established as a Phoenician colony as early as the 6th century BC. [ page needed ] Morocco later became a realm of the Northwest African civilisation of ancient Carthage , and part of the Carthaginian empire. The earliest known independent Moroccan state was the Berber kingdom of Mauretania , under King Baga . This ancient kingdom (not to be confused with the modern state of Mauritania ) flourished around 225 BC or earlier. Mauretania became a client kingdom of the Roman Empire in 33 BC. Emperor Claudius annexed Mauretania directly in 44 AD, making it a Roman province ruled by an imperial governor (either a procurator Augusti , or a legatus Augusti pro praetore ). During the Crisis of the Third Century , parts of Mauretania were reconquered by Berbers. By the late 3rd century, direct Roman rule had become confined to a few coastal cities, such as Septum ( Ceuta ) in Mauretania Tingitana and Cherchell in Mauretania Caesariensis . When, in 429 AD, the area was devastated by the Vandals , the Roman Empire lost its remaining possessions in Mauretania, and local Mauro-Roman kings assumed control of them. In the 530s, the Eastern Roman Empire , under Byzantine control, re-established direct imperial rule of Septum and Tingi , fortified Tingis and erected a church.The Muslim conquest of the Maghreb that had begun during the mid-7th century was completed under the Umayyad Caliphate by 709. The caliphate introduced both Islam and the Arabic language to the area; this period also saw the beginning of a trend of Arab migration to the Maghreb which would last for centuries and effect a demographic shift in the region. While constituting part of the larger empire, Morocco was initially organised as a subsidiary province of Ifriqiya , with the local governors appointed by the Muslim governor in Kairouan . The indigenous Berber tribes adopted Islam, but retained their customary laws . They also paid taxes and tribute to the new Muslim administration. The first independent Muslim state in the area of modern Morocco was the Kingdom of Nekor , an emirate in the Rif Mountains . It was founded by Salih I ibn Mansur in 710, as a client state to the Umayyad Caliphate. After the outbreak of the Berber Revolt in 739, the Berbers formed other independent states such as the Miknasa of Sijilmasa and the Barghawata . The founder of the Idrisid dynasty and the great-grandson of Hasan ibn Ali , Idris ibn Abdallah , had fled to Morocco after the massacre of his family by the Abbasids in the Hejaz . He convinced the Awraba Berber tribes to break their allegiance to the distant Abbasid caliphs and he founded the Idrisid dynasty in 788. The Idrisids established Fes as their capital and Morocco became a centre of Muslim learning and a major regional power . The Idrisids were ousted in 927 by the Fatimid Caliphate and their Miknasa allies. After Miknasa broke off relations with the Fatimids in 932, they were removed from power by the Maghrawa of Sijilmasa in 980. From the 11th century onward, a series of Berber dynasties arose. Under the Sanhaja Almoravid dynasty and the Masmuda Almohad dynasty , Morocco dominated the Maghreb, al-Andalus in Iberia , and the western Mediterranean region. From the 13th century onward the country saw a massive migration of the Banu Hilal Arab tribes. In the 13th and 14th centuries the Zenata Berber Marinids held power in Morocco and strove to replicate the successes of the Almohads through military campaigns in Algeria and Spain. They were followed by the Wattasids . In the 15th century, the Reconquista ended Muslim rule in Iberia and many Muslims and Jews fled to Morocco. Portuguese efforts to control the Atlantic sea trade in the 15th century did not greatly affect the interior of Morocco even though they managed to control some possessions on the Moroccan coast but not venturing further afield inland. In 1549, the region fell to successive Arab dynasties claiming descent from the Islamic prophet Muhammad : first the Saadi dynasty who ruled from 1549 to 1659, and then the Alawi dynasty , who have remained in power since the 17th century. Morocco faced aggression from Spain in the north, and the Ottoman Empire's allies pressing westward. Under the Saadis, the sultanate ended the Portuguese Aviz dynasty in 1578 at the Battle of Alcácer Quibir . The reign of Ahmad al-Mansur brought new wealth and prestige to the Sultanate, and a large expedition to West Africa inflicted a crushing defeat on the Songhay Empire in 1591. However, managing the territories across the Sahara proved too difficult. [ citation needed ] Upon the death of al-Mansur, the country was divided among his sons. After a period of political fragmentation and conflict during the decline of the Saadi dynasty, Morocco was finally reunited by the Alawi sultan al-Rashid in the late 1660s, who took Fez in 1666 and Marrakesh in 1668. : 230 : 225 The 'Alawis succeeded in stabilising their position, and while the kingdom was smaller than previous ones in the region, it remained quite wealthy. Against the opposition of local tribes Ismail Ibn Sharif (1672–1727) began to create a unified state. With his Riffian army, he re-occupied Tangier from the English who had abandoned it in 1684 and drove the Spanish from Larache in 1689. Portuguese abandoned Mazagão , their last territory in Morocco, in 1769. However, the siege of Melilla against the Spanish ended in defeat in 1775. Morocco was the first nation to recognise the fledgling United States as an independent nation in 1777. In the beginning of the American Revolution , American merchant ships in the Atlantic Ocean were subject to attacks by other fleets. On 20 December 1777, Morocco's Sultan Mohammed III declared that American merchant ships would be under the protection of the sultanate and could thus enjoy safe passage. The 1786 Moroccan–American Treaty of Friendship stands as the United States' oldest unbroken friendship treaty. As Europe industrialised, Northwest Africa was increasingly prized for its potential for colonisation. France showed a strong interest in Morocco as early as 1830, not only to protect the border of its Algerian territory, but also because of the strategic position of Morocco with coasts on the Mediterranean and the open Atlantic. In 1860, a dispute over Spain's Ceuta enclave led Spain to declare war. Victorious Spain won a further enclave and an enlarged Ceuta in the settlement. In 1884, Spain created a protectorate in the coastal areas of Morocco. In 1904, France and Spain carved out zones of influence in Morocco. Recognition by the United Kingdom of France's sphere of influence provoked a strong reaction from the German Empire ; and a crisis loomed in 1905. The matter was resolved at the Algeciras Conference in 1906. The Agadir Crisis of 1911 increased tensions between European powers. The 1912 Treaty of Fez made Morocco a protectorate of France, and triggered the 1912 Fez riots . Spain continued to operate its coastal protectorate. By the same treaty, Spain assumed the role of protecting power over the northern coastal and southern Saharan zones. Tens of thousands of colonists entered Morocco. Some bought up large amounts of rich agricultural land, while others organised the exploitation and modernisation of mines and harbours. Interest groups that formed among these elements continually pressured France to increase its control over Morocco – a control which was also made necessary by the continuous wars among Moroccan tribes, part of which had taken sides with the French since the beginning of the conquest. The French colonial administrator, Governor general Marshal Hubert Lyautey , sincerely admired Moroccan culture and succeeded in imposing a joint Moroccan-French administration, while creating a modern school system. Several divisions of Moroccan soldiers ( Goumiers or regular troops and officers) served in the French army in both World War I and World War II , and in the Spanish Nationalist Army in the Spanish Civil War and after ( Regulares ). The institution of slavery was abolished in 1925. Between 1921 and 1926, an uprising in the Rif Mountains, led by Abd el-Krim , led to the establishment of the Republic of the Rif . The Spanish used anti-civilian bombing raids and mustard gas to prevent the Rif republic from independence. They lost more than 13,000 soldiers at Annual in July–August 1921 alone. The Riffi were eventually suppressed by 1927 by the Franco-Spanish military. The casualties on the Spanish-French side were 52,000 and from the Riffi 10,000 died. In 1943, the Istiqlal Party (Independence Party) was founded to press for independence, with discreet US support. Moroccan nationalists drew heavily on transnational activist networks for lobbying to end colonial rule, primarily at the United Nations. The Istiqlal Party subsequently provided most of the leadership for the nationalist movement. France's exile of Sultan Mohammed V in 1953 to Madagascar and his replacement by the unpopular Mohammed Ben Aarafa sparked active opposition to the French and Spanish protectorates. [ citation needed ] The most notable violence occurred in Oujda where Moroccans attacked French and other European residents in the streets. [ citation needed ] France allowed Mohammed V to return in 1955, and the negotiations that led to Moroccan independence began the following year. In March 1956 Morocco regained its independence from France as the Kingdom of Morocco. A month later Spain forsook its protectorate in Northern Morocco to the new state but kept its two coastal enclaves ( Ceuta and Melilla ) on the Mediterranean coast which dated from earlier conquests, but on which Morocco still claims sovereignty to this day.Sultan Mohammed became King in 1957. Upon the death of Mohammed V, Hassan II became King of Morocco on 3 March 1961. Morocco held its first general elections in 1963 . However, Hassan declared a state of emergency and suspended parliament in 1965. In 1971 and 1972, there were two failed attempts to depose the king and establish a republic. A truth commission set up in 2005 to investigate human rights abuses during his reign confirmed nearly 10,000 cases, ranging from death in detention to forced exile. Some 592 people were recorded killed during Hassan's rule according to the truth commission. In 1963, the Sand War was fought between Algerian and Moroccan troops over Moroccan claims to parts of Algerian territory. A formal peace agreement was signed in February 1964; however, relations remained strained between the two countries following the conflict. The Spanish enclave of Ifni in the south was returned to Morocco in 1969. The Polisario movement was formed in 1973, with the aim of establishing an independent state in the Spanish Sahara. On 6 November 1975, King Hassan asked for volunteers to cross into the Spanish Sahara. Some 350,000 civilians were reported as being involved in the " Green March ". A month later, Spain agreed to leave the Spanish Sahara, soon to become Western Sahara, and to transfer it to joint Moroccan-Mauritanian control, despite the objections and threats of military intervention by Algeria. Moroccan forces occupied the territory. Moroccan and Algerian troops soon clashed in Western Sahara . Morocco and Mauritania divided up Western Sahara. Fighting between the Moroccan military and Polisario forces continued for many years. The prolonged war was a considerable financial drain on Morocco. In 1983, Hassan cancelled planned elections amid political unrest and economic crisis. In 1984, Morocco left the Organisation of African Unity in protest at the SADR 's admission to the body. Polisario claimed to have killed more than 5,000 Moroccan soldiers between 1982 and 1985. Algerian authorities have estimated the number of Sahrawi refugees in Algeria to be 165,000. Diplomatic relations with Algeria were restored in 1988. In 1991, a UN-monitored ceasefire began in Western Sahara, but the territory's status remains undecided and ceasefire violations are reported. The following decade saw much wrangling over a proposed referendum on the future of the territory but the deadlock was not broken. [ citation needed ] Political reforms in the 1990s resulted in the establishment of a bicameral legislature with Morocco's first opposition-led government coming to power. King Hassan II died in 1999 and was succeeded by his son, Mohammed VI . He is a cautious moderniser who has introduced some economic and social liberalisation. Mohammed VI paid a controversial visit to the Western Sahara in 2002. Morocco unveiled an autonomy blueprint for Western Sahara to the United Nations in 2007. The Polisario rejected the plan and put forward its own proposal. Morocco and the Polisario Front held UN-sponsored talks in New York City but failed to come to any agreement. In 2010, security forces stormed a protest camp in the Western Sahara, triggering violent demonstrations in the regional capital El Aaiún . In 2002, Morocco and Spain agreed to a US-brokered resolution over the disputed island of Perejil . Spanish troops had taken the normally uninhabited island after Moroccan soldiers landed on it and set up tents and a flag. There were renewed tensions in 2005, as dozens of African migrants stormed the borders of the Spanish enclaves of Melilla and Ceuta. In response, Spain deported dozens of the illegal migrants to Morocco from Melilla. In 2006, the Spanish Premier Zapatero visited Spanish enclaves. He was the first Spanish leader in 25 years to make an official visit to the territories. The following year, Spanish King Juan Carlos I visited Ceuta and Melilla, further angering Morocco which demanded control of the enclaves. During the 2011–2012 Moroccan protests , thousands of people rallied in Rabat and other cities calling for political reform and a new constitution curbing the powers of the king. In July 2011, the King won a landslide victory in a referendum on a reformed constitution he had proposed to placate the Arab Spring protests. In the first general elections that followed, the moderate Islamist Justice and Development Party won a plurality of seats, with Abdelilah Benkirane being designated as head of government per the new constitution. Despite the reforms made by Mohammed VI, demonstrators continued to call for deeper reforms. Hundreds took part in a trade union rally in Casablanca in May 2012. Participants accused the government of failing to deliver on reforms. On 10 December 2020, Israel–Morocco normalisation agreement was announced and Morocco announced its intention to resume diplomatic relations with Israel. Joint Declaration of the Kingdom of Morocco, the United States of America and the State of Israel was signed on 22 December 2020. On 24 August 2021, neighbouring Algeria cut diplomatic relations with Morocco, accusing Morocco of supporting a separatist group and hostile actions against Algeria. Morocco called the decision unjustified. On 8 September 2023, a 6.8 magnitude earthquake hit Morocco killing more than 2,800 people and injuring thousands. The epicentre of the quake was around 70 km southwest of city of Marrakech. Morocco has a coast by the Atlantic Ocean that reaches past the Strait of Gibraltar into the Mediterranean Sea . It is bordered by Spain to the north (a water border through the Strait and land borders with three small Spanish-controlled exclaves , Ceuta , Melilla , and Peñón de Vélez de la Gomera ), Algeria to the east, and Western Sahara to the south. Since Morocco controls most of Western Sahara, its de facto southern boundary is with Mauritania . [ citation needed ] The internationally recognised borders of the country lie between latitudes 27° and 36°N, and longitudes 1° and 14°W . The geography of Morocco spans from the Atlantic Ocean, to mountainous areas, to the Sahara desert. Morocco is a Northern African country, bordering the North Atlantic Ocean and the Mediterranean Sea, between Algeria and the annexed Western Sahara. It is one of only three nations (along with Spain and France ) to have both Atlantic and Mediterranean coastlines. [ citation needed ] A large part of Morocco is mountainous. The Atlas Mountains are located mainly in the centre and the south of the country. The Rif Mountains are located in the north of the country. Both ranges are mainly inhabited by the Berber people . [ citation needed ] Its total area is about 446,300 km 2 (172,317 sq mi) . Algeria borders Morocco to the east and southeast, though the border between the two countries has been closed since 1994. Spanish territory in Northwest Africa neighbouring Morocco comprises five enclaves on the Mediterranean coast: Ceuta , Melilla , Peñón de Vélez de la Gomera , Peñón de Alhucemas , the Chafarinas islands, and the disputed islet Perejil . Off the Atlantic coast the Canary Islands belong to Spain, whereas Madeira to the north is Portuguese . To the north, Morocco is bordered by the Strait of Gibraltar, where international shipping has unimpeded transit passage between the Atlantic and Mediterranean. The Rif mountains stretch over the region bordering the Mediterranean from the north-west to the north-east. The Atlas Mountains run down the backbone of the country, from the northeast to the southwest. Most of the southeast portion of the country is in the Sahara Desert and as such is generally sparsely populated and unproductive economically. Most of the population lives to the north of these mountains, while to the south lies the Western Sahara, a former Spanish colony that was annexed by Morocco in 1975 (see Green March ). [lower-alpha 7] Morocco claims that the Western Sahara is part of its territory and refers to that as its Southern Provinces . [ citation needed ] Morocco's capital city is Rabat ; its largest city is its main port, Casablanca . Other cities recording a population over 500,000 in the 2014 Moroccan census are Fes , Marrakesh , Meknes , Salé and Tangier . Morocco is represented in the ISO 3166-1 alpha-2 geographical encoding standard by the symbol MA . This code was used as the basis for Morocco's internet domain, .ma . In area, Morocco's climate is mainly " hot summer Mediterranean " ( Csa ) and " hot desert " ( BWh ) zones. [ citation needed ] Central mountain ranges and the effects of the cold Canary Current , off the Atlantic coast, are significant factors in Morocco's relatively large variety of vegetation zones, ranging from lush forests in the northern and central mountains, giving way to steppe, semi-arid and desert areas in the eastern and southern regions. The Moroccan coastal plains experience remarkably moderate temperatures even in summer. On the whole, this range of climates is similar to that of Southern California . [ citation needed ] In the Rif, Middle and High Atlas Mountains, there exist several different types of climates: Mediterranean along the coastal lowlands, giving way to a humid temperate climate at higher elevations with sufficient moisture to allow for the growth of different species of oaks, moss carpets, junipers, and Atlantic fir which is a royal conifer tree endemic to Morocco. In the valleys, fertile soils and high precipitation allow for the growth of thick and lush forests. Cloud forests can be found in the west of the Rif Mountains and Middle Atlas Mountains. At higher elevations, the climate becomes alpine in character, and can sustain ski resorts. [ citation needed ] Southeast of the Atlas mountains, near the Algerian borders, the climate becomes very dry, with long and hot summers. Extreme heat and low moisture levels are especially pronounced in the lowland regions east of the Atlas range due to the rain shadow effect of the mountain system. The southeasternmost portions of Morocco are very hot, and include portions of the Sahara desert, where vast swathes of sand dunes and rocky plains are dotted with lush oases . [ citation needed ] In contrast to the Sahara region in the south, coastal plains are fertile in the central and northern regions of the country, and comprise the backbone of the country's agriculture, in which 95% of the population live. The direct exposure to the North Atlantic Ocean, the proximity to mainland Europe and the long stretched Rif and Atlas mountains are the factors of the rather European-like climate in the northern half of the country. That makes Morocco a country of contrasts. Forested areas cover about 12% of the country while arable land accounts for 18%. Approximately 5% of Moroccan land is irrigated for agricultural use. [ citation needed ] In general, apart from the southeast regions (pre-Saharan and desert areas), Morocco's climate and geography are very similar to the Iberian peninsula. Thus Morocco has the following climate zones: South of Agadir and east of Jerada near the Algerian borders, arid and desert climate starts to prevail. Due to Morocco's proximity to the Sahara desert and the North Sea of the Atlantic Ocean, two phenomena occur to influence the regional seasonal temperatures, either by raising temperatures by 7–8 degrees Celsius when sirocco blows from the east creating heatwaves, or by lowering temperatures by 7–8 degrees Celsius when cold damp air blows from the northwest, creating a coldwave or cold spell. However, these phenomena do not last for more than two to five days on average. [ citation needed ] Climate change is expected to significantly impact Morocco on multiple dimensions. As a coastal country with hot and arid climates, environmental impacts are likely to be wide and varied. As of the 2019 Climate Change Performance Index , Morocco was ranked second in preparedness behind Sweden . Morocco has a wide range of biodiversity . It is part of the Mediterranean basin , an area with exceptional concentrations of endemic species undergoing rapid rates of habitat loss, and is therefore considered to be a hotspot for conservation priority. Avifauna are notably variant. The avifauna of Morocco includes a total of 454 species, five of which have been introduced by humans, and 156 are rarely or accidentally seen. The Barbary lion , hunted to extinction in the wild, was a subspecies native to Morocco and is a national emblem. The last Barbary lion in the wild was shot in the Atlas Mountains in 1922. The other two primary predators of northern Africa, the Atlas bear and Barbary leopard , are now extinct and critically endangered, respectively. Relic populations of the West African crocodile persisted in the Draa river until the 20th century. The Barbary macaque, a primate endemic to Morocco and Algeria, is also facing extinction due to offtake for trade human interruption, urbanisation, wood and real estate expansion that diminish forested area – the macaque's habitat. Trade of animals and plants for food, pets, medicinal purposes, souvenirs and photo props is common across Morocco, despite laws making much of it illegal. This trade is unregulated and causing unknown reductions of wild populations of native Moroccan wildlife. Because of the proximity of northern Morocco to Europe, species such as cacti, tortoises, mammal skins, and high-value birds (falcons and bustards) are harvested in various parts of the country and exported in appreciable quantities, with especially large volumes of eel harvested – 60 tons exported to the Far East in the period 2009‒2011. Morocco is home to six terrestrial ecoregions: Mediterranean conifer and mixed forests , Mediterranean High Atlas juniper steppe , Mediterranean acacia-argania dry woodlands and succulent thickets , Mediterranean dry woodlands and steppe , Mediterranean woodlands and forests , and North Saharan steppe and woodlands . It had a 2019 Forest Landscape Integrity Index mean score of 6.74/10, ranking it 66th globally out of 172 countries. In area, Morocco's climate is mainly " hot summer Mediterranean " ( Csa ) and " hot desert " ( BWh ) zones. [ citation needed ] Central mountain ranges and the effects of the cold Canary Current , off the Atlantic coast, are significant factors in Morocco's relatively large variety of vegetation zones, ranging from lush forests in the northern and central mountains, giving way to steppe, semi-arid and desert areas in the eastern and southern regions. The Moroccan coastal plains experience remarkably moderate temperatures even in summer. On the whole, this range of climates is similar to that of Southern California . [ citation needed ] In the Rif, Middle and High Atlas Mountains, there exist several different types of climates: Mediterranean along the coastal lowlands, giving way to a humid temperate climate at higher elevations with sufficient moisture to allow for the growth of different species of oaks, moss carpets, junipers, and Atlantic fir which is a royal conifer tree endemic to Morocco. In the valleys, fertile soils and high precipitation allow for the growth of thick and lush forests. Cloud forests can be found in the west of the Rif Mountains and Middle Atlas Mountains. At higher elevations, the climate becomes alpine in character, and can sustain ski resorts. [ citation needed ] Southeast of the Atlas mountains, near the Algerian borders, the climate becomes very dry, with long and hot summers. Extreme heat and low moisture levels are especially pronounced in the lowland regions east of the Atlas range due to the rain shadow effect of the mountain system. The southeasternmost portions of Morocco are very hot, and include portions of the Sahara desert, where vast swathes of sand dunes and rocky plains are dotted with lush oases . [ citation needed ] In contrast to the Sahara region in the south, coastal plains are fertile in the central and northern regions of the country, and comprise the backbone of the country's agriculture, in which 95% of the population live. The direct exposure to the North Atlantic Ocean, the proximity to mainland Europe and the long stretched Rif and Atlas mountains are the factors of the rather European-like climate in the northern half of the country. That makes Morocco a country of contrasts. Forested areas cover about 12% of the country while arable land accounts for 18%. Approximately 5% of Moroccan land is irrigated for agricultural use. [ citation needed ] In general, apart from the southeast regions (pre-Saharan and desert areas), Morocco's climate and geography are very similar to the Iberian peninsula. Thus Morocco has the following climate zones: South of Agadir and east of Jerada near the Algerian borders, arid and desert climate starts to prevail. Due to Morocco's proximity to the Sahara desert and the North Sea of the Atlantic Ocean, two phenomena occur to influence the regional seasonal temperatures, either by raising temperatures by 7–8 degrees Celsius when sirocco blows from the east creating heatwaves, or by lowering temperatures by 7–8 degrees Celsius when cold damp air blows from the northwest, creating a coldwave or cold spell. However, these phenomena do not last for more than two to five days on average. [ citation needed ] Climate change is expected to significantly impact Morocco on multiple dimensions. As a coastal country with hot and arid climates, environmental impacts are likely to be wide and varied. As of the 2019 Climate Change Performance Index , Morocco was ranked second in preparedness behind Sweden . Morocco has a wide range of biodiversity . It is part of the Mediterranean basin , an area with exceptional concentrations of endemic species undergoing rapid rates of habitat loss, and is therefore considered to be a hotspot for conservation priority. Avifauna are notably variant. The avifauna of Morocco includes a total of 454 species, five of which have been introduced by humans, and 156 are rarely or accidentally seen. The Barbary lion , hunted to extinction in the wild, was a subspecies native to Morocco and is a national emblem. The last Barbary lion in the wild was shot in the Atlas Mountains in 1922. The other two primary predators of northern Africa, the Atlas bear and Barbary leopard , are now extinct and critically endangered, respectively. Relic populations of the West African crocodile persisted in the Draa river until the 20th century. The Barbary macaque, a primate endemic to Morocco and Algeria, is also facing extinction due to offtake for trade human interruption, urbanisation, wood and real estate expansion that diminish forested area – the macaque's habitat. Trade of animals and plants for food, pets, medicinal purposes, souvenirs and photo props is common across Morocco, despite laws making much of it illegal. This trade is unregulated and causing unknown reductions of wild populations of native Moroccan wildlife. Because of the proximity of northern Morocco to Europe, species such as cacti, tortoises, mammal skins, and high-value birds (falcons and bustards) are harvested in various parts of the country and exported in appreciable quantities, with especially large volumes of eel harvested – 60 tons exported to the Far East in the period 2009‒2011. Morocco is home to six terrestrial ecoregions: Mediterranean conifer and mixed forests , Mediterranean High Atlas juniper steppe , Mediterranean acacia-argania dry woodlands and succulent thickets , Mediterranean dry woodlands and steppe , Mediterranean woodlands and forests , and North Saharan steppe and woodlands . It had a 2019 Forest Landscape Integrity Index mean score of 6.74/10, ranking it 66th globally out of 172 countries. According to the 2022 Economist Democracy Index , Morocco is ruled under a hybrid regime , scoring #3 in the Middle East and North Africa , and #95 in the world. Morocco has a "difficult" ranking on the 2023 World Press Freedom Index . Following the March 1998 elections, a coalition government headed by opposition socialist leader Abderrahmane Youssoufi and composed largely of ministers drawn from opposition parties, was formed. Prime Minister Youssoufi's government was the first ever government drawn primarily from opposition parties, and also represents the first opportunity for a coalition of socialists, left-of-centre, and nationalist parties to be included in the government until October 2002. It was also the first time in the modern political history of the Arab world that the opposition assumed power following an election. The current government is headed by Aziz Akhannouch . The Constitution of Morocco provides for a monarchy with a Parliament and an independent judiciary . With the 2011 constitutional reforms , the King of Morocco retains less executive powers whereas those of the prime minister have been enlarged. The constitution grants the king honorific powers (among other powers); he is both the secular political leader and the " Commander of the Faithful " as a direct descendant of the Prophet Mohammed . He presides over the Council of Ministers; appoints the Prime Minister from the political party that has won the most seats in the parliamentary elections, and on recommendations from the latter, appoints the members of the government. The constitution of 1996 theoretically allowed the king to terminate the tenure of any minister, and after consultation with the heads of the higher and lower Assemblies, to dissolve the Parliament, suspend the constitution, call for new elections, or rule by decree. The only time this happened was in 1965. The King is formally the commander-in-chief of the armed forces. Since the constitutional reform of 1996, the bicameral legislature consists of two chambers. The Assembly of Representatives of Morocco ( Majlis an-Nuwwâb/Assemblée des Répresentants ) has 325 members elected for a five-year term, 295 elected in multi-seat constituencies and 30 in national lists consisting only of women. The Assembly of Councillors ( Majlis al-Mustasharin ) has 270 members, elected for a nine-year term, elected by local councils (162 seats), professional chambers (91 seats) and wage-earners (27 seats). [ citation needed ] The Parliament's powers, though still relatively limited, were expanded under the 1992 and 1996 and even further in the 2011 constitutional revisions and include budgetary matters, approving bills , questioning ministers, and establishing ad hoc commissions of inquiry to investigate the government's actions. The lower chamber of Parliament may dissolve the government through a vote of no confidence . [ citation needed ] The latest parliamentary elections were held on 8 September 2021 . Voter turnout in these elections was estimated to be 50.35% of registered voters. [ citation needed ] Morocco's military consists of the Royal Armed Forces—this includes the Army (the largest branch), the Navy , the Air Force , the Royal Guard , the Royal Gendarmerie and the Auxiliary Forces . Internal security is generally effective, and acts of political violence are rare (with one exception, the 2003 Casablanca bombings which killed 45 people ). The UN maintains a small observer force in Western Sahara, where a large number of Moroccan troops are stationed. The Sahrawi Polisario Front maintains an active militia of an estimated 5,000 fighters in Western Sahara and has engaged in intermittent warfare with Moroccan forces since the 1970s. Morocco is a member of the United Nations and belongs to the African Union (AU), Arab League , Arab Maghreb Union (UMA), Organisation of Islamic Cooperation (OIC), the Non-Aligned Movement and the Community of Sahel–Saharan States (CEN_SAD). Morocco's relationships vary greatly between African, Arab, and Western states. Morocco has had strong ties to the West in order to gain economic and political benefits. France and Spain remain the primary trade partners, as well as the primary creditors and foreign investors in Morocco. From the total foreign investments in Morocco, the European Union invests approximately 73.5%, whereas, the Arab world invests only 19.3%. Many countries from the Persian Gulf and Maghreb regions are getting more involved in large-scale development projects in Morocco. Morocco's membership in the African Union has been marked by significant events. In 1984, Morocco withdrew from the organisation after it admitted the Sahrawi Arab Democratic Republic in 1982 without conducting a referendum of self-determination in the disputed territory of Western Sahara. This decision was made unilaterally by Morocco. However, in 2017, Morocco rejoined the AU, signaling a shift in its diplomatic stance. In August 2021, Algeria severed diplomatic relations with Morocco. In 2002, a dispute with Spain in 2002 over the small island of Perejil arose, which brought attention to the issue of the sovereignty of Melilla and Ceuta . These small enclaves on the Mediterranean coast are surrounded by Morocco and have been under Spanish administration for centuries. In 2004, the George W. Bush administration granted Morocco the status of major non-NATO ally . It is worth noting that Morocco was the first country in the world to recognise US sovereignty, in 1777. After gaining independence, Morocco established strong ties with the United States , receiving significant economic and military aid. This partnership flourished during the Cold War , with Morocco becoming a key ally against communist expansion in North Africa . In return, the US supported Morocco's territorial ambitions and efforts to modernise its economy. Morocco received more than $400 million in American aid between 1957 and 1963, which elevated it to the fifth-largest recipient of US agricultural assistance by 1966. The long-lasting relationship between the two nations has endured, with the US remaining one of Morocco's top allies. Additionally, Morocco is included in the European Union's European Neighbourhood Policy (ENP), which aims at bringing the EU and its neighbours closer. The status of the Saguia el-Hamra and Río de Oro regions is disputed. The Western Sahara War saw the Polisario Front , the Sahrawi rebel national liberation movement, battling both Morocco and Mauritania between 1976 and a ceasefire in 1991 that is still in effect. A United Nations mission, MINURSO , is tasked with organising a referendum on whether the territory should become independent or recognised as a part of Morocco. Part of the territory, the Free Zone , is a mostly uninhabited area that the Polisario Front controls as the Sahrawi Arab Democratic Republic . Its administrative headquarters are located in Tindouf , Algeria. As of 2006 [ update ] , no UN member state had recognised Moroccan sovereignty over Western Sahara. In 2020, the United States under the Trump administration became the first Western country to back Morocco's contested sovereignty over the disputed Western Sahara region, on the agreement that Morocco would simultaneously normalise relations with Israel . In 2006, the government of Morocco suggested autonomous status for the region, through the Moroccan Royal Advisory Council for Saharan Affairs (CORCAS). The project was presented to the United Nations Security Council in mid-April 2007. The proposal was encouraged by Moroccan allies such as the United States , France and Spain . [ citation needed ] The Security Council has called upon the parties to enter into direct and unconditional negotiations to reach a mutually accepted political solution. Morocco is officially divided into 12 regions , which, in turn, are subdivided into 62 provinces and 13 prefectures . Regions During the early 1960s to the late 1980s, under the leadership of Hassan II , Morocco had one of the worst human rights records in both Africa and the world. Government repression of political dissent was widespread during Hassan II's leadership, until it dropped sharply in the mid-1990s. The decades during which abuses were committed are referred to as the Years of Lead ( les années de plomb ), and included forced disappearances , assassinations of government opponents and protesters, and secret internment camps such as Tazmamart . To examine abuses committed during the reign of King Hassan II (1961–1999), the government under King Mohammed set up an Equity and Reconciliation Commission (IER). According to a Human Rights Watch annual report in 2016, Moroccan authorities restricted the rights to peaceful expression, association and assembly through several laws. The authorities continue to prosecute both printed and online media which criticises the government or the king (or the royal family). There are also persistent allegations of violence against both Sahrawi pro- independence and pro- Polisario demonstrators in Western Sahara; a disputed territory which is occupied by and considered by Morocco as part of its Southern Provinces . Morocco has been accused of detaining Sahrawi pro-independence activists as prisoners of conscience. Homosexual acts as well as pre-marital sex are illegal in Morocco, and can be punishable by six months to three years of imprisonment. It is illegal to proselytise for any religion other than Islam (article 220 of the Moroccan Penal Code), and that crime is punishable by a maximum of 15 years of imprisonment. Violence against women and sexual harassment have been criminalised. The penalty can be from one month to five years, with fines ranging from $200 to $1,000. It is a criminal offence in Morocco to undermine the monarchy: in August 2023, a Moroccan resident of Qatar was sentenced to five years' imprisonment for criticising the King's policy decisions on Facebook. Since the constitutional reform of 1996, the bicameral legislature consists of two chambers. The Assembly of Representatives of Morocco ( Majlis an-Nuwwâb/Assemblée des Répresentants ) has 325 members elected for a five-year term, 295 elected in multi-seat constituencies and 30 in national lists consisting only of women. The Assembly of Councillors ( Majlis al-Mustasharin ) has 270 members, elected for a nine-year term, elected by local councils (162 seats), professional chambers (91 seats) and wage-earners (27 seats). [ citation needed ] The Parliament's powers, though still relatively limited, were expanded under the 1992 and 1996 and even further in the 2011 constitutional revisions and include budgetary matters, approving bills , questioning ministers, and establishing ad hoc commissions of inquiry to investigate the government's actions. The lower chamber of Parliament may dissolve the government through a vote of no confidence . [ citation needed ] The latest parliamentary elections were held on 8 September 2021 . Voter turnout in these elections was estimated to be 50.35% of registered voters. [ citation needed ]Morocco's military consists of the Royal Armed Forces—this includes the Army (the largest branch), the Navy , the Air Force , the Royal Guard , the Royal Gendarmerie and the Auxiliary Forces . Internal security is generally effective, and acts of political violence are rare (with one exception, the 2003 Casablanca bombings which killed 45 people ). The UN maintains a small observer force in Western Sahara, where a large number of Moroccan troops are stationed. The Sahrawi Polisario Front maintains an active militia of an estimated 5,000 fighters in Western Sahara and has engaged in intermittent warfare with Moroccan forces since the 1970s.Morocco is a member of the United Nations and belongs to the African Union (AU), Arab League , Arab Maghreb Union (UMA), Organisation of Islamic Cooperation (OIC), the Non-Aligned Movement and the Community of Sahel–Saharan States (CEN_SAD). Morocco's relationships vary greatly between African, Arab, and Western states. Morocco has had strong ties to the West in order to gain economic and political benefits. France and Spain remain the primary trade partners, as well as the primary creditors and foreign investors in Morocco. From the total foreign investments in Morocco, the European Union invests approximately 73.5%, whereas, the Arab world invests only 19.3%. Many countries from the Persian Gulf and Maghreb regions are getting more involved in large-scale development projects in Morocco. Morocco's membership in the African Union has been marked by significant events. In 1984, Morocco withdrew from the organisation after it admitted the Sahrawi Arab Democratic Republic in 1982 without conducting a referendum of self-determination in the disputed territory of Western Sahara. This decision was made unilaterally by Morocco. However, in 2017, Morocco rejoined the AU, signaling a shift in its diplomatic stance. In August 2021, Algeria severed diplomatic relations with Morocco. In 2002, a dispute with Spain in 2002 over the small island of Perejil arose, which brought attention to the issue of the sovereignty of Melilla and Ceuta . These small enclaves on the Mediterranean coast are surrounded by Morocco and have been under Spanish administration for centuries. In 2004, the George W. Bush administration granted Morocco the status of major non-NATO ally . It is worth noting that Morocco was the first country in the world to recognise US sovereignty, in 1777. After gaining independence, Morocco established strong ties with the United States , receiving significant economic and military aid. This partnership flourished during the Cold War , with Morocco becoming a key ally against communist expansion in North Africa . In return, the US supported Morocco's territorial ambitions and efforts to modernise its economy. Morocco received more than $400 million in American aid between 1957 and 1963, which elevated it to the fifth-largest recipient of US agricultural assistance by 1966. The long-lasting relationship between the two nations has endured, with the US remaining one of Morocco's top allies. Additionally, Morocco is included in the European Union's European Neighbourhood Policy (ENP), which aims at bringing the EU and its neighbours closer. The status of the Saguia el-Hamra and Río de Oro regions is disputed. The Western Sahara War saw the Polisario Front , the Sahrawi rebel national liberation movement, battling both Morocco and Mauritania between 1976 and a ceasefire in 1991 that is still in effect. A United Nations mission, MINURSO , is tasked with organising a referendum on whether the territory should become independent or recognised as a part of Morocco. Part of the territory, the Free Zone , is a mostly uninhabited area that the Polisario Front controls as the Sahrawi Arab Democratic Republic . Its administrative headquarters are located in Tindouf , Algeria. As of 2006 [ update ] , no UN member state had recognised Moroccan sovereignty over Western Sahara. In 2020, the United States under the Trump administration became the first Western country to back Morocco's contested sovereignty over the disputed Western Sahara region, on the agreement that Morocco would simultaneously normalise relations with Israel . In 2006, the government of Morocco suggested autonomous status for the region, through the Moroccan Royal Advisory Council for Saharan Affairs (CORCAS). The project was presented to the United Nations Security Council in mid-April 2007. The proposal was encouraged by Moroccan allies such as the United States , France and Spain . [ citation needed ] The Security Council has called upon the parties to enter into direct and unconditional negotiations to reach a mutually accepted political solution. Morocco is officially divided into 12 regions , which, in turn, are subdivided into 62 provinces and 13 prefectures . RegionsDuring the early 1960s to the late 1980s, under the leadership of Hassan II , Morocco had one of the worst human rights records in both Africa and the world. Government repression of political dissent was widespread during Hassan II's leadership, until it dropped sharply in the mid-1990s. The decades during which abuses were committed are referred to as the Years of Lead ( les années de plomb ), and included forced disappearances , assassinations of government opponents and protesters, and secret internment camps such as Tazmamart . To examine abuses committed during the reign of King Hassan II (1961–1999), the government under King Mohammed set up an Equity and Reconciliation Commission (IER). According to a Human Rights Watch annual report in 2016, Moroccan authorities restricted the rights to peaceful expression, association and assembly through several laws. The authorities continue to prosecute both printed and online media which criticises the government or the king (or the royal family). There are also persistent allegations of violence against both Sahrawi pro- independence and pro- Polisario demonstrators in Western Sahara; a disputed territory which is occupied by and considered by Morocco as part of its Southern Provinces . Morocco has been accused of detaining Sahrawi pro-independence activists as prisoners of conscience. Homosexual acts as well as pre-marital sex are illegal in Morocco, and can be punishable by six months to three years of imprisonment. It is illegal to proselytise for any religion other than Islam (article 220 of the Moroccan Penal Code), and that crime is punishable by a maximum of 15 years of imprisonment. Violence against women and sexual harassment have been criminalised. The penalty can be from one month to five years, with fines ranging from $200 to $1,000. It is a criminal offence in Morocco to undermine the monarchy: in August 2023, a Moroccan resident of Qatar was sentenced to five years' imprisonment for criticising the King's policy decisions on Facebook. Morocco's economy is considered a relatively liberal economy governed by the law of supply and demand . Since 1993, the country has followed a policy of privatisation of certain economic sectors which used to be in the hands of the government . Morocco has become a major player in African economic affairs, and is the fifth largest economy in Africa by GDP (PPP). Morocco was ranked as the first African country by the Economist Intelligence Unit 's quality-of-life index , ahead of South Africa . However, in the years since that first-place ranking was given, Morocco has slipped into fourth place behind Egypt . Government reforms and steady yearly growth in the region of 4–5% from 2000 to 2007, including 4.9% year-on-year growth in 2003–2007 helped the Moroccan economy to become much more robust compared to a few years earlier. For 2012 the World Bank forecast a rate of 4% growth for Morocco and 4.2% for following year, 2013. The services sector accounts for just over half of GDP and industry, made up of mining, construction and manufacturing, is an additional quarter. The industries that recorded the highest growth are tourism , telecoms, information technology, and textile. Tourism is one of the most important sectors in Moroccan economy. It is well developed with a strong tourist industry focused on the country's coast, culture, and history. Morocco attracted more than 13 million tourists in 2019. Tourism is the second largest foreign exchange earner in Morocco after the phosphate industry. The Moroccan government is heavily investing in tourism development, in 2010 the government launched its Vision 2020 which plans to make Morocco one of the top 20 tourist destinations in the world and to double the annual number of international arrivals to 20 million by 2020, with the hope that tourism will then have risen to 20% of GDP. Large government sponsored marketing campaigns to attract tourists advertised Morocco as an inexpensive and exotic, yet safe, place for tourists. Most of the visitors to Morocco continue to be European, with French nationals making up almost 20% of all visitors. Most Europeans visit between April and August. Morocco's relatively high number of tourists has been aided by its location—Morocco is close to Europe and attracts visitors to its beaches. Because of its proximity to Spain, tourists in southern Spain's coastal areas take one- to three-day trips to Morocco. Since air services between Morocco and Algeria have been established, many Algerians have gone to Morocco to shop and visit family and friends. Morocco is relatively inexpensive because of the devaluation of the dirham and the increase of hotel prices in Spain. Morocco has an excellent road and rail infrastructure that links the major cities and tourist destinations with ports and cities with international airports. Low-cost airlines offer reduced-price flights to the country. Tourism is increasingly focused on Morocco's culture, such as its ancient cities. The modern tourist industry capitalises on Morocco's ancient and Islamic sites, and on its landscape and cultural history. 60% of Morocco's tourists visit for its culture and heritage. Agadir is a major coastal resort and has a third [ citation needed ] of all Moroccan bed nights. It is a base for tours to the Atlas Mountains. Other resorts in north Morocco are also very popular. Casablanca is the major cruise port in Morocco, and has the best developed market for tourists in Morocco, Marrakech in central Morocco is a popular tourist destination, but is more popular among tourists for one- and two-day excursions that provide a taste of Morocco's history and culture. The Majorelle botanical garden in Marrakech is a popular tourist attraction. It was bought by the fashion designer Yves Saint-Laurent and Pierre Bergé in 1980. Their presence in the city helped to boost the city's profile as a tourist destination. As of 2006 [ update ] , activity and adventure tourism in the Atlas and Rif Mountains are the fastest growth area in Moroccan tourism. These locations have excellent walking and trekking opportunities from late March to mid-November. The government is investing in trekking circuits. They are also developing desert tourism in competition with Tunisia . Agriculture in Morocco employs about 40% of the nation's workforce. Thus, it is the largest employer in the country. In the rainy sections of the northwest, barley , wheat , and other cereals can be raised without irrigation. On the Atlantic coast, where there are extensive plains, olives, citrus fruits, and wine grapes are grown, largely with water supplied by artesian wells. Livestock are raised and forests yield cork, cabinet wood, and building materials. Part of the maritime population fishes for its livelihood. Agadir , Essaouira , El Jadida , and Larache are among the important fishing harbors. Both the agriculture and fishing industries are expected to be severely impacted by climate change . Moroccan agricultural production also consists of orange, tomatoes, potatoes, olives, and olive oil. High quality agricultural products are usually exported to Europe. Morocco produces enough food for domestic consumption except for grains, sugar, coffee and tea. More than 40% of Morocco's consumption of grains and flour is imported from the United States and France . According to the Global Competitiveness Report of 2019, Morocco Ranked 32nd in the world in terms of Roads, 16th in Sea, 45th in Air and 64th in Railways. This gives Morocco the best infrastructure rankings in the African continent. Modern infrastructure development, such as ports, airports, and rail links, is a top government priority. To meet the growing domestic demand, the Moroccan government invested more than $15 billion from 2010 to 2015 in upgrading its basic infrastructure. Morocco has one of the best road systems on the continent. Over the past 20 years, the government has built approximately 1770 kilometers of modern roads, connecting most major cities via toll expressways. The Moroccan Ministry of Equipment, Transport, Logistics, and Water aims to build an additional 3380 kilometers of expressway and 2100 kilometers of highway by 2030, at an expected cost of $9.6 billion. It focuses on linking the southern provinces, notably the cities of Laayoune and Dakhla to the rest of Morocco. In 2014, Morocco began the construction of the first high-speed railway system in Africa linking the cities of Tangier and Casablanca. It was inaugurated in 2018 by the King following over a decade of planning and construction by Moroccan national railway company ONCF. It is the first phase of what is planned to eventually be a 1,500 kilometeres (930 mi) high-speed rail network in Morocco. An extension of the line to Marrakesh is already being planned. Morocco also has the largest port in Africa and the Mediterranean, Tanger-Med , which is ranked the 18th in the world with a handling capacity of over 9 million containers. It is situated in the Tangier free economic zone and serves as a logistics hub for Africa and the world. In 2008, about 56% of Morocco's electricity supply was provided by coal. However, as forecasts indicate that energy requirements in Morocco will rise 6% per year between 2012 and 2050, a new law passed encouraging Moroccans to look for ways to diversify the energy supply, including more renewable resources . The Moroccan government has launched a project to build a solar thermal energy power plant and is also looking into the use of natural gas as a potential source of revenue for Morocco's government. Morocco has embarked upon the construction of large solar energy farms to lessen dependence on fossil fuels, and to eventually export electricity to Europe . On 17 April 2022, Rabat- Moroccan agency for solar energy (Masen) and the ministry of energy transition and sustainable development announced the launch of phase one of the mega project Nor II solar energy plant which is a multi-site solar energy project with a total capacity set at 400 megawatts (MN). Since the 7th century, cannabis has been cultivated in the Rif region. In 2004, according to the UN World Drugs Report, cultivation and transformation of cannabis represents 0.57% of the national GDP of Morocco in 2002. According to a French Ministry of the Interior 2006 report, 80% of the cannabis resin (hashish) consumed in Europe comes from the Rif region in Morocco, which is mostly mountainous terrain in the north of Morocco, also hosting plains that are very fertile and expanding from Melwiyya River and Ras Kebdana in the East to Tangier and Cape Spartel in the West. Also, the region extends from the Mediterranean in the south, home of the Wergha River, to the north. In addition to that, Morocco is a transit point for cocaine from South America destined for Western Europe. Water supply and sanitation in Morocco is provided by a wide array of utilities. They range from private companies in the largest city, Casablanca , the capital, Rabat , and two other cities, [ clarification needed ] to public municipal utilities in 13 other cities, as well as a national electricity and water company (ONEE). The latter is in charge of bulk water supply to the aforementioned utilities, water distribution in about 500 small towns, as well as sewerage and wastewater treatment in 60 of these towns. There have been substantial improvements in access to water supply, and to a lesser extent to sanitation, over the past fifteen years. Remaining challenges include a low level of wastewater treatment (only 13% of collected wastewater is being treated), lack of house connections in the poorest urban neighbourhoods, and limited sustainability of rural systems (20 percent of rural systems are estimated not to function). In 2005 a National Sanitation Programme was approved that aims at treating 60% of collected wastewater and connecting 80% of urban households to sewers by 2020. The issue of lack of water connections for some of the urban poor is being addressed as part of the National Human Development Initiative , under which residents of informal settlements have received land titles and have fees waived that are normally paid to utilities in order to connect to the water and sewer network.Tourism is one of the most important sectors in Moroccan economy. It is well developed with a strong tourist industry focused on the country's coast, culture, and history. Morocco attracted more than 13 million tourists in 2019. Tourism is the second largest foreign exchange earner in Morocco after the phosphate industry. The Moroccan government is heavily investing in tourism development, in 2010 the government launched its Vision 2020 which plans to make Morocco one of the top 20 tourist destinations in the world and to double the annual number of international arrivals to 20 million by 2020, with the hope that tourism will then have risen to 20% of GDP. Large government sponsored marketing campaigns to attract tourists advertised Morocco as an inexpensive and exotic, yet safe, place for tourists. Most of the visitors to Morocco continue to be European, with French nationals making up almost 20% of all visitors. Most Europeans visit between April and August. Morocco's relatively high number of tourists has been aided by its location—Morocco is close to Europe and attracts visitors to its beaches. Because of its proximity to Spain, tourists in southern Spain's coastal areas take one- to three-day trips to Morocco. Since air services between Morocco and Algeria have been established, many Algerians have gone to Morocco to shop and visit family and friends. Morocco is relatively inexpensive because of the devaluation of the dirham and the increase of hotel prices in Spain. Morocco has an excellent road and rail infrastructure that links the major cities and tourist destinations with ports and cities with international airports. Low-cost airlines offer reduced-price flights to the country. Tourism is increasingly focused on Morocco's culture, such as its ancient cities. The modern tourist industry capitalises on Morocco's ancient and Islamic sites, and on its landscape and cultural history. 60% of Morocco's tourists visit for its culture and heritage. Agadir is a major coastal resort and has a third [ citation needed ] of all Moroccan bed nights. It is a base for tours to the Atlas Mountains. Other resorts in north Morocco are also very popular. Casablanca is the major cruise port in Morocco, and has the best developed market for tourists in Morocco, Marrakech in central Morocco is a popular tourist destination, but is more popular among tourists for one- and two-day excursions that provide a taste of Morocco's history and culture. The Majorelle botanical garden in Marrakech is a popular tourist attraction. It was bought by the fashion designer Yves Saint-Laurent and Pierre Bergé in 1980. Their presence in the city helped to boost the city's profile as a tourist destination. As of 2006 [ update ] , activity and adventure tourism in the Atlas and Rif Mountains are the fastest growth area in Moroccan tourism. These locations have excellent walking and trekking opportunities from late March to mid-November. The government is investing in trekking circuits. They are also developing desert tourism in competition with Tunisia . Agriculture in Morocco employs about 40% of the nation's workforce. Thus, it is the largest employer in the country. In the rainy sections of the northwest, barley , wheat , and other cereals can be raised without irrigation. On the Atlantic coast, where there are extensive plains, olives, citrus fruits, and wine grapes are grown, largely with water supplied by artesian wells. Livestock are raised and forests yield cork, cabinet wood, and building materials. Part of the maritime population fishes for its livelihood. Agadir , Essaouira , El Jadida , and Larache are among the important fishing harbors. Both the agriculture and fishing industries are expected to be severely impacted by climate change . Moroccan agricultural production also consists of orange, tomatoes, potatoes, olives, and olive oil. High quality agricultural products are usually exported to Europe. Morocco produces enough food for domestic consumption except for grains, sugar, coffee and tea. More than 40% of Morocco's consumption of grains and flour is imported from the United States and France .According to the Global Competitiveness Report of 2019, Morocco Ranked 32nd in the world in terms of Roads, 16th in Sea, 45th in Air and 64th in Railways. This gives Morocco the best infrastructure rankings in the African continent. Modern infrastructure development, such as ports, airports, and rail links, is a top government priority. To meet the growing domestic demand, the Moroccan government invested more than $15 billion from 2010 to 2015 in upgrading its basic infrastructure. Morocco has one of the best road systems on the continent. Over the past 20 years, the government has built approximately 1770 kilometers of modern roads, connecting most major cities via toll expressways. The Moroccan Ministry of Equipment, Transport, Logistics, and Water aims to build an additional 3380 kilometers of expressway and 2100 kilometers of highway by 2030, at an expected cost of $9.6 billion. It focuses on linking the southern provinces, notably the cities of Laayoune and Dakhla to the rest of Morocco. In 2014, Morocco began the construction of the first high-speed railway system in Africa linking the cities of Tangier and Casablanca. It was inaugurated in 2018 by the King following over a decade of planning and construction by Moroccan national railway company ONCF. It is the first phase of what is planned to eventually be a 1,500 kilometeres (930 mi) high-speed rail network in Morocco. An extension of the line to Marrakesh is already being planned. Morocco also has the largest port in Africa and the Mediterranean, Tanger-Med , which is ranked the 18th in the world with a handling capacity of over 9 million containers. It is situated in the Tangier free economic zone and serves as a logistics hub for Africa and the world. In 2008, about 56% of Morocco's electricity supply was provided by coal. However, as forecasts indicate that energy requirements in Morocco will rise 6% per year between 2012 and 2050, a new law passed encouraging Moroccans to look for ways to diversify the energy supply, including more renewable resources . The Moroccan government has launched a project to build a solar thermal energy power plant and is also looking into the use of natural gas as a potential source of revenue for Morocco's government. Morocco has embarked upon the construction of large solar energy farms to lessen dependence on fossil fuels, and to eventually export electricity to Europe . On 17 April 2022, Rabat- Moroccan agency for solar energy (Masen) and the ministry of energy transition and sustainable development announced the launch of phase one of the mega project Nor II solar energy plant which is a multi-site solar energy project with a total capacity set at 400 megawatts (MN).Since the 7th century, cannabis has been cultivated in the Rif region. In 2004, according to the UN World Drugs Report, cultivation and transformation of cannabis represents 0.57% of the national GDP of Morocco in 2002. According to a French Ministry of the Interior 2006 report, 80% of the cannabis resin (hashish) consumed in Europe comes from the Rif region in Morocco, which is mostly mountainous terrain in the north of Morocco, also hosting plains that are very fertile and expanding from Melwiyya River and Ras Kebdana in the East to Tangier and Cape Spartel in the West. Also, the region extends from the Mediterranean in the south, home of the Wergha River, to the north. In addition to that, Morocco is a transit point for cocaine from South America destined for Western Europe. Water supply and sanitation in Morocco is provided by a wide array of utilities. They range from private companies in the largest city, Casablanca , the capital, Rabat , and two other cities, [ clarification needed ] to public municipal utilities in 13 other cities, as well as a national electricity and water company (ONEE). The latter is in charge of bulk water supply to the aforementioned utilities, water distribution in about 500 small towns, as well as sewerage and wastewater treatment in 60 of these towns. There have been substantial improvements in access to water supply, and to a lesser extent to sanitation, over the past fifteen years. Remaining challenges include a low level of wastewater treatment (only 13% of collected wastewater is being treated), lack of house connections in the poorest urban neighbourhoods, and limited sustainability of rural systems (20 percent of rural systems are estimated not to function). In 2005 a National Sanitation Programme was approved that aims at treating 60% of collected wastewater and connecting 80% of urban households to sewers by 2020. The issue of lack of water connections for some of the urban poor is being addressed as part of the National Human Development Initiative , under which residents of informal settlements have received land titles and have fees waived that are normally paid to utilities in order to connect to the water and sewer network.The Moroccan government has been implementing reforms to improve the quality of education and make research more responsive to socio-economic needs. In May 2009, Morocco's prime minister, Abbas El Fassi, announced greater support for science during a meeting at the National Centre for Scientific and Technical Research. The aim was to give universities greater financial autonomy from the government to make them more responsive to research needs and better able to forge links with the private sector, in the hope that this would nurture a culture of entrepreneurship in academia. He announced that investment in science and technology would rise from US$620,000 in 2008 to US$8.5 million (69 million Moroccan dirhams) in 2009, in order to finance the refurbishment and construction of laboratories, training courses for researchers in financial management, a scholarship programme for postgraduate research and incentive measures for companies prepared to finance research, such as giving them access to scientific results that they could then use to develop new products. Morocco was ranked 70th in the Global Innovation Index in 2023. The Moroccan Innovation Strategy was launched at the country's first National Innovation Summit in June 2009 by the Ministry of Industry, Commerce, Investment and the Digital Economy. The Moroccan Innovation Strategy fixed the target of producing 1,000 Moroccan patents and creating 200 innovative start-ups by 2014. In 2012, Moroccan inventors applied for 197 patents, up from 152 two years earlier. In 2011, the Ministry of Industry, Commerce and New Technologies created a Moroccan Club of Innovation, in partnership with the Moroccan Office of Industrial and Commercial Property. The idea is to create a network of players in innovation, including researchers, entrepreneurs, students and academics, to help them develop innovative projects. The Ministry of Higher Education and Scientific Research is supporting research in advanced technologies and the development of innovative cities in Fez, Rabat and Marrakesh. The government is encouraging public institutions to engage with citizens in innovation. One example is the Moroccan Phosphate Office (Office chérifien des phosphates), which has invested in a project to develop a smart city, King Mohammed VI Green City, around Mohammed VI University located between Casablanca and Marrakesh, at a cost of DH 4.7 billion ( circa US$479 million). As of 2015, Morocco had three technoparks. Since the first technopark was established in Rabat in 2005, a second has been set up in Casablanca, followed, in 2015, by a third in Tangers. The technoparks host start-ups and small and medium-sized enterprises specialising in information and communication technologies (ICTs), 'green' technologies (namely, environmentally friendly technologies) and cultural industries. In 2012, the Hassan II Academy of Science and Technology identified a number of sectors where Morocco has a comparative advantage and skilled human capital, including mining, fisheries, food chemistry and new technologies. It also identified a number of strategic sectors, such as energy, with an emphasis on renewable energies such as photovoltaic, thermal solar energy, wind and biomass; as well as the water, nutrition and health sectors, the environment and geosciences. On 20 May 2015, less than a year after its inception, the Higher Council for Education, Training and Scientific Research presented a report to the king offering a Vision for Education in Morocco 2015–2030 . The report advocated making education egalitarian and, thus, accessible to the greatest number. Since improving the quality of education goes hand in hand with promoting research and development, the report also recommended developing an integrated national innovation system which would be financed by gradually increasing the share of GDP devoted to research and development (R&D) from 0.73% of GDP in 2010 'to 1% in the short term, 1.5% by 2025 and 2% by 2030'. Morocco has a population of around 37,076,584 inhabitants ( 2021 est.). It is estimated that between 44% and 67% of residents are Arabs and between 31% and 41% are Berbers . A sizeable portion of the population is identified as Haratin and Gnawa (or Gnaoua), West African or mixed-race descendants of slaves , and Moriscos , European Muslims expelled from Spain and Portugal in the 17th century. Centuries of Arab migration to the Maghreb since the 7th century shifted the demographic scope of Morocco. According to the 2014 Morocco population census, there were around 84,000 immigrants in the country. Of these foreign-born residents, most were of French origin, followed by individuals mainly from various nations in West Africa and Algeria. There are also a number of foreign residents of Spanish origin. Some of them are descendants of colonial settlers, who primarily work for European multinational companies, while others are married to Moroccans or are retirees. Prior to independence, Morocco was home to half a million Europeans ; who were mostly Christians . Also, prior to independence, Morocco was home to 250,000 Spaniards. Morocco's once prominent Jewish minority has decreased significantly since its peak of 265,000 in 1948, declining to around 3,500 in 2022. Morocco has a large diaspora , most of which is located in France, which has reportedly over one million Moroccans of up to the third generation. There are also large Moroccan communities in Spain (about 700,000 Moroccans), the Netherlands (360,000), and Belgium (300,000). Other large communities can be found in Italy, Canada, the United States, and Israel, where Moroccan Jews are thought to constitute the second biggest Jewish ethnic subgroup. The religious affiliation in the country was estimated by the Pew Forum in 2010 as 99% Muslim , with all remaining groups accounting for less than 1% of the population. Of those affiliated with Islam, virtually all are Sunni Muslims , with Shia Muslims accounting for less than 0.1%. However, nearly 15% of Moroccans nonetheless describe themselves as non religious according to an 2018 survey conducted by the research network Arab Barometer; the same survey saw nearly 100 percent of respondents identify as Muslims. Another 2021 Arab Barometer survey found that 67.8% of Moroccans identified as religious, 29.1% as somewhat religious, and 3.1% as non religious. The 2015 Gallup International poll reported that 93% of Moroccans considered themselves to be religious. Prior to independence, Morocco was home to more than 500,000 Christians (mostly of Spanish and French ancestry). Many Christian settlers left to Spain or France after the independence in 1956. The predominantly Catholic and Protestant foreign-resident Christian community consists of approximately 40,000 practising members. Most foreign resident Christians reside in the Casablanca , Tangier , and Rabat urban areas. Various local Christian leaders estimate that between 2005 and 2010 there are 5,000 citizen converted Christians (mostly ethnically Berber) who regularly attend "house" churches and live predominantly in the south. Some local Christian leaders estimate that there may be as many as 8,000 Christian citizens throughout the country, but many reportedly do not meet regularly due to fear of government surveillance and social persecution. The number of the Moroccans who converted to Christianity (most of them secret worshippers) are estimated between 8,000 and 50,000. The most recent estimates put the size of the historic Casablanca Jewish community at about 2,500, and the Rabat and Marrakesh Jewish communities at about 100 members each. The remainder of the Jewish population is dispersed throughout the country. This population is mostly elderly, with a decreasing number of young people. The Bahá'í Faith community, located in urban areas, numbers 350 to 400 persons. Morocco's official languages are Arabic and Berber . The country's distinctive group of Moroccan Arabic dialects is referred to as Darija . Approximately 89.8% of the whole population can communicate to some degree in Moroccan Arabic . The Berber language is spoken in three dialects ( Tarifit , Tashelhit and Central Atlas Tamazight ). In 2008, Frédéric Deroche estimated that there were 12 million Berber speakers, making up about 40% of the population. The 2004 population census reported that 28.1% of the population spoke Berber. French is widely used in governmental institutions, media, mid-size and large companies, international commerce with French-speaking countries, and often in international diplomacy. French is taught as an obligatory language in all schools. In 2010, there were 10,366,000 French-speakers in Morocco, or about 32% of the population. According to the 2004 census, 2.19 million Moroccans spoke a foreign language other than French. English , while far behind French in terms of number of speakers, is the first foreign language of choice, since French is obligatory, among educated youth and professionals. According to Ethnologue , as of 2016, there are 1,536,590 individuals (or approximately 4.5% of the population) in Morocco who speak Spanish . Spanish is mostly spoken in northern Morocco and the former Spanish Sahara because Spain had previously occupied those areas. Meanwhile, a 2018 study by the Instituto Cervantes found 1.7 million Moroccans who were at least proficient in Spanish, placing Morocco as the country with the most Spanish speakers outside the Hispanophone world (unless the United States is also excluded from Spanish-speaking countries). A significant portion of northern Morocco receives Spanish media, television signal and radio airwaves, which reportedly facilitate competence in the language in the region. After Morocco declared independence in 1956, French and Arabic became the main languages of administration and education, causing the role of Spanish to decline. Education in Morocco is free and compulsory through primary school. The estimated literacy rate for the country in 2012 was 72%. In September 2006, UNESCO awarded Morocco amongst other countries such as Cuba , Pakistan , India and Turkey the "UNESCO 2006 Literacy Prize". Morocco has more than four dozen universities , institutes of higher learning, and polytechnics dispersed at urban centres throughout the country. Its leading institutions include Mohammed V University in Rabat, the country's largest university, with branches in Casablanca and Fès; the Hassan II Agriculture and Veterinary Institute in Rabat, which conducts leading social science research in addition to its agricultural specialties; and Al-Akhawayn University in Ifrane, the first English-language university in Northwest Africa, inaugurated in 1995 with contributions from Saudi Arabia and the United States. The al-Qarawiyin University , founded by Fatima al-Fihri in the city of Fez in 859 as a madrasa , is considered by some sources, including UNESCO , to be the "oldest university of the world". Morocco has also some of prestigious postgraduate schools, including: Mohammed VI Polytechnic University , l' Institut national des postes et télécommunications [ fr ; ar ] , École Nationale Supérieure d'Électricité et de Mecanique (ENSEM), EMI , ISCAE , INSEA , National School of Mineral Industry , École Hassania des Travaux Publics , Les Écoles nationales de commerce et de gestion, École supérieure de technologie de Casablanca. Many efforts are made by countries around the world to address health issues and eradicate disease, Morocco included. Child health, maternal health, and diseases are all components of health and well-being. Morocco is a developing country that has made many strides to improve these categories. However, Morocco still has many health issues to improve on. According to research published, in 2005 only 16% of citizens in Morocco had health insurance or coverage. In data from the World Bank, Morocco experiences high infant mortality rates at 20 deaths per 1,000 births (2017) and high maternal mortality rates at 121 deaths per 100,000 births (2015). The government of Morocco sets up surveillance systems within the already existing healthcare system to monitor and collect data. Mass education in hygiene is implemented in primary education schools which are free for residents of Morocco. In 2005, The government of Morocco approved two reforms to expand health insurance coverage. The first reform was a mandatory health insurance plan for public and private sector employees to expand coverage from 16 percent of the population to 30 percent. The second reform created a fund to cover services for the poor. Both reforms improved access to high-quality care. Infant mortality has improved significantly since 1960 when there were 144 deaths per 1,000 live births, in 2000, 42 per 1,000 live births, and now it is 20 per 1,000 live births. The country's under-five mortality rate dropped by 60% between 1990 and 2011. According to data from the World Bank, the present mortality rate is still very high, over seven times higher than in neighbouring country Spain. In 2014, Morocco adopted a national plan to increase progress on maternal and child health. The Moroccan Plan was started by the Moroccan Minister of Health, El Houssaine Louardi, and Ala Alwan, WHO Regional Director for the Eastern Mediterranean Region, on 13 November 2013 in Rabat. Morocco has made significant progress in reducing deaths among both children and mothers. Based on World Bank data, the nation's maternal mortality ratio fell by 67% between 1990 and 2010. In 2014, spending on healthcare accounted for 5.9% of the country's GDP. Since 2014, spending on healthcare as part of the GDP has decreased. However, health expenditure per capita (PPP) has steadily increased since 2000. In 2015, the Moroccan health expenditure was $435.29 per capita. In 2016 the life expectancy at birth was 74.3, or 73.3 for men and 75.4 for women, and there were 6.3 physicians and 8.9 nurses and midwives per 10,000 inhabitants. In 2017, Morocco ranked 16th out of 29 countries on the Global Youth Wellbeing Index. Moroccan youths experience a lower self-harm rate than the global index by an average of 4 encounters per year. The religious affiliation in the country was estimated by the Pew Forum in 2010 as 99% Muslim , with all remaining groups accounting for less than 1% of the population. Of those affiliated with Islam, virtually all are Sunni Muslims , with Shia Muslims accounting for less than 0.1%. However, nearly 15% of Moroccans nonetheless describe themselves as non religious according to an 2018 survey conducted by the research network Arab Barometer; the same survey saw nearly 100 percent of respondents identify as Muslims. Another 2021 Arab Barometer survey found that 67.8% of Moroccans identified as religious, 29.1% as somewhat religious, and 3.1% as non religious. The 2015 Gallup International poll reported that 93% of Moroccans considered themselves to be religious. Prior to independence, Morocco was home to more than 500,000 Christians (mostly of Spanish and French ancestry). Many Christian settlers left to Spain or France after the independence in 1956. The predominantly Catholic and Protestant foreign-resident Christian community consists of approximately 40,000 practising members. Most foreign resident Christians reside in the Casablanca , Tangier , and Rabat urban areas. Various local Christian leaders estimate that between 2005 and 2010 there are 5,000 citizen converted Christians (mostly ethnically Berber) who regularly attend "house" churches and live predominantly in the south. Some local Christian leaders estimate that there may be as many as 8,000 Christian citizens throughout the country, but many reportedly do not meet regularly due to fear of government surveillance and social persecution. The number of the Moroccans who converted to Christianity (most of them secret worshippers) are estimated between 8,000 and 50,000. The most recent estimates put the size of the historic Casablanca Jewish community at about 2,500, and the Rabat and Marrakesh Jewish communities at about 100 members each. The remainder of the Jewish population is dispersed throughout the country. This population is mostly elderly, with a decreasing number of young people. The Bahá'í Faith community, located in urban areas, numbers 350 to 400 persons. Morocco's official languages are Arabic and Berber . The country's distinctive group of Moroccan Arabic dialects is referred to as Darija . Approximately 89.8% of the whole population can communicate to some degree in Moroccan Arabic . The Berber language is spoken in three dialects ( Tarifit , Tashelhit and Central Atlas Tamazight ). In 2008, Frédéric Deroche estimated that there were 12 million Berber speakers, making up about 40% of the population. The 2004 population census reported that 28.1% of the population spoke Berber. French is widely used in governmental institutions, media, mid-size and large companies, international commerce with French-speaking countries, and often in international diplomacy. French is taught as an obligatory language in all schools. In 2010, there were 10,366,000 French-speakers in Morocco, or about 32% of the population. According to the 2004 census, 2.19 million Moroccans spoke a foreign language other than French. English , while far behind French in terms of number of speakers, is the first foreign language of choice, since French is obligatory, among educated youth and professionals. According to Ethnologue , as of 2016, there are 1,536,590 individuals (or approximately 4.5% of the population) in Morocco who speak Spanish . Spanish is mostly spoken in northern Morocco and the former Spanish Sahara because Spain had previously occupied those areas. Meanwhile, a 2018 study by the Instituto Cervantes found 1.7 million Moroccans who were at least proficient in Spanish, placing Morocco as the country with the most Spanish speakers outside the Hispanophone world (unless the United States is also excluded from Spanish-speaking countries). A significant portion of northern Morocco receives Spanish media, television signal and radio airwaves, which reportedly facilitate competence in the language in the region. After Morocco declared independence in 1956, French and Arabic became the main languages of administration and education, causing the role of Spanish to decline. Education in Morocco is free and compulsory through primary school. The estimated literacy rate for the country in 2012 was 72%. In September 2006, UNESCO awarded Morocco amongst other countries such as Cuba , Pakistan , India and Turkey the "UNESCO 2006 Literacy Prize". Morocco has more than four dozen universities , institutes of higher learning, and polytechnics dispersed at urban centres throughout the country. Its leading institutions include Mohammed V University in Rabat, the country's largest university, with branches in Casablanca and Fès; the Hassan II Agriculture and Veterinary Institute in Rabat, which conducts leading social science research in addition to its agricultural specialties; and Al-Akhawayn University in Ifrane, the first English-language university in Northwest Africa, inaugurated in 1995 with contributions from Saudi Arabia and the United States. The al-Qarawiyin University , founded by Fatima al-Fihri in the city of Fez in 859 as a madrasa , is considered by some sources, including UNESCO , to be the "oldest university of the world". Morocco has also some of prestigious postgraduate schools, including: Mohammed VI Polytechnic University , l' Institut national des postes et télécommunications [ fr ; ar ] , École Nationale Supérieure d'Électricité et de Mecanique (ENSEM), EMI , ISCAE , INSEA , National School of Mineral Industry , École Hassania des Travaux Publics , Les Écoles nationales de commerce et de gestion, École supérieure de technologie de Casablanca. Many efforts are made by countries around the world to address health issues and eradicate disease, Morocco included. Child health, maternal health, and diseases are all components of health and well-being. Morocco is a developing country that has made many strides to improve these categories. However, Morocco still has many health issues to improve on. According to research published, in 2005 only 16% of citizens in Morocco had health insurance or coverage. In data from the World Bank, Morocco experiences high infant mortality rates at 20 deaths per 1,000 births (2017) and high maternal mortality rates at 121 deaths per 100,000 births (2015). The government of Morocco sets up surveillance systems within the already existing healthcare system to monitor and collect data. Mass education in hygiene is implemented in primary education schools which are free for residents of Morocco. In 2005, The government of Morocco approved two reforms to expand health insurance coverage. The first reform was a mandatory health insurance plan for public and private sector employees to expand coverage from 16 percent of the population to 30 percent. The second reform created a fund to cover services for the poor. Both reforms improved access to high-quality care. Infant mortality has improved significantly since 1960 when there were 144 deaths per 1,000 live births, in 2000, 42 per 1,000 live births, and now it is 20 per 1,000 live births. The country's under-five mortality rate dropped by 60% between 1990 and 2011. According to data from the World Bank, the present mortality rate is still very high, over seven times higher than in neighbouring country Spain. In 2014, Morocco adopted a national plan to increase progress on maternal and child health. The Moroccan Plan was started by the Moroccan Minister of Health, El Houssaine Louardi, and Ala Alwan, WHO Regional Director for the Eastern Mediterranean Region, on 13 November 2013 in Rabat. Morocco has made significant progress in reducing deaths among both children and mothers. Based on World Bank data, the nation's maternal mortality ratio fell by 67% between 1990 and 2010. In 2014, spending on healthcare accounted for 5.9% of the country's GDP. Since 2014, spending on healthcare as part of the GDP has decreased. However, health expenditure per capita (PPP) has steadily increased since 2000. In 2015, the Moroccan health expenditure was $435.29 per capita. In 2016 the life expectancy at birth was 74.3, or 73.3 for men and 75.4 for women, and there were 6.3 physicians and 8.9 nurses and midwives per 10,000 inhabitants. In 2017, Morocco ranked 16th out of 29 countries on the Global Youth Wellbeing Index. Moroccan youths experience a lower self-harm rate than the global index by an average of 4 encounters per year. Morocco is a country with a rich culture and civilisation . Through Moroccan history , it has hosted many people. All of whom have affected the social structure of Morocco. Since independence, a veritable blossoming has taken place in painting and sculpture, popular music, amateur theatre, and filmmaking. The Moroccan National Theatre (founded 1956) offers regular productions of Moroccan and French dramatic works. Art and music festivals take place throughout the country during the summer months, among them the World Sacred Music Festival at Fès . Each region possesses its own specificities, thus contributing to the national culture and to the legacy of civilisation. Morocco has set among its top priorities the protection of its diverse legacy and the preservation of its cultural heritage. Culturally speaking, Morocco has always been successful in combining its Arabic, Berber and Jewish cultural heritage with external influences such as the French and the Spanish and, during the last decades, the Anglo-American lifestyles. Moroccan architecture reflects Morocco's diverse geography and long history, marked by successive waves of settlers through both migration and military conquest. This architectural heritage includes ancient Roman sites, historic Islamic architecture , local vernacular architecture , 20th-century French colonial architecture , and modern architecture . Much of Morocco's traditional architecture is marked by the style that developed during the Islamic period , from the 7th century onward. This architecture was part of a wider tradition of "Moorish" or western Islamic architecture , which characterized both the Maghreb (Morocco, Algeria , and Tunisia ) and al-Andalus (Muslim Spain and Portugal ). It blended influences from Amazigh (Berber) culture in North Africa , pre-Islamic Spain ( Roman , Byzantine , and Visigothic ), and contemporary artistic currents in the Islamic Middle East to elaborate a unique style over centuries with recognizable features such as the horseshoe arch , riad gardens, and elaborate geometric and arabesque motifs in wood, carved stucco , and zellij tilework. Although Moroccan Amazigh architecture is not strictly separate from the rest of Moroccan architecture, many structures and architectural styles are distinctively associated with traditionally Amazigh or Amazigh-dominated regions such as the Atlas Mountains and the Sahara and pre-Sahara regions. These mostly rural regions are marked by numerous kasbahs (fortresses) and ksour (fortified villages) shaped by local geography and social structures, of which one of the most famous is Ait Benhaddou . They are typically made of rammed earth and decorated with local geometric motifs. Far from being isolated from other historical artistic currents around them, the Amazigh peoples of Morocco (and across North Africa) adapted the forms and ideas of Islamic architecture to their own conditions and in turn contributed to the formation of Western Islamic art, particularly during their political domination of the region over the centuries of Almoravid , Almohad , and Marinid rule. Moroccan literature is written mostly in Arabic, Berber, Hebrew, and French. Particularly under the Almoravid and Almohad empires, Moroccan literature was closely related to the literature of al-Andalus , and shared important poetic and literary forms such as zajal , the muwashshah , and the maqama . Islamic literature, such as Quranic exegeses and other religious works such as Qadi Ayyad 's Al-Shifa were influential. The University of al-Qarawiyyin in Fes was an important literary centre attracting scholars from abroad, including Maimonides , Ibn al-Khatib , and Ibn Khaldun . Under the Almohad dynasty Morocco experienced a period of prosperity and brilliance of learning. The Almohad built the Kutubiyya Mosque in Marrakesh, which accommodated no fewer than 25,000 people, but was also famed for its books, manuscripts, libraries and book shops, which gave it its name; the first book bazaar in history. The Almohad Caliph Abu Yakub had a great love for collecting books. He founded a great library, which was eventually carried to the Casbah and turned into a public library . Modern Moroccan literature began in the 1930s. Two main factors gave Morocco a pulse toward witnessing the birth of a modern literature. Morocco, as a French and Spanish protectorate left Moroccan intellectuals the opportunity to exchange and to produce literary works freely enjoying the contact of other Arabic literature and Europe. Three generations of writers especially shaped 20th century Moroccan literature. The first was the generation that lived and wrote during the Protectorate (1912–56), its most important representative being Mohammed Ben Brahim (1897–1955). The second generation was the one that played an important role in the transition to independence with writers like Abdelkrim Ghallab (1919–2006), Allal al-Fassi (1910–1974) and Mohammed al-Mokhtar Soussi (1900–1963). The third generation is that of writers of the sixties. Moroccan literature then flourished with writers such as Mohamed Choukri , Driss Chraïbi , Mohamed Zafzaf and Driss El Khouri . Those writers were an important influence to the many Moroccan novelists, poets and playwrights that were still to come. During the 1950s and 1960s, Morocco was a refuge and artistic centre and attracted writers as Paul Bowles , Tennessee Williams and William S. Burroughs . Moroccan literature flourished with novelists such as Mohamed Zafzaf and Mohamed Choukri , who wrote in Arabic, and Driss Chraïbi and Tahar Ben Jelloun who wrote in French. Other important Moroccan authors include, Abdellatif Laabi , Abdelkrim Ghallab , Fouad Laroui , Mohammed Berrada and Leila Abouzeid . Orature (oral literature) is an integral part of Moroccan culture, be it in Moroccan Arabic or Berber. Moroccan music is of Arabic, Berber and sub-Saharan origins. Rock-influenced chaabi bands are widespread, as is trance music with historical origins in Islamic music . Morocco is home to Andalusian classical music that is found throughout Northwest Africa. It probably evolved under the Moors in Cordoba , and the Persian-born musician Ziryab is usually credited with its invention. A genre known as Contemporary Andalusian Music and art is the brainchild of Morisco visual artist/composer/ oudist Tarik Banzi , founder of the Al-Andalus Ensemble . Aita is a Bedouin musical style sung in the countryside. Chaabi ("popular") is a music consisting of numerous varieties which are descended from the multifarious forms of Moroccan folk music. Chaabi was originally performed in markets, but is now found at any celebration or meeting. Popular Western forms of music are becoming increasingly popular in Morocco, such as fusion , rock, country , metal and, in particular, hip hop . Morocco participated in the 1980 Eurovision Song Contest , where it finished in the penultimate position. Cinema in Morocco has a long history, stretching back over a century to the filming of Le chevrier Marocain ("The Moroccan Goatherd") by Louis Lumière in 1897. Between that time and 1944, many foreign movies were shot in the country, especially in the Ouarzazate area. In 1944, the Moroccan Cinematographic Centre [ fr ] (CCM), the nation's film regulatory agency , was established. Studios were also opened in Rabat . In 1952, Orson Welles ' Othello won the Palme d'Or at the Cannes Film Festival under the Moroccan flag. However, the Festival's musicians did not play the Moroccan national anthem , as no one in attendance knew what it was. Six years later, Mohammed Ousfour would create the first Moroccan movie, Le fils maudit ("The Damned Son"). In 1968, the first Mediterranean Film Festival was held in Tangier . In its current incarnation, the event is held in Tetouan . This was followed in 1982 with the first national festival of cinema, which was held in Rabat. In 2001, the first International Film Festival of Marrakech (FIFM) was also held in Marrakech . Moroccan cuisine is considered one of the most diversified cuisines in the world. This is a result of the centuries-long interaction of Morocco with the outside world. The cuisine of Morocco is mainly a fusion of Moorish, European and Mediterranean cuisines. Spices are used extensively in Moroccan cuisine. While spices have been imported to Morocco for thousands of years, many ingredients such as saffron from Tiliouine , mint and olives from Meknes , and oranges and lemons from Fez, are home-grown. Chicken is the most widely eaten meat in Morocco. The most commonly eaten red meat in Morocco is beef; lamb is preferred but is relatively expensive. The main Moroccan dish most people are familiar with is couscous , the old national delicacy. Beef is the most commonly eaten red meat in Morocco, usually eaten in a Tagine with vegetables or legumes. Chicken is also very commonly used in Tagines, knowing that one of the most famous tagine is the Tagine of Chicken, potatoes and olives. Lamb is also consumed, but as Northwest African sheep breeds store most of their fat in their tails, Moroccan lamb does not have the pungent flavour that Western lamb and mutton have. Poultry is also very common, and the use of seafood is increasing in Moroccan food. In addition, there are dried salted meats and salted preserved meats such as kliia/khlia and "g'did" which are used to flavor tagines or used in "el ghraif" a folded savory Moroccan pancake. Among the most famous Moroccan dishes are Couscous , Pastilla (also spelled Bsteeya or Bestilla), Tajine , Tanjia and Harira . Although the latter is a soup , it is considered a dish in itself and is served as such or with dates especially during the month of Ramadan . Pork consumption is forbidden in accordance with Sharia , religious laws of Islam. A big part of the daily meal is bread. Bread in Morocco is principally from durum wheat semolina known as khobz . Bakeries are very common throughout Morocco and fresh bread is a staple in every city, town and village. The most common is whole grain coarse ground or white flour bread. There are also a number of flat breads and pulled unleavened pan-fried breads. The most popular drink is "atai", green tea with mint leaves and other ingredients. Tea occupies a very important place in the culture of Morocco and is considered an art form. It is served not only at mealtimes but all through the day, and it is especially a drink of hospitality, commonly served whenever there are guests. It is served to guests, and it is impolite to refuse it. Football is the country's most popular sport, popular among the urban youth in particular. In 1986, Morocco became the first Arab and African country to qualify for the second round of the FIFA World Cup . Morocco hosted the Africa Cup of Nations in 1988 and will host it again in 2025 after original host Guinea was stripped from hosting rights due to inadequacy of hosting preparations. Morocco was originally scheduled to host the 2015 Africa Cup of Nations , but refused to host the tournament on the scheduled dates because of fears over the Ebola outbreak on the continent. Morocco made six attempts to host the FIFA World Cup but lost five times to the United States, France, Germany, South Africa and a Canada–Mexico–United States joint bid, however Morocco will co-host it in 2030 along with Portugal and Spain having finally won the bid in their sixth attempt. In 2022 , Morocco became the first African and Arab team to reach the semifinals and finished 4th in the tournament. At the 1984 Olympic Games , two Moroccans won gold medals in track and field. Nawal El Moutawakel won in the 400 metres hurdles ; she was the first woman from an Arab or Islamic country to win an Olympic gold medal. Saïd Aouita won the 5000 metres at the same games. Hicham El Guerrouj won gold medals for Morocco at the 2004 Summer Olympics in the 1500 metres and 5000 metres and holds several world records in the mile run . Spectator sports in Morocco traditionally centred on the art of horsemanship until European sports— football , polo , swimming , and tennis —were introduced at the end of the 19th century. Tennis and golf have become popular. [ citation needed ] Several Moroccan professional players have competed in international competition, and the country fielded its first Davis Cup team in 1999. Morocco was one of the continent's pioneers in basketball as it established one of Africa's first competitive leagues. Rugby came to Morocco in the early 20th century, mainly by the French who occupied the country. As a result, Moroccan rugby was tied to the fortunes of France, during the first and second World War , with many Moroccan players going away to fight. Like many other Maghreb nations, Moroccan rugby tended to look to Europe for inspiration, rather than to the rest of Africa. Kickboxing is also popular in Morocco. [ citation needed ] The Moroccan-Dutch Badr Hari , heavyweight kickboxer and martial artist, is a former K-1 heavyweight champion and K-1 World Grand Prix 2008 and 2009 finalist. [ citation needed ]Moroccan architecture reflects Morocco's diverse geography and long history, marked by successive waves of settlers through both migration and military conquest. This architectural heritage includes ancient Roman sites, historic Islamic architecture , local vernacular architecture , 20th-century French colonial architecture , and modern architecture . Much of Morocco's traditional architecture is marked by the style that developed during the Islamic period , from the 7th century onward. This architecture was part of a wider tradition of "Moorish" or western Islamic architecture , which characterized both the Maghreb (Morocco, Algeria , and Tunisia ) and al-Andalus (Muslim Spain and Portugal ). It blended influences from Amazigh (Berber) culture in North Africa , pre-Islamic Spain ( Roman , Byzantine , and Visigothic ), and contemporary artistic currents in the Islamic Middle East to elaborate a unique style over centuries with recognizable features such as the horseshoe arch , riad gardens, and elaborate geometric and arabesque motifs in wood, carved stucco , and zellij tilework. Although Moroccan Amazigh architecture is not strictly separate from the rest of Moroccan architecture, many structures and architectural styles are distinctively associated with traditionally Amazigh or Amazigh-dominated regions such as the Atlas Mountains and the Sahara and pre-Sahara regions. These mostly rural regions are marked by numerous kasbahs (fortresses) and ksour (fortified villages) shaped by local geography and social structures, of which one of the most famous is Ait Benhaddou . They are typically made of rammed earth and decorated with local geometric motifs. Far from being isolated from other historical artistic currents around them, the Amazigh peoples of Morocco (and across North Africa) adapted the forms and ideas of Islamic architecture to their own conditions and in turn contributed to the formation of Western Islamic art, particularly during their political domination of the region over the centuries of Almoravid , Almohad , and Marinid rule. Moroccan literature is written mostly in Arabic, Berber, Hebrew, and French. Particularly under the Almoravid and Almohad empires, Moroccan literature was closely related to the literature of al-Andalus , and shared important poetic and literary forms such as zajal , the muwashshah , and the maqama . Islamic literature, such as Quranic exegeses and other religious works such as Qadi Ayyad 's Al-Shifa were influential. The University of al-Qarawiyyin in Fes was an important literary centre attracting scholars from abroad, including Maimonides , Ibn al-Khatib , and Ibn Khaldun . Under the Almohad dynasty Morocco experienced a period of prosperity and brilliance of learning. The Almohad built the Kutubiyya Mosque in Marrakesh, which accommodated no fewer than 25,000 people, but was also famed for its books, manuscripts, libraries and book shops, which gave it its name; the first book bazaar in history. The Almohad Caliph Abu Yakub had a great love for collecting books. He founded a great library, which was eventually carried to the Casbah and turned into a public library . Modern Moroccan literature began in the 1930s. Two main factors gave Morocco a pulse toward witnessing the birth of a modern literature. Morocco, as a French and Spanish protectorate left Moroccan intellectuals the opportunity to exchange and to produce literary works freely enjoying the contact of other Arabic literature and Europe. Three generations of writers especially shaped 20th century Moroccan literature. The first was the generation that lived and wrote during the Protectorate (1912–56), its most important representative being Mohammed Ben Brahim (1897–1955). The second generation was the one that played an important role in the transition to independence with writers like Abdelkrim Ghallab (1919–2006), Allal al-Fassi (1910–1974) and Mohammed al-Mokhtar Soussi (1900–1963). The third generation is that of writers of the sixties. Moroccan literature then flourished with writers such as Mohamed Choukri , Driss Chraïbi , Mohamed Zafzaf and Driss El Khouri . Those writers were an important influence to the many Moroccan novelists, poets and playwrights that were still to come. During the 1950s and 1960s, Morocco was a refuge and artistic centre and attracted writers as Paul Bowles , Tennessee Williams and William S. Burroughs . Moroccan literature flourished with novelists such as Mohamed Zafzaf and Mohamed Choukri , who wrote in Arabic, and Driss Chraïbi and Tahar Ben Jelloun who wrote in French. Other important Moroccan authors include, Abdellatif Laabi , Abdelkrim Ghallab , Fouad Laroui , Mohammed Berrada and Leila Abouzeid . Orature (oral literature) is an integral part of Moroccan culture, be it in Moroccan Arabic or Berber.Moroccan music is of Arabic, Berber and sub-Saharan origins. Rock-influenced chaabi bands are widespread, as is trance music with historical origins in Islamic music . Morocco is home to Andalusian classical music that is found throughout Northwest Africa. It probably evolved under the Moors in Cordoba , and the Persian-born musician Ziryab is usually credited with its invention. A genre known as Contemporary Andalusian Music and art is the brainchild of Morisco visual artist/composer/ oudist Tarik Banzi , founder of the Al-Andalus Ensemble . Aita is a Bedouin musical style sung in the countryside. Chaabi ("popular") is a music consisting of numerous varieties which are descended from the multifarious forms of Moroccan folk music. Chaabi was originally performed in markets, but is now found at any celebration or meeting. Popular Western forms of music are becoming increasingly popular in Morocco, such as fusion , rock, country , metal and, in particular, hip hop . Morocco participated in the 1980 Eurovision Song Contest , where it finished in the penultimate position.Cinema in Morocco has a long history, stretching back over a century to the filming of Le chevrier Marocain ("The Moroccan Goatherd") by Louis Lumière in 1897. Between that time and 1944, many foreign movies were shot in the country, especially in the Ouarzazate area. In 1944, the Moroccan Cinematographic Centre [ fr ] (CCM), the nation's film regulatory agency , was established. Studios were also opened in Rabat . In 1952, Orson Welles ' Othello won the Palme d'Or at the Cannes Film Festival under the Moroccan flag. However, the Festival's musicians did not play the Moroccan national anthem , as no one in attendance knew what it was. Six years later, Mohammed Ousfour would create the first Moroccan movie, Le fils maudit ("The Damned Son"). In 1968, the first Mediterranean Film Festival was held in Tangier . In its current incarnation, the event is held in Tetouan . This was followed in 1982 with the first national festival of cinema, which was held in Rabat. In 2001, the first International Film Festival of Marrakech (FIFM) was also held in Marrakech .Moroccan cuisine is considered one of the most diversified cuisines in the world. This is a result of the centuries-long interaction of Morocco with the outside world. The cuisine of Morocco is mainly a fusion of Moorish, European and Mediterranean cuisines. Spices are used extensively in Moroccan cuisine. While spices have been imported to Morocco for thousands of years, many ingredients such as saffron from Tiliouine , mint and olives from Meknes , and oranges and lemons from Fez, are home-grown. Chicken is the most widely eaten meat in Morocco. The most commonly eaten red meat in Morocco is beef; lamb is preferred but is relatively expensive. The main Moroccan dish most people are familiar with is couscous , the old national delicacy. Beef is the most commonly eaten red meat in Morocco, usually eaten in a Tagine with vegetables or legumes. Chicken is also very commonly used in Tagines, knowing that one of the most famous tagine is the Tagine of Chicken, potatoes and olives. Lamb is also consumed, but as Northwest African sheep breeds store most of their fat in their tails, Moroccan lamb does not have the pungent flavour that Western lamb and mutton have. Poultry is also very common, and the use of seafood is increasing in Moroccan food. In addition, there are dried salted meats and salted preserved meats such as kliia/khlia and "g'did" which are used to flavor tagines or used in "el ghraif" a folded savory Moroccan pancake. Among the most famous Moroccan dishes are Couscous , Pastilla (also spelled Bsteeya or Bestilla), Tajine , Tanjia and Harira . Although the latter is a soup , it is considered a dish in itself and is served as such or with dates especially during the month of Ramadan . Pork consumption is forbidden in accordance with Sharia , religious laws of Islam. A big part of the daily meal is bread. Bread in Morocco is principally from durum wheat semolina known as khobz . Bakeries are very common throughout Morocco and fresh bread is a staple in every city, town and village. The most common is whole grain coarse ground or white flour bread. There are also a number of flat breads and pulled unleavened pan-fried breads. The most popular drink is "atai", green tea with mint leaves and other ingredients. Tea occupies a very important place in the culture of Morocco and is considered an art form. It is served not only at mealtimes but all through the day, and it is especially a drink of hospitality, commonly served whenever there are guests. It is served to guests, and it is impolite to refuse it.Football is the country's most popular sport, popular among the urban youth in particular. In 1986, Morocco became the first Arab and African country to qualify for the second round of the FIFA World Cup . Morocco hosted the Africa Cup of Nations in 1988 and will host it again in 2025 after original host Guinea was stripped from hosting rights due to inadequacy of hosting preparations. Morocco was originally scheduled to host the 2015 Africa Cup of Nations , but refused to host the tournament on the scheduled dates because of fears over the Ebola outbreak on the continent. Morocco made six attempts to host the FIFA World Cup but lost five times to the United States, France, Germany, South Africa and a Canada–Mexico–United States joint bid, however Morocco will co-host it in 2030 along with Portugal and Spain having finally won the bid in their sixth attempt. In 2022 , Morocco became the first African and Arab team to reach the semifinals and finished 4th in the tournament. At the 1984 Olympic Games , two Moroccans won gold medals in track and field. Nawal El Moutawakel won in the 400 metres hurdles ; she was the first woman from an Arab or Islamic country to win an Olympic gold medal. Saïd Aouita won the 5000 metres at the same games. Hicham El Guerrouj won gold medals for Morocco at the 2004 Summer Olympics in the 1500 metres and 5000 metres and holds several world records in the mile run . Spectator sports in Morocco traditionally centred on the art of horsemanship until European sports— football , polo , swimming , and tennis —were introduced at the end of the 19th century. Tennis and golf have become popular. [ citation needed ] Several Moroccan professional players have competed in international competition, and the country fielded its first Davis Cup team in 1999. Morocco was one of the continent's pioneers in basketball as it established one of Africa's first competitive leagues. Rugby came to Morocco in the early 20th century, mainly by the French who occupied the country. As a result, Moroccan rugby was tied to the fortunes of France, during the first and second World War , with many Moroccan players going away to fight. Like many other Maghreb nations, Moroccan rugby tended to look to Europe for inspiration, rather than to the rest of Africa. Kickboxing is also popular in Morocco. [ citation needed ] The Moroccan-Dutch Badr Hari , heavyweight kickboxer and martial artist, is a former K-1 heavyweight champion and K-1 World Grand Prix 2008 and 2009 finalist. [ citation needed ]

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Liberia/html

Liberia

Liberia ( / l aɪ ˈ b ɪər i ə / ⓘ ), officially the Republic of Liberia , is a country on the West African coast. It is bordered by Sierra Leone to its northwest , Guinea to its north , Ivory Coast to its east , and the Atlantic Ocean to its south and southwest. It has a population of around five and one-half million and covers an area of 43,000 square miles (111,369 km 2 ) . The country's official language is English; however, over 20 indigenous languages are spoken, reflecting the country's ethnic and cultural diversity. The capital and largest city is Monrovia . Liberia began in the early 19th century as a project of the American Colonization Society (ACS), which believed black people would face better chances for freedom and prosperity in Africa than in the United States. Between 1822 and the outbreak of the American Civil War in 1861, more than 15,000 freed and free-born African Americans , along with 3,198 Afro-Caribbeans , relocated to Liberia. Gradually developing an Americo-Liberian identity, the settlers carried their culture and tradition with them. Liberia declared independence on July 26, 1847, which the U.S. did not recognize until February 5, 1862. Liberia was the first African republic to proclaim its independence and is Africa's first and oldest modern republic. Along with Ethiopia , it was one of the two African countries to maintain its sovereignty and independence during the European colonial " Scramble for Africa ". During World War II , Liberia supported the United States war effort against Germany , and in turn received considerable American investment in infrastructure, which aided the country's wealth and development. President William Tubman encouraged economic and political changes that heightened the country's prosperity and international profile; Liberia was a founding member of the League of Nations , United Nations , and the Organisation of African Unity . The Americo-Liberian settlers did not relate well to the indigenous peoples they encountered. Colonial settlements were raided by the Kru and Grebo from their inland chiefdoms. Americo-Liberians formed into a small elite that held disproportionate political power; indigenous Africans were excluded from birthright citizenship in their own land until 1904. In 1980, political tensions from the rule of William R. Tolbert resulted in a military coup during which Tolbert was killed, marking the end of Americo-Liberian rule in the country and beginning over two decades of political instability. Five years of military rule by the People's Redemption Council and five years of civilian rule by the National Democratic Party of Liberia were followed by the First and Second Liberian Civil Wars . These resulted in the deaths of 250,000 people (about 8% of the population) and the displacement of many more, with Liberia's economy shrinking by 90%. A peace agreement in 2003 led to democratic elections in 2005 .The presence of Oldowan Earlier Stone Age (earliest ESA) artifacts in West Africa has been confirmed by Michael Omolewa , attesting to the presence of ancient humans. Undated Acheulean (ESA) artifacts are well documented across West Africa . The emerging chronometric record of the Middle Stone Age (MSA) indicates that core and flake technologies have been present in West Africa since at least the Chibanian (~780–126 thousand years ago or ka ) in northern, open Sahelian zones, and that they persisted until the Terminal Pleistocene / Holocene boundary (~12 ka) in both northern and southern zones of West Africa. This makes them the youngest examples of such MSA technology anywhere in Africa. The presence of MSA populations in forests remains an open question; however technological differences may correlate with various ecological zones . Later Stone Age (LSA) populations evidence significant technological diversification, including both microlithic and macrolithic traditions. The record shows that aceramic and ceramic Later Stone Age (LSA) assemblages in West Africa overlap chronologically, and that changing densities of microlithic industries from the coast to the north are geographically structured. These features may represent social networks or some form of cultural diffusion allied to changing ecological conditions. Microlithic industries with ceramics became common by the Mid-Holocene , coupled with an apparent intensification of wild food exploitation. Between ~4–3.5 ka, these societies gradually transformed into food producers, possibly through contact with northern pastoralists and agriculturalists, as the environment became more arid. However, hunter-gatherers have survived in the more forested parts of West Africa until much later, attesting to the strength of ecological boundaries in this region. The Pepper Coast , also known as the Grain Coast, has been inhabited by indigenous peoples of Africa at least as far back as the 12th century. Mande -speaking people expanded from the north and east, forcing many smaller ethnic groups southward toward the Atlantic Ocean. The Dei , Bassa , Kru , Gola , and Kissi were some of the earliest documented peoples in the area. This influx of these groups was compounded by the decline of the Mali Empire in 1375 and the Songhai Empire in 1591. As inland regions underwent desertification , inhabitants moved to the wetter coast. These new inhabitants brought skills such as cotton spinning , cloth weaving , iron smelting , rice and sorghum cultivation, and social and political institutions from the Mali and Songhai empires. Shortly after the Mane conquered the region, the Vai people of the former Mali Empire immigrated into the Grand Cape Mount County region. The ethnic Kru opposed the influx of Vai, forming an alliance with the Mane to stop further influx of Vai. People along the coast built canoes and traded with other West Africans from Cap-Vert to the Gold Coast . Between 1461 and the late 17th century, Portuguese , Dutch , and British traders had contacts and trading posts in the region. The Portuguese named the area Costa da Pimenta ("Pepper Coast") but it later came to be known as the Grain Coast , due to the abundance of melegueta pepper grains. The traders would barter commodities and goods with local people. [ citation needed ] In the United States, there was a movement to settle African Americans , both free-born and formerly enslaved, in Africa. This was because they faced racial discrimination in the form of political disenfranchisement and the denial of civil, religious, and social rights. Formed in 1816, the American Colonization Society (ACS) was made up mostly of Quakers and slaveholders. Quakers believed black people would face better chances for freedom in Africa than in the U.S. While slaveholders opposed freedom for enslaved people, some viewed "repatriation" of free people of color as a way to avoid slave rebellions . In 1822, the American Colonization Society began sending free people of color to the Pepper Coast voluntarily to establish a colony. Mortality from tropical diseases was high—of the 4,571 emigrants who arrived in Liberia between 1820 and 1843, only 1,819 survived. By 1867, the ACS (and state-related chapters) had assisted in the migration of more than 13,000 people of color from the United States and the Caribbean to Liberia. These free African Americans and their descendants married within their community and came to identify as Americo-Liberians . Many were of mixed race and educated in American culture; they did not identify with the indigenous natives of the tribes they encountered. They developed an ethnic group that had a cultural tradition infused with American notions of political republicanism and Protestant Christianity. The ACS, supported by prominent American politicians such as Abraham Lincoln , Henry Clay , and James Monroe , believed "repatriation" was preferable to having emancipated slaves remain in the United States. Similar state-based organizations established colonies in Mississippi-in-Africa , Kentucky in Africa , and the Republic of Maryland , which Liberia later annexed. However, Lincoln in 1862 described Liberia as only "in a certain sense...a success", and proposed instead that free people of color be assisted to emigrate to Chiriquí , today part of Panama. The Americo-Liberian settlers did not relate well to the indigenous peoples they encountered, especially those in communities of the more isolated " bush ". The colonial settlements were raided by the Kru and Grebo from their inland chiefdoms. Encounters with tribal Africans in the bush often became violent. Believing themselves different from and culturally and educationally superior to the indigenous peoples, the Americo-Liberians developed as an elite minority that created and held on to political power. The Americo-Liberian settlers adopted clothing such as hoop skirts and tailcoats and generally viewed themselves as culturally and socially superior to indigenous Africans. Indigenous tribesmen did not enjoy birthright citizenship in their own land until 1904. Americo-Liberians encouraged religious organizations to set up missions and schools to educate the indigenous peoples. On July 26, 1847, the settlers issued a Declaration of Independence and promulgated a constitution . Based on the political principles of the United States Constitution , it established the independent Republic of Liberia. On August 24, Liberia adopted its 11-striped national flag . The United Kingdom was the first country to recognize Liberia's independence. The United States did not recognize Liberia until 1862, after the Southern states, which had strong political power in the American government, declared their secession and the formation of the Confederacy . The leadership of the new nation consisted largely of the Americo-Liberians , who at the beginning established political and economic dominance in the coastal areas that the ACS had purchased; they maintained relations with the United States and contacts in developing these areas and the resulting trade. Their passage of the 1865 Ports of Entry Act prohibited foreign commerce with the inland tribes, ostensibly to "encourage the growth of civilized values" before such trade was allowed in the region. By 1877, the True Whig Party was the country's most powerful political entity. It was made up primarily of Americo-Liberians, who maintained social, economic and political dominance well into the 20th century, repeating patterns of European colonists in other nations in Africa. Competition for office was usually contained within the party; a party nomination virtually ensured election. Pressure from the United Kingdom, which controlled Sierra Leone to the northwest, and France, with its interests in the north and east, led to a loss of Liberia's claims to extensive territories. Both Sierra Leone and the Ivory Coast annexed territories. Liberia struggled to attract investment to develop infrastructure and a larger, industrial economy. There was a decline in production of Liberian goods in the late 19th century, and the government struggled financially, resulting in indebtedness on a series of international loans. On July 16, 1892, Martha Ann Erskine Ricks met Queen Victoria at Windsor Castle and presented her with a handmade quilt, Liberia's first diplomatic gift. Born into slavery in Tennessee, Ricks said, "I had heard it often, from the time I was a child, how good the Queen had been to my people—to slaves—and how she wanted us to be free." American and other international interests emphasized resource extraction, with rubber production as a major industry in the early 20th century. In 1914, Imperial Germany accounted for three quarters of the trade of Liberia. This was a cause for concern among the British colonial authorities of Sierra Leone and the French colonial authorities of French Guinea and the Ivory Coast as tensions with Germany increased. Liberia remained neutral during World War I until August 4, 1917, when it declared war on Germany. Subsequently, it was one of 32 nations to take part in the Versailles Peace Conference in 1919, which ended the war and established the League of Nations ; Liberia was among the few African and non-Western nations to participate in both the conference and the founding of the League. In 1927, the country's elections again showed the power of the True Whig Party, with electoral proceedings that have been called some of the most rigged ever; the winning candidate was declared to have received votes amounting to more than 15 times the number of eligible voters. (The loser actually received around 60% of the eligible vote.) Soon after, allegations of modern slavery in Liberia led the League of Nations to establish the Christy Commission . Findings included government involvement in widespread "Forced or compulsory labour". Minority ethnic groups especially were exploited in a system that enriched well-connected elites. As a result of the report, President Charles D. B. King and Vice President Allen N. Yancy resigned. In the mid-20th century, Liberia gradually began to modernize with American assistance. During World War II , the United States made major infrastructure improvements to support its military efforts in Africa and Europe against Germany. It built the Freeport of Monrovia and Roberts International Airport under the Lend-Lease program before its entry into the Second World War. After the war, President William Tubman encouraged foreign investment, with Liberia achieving the second-highest rate of economic growth in the world during the 1950s. In international affairs, it was a founding member of the United Nations , a vocal critic of South African apartheid , a proponent of African independence from European colonial powers, and a supporter of Pan-Africanism . Liberia also helped to fund the Organisation of African Unity . On April 12, 1980, a military coup led by Master Sergeant Samuel Doe of the Krahn ethnic group overthrew and killed President William R. Tolbert Jr. Doe and the other plotters later executed most of Tolbert's cabinet and other Americo-Liberian government officials and True Whig Party members on a Monrovia beach. The coup leaders formed the People's Redemption Council (PRC) to govern the country. A strategic Cold War ally of the West, Doe received significant financial backing from the United States while critics condemned the PRC for corruption and political repression. After Liberia adopted a new constitution in 1985, Doe was elected president in subsequent elections that were internationally condemned as fraudulent. On November 12, 1985, a failed coup was launched by Thomas Quiwonkpa , whose soldiers briefly occupied the national radio station . Government repression intensified in response, as Doe's troops responded by executing members of the Gio and Mano ethnic groups in Nimba County . The National Patriotic Front of Liberia (NPFL), a rebel group led by Charles Taylor , launched an insurrection in December 1989 against Doe's government with the backing of neighboring countries such as Burkina Faso and Ivory Coast . This triggered the First Liberian Civil War . By September 1990, Doe's forces controlled only a small area just outside the capital, and Doe was captured and executed in that month by rebel forces. The rebels soon split into conflicting factions. The Economic Community Monitoring Group under the Economic Community of West African States organized an armed intervention. Between 1989 and 1997, around 60,000 to 80,000 Liberians died, and, by 1996, around 700,000 others had been displaced into refugee camps in neighboring countries. A peace deal between warring parties was reached in 1995, leading to Taylor's election as president in 1997. Under Taylor's leadership, Liberia became a pariah state due to its use of blood diamonds and illegal timber exports to fund the Revolutionary United Front in the Sierra Leone Civil War . The Second Liberian Civil War began in 1999 when Liberians United for Reconciliation and Democracy , a rebel group based in the northwest of the country, launched an armed insurrection against Taylor. In March 2003, a second rebel group, Movement for Democracy in Liberia , began launching attacks against Taylor from the southeast. Peace talks between the factions began in Accra in June of that year, and Taylor was indicted by the Special Court for Sierra Leone (SCSL) for crimes against humanity the same month. By July 2003, the rebels had launched an assault on Monrovia . Under heavy pressure from the international community and the domestic Women of Liberia Mass Action for Peace movement, Taylor resigned in August 2003 and went into exile in Nigeria . A peace deal was signed later that month. The United Nations Mission in Liberia began arriving in September 2003 to provide security and monitor the peace accord, and an interim government took power the following October. The subsequent 2005 elections were internationally regarded as the freest and fairest in Liberian history. Ellen Johnson Sirleaf , a US-educated economist, former Minister of Finance and future Nobel Prize for Peace winner, was elected as the first female president in Africa. Upon her inauguration, Sirleaf requested the extradition of Taylor from Nigeria and transferred him to the SCSL for trial in The Hague . In 2006, the government established a Truth and Reconciliation Commission to address the causes and crimes of the civil war. In 2011, July 26 was proclaimed by President Ellen Johnson Sirleaf to be observed as National Independence Day. In October 2011, peace activist Leymah Gbowee received the Nobel Peace Prize in her work of leading a women's peace movement that brought to an end to the Second Liberian Civil War in 2003. In November 2011, President Ellen Johnson Sirleaf was re-elected for a second six-year term. Following the 2017 Liberian general election , former professional football striker George Weah , considered one of the greatest African players of all time, was sworn in as president on January 22, 2018, becoming the fourth youngest serving president in Africa. The inauguration marked Liberia's first fully democratic transition in 74 years. Weah cited fighting corruption, reforming the economy, combating illiteracy, and improving living conditions as the main targets of his presidency. However, opposition leader Joseph Boakai defeated Weah in the tightly contested 2023 presidential election . On 22 January 2024, Joseph Boakai was sworn in as Liberia's new president. The presence of Oldowan Earlier Stone Age (earliest ESA) artifacts in West Africa has been confirmed by Michael Omolewa , attesting to the presence of ancient humans. Undated Acheulean (ESA) artifacts are well documented across West Africa . The emerging chronometric record of the Middle Stone Age (MSA) indicates that core and flake technologies have been present in West Africa since at least the Chibanian (~780–126 thousand years ago or ka ) in northern, open Sahelian zones, and that they persisted until the Terminal Pleistocene / Holocene boundary (~12 ka) in both northern and southern zones of West Africa. This makes them the youngest examples of such MSA technology anywhere in Africa. The presence of MSA populations in forests remains an open question; however technological differences may correlate with various ecological zones . Later Stone Age (LSA) populations evidence significant technological diversification, including both microlithic and macrolithic traditions. The record shows that aceramic and ceramic Later Stone Age (LSA) assemblages in West Africa overlap chronologically, and that changing densities of microlithic industries from the coast to the north are geographically structured. These features may represent social networks or some form of cultural diffusion allied to changing ecological conditions. Microlithic industries with ceramics became common by the Mid-Holocene , coupled with an apparent intensification of wild food exploitation. Between ~4–3.5 ka, these societies gradually transformed into food producers, possibly through contact with northern pastoralists and agriculturalists, as the environment became more arid. However, hunter-gatherers have survived in the more forested parts of West Africa until much later, attesting to the strength of ecological boundaries in this region. The Pepper Coast , also known as the Grain Coast, has been inhabited by indigenous peoples of Africa at least as far back as the 12th century. Mande -speaking people expanded from the north and east, forcing many smaller ethnic groups southward toward the Atlantic Ocean. The Dei , Bassa , Kru , Gola , and Kissi were some of the earliest documented peoples in the area. This influx of these groups was compounded by the decline of the Mali Empire in 1375 and the Songhai Empire in 1591. As inland regions underwent desertification , inhabitants moved to the wetter coast. These new inhabitants brought skills such as cotton spinning , cloth weaving , iron smelting , rice and sorghum cultivation, and social and political institutions from the Mali and Songhai empires. Shortly after the Mane conquered the region, the Vai people of the former Mali Empire immigrated into the Grand Cape Mount County region. The ethnic Kru opposed the influx of Vai, forming an alliance with the Mane to stop further influx of Vai. People along the coast built canoes and traded with other West Africans from Cap-Vert to the Gold Coast .Between 1461 and the late 17th century, Portuguese , Dutch , and British traders had contacts and trading posts in the region. The Portuguese named the area Costa da Pimenta ("Pepper Coast") but it later came to be known as the Grain Coast , due to the abundance of melegueta pepper grains. The traders would barter commodities and goods with local people. [ citation needed ] In the United States, there was a movement to settle African Americans , both free-born and formerly enslaved, in Africa. This was because they faced racial discrimination in the form of political disenfranchisement and the denial of civil, religious, and social rights. Formed in 1816, the American Colonization Society (ACS) was made up mostly of Quakers and slaveholders. Quakers believed black people would face better chances for freedom in Africa than in the U.S. While slaveholders opposed freedom for enslaved people, some viewed "repatriation" of free people of color as a way to avoid slave rebellions . In 1822, the American Colonization Society began sending free people of color to the Pepper Coast voluntarily to establish a colony. Mortality from tropical diseases was high—of the 4,571 emigrants who arrived in Liberia between 1820 and 1843, only 1,819 survived. By 1867, the ACS (and state-related chapters) had assisted in the migration of more than 13,000 people of color from the United States and the Caribbean to Liberia. These free African Americans and their descendants married within their community and came to identify as Americo-Liberians . Many were of mixed race and educated in American culture; they did not identify with the indigenous natives of the tribes they encountered. They developed an ethnic group that had a cultural tradition infused with American notions of political republicanism and Protestant Christianity. The ACS, supported by prominent American politicians such as Abraham Lincoln , Henry Clay , and James Monroe , believed "repatriation" was preferable to having emancipated slaves remain in the United States. Similar state-based organizations established colonies in Mississippi-in-Africa , Kentucky in Africa , and the Republic of Maryland , which Liberia later annexed. However, Lincoln in 1862 described Liberia as only "in a certain sense...a success", and proposed instead that free people of color be assisted to emigrate to Chiriquí , today part of Panama. The Americo-Liberian settlers did not relate well to the indigenous peoples they encountered, especially those in communities of the more isolated " bush ". The colonial settlements were raided by the Kru and Grebo from their inland chiefdoms. Encounters with tribal Africans in the bush often became violent. Believing themselves different from and culturally and educationally superior to the indigenous peoples, the Americo-Liberians developed as an elite minority that created and held on to political power. The Americo-Liberian settlers adopted clothing such as hoop skirts and tailcoats and generally viewed themselves as culturally and socially superior to indigenous Africans. Indigenous tribesmen did not enjoy birthright citizenship in their own land until 1904. Americo-Liberians encouraged religious organizations to set up missions and schools to educate the indigenous peoples. On July 26, 1847, the settlers issued a Declaration of Independence and promulgated a constitution . Based on the political principles of the United States Constitution , it established the independent Republic of Liberia. On August 24, Liberia adopted its 11-striped national flag . The United Kingdom was the first country to recognize Liberia's independence. The United States did not recognize Liberia until 1862, after the Southern states, which had strong political power in the American government, declared their secession and the formation of the Confederacy . The leadership of the new nation consisted largely of the Americo-Liberians , who at the beginning established political and economic dominance in the coastal areas that the ACS had purchased; they maintained relations with the United States and contacts in developing these areas and the resulting trade. Their passage of the 1865 Ports of Entry Act prohibited foreign commerce with the inland tribes, ostensibly to "encourage the growth of civilized values" before such trade was allowed in the region. By 1877, the True Whig Party was the country's most powerful political entity. It was made up primarily of Americo-Liberians, who maintained social, economic and political dominance well into the 20th century, repeating patterns of European colonists in other nations in Africa. Competition for office was usually contained within the party; a party nomination virtually ensured election. Pressure from the United Kingdom, which controlled Sierra Leone to the northwest, and France, with its interests in the north and east, led to a loss of Liberia's claims to extensive territories. Both Sierra Leone and the Ivory Coast annexed territories. Liberia struggled to attract investment to develop infrastructure and a larger, industrial economy. There was a decline in production of Liberian goods in the late 19th century, and the government struggled financially, resulting in indebtedness on a series of international loans. On July 16, 1892, Martha Ann Erskine Ricks met Queen Victoria at Windsor Castle and presented her with a handmade quilt, Liberia's first diplomatic gift. Born into slavery in Tennessee, Ricks said, "I had heard it often, from the time I was a child, how good the Queen had been to my people—to slaves—and how she wanted us to be free." American and other international interests emphasized resource extraction, with rubber production as a major industry in the early 20th century. In 1914, Imperial Germany accounted for three quarters of the trade of Liberia. This was a cause for concern among the British colonial authorities of Sierra Leone and the French colonial authorities of French Guinea and the Ivory Coast as tensions with Germany increased. Liberia remained neutral during World War I until August 4, 1917, when it declared war on Germany. Subsequently, it was one of 32 nations to take part in the Versailles Peace Conference in 1919, which ended the war and established the League of Nations ; Liberia was among the few African and non-Western nations to participate in both the conference and the founding of the League. In 1927, the country's elections again showed the power of the True Whig Party, with electoral proceedings that have been called some of the most rigged ever; the winning candidate was declared to have received votes amounting to more than 15 times the number of eligible voters. (The loser actually received around 60% of the eligible vote.) Soon after, allegations of modern slavery in Liberia led the League of Nations to establish the Christy Commission . Findings included government involvement in widespread "Forced or compulsory labour". Minority ethnic groups especially were exploited in a system that enriched well-connected elites. As a result of the report, President Charles D. B. King and Vice President Allen N. Yancy resigned. In the mid-20th century, Liberia gradually began to modernize with American assistance. During World War II , the United States made major infrastructure improvements to support its military efforts in Africa and Europe against Germany. It built the Freeport of Monrovia and Roberts International Airport under the Lend-Lease program before its entry into the Second World War. After the war, President William Tubman encouraged foreign investment, with Liberia achieving the second-highest rate of economic growth in the world during the 1950s. In international affairs, it was a founding member of the United Nations , a vocal critic of South African apartheid , a proponent of African independence from European colonial powers, and a supporter of Pan-Africanism . Liberia also helped to fund the Organisation of African Unity . Liberia remained neutral during World War I until August 4, 1917, when it declared war on Germany. Subsequently, it was one of 32 nations to take part in the Versailles Peace Conference in 1919, which ended the war and established the League of Nations ; Liberia was among the few African and non-Western nations to participate in both the conference and the founding of the League. In 1927, the country's elections again showed the power of the True Whig Party, with electoral proceedings that have been called some of the most rigged ever; the winning candidate was declared to have received votes amounting to more than 15 times the number of eligible voters. (The loser actually received around 60% of the eligible vote.) Soon after, allegations of modern slavery in Liberia led the League of Nations to establish the Christy Commission . Findings included government involvement in widespread "Forced or compulsory labour". Minority ethnic groups especially were exploited in a system that enriched well-connected elites. As a result of the report, President Charles D. B. King and Vice President Allen N. Yancy resigned. In the mid-20th century, Liberia gradually began to modernize with American assistance. During World War II , the United States made major infrastructure improvements to support its military efforts in Africa and Europe against Germany. It built the Freeport of Monrovia and Roberts International Airport under the Lend-Lease program before its entry into the Second World War. After the war, President William Tubman encouraged foreign investment, with Liberia achieving the second-highest rate of economic growth in the world during the 1950s. In international affairs, it was a founding member of the United Nations , a vocal critic of South African apartheid , a proponent of African independence from European colonial powers, and a supporter of Pan-Africanism . Liberia also helped to fund the Organisation of African Unity . On April 12, 1980, a military coup led by Master Sergeant Samuel Doe of the Krahn ethnic group overthrew and killed President William R. Tolbert Jr. Doe and the other plotters later executed most of Tolbert's cabinet and other Americo-Liberian government officials and True Whig Party members on a Monrovia beach. The coup leaders formed the People's Redemption Council (PRC) to govern the country. A strategic Cold War ally of the West, Doe received significant financial backing from the United States while critics condemned the PRC for corruption and political repression. After Liberia adopted a new constitution in 1985, Doe was elected president in subsequent elections that were internationally condemned as fraudulent. On November 12, 1985, a failed coup was launched by Thomas Quiwonkpa , whose soldiers briefly occupied the national radio station . Government repression intensified in response, as Doe's troops responded by executing members of the Gio and Mano ethnic groups in Nimba County . The National Patriotic Front of Liberia (NPFL), a rebel group led by Charles Taylor , launched an insurrection in December 1989 against Doe's government with the backing of neighboring countries such as Burkina Faso and Ivory Coast . This triggered the First Liberian Civil War . By September 1990, Doe's forces controlled only a small area just outside the capital, and Doe was captured and executed in that month by rebel forces. The rebels soon split into conflicting factions. The Economic Community Monitoring Group under the Economic Community of West African States organized an armed intervention. Between 1989 and 1997, around 60,000 to 80,000 Liberians died, and, by 1996, around 700,000 others had been displaced into refugee camps in neighboring countries. A peace deal between warring parties was reached in 1995, leading to Taylor's election as president in 1997. Under Taylor's leadership, Liberia became a pariah state due to its use of blood diamonds and illegal timber exports to fund the Revolutionary United Front in the Sierra Leone Civil War . The Second Liberian Civil War began in 1999 when Liberians United for Reconciliation and Democracy , a rebel group based in the northwest of the country, launched an armed insurrection against Taylor. In March 2003, a second rebel group, Movement for Democracy in Liberia , began launching attacks against Taylor from the southeast. Peace talks between the factions began in Accra in June of that year, and Taylor was indicted by the Special Court for Sierra Leone (SCSL) for crimes against humanity the same month. By July 2003, the rebels had launched an assault on Monrovia . Under heavy pressure from the international community and the domestic Women of Liberia Mass Action for Peace movement, Taylor resigned in August 2003 and went into exile in Nigeria . A peace deal was signed later that month. The United Nations Mission in Liberia began arriving in September 2003 to provide security and monitor the peace accord, and an interim government took power the following October. The subsequent 2005 elections were internationally regarded as the freest and fairest in Liberian history. Ellen Johnson Sirleaf , a US-educated economist, former Minister of Finance and future Nobel Prize for Peace winner, was elected as the first female president in Africa. Upon her inauguration, Sirleaf requested the extradition of Taylor from Nigeria and transferred him to the SCSL for trial in The Hague . In 2006, the government established a Truth and Reconciliation Commission to address the causes and crimes of the civil war. In 2011, July 26 was proclaimed by President Ellen Johnson Sirleaf to be observed as National Independence Day. In October 2011, peace activist Leymah Gbowee received the Nobel Peace Prize in her work of leading a women's peace movement that brought to an end to the Second Liberian Civil War in 2003. In November 2011, President Ellen Johnson Sirleaf was re-elected for a second six-year term. Following the 2017 Liberian general election , former professional football striker George Weah , considered one of the greatest African players of all time, was sworn in as president on January 22, 2018, becoming the fourth youngest serving president in Africa. The inauguration marked Liberia's first fully democratic transition in 74 years. Weah cited fighting corruption, reforming the economy, combating illiteracy, and improving living conditions as the main targets of his presidency. However, opposition leader Joseph Boakai defeated Weah in the tightly contested 2023 presidential election . On 22 January 2024, Joseph Boakai was sworn in as Liberia's new president. Liberia is situated in West Africa , bordering the North Atlantic Ocean to the country's southwest. It lies between latitudes 4° and 9°N , and longitudes 7° and 12°W . The landscape is characterized by mostly flat to rolling coastal plains that contain mangroves and swamps , which rise to a rolling plateau and low mountains in the northeast. Tropical rainforests cover the hills, while elephant grass and semi-deciduous forests make up the dominant vegetation in the northern sections. Liberia's watershed tends to move in a southwestern pattern towards the sea as new rains move down the forested plateau off the inland mountain range of Guinée Forestière , in Guinea . Cape Mount near the border with Sierra Leone receives the most precipitation in the nation. Liberia's main northwestern boundary is traversed by the Mano River while its southeast limits are bounded by the Cavalla River . Liberia's three largest rivers are St. Paul exiting near Monrovia , the river St. John at Buchanan , and the Cestos River , all of which flow into the Atlantic. The Cavalla is the longest river in the nation at 320 miles (510 km) . The highest point wholly within Liberia is Mount Wuteve at 4,724 feet (1,440 m) above sea level in the northwestern Liberia range of the West Africa Mountains and the Guinea Highlands . However, Mount Nimba near Yekepa , is higher at 1,752 metres (5,748 ft) above sea level , but is not wholly within Liberia as Nimba is located at the point where Liberia borders both Guinea and Ivory Coast . Nimba is thus the tallest mountain in those countries, as well. The equatorial climate, in the south of the country, is hot year-round with heavy rainfall from May to October with a short interlude in mid-July to August. During the winter months of November to March, dry dust-laden harmattan winds blow inland, causing many problems for residents. Climate change in Liberia causes many problems as Liberia is particularly vulnerable to climate change . Like many other countries in Africa , Liberia both faces existing environmental issues , as well as sustainable development challenges. Because of its location in Africa, it is vulnerable to extreme weather , the coastal effects of sea level rise , and changing water systems and water availability. Climate change is expected to severely impact the economy of Liberia , especially agriculture, fisheries, and forestry. Liberia has been an active participant in international and local policy changes related to climate change. Forests on the coastline are composed mostly of salt-tolerant mangrove trees, while the more sparsely populated inland has forests opening onto a plateau of drier grasslands . The climate is equatorial , with significant rainfall during the May–October rainy season and harsh harmattan winds the remainder of the year. Liberia possesses about forty percent of the remaining Upper Guinean rainforest . It was an important producer of rubber in the early 20th century. Four terrestrial ecoregions lie within Liberia's borders: Guinean montane forests , Western Guinean lowland forests , Guinean forest–savanna mosaic , and Guinean mangroves . It had a 2019 Forest Landscape Integrity Index mean score of 4.79/10, ranking it 116th globally out of 172 countries. Liberia is a global biodiversity hotspot —a significant reservoir of biodiversity that is under threat from humans. Endangered species are hunted for human consumption as bushmeat in Liberia. Species hunted for food in Liberia include elephants , pygmy hippopotamus , chimpanzees , leopards , duikers , and other monkeys. Bushmeat is often exported to neighboring Sierra Leone and Ivory Coast, despite a ban on the cross-border sale of wild animals. Bushmeat is widely eaten in Liberia, and is considered a delicacy. A 2004 public opinion survey found that bushmeat ranked second behind fish amongst residents of the capital Monrovia as a preferred source of protein. Of households where bushmeat was served, 80% of residents said they cooked it "once in a while," while 13% cooked it once a week and 7% cooked bushmeat daily. The survey was conducted during the last civil war, and bushmeat consumption is now believed to be far higher. Trypanosoma brucei gambiense is endemic in some animal hosts here including both domestic and wild . This causes the disease nagana . In pigs here and in Ivory Coast , that includes Tbg group 1 . Tbg and its vector Glossina palpalis gambiense are a constant presence in the rainforests here. Much research into Tbg was performed in the 1970s by Mehlitz and by Gibson, both working in Bong Mine with samples from around the country. The West African pariah dog is also a host for Tbg . The Desert Locust ( Schistocerca gregaria ) is a constant presence here. The Hairy Slit-Faced Bat ( Nycteris hispida ) suffers from malaria here. Slash-and-burn agriculture is one of the human activities eroding Liberia's natural forests. A 2004 UN report estimated that 99% of Liberians burned charcoal and fuel wood for cooking and heating, resulting in deforestation . Illegal logging has increased in Liberia since the end of the Second Civil War in 2003 . In 2012, President Sirleaf granted licenses to companies to cut down 58% of all the primary rainforest left in Liberia. After international protests, many of those logging permits were canceled. In September 2014, Liberia and Norway struck an agreement whereby Liberia ceased all logging in exchange for $150 million in development aid. Pollution is a significant issue in Monrovia . Since 2006, the international community has paid for all garbage collection and disposal in Monrovia via the World Bank . Liberia is divided into fifteen counties , which, in turn, are subdivided into a total of 90 districts and further subdivided into clans . The oldest counties are Grand Bassa and Montserrado, both founded in 1839 prior to Liberian independence. Gbarpolu is the newest county, created in 2001. Nimba is the largest of the counties in size at 11,551 km 2 (4,460 sq mi) , while Montserrado is the smallest at 737.069 sq mi (1,909.00 km 2 ) . Montserrado is also the most populous county with 1,144,806 residents as of the 2008 census. The fifteen counties are administered by superintendents appointed by the president. The Constitution calls for the election of various chiefs at the county and local level, but these elections have not taken place since 1985 due to war and financial constraints. Parallel to the administrative divisions of the country are the local and municipal divisions. Liberia currently does not have any constitutional framework or uniform statutes which deal with the creation or revocation of local governments. All existing local governments—cities, townships, and a borough—were created by specific acts of the Liberian government, and thus the structure and duties/responsibilities of each local government vary greatly from one to the other. [ citation needed ]The equatorial climate, in the south of the country, is hot year-round with heavy rainfall from May to October with a short interlude in mid-July to August. During the winter months of November to March, dry dust-laden harmattan winds blow inland, causing many problems for residents. Climate change in Liberia causes many problems as Liberia is particularly vulnerable to climate change . Like many other countries in Africa , Liberia both faces existing environmental issues , as well as sustainable development challenges. Because of its location in Africa, it is vulnerable to extreme weather , the coastal effects of sea level rise , and changing water systems and water availability. Climate change is expected to severely impact the economy of Liberia , especially agriculture, fisheries, and forestry. Liberia has been an active participant in international and local policy changes related to climate change. Forests on the coastline are composed mostly of salt-tolerant mangrove trees, while the more sparsely populated inland has forests opening onto a plateau of drier grasslands . The climate is equatorial , with significant rainfall during the May–October rainy season and harsh harmattan winds the remainder of the year. Liberia possesses about forty percent of the remaining Upper Guinean rainforest . It was an important producer of rubber in the early 20th century. Four terrestrial ecoregions lie within Liberia's borders: Guinean montane forests , Western Guinean lowland forests , Guinean forest–savanna mosaic , and Guinean mangroves . It had a 2019 Forest Landscape Integrity Index mean score of 4.79/10, ranking it 116th globally out of 172 countries. Liberia is a global biodiversity hotspot —a significant reservoir of biodiversity that is under threat from humans. Endangered species are hunted for human consumption as bushmeat in Liberia. Species hunted for food in Liberia include elephants , pygmy hippopotamus , chimpanzees , leopards , duikers , and other monkeys. Bushmeat is often exported to neighboring Sierra Leone and Ivory Coast, despite a ban on the cross-border sale of wild animals. Bushmeat is widely eaten in Liberia, and is considered a delicacy. A 2004 public opinion survey found that bushmeat ranked second behind fish amongst residents of the capital Monrovia as a preferred source of protein. Of households where bushmeat was served, 80% of residents said they cooked it "once in a while," while 13% cooked it once a week and 7% cooked bushmeat daily. The survey was conducted during the last civil war, and bushmeat consumption is now believed to be far higher. Trypanosoma brucei gambiense is endemic in some animal hosts here including both domestic and wild . This causes the disease nagana . In pigs here and in Ivory Coast , that includes Tbg group 1 . Tbg and its vector Glossina palpalis gambiense are a constant presence in the rainforests here. Much research into Tbg was performed in the 1970s by Mehlitz and by Gibson, both working in Bong Mine with samples from around the country. The West African pariah dog is also a host for Tbg . The Desert Locust ( Schistocerca gregaria ) is a constant presence here. The Hairy Slit-Faced Bat ( Nycteris hispida ) suffers from malaria here. Slash-and-burn agriculture is one of the human activities eroding Liberia's natural forests. A 2004 UN report estimated that 99% of Liberians burned charcoal and fuel wood for cooking and heating, resulting in deforestation . Illegal logging has increased in Liberia since the end of the Second Civil War in 2003 . In 2012, President Sirleaf granted licenses to companies to cut down 58% of all the primary rainforest left in Liberia. After international protests, many of those logging permits were canceled. In September 2014, Liberia and Norway struck an agreement whereby Liberia ceased all logging in exchange for $150 million in development aid. Pollution is a significant issue in Monrovia . Since 2006, the international community has paid for all garbage collection and disposal in Monrovia via the World Bank . Liberia is divided into fifteen counties , which, in turn, are subdivided into a total of 90 districts and further subdivided into clans . The oldest counties are Grand Bassa and Montserrado, both founded in 1839 prior to Liberian independence. Gbarpolu is the newest county, created in 2001. Nimba is the largest of the counties in size at 11,551 km 2 (4,460 sq mi) , while Montserrado is the smallest at 737.069 sq mi (1,909.00 km 2 ) . Montserrado is also the most populous county with 1,144,806 residents as of the 2008 census. The fifteen counties are administered by superintendents appointed by the president. The Constitution calls for the election of various chiefs at the county and local level, but these elections have not taken place since 1985 due to war and financial constraints. Parallel to the administrative divisions of the country are the local and municipal divisions. Liberia currently does not have any constitutional framework or uniform statutes which deal with the creation or revocation of local governments. All existing local governments—cities, townships, and a borough—were created by specific acts of the Liberian government, and thus the structure and duties/responsibilities of each local government vary greatly from one to the other. [ citation needed ]The government of Liberia, modeled on the government of the United States , is a unitary constitutional republic and representative democracy as established by the Constitution . The government has three co-equal branches of government: the executive , headed by the president ; the legislative , consisting of the bicameral Legislature of Liberia ; and the judicial , consisting of the Supreme Court and several lower courts . The president serves as head of government , head of state , and the commander-in-chief of the Armed Forces of Liberia . Among the president's other duties are to sign or veto legislative bills , grant pardons , and appoint Cabinet members, judges, and other public officials. Together with the vice president , the president is elected to a six-year term by majority vote in a two-round system and can serve up to two terms in office. The Legislature is composed of the Senate and the House of Representatives . The House, led by a speaker , has 73 members apportioned among the 15 counties on the basis of the national census , with each county receiving a minimum of two members. Each House member represents an electoral district within a county as drawn by the National Elections Commission and is elected by a plurality of the popular vote of their district into a six-year term. The Senate is made up of two senators from each county for a total of 30 senators. Senators serve nine-year terms and are elected at-large by a plurality of the popular vote. The vice president serves as the President of the Senate , with a President pro tempore serving in their absence. Liberia's highest judicial authority is the Supreme Court, made up of five members and headed by the Chief Justice of Liberia . Members are nominated to the court by the president and are confirmed by the Senate, serving until the age of 70. The judiciary is further divided into circuit and speciality courts , magistrate courts, and justices of the peace . The judicial system is a blend of common law , based on Anglo-American law, and customary law. An informal system of traditional courts still exists within the rural areas of the country, with trial by ordeal remaining common despite being officially outlawed. From 1877 to 1980, the government was dominated by the True Whig Party . Today, over 20 political parties are registered in the country, based largely around personalities and ethnic groups. Most parties suffer from poor organizational capacity. The 2005 elections marked the first time that the president's party did not gain a majority of seats in the Legislature. According to 2023 V-Dem Democracy indices Liberia is ranked 65th electoral democracy worldwide and 9th electoral democracy in Africa . The Armed Forces of Liberia (AFL) have 2,010 active personnel as of 2023, with most of them organized into the 23rd Infantry Brigade , consisting of two infantry battalions, one engineer company, and one military police company. There is also a small National Coast Guard with 60 personnel and several patrol ships. The AFL used to have an Air Wing, but all of its aircraft and facilities have been out of operation since the civil wars. It is in the process of reactivating its Air Wing with help from the Nigerian Air Force . Liberia has deployed peacekeepers to other countries since 2013 as part of UN or ECOWAS missions, with the largest being an infantry unit in Mali, and smaller numbers of personnel in Sudan, Guinea-Bissau, and South Sudan. About 800 of the AFL's 2,000 personnel have been deployed to Mali in several rotations before the UN mission there ended in December 2023. In 2022 the country had a military budget of US$18.7 million. The old military was disbanded after the civil wars and entirely rebuilt, starting in 2005, with assistance and funding from the United States. The military assistance program, which became known as Operation Onward Liberty in 2010, provided training with the goal of making the AFL into an apolitical and professional military. The operation ended in 2016, though the Michigan National Guard still continues to work with the AFL as part of the U.S. National Guard's State Partnership Program. After the turmoil following the First and Second Liberian Civil Wars , Liberia's internal stabilization in the 21st century brought a return to cordial relations with neighboring countries and much of the Western world. As in other African countries, China is an important part of the post-conflict reconstruction. In the past, both of Liberia's neighbors, Guinea and Sierra Leone , have accused Liberia of backing rebels in their countries. The Liberian National Police is the country's national police force. As of October 2007 it has 844 officers in 33 stations in Montserrado County , which contains Monrovia . The National Police Training Academy is in Paynesville City . A history of corruption among police officers diminishes public trust and operational effectiveness. The internal security is characterized by a general lawlessness coupled with the danger that former combatants in the late civil war might reestablish militias to challenge the civil authorities. Rape and sexual assault are frequent in the post-conflict era in Liberia. Liberia has one of the highest incidences of sexual violence against women in the world. Rape is the most frequently reported crime, accounting for more than one-third of sexual violence cases. Adolescent girls are the most frequently assaulted, and almost 40% of perpetrators are adult men known to victims. Both male and female homosexuality are illegal in Liberia . On July 20, 2012, the Liberian senate voted unanimously to enact legislation to prohibit and criminalize same-sex marriages . Corruption is endemic at every level of the Liberian government. When President Sirleaf took office in 2006, she announced that corruption was "the major public enemy." In 2014, the US ambassador to Liberia said that corruption there was harming people through "unnecessary costs to products and services that are already difficult for many Liberians to afford". Liberia scored a 3.3 on a scale from 10 (highly clean) to 0 (highly corrupt) on the 2010 Corruption Perceptions Index . This gave it a ranking 87th of 178 countries worldwide and 11th of 47 in Sub-Saharan Africa. This score represented a significant improvement since 2007, when the country scored 2.1 and ranked 150th of 180 countries. When dealing with public-facing government functionaries, 89% of Liberians say they have had to pay a bribe, the highest national percentage in the world according to the organization's 2010 Global Corruption Barometer. The Armed Forces of Liberia (AFL) have 2,010 active personnel as of 2023, with most of them organized into the 23rd Infantry Brigade , consisting of two infantry battalions, one engineer company, and one military police company. There is also a small National Coast Guard with 60 personnel and several patrol ships. The AFL used to have an Air Wing, but all of its aircraft and facilities have been out of operation since the civil wars. It is in the process of reactivating its Air Wing with help from the Nigerian Air Force . Liberia has deployed peacekeepers to other countries since 2013 as part of UN or ECOWAS missions, with the largest being an infantry unit in Mali, and smaller numbers of personnel in Sudan, Guinea-Bissau, and South Sudan. About 800 of the AFL's 2,000 personnel have been deployed to Mali in several rotations before the UN mission there ended in December 2023. In 2022 the country had a military budget of US$18.7 million. The old military was disbanded after the civil wars and entirely rebuilt, starting in 2005, with assistance and funding from the United States. The military assistance program, which became known as Operation Onward Liberty in 2010, provided training with the goal of making the AFL into an apolitical and professional military. The operation ended in 2016, though the Michigan National Guard still continues to work with the AFL as part of the U.S. National Guard's State Partnership Program. After the turmoil following the First and Second Liberian Civil Wars , Liberia's internal stabilization in the 21st century brought a return to cordial relations with neighboring countries and much of the Western world. As in other African countries, China is an important part of the post-conflict reconstruction. In the past, both of Liberia's neighbors, Guinea and Sierra Leone , have accused Liberia of backing rebels in their countries. The Liberian National Police is the country's national police force. As of October 2007 it has 844 officers in 33 stations in Montserrado County , which contains Monrovia . The National Police Training Academy is in Paynesville City . A history of corruption among police officers diminishes public trust and operational effectiveness. The internal security is characterized by a general lawlessness coupled with the danger that former combatants in the late civil war might reestablish militias to challenge the civil authorities. Rape and sexual assault are frequent in the post-conflict era in Liberia. Liberia has one of the highest incidences of sexual violence against women in the world. Rape is the most frequently reported crime, accounting for more than one-third of sexual violence cases. Adolescent girls are the most frequently assaulted, and almost 40% of perpetrators are adult men known to victims. Both male and female homosexuality are illegal in Liberia . On July 20, 2012, the Liberian senate voted unanimously to enact legislation to prohibit and criminalize same-sex marriages . Corruption is endemic at every level of the Liberian government. When President Sirleaf took office in 2006, she announced that corruption was "the major public enemy." In 2014, the US ambassador to Liberia said that corruption there was harming people through "unnecessary costs to products and services that are already difficult for many Liberians to afford". Liberia scored a 3.3 on a scale from 10 (highly clean) to 0 (highly corrupt) on the 2010 Corruption Perceptions Index . This gave it a ranking 87th of 178 countries worldwide and 11th of 47 in Sub-Saharan Africa. This score represented a significant improvement since 2007, when the country scored 2.1 and ranked 150th of 180 countries. When dealing with public-facing government functionaries, 89% of Liberians say they have had to pay a bribe, the highest national percentage in the world according to the organization's 2010 Global Corruption Barometer. The Central Bank of Liberia is responsible for printing and maintaining the Liberian dollar , Liberia's primary currency (the United States dollar is also legal tender in Liberia). Liberia is one of the world's poorest countries, with a formal employment rate of 15%. GDP per capita peaked in 1980 at US$496, (~$ 1,834 in 2023 ) when it was comparable to Egypt's (at the time). In 2011, the country's nominal GDP was US$1.154 billion, while nominal GDP per capita stood at US$297, the third-lowest in the world. Historically the Liberian economy has depended heavily on foreign aid , foreign direct investment and exports of natural resources such as iron ore , rubber , and timber . Following a peak in growth in 1979, the Liberian economy began a steady decline due to economic mismanagement after the 1980 coup. This decline was accelerated by the outbreak of civil war in 1989; GDP was reduced by an estimated 90% between 1989 and 1995, one of the fastest declines in modern history. Upon the end of the war in 2003, GDP growth began to accelerate, reaching 9.4% in 2007. The global financial crisis slowed GDP growth to 4.6% in 2009, though a strengthening agricultural sector led by rubber and timber exports increased growth to 5.1% in 2010 and an expected 7.3% in 2011, making the economy one of the 20 fastest-growing in the world. Current impediments to growth include a small domestic market , lack of adequate infrastructure, high transportation costs, poor trade links with neighboring countries, and the high dollarization of the economy. Liberia used the United States dollar as its currency from 1943 until 1982 and continues to use the U.S. dollar alongside the Liberian dollar . Following a decrease in inflation beginning in 2003, inflation spiked in 2008 as a result of worldwide food and energy crises , reaching 17.5% before declining to 7.4% in 2009. Liberia's external debt was estimated in 2006 at approximately $4.5 billion, 800% of GDP. As a result of bilateral, multilateral and commercial debt relief from 2007 to 2010, the country's external debt fell to $222.9 million by 2011. While official commodity exports declined during the 1990s as many investors fled the civil war, Liberia's wartime economy featured the exploitation of the region's diamond wealth. The country acted as a major trader in Sierra Leonian blood diamonds , exporting over US$300 million (~$ 516 million in 2023 ) in diamonds in 1999. This led to a United Nations ban on Liberian diamond exports in 2001, which was lifted in 2007 following Liberia's accession to the Kimberley Process Certification Scheme . In 2003, additional UN sanctions were placed on Liberian timber exports, which had risen from US$5 million in 1997 to over US$100 million in 2002 and were believed to be funding rebels in Sierra Leone. These sanctions were lifted in 2006. Due in large part to foreign aid and investment inflow following the end of the war, Liberia maintains a large account deficit , which peaked at nearly 60% in 2008. Liberia gained observer status with the World Trade Organization in 2010 and became an official member in 2016. Liberia has the highest ratio of foreign direct investment to GDP in the world, with US$16 billion (~$ 23.3 billion in 2023 ) in investment since 2006. Following Sirleaf's inauguration in 2006, Liberia signed several multi-billion-dollar concession agreements in the iron ore and palm oil industries with numerous multinational corporations , including ArcelorMittal , BHP and Sime Darby . Palm oil companies like Sime Darby (Malaysia) and Golden Veroleum (USA) have been accused of destroying livelihoods and displacing local communities, enabled by government concessions. Since 1926 Firestone has operated the world's largest rubber plantation in Harbel , Margibi County. As of 2015, it had more than 8,000 mostly Liberian employees, making it the country's largest private employer. Due to its status as a flag of convenience , Liberia has the second-largest maritime registry in the world behind Panama . It has 3,500 vessels registered under its flag, accounting for 11% of ships worldwide. Agriculture in Liberia is a major sector of the country's economy worth 38.8% of GDP, employing more than 70% of the population and providing a valuable export for one of the world's least developed countries (as defined by the UN). Liberia has a climate favourable to farming, vast forests, and an abundance of water, yet low yields mean that over half of foodstuffs are imported, with net agricultural trade at -$73.12 million in 2010. This was dismissed as a "misconception" by Liberia's Minister of Agriculture. The mining industry of Liberia has witnessed a revival after the civil war which ended in 2003. Gold, diamonds, and iron ore form the core minerals of the mining sector with a new Mineral Development Policy and Mining Code being put in place to attract foreign investments. In 2013, the mineral sector accounted for 11% of GDP in the country and the World Bank projected a further increase in the sector by 2017. There are six major newspapers in Liberia, and 65% of the population has a mobile phone service. Much of Liberia's communications infrastructure was destroyed or plundered during the two civil wars (1989–1996 and 1999–2003). With low rates of adult literacy and high poverty rates, television and newspaper use is limited, leaving radio as the predominant means of communicating with the public. Public electricity services are provided solely by the state-owned Liberia Electricity Corporation, which operates a small grid almost exclusively in the Greater Monrovia District . The vast majority of electric energy services is provided by small, privately owned generators . At $0.54 per kWh, the cost of electricity in Liberia is among the highest in the world. Total capacity in 2013 was 20 MW, a sharp decline from a peak of 191 MW in 1989 before the wars. The repair and expansion of the Mount Coffee Hydropower Project , with a maximum capacity of 80 MW, was completed in 2018. Construction of three new heavy fuel oil power plants is expected to boost electrical capacity by 38 MW. In 2013, Liberia began importing power from neighboring Ivory Coast and Guinea through the West African Power Pool . Liberia has begun exploration for offshore oil; unproven oil reserves may be in excess of one billion barrels. The government divided its offshore waters into 17 blocks and began auctioning off exploration licenses for the blocks in 2004, with further auctions in 2007 and 2009. An additional 13 ultra-deep offshore blocks were demarcated in 2011 and planned for auction. Among the companies to have won licenses are Repsol YPF , Chevron Corporation , and Woodside Petroleum . Following a peak in growth in 1979, the Liberian economy began a steady decline due to economic mismanagement after the 1980 coup. This decline was accelerated by the outbreak of civil war in 1989; GDP was reduced by an estimated 90% between 1989 and 1995, one of the fastest declines in modern history. Upon the end of the war in 2003, GDP growth began to accelerate, reaching 9.4% in 2007. The global financial crisis slowed GDP growth to 4.6% in 2009, though a strengthening agricultural sector led by rubber and timber exports increased growth to 5.1% in 2010 and an expected 7.3% in 2011, making the economy one of the 20 fastest-growing in the world. Current impediments to growth include a small domestic market , lack of adequate infrastructure, high transportation costs, poor trade links with neighboring countries, and the high dollarization of the economy. Liberia used the United States dollar as its currency from 1943 until 1982 and continues to use the U.S. dollar alongside the Liberian dollar . Following a decrease in inflation beginning in 2003, inflation spiked in 2008 as a result of worldwide food and energy crises , reaching 17.5% before declining to 7.4% in 2009. Liberia's external debt was estimated in 2006 at approximately $4.5 billion, 800% of GDP. As a result of bilateral, multilateral and commercial debt relief from 2007 to 2010, the country's external debt fell to $222.9 million by 2011. While official commodity exports declined during the 1990s as many investors fled the civil war, Liberia's wartime economy featured the exploitation of the region's diamond wealth. The country acted as a major trader in Sierra Leonian blood diamonds , exporting over US$300 million (~$ 516 million in 2023 ) in diamonds in 1999. This led to a United Nations ban on Liberian diamond exports in 2001, which was lifted in 2007 following Liberia's accession to the Kimberley Process Certification Scheme . In 2003, additional UN sanctions were placed on Liberian timber exports, which had risen from US$5 million in 1997 to over US$100 million in 2002 and were believed to be funding rebels in Sierra Leone. These sanctions were lifted in 2006. Due in large part to foreign aid and investment inflow following the end of the war, Liberia maintains a large account deficit , which peaked at nearly 60% in 2008. Liberia gained observer status with the World Trade Organization in 2010 and became an official member in 2016. Liberia has the highest ratio of foreign direct investment to GDP in the world, with US$16 billion (~$ 23.3 billion in 2023 ) in investment since 2006. Following Sirleaf's inauguration in 2006, Liberia signed several multi-billion-dollar concession agreements in the iron ore and palm oil industries with numerous multinational corporations , including ArcelorMittal , BHP and Sime Darby . Palm oil companies like Sime Darby (Malaysia) and Golden Veroleum (USA) have been accused of destroying livelihoods and displacing local communities, enabled by government concessions. Since 1926 Firestone has operated the world's largest rubber plantation in Harbel , Margibi County. As of 2015, it had more than 8,000 mostly Liberian employees, making it the country's largest private employer. Due to its status as a flag of convenience , Liberia has the second-largest maritime registry in the world behind Panama . It has 3,500 vessels registered under its flag, accounting for 11% of ships worldwide. Agriculture in Liberia is a major sector of the country's economy worth 38.8% of GDP, employing more than 70% of the population and providing a valuable export for one of the world's least developed countries (as defined by the UN). Liberia has a climate favourable to farming, vast forests, and an abundance of water, yet low yields mean that over half of foodstuffs are imported, with net agricultural trade at -$73.12 million in 2010. This was dismissed as a "misconception" by Liberia's Minister of Agriculture. The mining industry of Liberia has witnessed a revival after the civil war which ended in 2003. Gold, diamonds, and iron ore form the core minerals of the mining sector with a new Mineral Development Policy and Mining Code being put in place to attract foreign investments. In 2013, the mineral sector accounted for 11% of GDP in the country and the World Bank projected a further increase in the sector by 2017. There are six major newspapers in Liberia, and 65% of the population has a mobile phone service. Much of Liberia's communications infrastructure was destroyed or plundered during the two civil wars (1989–1996 and 1999–2003). With low rates of adult literacy and high poverty rates, television and newspaper use is limited, leaving radio as the predominant means of communicating with the public. Public electricity services are provided solely by the state-owned Liberia Electricity Corporation, which operates a small grid almost exclusively in the Greater Monrovia District . The vast majority of electric energy services is provided by small, privately owned generators . At $0.54 per kWh, the cost of electricity in Liberia is among the highest in the world. Total capacity in 2013 was 20 MW, a sharp decline from a peak of 191 MW in 1989 before the wars. The repair and expansion of the Mount Coffee Hydropower Project , with a maximum capacity of 80 MW, was completed in 2018. Construction of three new heavy fuel oil power plants is expected to boost electrical capacity by 38 MW. In 2013, Liberia began importing power from neighboring Ivory Coast and Guinea through the West African Power Pool . Liberia has begun exploration for offshore oil; unproven oil reserves may be in excess of one billion barrels. The government divided its offshore waters into 17 blocks and began auctioning off exploration licenses for the blocks in 2004, with further auctions in 2007 and 2009. An additional 13 ultra-deep offshore blocks were demarcated in 2011 and planned for auction. Among the companies to have won licenses are Repsol YPF , Chevron Corporation , and Woodside Petroleum . Agriculture in Liberia is a major sector of the country's economy worth 38.8% of GDP, employing more than 70% of the population and providing a valuable export for one of the world's least developed countries (as defined by the UN). Liberia has a climate favourable to farming, vast forests, and an abundance of water, yet low yields mean that over half of foodstuffs are imported, with net agricultural trade at -$73.12 million in 2010. This was dismissed as a "misconception" by Liberia's Minister of Agriculture. The mining industry of Liberia has witnessed a revival after the civil war which ended in 2003. Gold, diamonds, and iron ore form the core minerals of the mining sector with a new Mineral Development Policy and Mining Code being put in place to attract foreign investments. In 2013, the mineral sector accounted for 11% of GDP in the country and the World Bank projected a further increase in the sector by 2017. There are six major newspapers in Liberia, and 65% of the population has a mobile phone service. Much of Liberia's communications infrastructure was destroyed or plundered during the two civil wars (1989–1996 and 1999–2003). With low rates of adult literacy and high poverty rates, television and newspaper use is limited, leaving radio as the predominant means of communicating with the public. Public electricity services are provided solely by the state-owned Liberia Electricity Corporation, which operates a small grid almost exclusively in the Greater Monrovia District . The vast majority of electric energy services is provided by small, privately owned generators . At $0.54 per kWh, the cost of electricity in Liberia is among the highest in the world. Total capacity in 2013 was 20 MW, a sharp decline from a peak of 191 MW in 1989 before the wars. The repair and expansion of the Mount Coffee Hydropower Project , with a maximum capacity of 80 MW, was completed in 2018. Construction of three new heavy fuel oil power plants is expected to boost electrical capacity by 38 MW. In 2013, Liberia began importing power from neighboring Ivory Coast and Guinea through the West African Power Pool . Liberia has begun exploration for offshore oil; unproven oil reserves may be in excess of one billion barrels. The government divided its offshore waters into 17 blocks and began auctioning off exploration licenses for the blocks in 2004, with further auctions in 2007 and 2009. An additional 13 ultra-deep offshore blocks were demarcated in 2011 and planned for auction. Among the companies to have won licenses are Repsol YPF , Chevron Corporation , and Woodside Petroleum . As of the 2017 national census, Liberia was home to 4,694,608 people. Of those, 1,118,241 lived in Montserrado County , the most populous county in the country and home to the capital of Monrovia. The Greater Monrovia District has 970,824 residents. Nimba County is the next most populous county, with 462,026 residents. As revealed in the 2008 census, Monrovia is more than four times more populous than all the county capitals combined. Prior to the 2008 census, the last census had been taken in 1984 and listed the country's population as 2,101,628. The population of Liberia was 1,016,443 in 1962 and increased to 1,503,368 in 1974. As of 2006 [ update ] , Liberia had the highest population growth rate in the world (4.50% per annum). In 2010 some 43.5% of Liberians were below the age of 15. The population includes 16 indigenous ethnic groups and various foreign minorities. Indigenous peoples comprise about 95 percent of the population. The 16 officially recognized ethnic groups include the Kpelle , Bassa , Mano , Gio or Dan, Kru , Grebo , Krahn , Vai , Gola , Mandingo or Mandinka , Mende , Kissi , Gbandi , Loma , Dei or Dewoin, Belleh , and Americo-Liberians (or Congo people [lower-alpha 1] ). The Kpelle comprise more than 20% of the population and are the largest ethnic group in Liberia, residing mostly in Bong County and adjacent areas in central Liberia. Americo-Liberians, who are descendants of African American and West Indian , mostly Barbadian (Bajan) settlers , make up 2.5%. Congo people, descendants of repatriated Congo and Afro-Caribbean slaves who arrived in 1825, make up an estimated 2.5%. [ better source needed ] These latter two groups established political control in the 19th century which they kept well into the 20th century. The Liberian constitution exercises jus sanguinis , which means it usually restricts its citizenship to "Negroes or persons of Negro descent." That being said, numerous immigrants have come as merchants and become a major part of the business community, including Lebanese , Indians , and other West African nationals. There is a high percentage of interracial marriage between ethnic Liberians and the Lebanese, resulting in a significant mixed-race population especially in and around Monrovia . A small minority of Liberians who are White Africans of European descent reside in the country. [ better source needed ] English is the official language and serves as the lingua franca of Liberia. As of 2022, 27 indigenous languages are spoken in Liberia, but each is a first language for only a small percentage of the population. Liberians also speak a variety of creolized dialects collectively known as Liberian English . According to the 2008 National Census, 85.6% of the population practiced Christianity , while Muslims represented a minority of 12.2%. A multitude of diverse Protestant confessions such as Lutheran , Baptist , Episcopal , Presbyterian , Pentecostal , United Methodist , African Methodist Episcopal (AME) and African Methodist Episcopal Zion (AME Zion) denominations form the bulk of the Christian population, followed by adherents of the Catholic Church and other non-Protestant Christians. Most of these Christian denominations were brought by African-American settlers moving from the United States into Liberia via the American Colonization Society , while some are indigenous—especially Pentecostal and evangelical Protestant ones. Protestantism was originally associated with Black American settlers and their Americo-Liberian descendants, while native peoples initially held to their own animist forms of African traditional religion before largely adopting Christianity. While Christian, many Liberians also participate in traditional, gender-based indigenous religious secret societies , such as Poro for men and Sande for women. The all-female Sande society practices female circumcision . Muslims comprised 12.2% of the population in 2008, largely represented by the Mandingo and Vai ethnic groups. Liberian Muslims are divided between Sunnis , Shias , Ahmadiyyas , Sufis , and non-denominational Muslims . In 2008, 0.5% identified adherence to traditional indigenous religions , while 1.5% claimed no religion. A small number of people were Bahá'í , Hindu , Sikh , or Buddhist . The Liberian constitution provides for freedom of religion , and the government generally respects this right. While separation of church and state is mandated by the Constitution, Liberia is considered a Christian state in practice. Public schools offer biblical studies , though parents may opt their children out. Commerce is prohibited by law on Sunday and major Christian holidays . The government does not require businesses or schools to excuse Muslims for Friday prayers . In 2010, the literacy rate of Liberia was estimated at 60.8% (64.8% for males and 56.8% for females). In some areas primary and secondary education is free and compulsory from the ages of 6 to 16, though enforcement of attendance is lax. In other areas children are required to pay a tuition fee to attend school. On average, children attain 10 years of education (11 for boys and 8 for girls). The country's education sector is hampered by inadequate schools and supplies, as well as a lack of qualified teachers. Higher education is provided by a number of public and private universities. The University of Liberia is the country's largest and oldest university. Located in Monrovia, the university opened in 1862. Today it has six colleges, including a medical school and the nation's only law school, Louis Arthur Grimes School of Law . In 2009, Tubman University in Harper , Maryland County was established as the second public university in Liberia. Since 2006, the government has also opened community colleges in Buchanan , Sanniquellie , and Voinjama . Due to student protests late in October 2018, newly elected president George Weah abolished tuition fees for undergraduate students in public universities in Liberia. Hospitals in Liberia include the John F. Kennedy Medical Center in Monrovia and several others. Life expectancy in Liberia is estimated to be 64.4 years in 2020. With a fertility rate of 5.9 births per woman, the maternal mortality rate stood at 990 per 100,000 births in 2010, and 1,072 per 100,000 births in 2017. A number of highly communicable diseases are widespread, including tuberculosis , diarrheal diseases and malaria . In 2007, the HIV infection rates stood at 2% of the population aged 15–49 whereas the incidence of tuberculosis was 420 per 100,000 people in 2008. Approximately 58.2% – 66% of women are estimated to have undergone female genital mutilation . Liberia imports 90% of its rice, a staple food, and is extremely vulnerable to food shortages. In 2007, 20.4% of children under the age of five were malnourished. In 2008, only 17% of the population had access to adequate sanitation facilities. Approximately 95% of the country's healthcare facilities had been destroyed by the time civil war ended in 2003. In 2009, government expenditure on health care per capita was US$22, (~$ 30.00 in 2023 ) accounting for 10.6% of total GDP. In 2008, Liberia had only one doctor and 27 nurses per 100,000 people. In 2014, an outbreak of Ebola virus in Guinea spread to Liberia . As of November 17, 2014 [ update ] , there were 2,812 confirmed deaths from the ongoing outbreak. In early August 2014 Guinea closed its borders to Liberia to help contain the spread of the virus, as more new cases were being reported in Liberia than in Guinea. On May 9, 2015, Liberia was declared Ebola free after six weeks with no new cases. According to an Overseas Development Institute report, private health expenditure accounts for 64.1% of total spending on health. The population includes 16 indigenous ethnic groups and various foreign minorities. Indigenous peoples comprise about 95 percent of the population. The 16 officially recognized ethnic groups include the Kpelle , Bassa , Mano , Gio or Dan, Kru , Grebo , Krahn , Vai , Gola , Mandingo or Mandinka , Mende , Kissi , Gbandi , Loma , Dei or Dewoin, Belleh , and Americo-Liberians (or Congo people [lower-alpha 1] ). The Kpelle comprise more than 20% of the population and are the largest ethnic group in Liberia, residing mostly in Bong County and adjacent areas in central Liberia. Americo-Liberians, who are descendants of African American and West Indian , mostly Barbadian (Bajan) settlers , make up 2.5%. Congo people, descendants of repatriated Congo and Afro-Caribbean slaves who arrived in 1825, make up an estimated 2.5%. [ better source needed ] These latter two groups established political control in the 19th century which they kept well into the 20th century. The Liberian constitution exercises jus sanguinis , which means it usually restricts its citizenship to "Negroes or persons of Negro descent." That being said, numerous immigrants have come as merchants and become a major part of the business community, including Lebanese , Indians , and other West African nationals. There is a high percentage of interracial marriage between ethnic Liberians and the Lebanese, resulting in a significant mixed-race population especially in and around Monrovia . A small minority of Liberians who are White Africans of European descent reside in the country. [ better source needed ] English is the official language and serves as the lingua franca of Liberia. As of 2022, 27 indigenous languages are spoken in Liberia, but each is a first language for only a small percentage of the population. Liberians also speak a variety of creolized dialects collectively known as Liberian English . According to the 2008 National Census, 85.6% of the population practiced Christianity , while Muslims represented a minority of 12.2%. A multitude of diverse Protestant confessions such as Lutheran , Baptist , Episcopal , Presbyterian , Pentecostal , United Methodist , African Methodist Episcopal (AME) and African Methodist Episcopal Zion (AME Zion) denominations form the bulk of the Christian population, followed by adherents of the Catholic Church and other non-Protestant Christians. Most of these Christian denominations were brought by African-American settlers moving from the United States into Liberia via the American Colonization Society , while some are indigenous—especially Pentecostal and evangelical Protestant ones. Protestantism was originally associated with Black American settlers and their Americo-Liberian descendants, while native peoples initially held to their own animist forms of African traditional religion before largely adopting Christianity. While Christian, many Liberians also participate in traditional, gender-based indigenous religious secret societies , such as Poro for men and Sande for women. The all-female Sande society practices female circumcision . Muslims comprised 12.2% of the population in 2008, largely represented by the Mandingo and Vai ethnic groups. Liberian Muslims are divided between Sunnis , Shias , Ahmadiyyas , Sufis , and non-denominational Muslims . In 2008, 0.5% identified adherence to traditional indigenous religions , while 1.5% claimed no religion. A small number of people were Bahá'í , Hindu , Sikh , or Buddhist . The Liberian constitution provides for freedom of religion , and the government generally respects this right. While separation of church and state is mandated by the Constitution, Liberia is considered a Christian state in practice. Public schools offer biblical studies , though parents may opt their children out. Commerce is prohibited by law on Sunday and major Christian holidays . The government does not require businesses or schools to excuse Muslims for Friday prayers . In 2010, the literacy rate of Liberia was estimated at 60.8% (64.8% for males and 56.8% for females). In some areas primary and secondary education is free and compulsory from the ages of 6 to 16, though enforcement of attendance is lax. In other areas children are required to pay a tuition fee to attend school. On average, children attain 10 years of education (11 for boys and 8 for girls). The country's education sector is hampered by inadequate schools and supplies, as well as a lack of qualified teachers. Higher education is provided by a number of public and private universities. The University of Liberia is the country's largest and oldest university. Located in Monrovia, the university opened in 1862. Today it has six colleges, including a medical school and the nation's only law school, Louis Arthur Grimes School of Law . In 2009, Tubman University in Harper , Maryland County was established as the second public university in Liberia. Since 2006, the government has also opened community colleges in Buchanan , Sanniquellie , and Voinjama . Due to student protests late in October 2018, newly elected president George Weah abolished tuition fees for undergraduate students in public universities in Liberia. Hospitals in Liberia include the John F. Kennedy Medical Center in Monrovia and several others. Life expectancy in Liberia is estimated to be 64.4 years in 2020. With a fertility rate of 5.9 births per woman, the maternal mortality rate stood at 990 per 100,000 births in 2010, and 1,072 per 100,000 births in 2017. A number of highly communicable diseases are widespread, including tuberculosis , diarrheal diseases and malaria . In 2007, the HIV infection rates stood at 2% of the population aged 15–49 whereas the incidence of tuberculosis was 420 per 100,000 people in 2008. Approximately 58.2% – 66% of women are estimated to have undergone female genital mutilation . Liberia imports 90% of its rice, a staple food, and is extremely vulnerable to food shortages. In 2007, 20.4% of children under the age of five were malnourished. In 2008, only 17% of the population had access to adequate sanitation facilities. Approximately 95% of the country's healthcare facilities had been destroyed by the time civil war ended in 2003. In 2009, government expenditure on health care per capita was US$22, (~$ 30.00 in 2023 ) accounting for 10.6% of total GDP. In 2008, Liberia had only one doctor and 27 nurses per 100,000 people. In 2014, an outbreak of Ebola virus in Guinea spread to Liberia . As of November 17, 2014 [ update ] , there were 2,812 confirmed deaths from the ongoing outbreak. In early August 2014 Guinea closed its borders to Liberia to help contain the spread of the virus, as more new cases were being reported in Liberia than in Guinea. On May 9, 2015, Liberia was declared Ebola free after six weeks with no new cases. According to an Overseas Development Institute report, private health expenditure accounts for 64.1% of total spending on health. The religious practices, social customs, and cultural standards of the Americo-Liberians had their roots in the antebellum American South . The settlers wore top hat and tails and modeled their homes on those of Southern slaveowners. Most Americo-Liberian men were members of the Masonic Order of Liberia , which became heavily involved in the nation's politics. [ citation needed ] Liberia has a rich history in textile arts and quilting, as the settlers brought with them their sewing and quilting skills. Liberia hosted National Fairs in 1857 and 1858 in which prizes were awarded for various needle arts. One of the most well-known Liberian quilters was Martha Ann Ricks, who presented a quilt featuring the famed Liberian coffee tree to Queen Victoria in 1892. When President Ellen Johnson Sirleaf moved into the Executive Mansion, she reportedly had a Liberian-made quilt installed in her presidential office. A rich literary tradition has existed in Liberia for over a century. Edward Wilmot Blyden , Bai T. Moore , Roland T. Dempster and Wilton G. S. Sankawulo are among Liberia's more prominent authors. Moore's novella Murder in the Cassava Patch is considered Liberia's most celebrated novel. One-third of married Liberian women between the ages of 15–49 are in polygamous marriages . Customary law allows men to have up to four wives. Liberian cuisine heavily incorporates rice , the country's staple food. Other ingredients include cassava , fish , bananas , citrus fruit , plantains , coconut , okra and sweet potatoes . Heavy stews spiced with habanero and scotch bonnet chilies are popular and eaten with fufu . Liberia also has a tradition of baking imported from the United States that is unique in West Africa. The most popular sport in Liberia is association football , with former President George Weah being the nation's most famous athlete. He is so far the only African to be named FIFA World Player of the Year . The Liberia national football team has reached the Africa Cup of Nations finals twice, in 1996 and 2002 . The second most popular sport in Liberia is basketball . The Liberian national basketball team has reached the AfroBasket twice, in 1983 and 2007 . In Liberia, the Samuel Kanyon Doe Sports Complex serves as a multi-purpose stadium . It hosts FIFA World Cup qualifying matches in addition to international concerts and national political events. Liberia has not yet completely adopted the International System of Units (abbreviated as the SI, also called the metric system). The Liberian government has begun transitioning away from use of United States customary units to the metric system. [ better source needed ] However, this change has been gradual, with government reports concurrently using both United States Customary and metric units. In 2018, the Liberian Commerce and Industry Minister announced that the Liberian government is committed to adopting the metric system. One-third of married Liberian women between the ages of 15–49 are in polygamous marriages . Customary law allows men to have up to four wives. Liberian cuisine heavily incorporates rice , the country's staple food. Other ingredients include cassava , fish , bananas , citrus fruit , plantains , coconut , okra and sweet potatoes . Heavy stews spiced with habanero and scotch bonnet chilies are popular and eaten with fufu . Liberia also has a tradition of baking imported from the United States that is unique in West Africa. The most popular sport in Liberia is association football , with former President George Weah being the nation's most famous athlete. He is so far the only African to be named FIFA World Player of the Year . The Liberia national football team has reached the Africa Cup of Nations finals twice, in 1996 and 2002 . The second most popular sport in Liberia is basketball . The Liberian national basketball team has reached the AfroBasket twice, in 1983 and 2007 . In Liberia, the Samuel Kanyon Doe Sports Complex serves as a multi-purpose stadium . It hosts FIFA World Cup qualifying matches in addition to international concerts and national political events. Liberia has not yet completely adopted the International System of Units (abbreviated as the SI, also called the metric system). The Liberian government has begun transitioning away from use of United States customary units to the metric system. [ better source needed ] However, this change has been gradual, with government reports concurrently using both United States Customary and metric units. In 2018, the Liberian Commerce and Industry Minister announced that the Liberian government is committed to adopting the metric system.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Responses_to_the_West_African_Ebola_virus_epidemic/html

Responses to the West African Ebola virus epidemic

Organizations from around the world responded to the West African Ebola virus epidemic . In July 2014, the World Health Organization (WHO) convened an emergency meeting with health ministers from eleven countries and announced collaboration on a strategy to co-ordinate technical support to combat the epidemic. In August, they declared the outbreak an international public health emergency and published a roadmap to guide and coordinate the international response to the outbreak, aiming to stop ongoing Ebola transmission worldwide within 6–9 months. In September, the United Nations Security Council declared the Ebola virus outbreak in the West Africa subregion a "threat to international peace and security" and unanimously adopted a resolution urging UN member states to provide more resources to fight the outbreak; the WHO stated that the cost for combating the epidemic will be a minimum of $1 billion. The Economic Community of West African States (ECOWAS) and the World Bank Group have pledged aid money and the World Food Programme announced plans to mobilize food assistance for an estimated 1 million people living in restricted access areas. Several Non-Governmental Organizations have provided assistance in the efforts to control the spread of the disease. Up until the end of September, the humanitarian aid organisation Médecins Sans Frontières ( Doctors Without Borders ) is the leading organization responding to the crisis, with several treatment centers in the area. Samaritan's Purse has also provided direct patient care and medical support in Liberia; many nations and charitable organizations, foundations, and individuals have also pledged assistance to control the epidemic. As of September 2014 [ update ] , a massive international response to the crisis is under way. The United Nations Mission for Ebola Emergency Response (UNMEER) has the task of overall planning and coordination, directing the efforts of the UN agencies, national governments, and other humanitarian actors to the areas where they are most needed. Calling Ebola healthcare workers "the ones who answered the call", in December the editors of Time magazine named the Ebola health workers as Person of the Year . Editor Nancy Gibbs said, "The rest of the world can sleep at night because a group of men and women are willing to stand and fight. For tireless acts of courage and mercy, for buying the world time to boost its defenses, for risking, for persisting, for sacrificing and saving, the Ebola fighters are Time's 2014 Person of the Year." Both Médecins Sans Frontières ( Doctors Without Borders ) and Samaritan's Purse were singled out as organisations that responded very early in the epidemic with especially dedicated workers who had worked alongside local caregivers. On 18 September 2014, the United Nations Security Council declared the Ebola virus outbreak in the West Africa subregion a "threat to international peace and security". The Security Council unanimously adopted United Nations Security Council Resolution 2177, which urged UN member states to provide more resources to fight the outbreak. The resolution was the first in the history of the Security Council to deal with a public health crisis. It was sponsored by 131 countries, which – according to U.S. Ambassador to the United Nations Samantha Power – makes it the most broadly supported of the 2,176 Security Council resolutions since 1945. Therefore, the UN Security Council has created the first ever UN mission for a public health emergency, the United Nations Mission for Ebola Emergency Response (UNMEER), with the primary task of coordinating the UN agencies' vast resources to combat the epidemic under the leadership of the WHO. Dr. David Nabarro , the UN Secretary General's Senior Coordinator said that "This unprecedented outbreak requires an unprecedented response. The number of cases have doubled in these countries in the last three weeks. To get in front of this, the response must be increased 20-fold from where it is today." UNMEER has been tasked to coordinate all relevant United Nations actors in order to ensure a rapid, effective, efficient and coherent response to the Ebola crisis. UNMEER's objective is to work with others to stop the Ebola outbreak. UNMEER will work closely with governments, regional and international actors, such as the African Union (AU) and the Economic Community of West African States (ECOWAS), and with UN Member States, the private sector and civil society. Accra , in Ghana, will serve as a base for UNMEER, with teams in Guinea, Liberia and Sierra Leone. A United Nations General Assembly document, the Report of the Secretary-General on UNMEER and the Office of the Special Envoy on Ebola (A/69/404), issued on 24 September 2014, details UNMEER's proposed mission, budget, and structure. In July 2014, the World Health Organization (WHO) convened an emergency sub-regional meeting with health ministers from eleven countries in Accra, Ghana to tackle the ongoing Ebola virus outbreak in West Africa. On 3 July, the West African states announced collaboration on a new strategy, and the creation of a WHO sub-regional centre in Guinea "to co-ordinate technical support"; the centre was inaugurated in Conakry on 24 July. The WHO Regional Director for Africa, Luis Sambo, visited the affected countries from 21 to 25 July, meeting with political leaders, ministers of health, NGOs , and other agencies. He stressed the need to "promote behavioural change while respecting cultural practices." On 24 July, WHO's Director General met with agencies and donors in Geneva to facilitate an increase in funding and manpower to respond to the outbreak. On 31 July, the WHO and West Africa nations announced a requirement for $100 million in aid to help contain the disease. WHO declared the outbreak an international public health emergency on 8 August, after a two-day teleconference of experts. On 11 August, they emphasised lack of supplies and capacity as one of the problems, while local awareness of the disease had increased. Revised guidelines on how to prevent the spread of the disease were released, updating guidelines from 2008. On 28 August, the WHO published a roadmap to guide and coordinate the international response to the outbreak, aiming to stop ongoing Ebola transmission worldwide within 6–9 months. It simultaneously revised its cost estimate for the global resources required over the next six months up to $490 million. They report that they "are on the ground establishing Ebola treatment centres and strengthening capacity for laboratory testing, contact tracing, social mobilization, safe burials, and non-Ebola health care" and "continue to monitor for reports of rumoured or suspected cases from countries around the world." Other than cases where individuals are suspected or have been confirmed of being infected with Ebola, or have had contact with cases of Ebola, the WHO does not recommend any travel or trade restrictions. On 16 September, the WHO Assistant Director General, Bruce Aylward, announced that the cost for combating the epidemic will be a minimum of $1 billion. "We don't know where the numbers are going on this," according to Aylward. There has been heavy criticism of WHO from some aid agencies because its response was perceived as slow and insufficient, especially during the early stage of the outbreak. The following are the key headings from the WHO roadmap for the international response to the epidemic, published on 28 August. 1 Urgently strengthen the field response Output 1: A local response team is in place in each "hot spot" Output 2: Provision of field logistical support including Personal Protective Equipment supply and local laboratory facilities capacity Output 3: Provision of care to patients with effective infection prevention and control in health care settings Output 4: Chains of transmission broken through active surveillance, case investigation, contact tracing and follow-up Output 5: Public relations and reputation management, social mobilization, and risk communications strengthened 2. Coordinate the outbreak response 2.1. Manage the WHO Sub-regional Ebola Operations Coordination Centre Output 1: Field coordination, collaboration and operational management of the outbreak response strengthened Output 2: Cross-border coordination strengthened 2.2. WHO's leadership and coordination of EVD outbreak response strengthened at all levels Output 1: Logistics management systems strengthened to support response activities Output 2: Disease-related and other content-based expert support provided for risk assessment and expert networks mobilized Output 3: Global communication and information provided Output 4: External relations strengthened Output 5: Clinical support strengthened Output 6: Development of new medical treatments and interventions against EVD advanced Output 1: A local response team is in place in each "hot spot" Output 2: Provision of field logistical support including Personal Protective Equipment supply and local laboratory facilities capacity Output 3: Provision of care to patients with effective infection prevention and control in health care settings Output 4: Chains of transmission broken through active surveillance, case investigation, contact tracing and follow-up Output 5: Public relations and reputation management, social mobilization, and risk communications strengthened 2.1. Manage the WHO Sub-regional Ebola Operations Coordination Centre Output 1: Field coordination, collaboration and operational management of the outbreak response strengthened Output 2: Cross-border coordination strengthened 2.2. WHO's leadership and coordination of EVD outbreak response strengthened at all levels Output 1: Logistics management systems strengthened to support response activities Output 2: Disease-related and other content-based expert support provided for risk assessment and expert networks mobilized Output 3: Global communication and information provided Output 4: External relations strengthened Output 5: Clinical support strengthened Output 6: Development of new medical treatments and interventions against EVD advanced Output 1: Field coordination, collaboration and operational management of the outbreak response strengthened Output 2: Cross-border coordination strengthened Output 1: Logistics management systems strengthened to support response activities Output 2: Disease-related and other content-based expert support provided for risk assessment and expert networks mobilized Output 3: Global communication and information provided Output 4: External relations strengthened Output 5: Clinical support strengthened Output 6: Development of new medical treatments and interventions against EVD advanced B. Preparedness in countries at-risk Output 1: Preparedness plans activated and tested Output 2: Active surveillance strengthened Output 3: Laboratory diagnostic capacity strengthened Output 4: Public information and social mobilization enhanced Output 5: Case management and infection prevention and control capacities strengthened During October, WHO and UNMEER announced a comprehensive 90-day plan to control and reverse the epidemic of EVD. The immediate objective is to isolate at least 70% of EVD cases and safely bury at least 70% of patients who die from EVD by 1 December 2014 (the 60-day target) - this has become known as the 70:70:60 program. The ultimate goal is to have capacity in place for the isolation of 100% of EVD cases and the safe burial of 100% of casualties by 1 January 2015 (the 90-day target). Many nations and charitable organizations are cooperating to realise this plan. A WHO situation report in mid-December indicated that the international community was on track to meet the 90-day target. On 18 August, the World Food Programme (WFP) of the United Nations announced plans to mobilize food assistance for an estimated 1 million people living in restricted access areas. In an 18 September WHO Ebola Response Roadmap Situation Report it was reported that as of that date the WFP have delivered an estimated 3,000 metric tonnes of food to the worst affected areas, enough to feed 147,500 people. They have also assisted in the transportation of 400 cubic meters of medical cargo. The WFP-led Logistics Cluster provides free logistics services, such as storage, transport, coordination and information management, to WHO and other health and humanitarian actors. WFP has launched a regional emergency operation to reach 1.3 million people in health centres and quarantine areas. WFP provides food and logistical assistance alongside national governments, the World Health Organization (WHO) and other partners to support the treatment of Ebola patients and mitigate the risk of the virus moving into new areas. The three pillars of WFP support in the Ebola crisis are to deliver food alongside the health response, ensure the movement of partner staff and equipment, and provide logistical services and infrastructure support for health partners. The Food and Agriculture Organization of the United Nations has launched a $30 million campaign to help stop the spread of the disease, meet immediate and long-term food and nutrition security needs and build resilience. In addition, it is training its network of field agents and extension staff to understand to how stop the spread of the disease by simple measures of control and hygiene, and to promulgate this knowledge in their communities. The FAO-led social mobilization campaign is expected to reach 9,000 households in Guinea; similar campaigns will follow in Liberia and Sierra Leone. The United Nations Children's Fund (UNICEF) has a $200 million program to respond to the Ebola outbreak - part of the $1 billion total UN program. Of this, $65 million will go to UNICEF's programmes in Liberia, $61 million to Sierra Leone and $55 million to Guinea. An additional $10 million will help neighbouring countries be prepared for a potential spread of the disease within their borders, with the remaining $9 million required for regional coordination efforts. UNICEF estimates that 8.5 million children and young people under the age of 20 live in areas affected by Ebola in Guinea, Sierra Leone and Liberia. Of these, 2.5 million are under the age of five. The program's immediate focus is to help contain the spread of the disease and address communities immediate needs. UNICEF is one of the largest agencies providing essential supplies for use in treatment and care centres and for continuity of basic services. By 8 October, more than 900 metric tonnes of supplies were delivered to the region in support of partners, through a total of 73 flights. On 18 September 2014, the United Nations Security Council declared the Ebola virus outbreak in the West Africa subregion a "threat to international peace and security". The Security Council unanimously adopted United Nations Security Council Resolution 2177, which urged UN member states to provide more resources to fight the outbreak. The resolution was the first in the history of the Security Council to deal with a public health crisis. It was sponsored by 131 countries, which – according to U.S. Ambassador to the United Nations Samantha Power – makes it the most broadly supported of the 2,176 Security Council resolutions since 1945. Therefore, the UN Security Council has created the first ever UN mission for a public health emergency, the United Nations Mission for Ebola Emergency Response (UNMEER), with the primary task of coordinating the UN agencies' vast resources to combat the epidemic under the leadership of the WHO. Dr. David Nabarro , the UN Secretary General's Senior Coordinator said that "This unprecedented outbreak requires an unprecedented response. The number of cases have doubled in these countries in the last three weeks. To get in front of this, the response must be increased 20-fold from where it is today." UNMEER has been tasked to coordinate all relevant United Nations actors in order to ensure a rapid, effective, efficient and coherent response to the Ebola crisis. UNMEER's objective is to work with others to stop the Ebola outbreak. UNMEER will work closely with governments, regional and international actors, such as the African Union (AU) and the Economic Community of West African States (ECOWAS), and with UN Member States, the private sector and civil society. Accra , in Ghana, will serve as a base for UNMEER, with teams in Guinea, Liberia and Sierra Leone. A United Nations General Assembly document, the Report of the Secretary-General on UNMEER and the Office of the Special Envoy on Ebola (A/69/404), issued on 24 September 2014, details UNMEER's proposed mission, budget, and structure. In July 2014, the World Health Organization (WHO) convened an emergency sub-regional meeting with health ministers from eleven countries in Accra, Ghana to tackle the ongoing Ebola virus outbreak in West Africa. On 3 July, the West African states announced collaboration on a new strategy, and the creation of a WHO sub-regional centre in Guinea "to co-ordinate technical support"; the centre was inaugurated in Conakry on 24 July. The WHO Regional Director for Africa, Luis Sambo, visited the affected countries from 21 to 25 July, meeting with political leaders, ministers of health, NGOs , and other agencies. He stressed the need to "promote behavioural change while respecting cultural practices." On 24 July, WHO's Director General met with agencies and donors in Geneva to facilitate an increase in funding and manpower to respond to the outbreak. On 31 July, the WHO and West Africa nations announced a requirement for $100 million in aid to help contain the disease. WHO declared the outbreak an international public health emergency on 8 August, after a two-day teleconference of experts. On 11 August, they emphasised lack of supplies and capacity as one of the problems, while local awareness of the disease had increased. Revised guidelines on how to prevent the spread of the disease were released, updating guidelines from 2008. On 28 August, the WHO published a roadmap to guide and coordinate the international response to the outbreak, aiming to stop ongoing Ebola transmission worldwide within 6–9 months. It simultaneously revised its cost estimate for the global resources required over the next six months up to $490 million. They report that they "are on the ground establishing Ebola treatment centres and strengthening capacity for laboratory testing, contact tracing, social mobilization, safe burials, and non-Ebola health care" and "continue to monitor for reports of rumoured or suspected cases from countries around the world." Other than cases where individuals are suspected or have been confirmed of being infected with Ebola, or have had contact with cases of Ebola, the WHO does not recommend any travel or trade restrictions. On 16 September, the WHO Assistant Director General, Bruce Aylward, announced that the cost for combating the epidemic will be a minimum of $1 billion. "We don't know where the numbers are going on this," according to Aylward. There has been heavy criticism of WHO from some aid agencies because its response was perceived as slow and insufficient, especially during the early stage of the outbreak. The following are the key headings from the WHO roadmap for the international response to the epidemic, published on 28 August. 1 Urgently strengthen the field response Output 1: A local response team is in place in each "hot spot" Output 2: Provision of field logistical support including Personal Protective Equipment supply and local laboratory facilities capacity Output 3: Provision of care to patients with effective infection prevention and control in health care settings Output 4: Chains of transmission broken through active surveillance, case investigation, contact tracing and follow-up Output 5: Public relations and reputation management, social mobilization, and risk communications strengthened 2. Coordinate the outbreak response 2.1. Manage the WHO Sub-regional Ebola Operations Coordination Centre Output 1: Field coordination, collaboration and operational management of the outbreak response strengthened Output 2: Cross-border coordination strengthened 2.2. WHO's leadership and coordination of EVD outbreak response strengthened at all levels Output 1: Logistics management systems strengthened to support response activities Output 2: Disease-related and other content-based expert support provided for risk assessment and expert networks mobilized Output 3: Global communication and information provided Output 4: External relations strengthened Output 5: Clinical support strengthened Output 6: Development of new medical treatments and interventions against EVD advanced Output 1: A local response team is in place in each "hot spot" Output 2: Provision of field logistical support including Personal Protective Equipment supply and local laboratory facilities capacity Output 3: Provision of care to patients with effective infection prevention and control in health care settings Output 4: Chains of transmission broken through active surveillance, case investigation, contact tracing and follow-up Output 5: Public relations and reputation management, social mobilization, and risk communications strengthened 2.1. Manage the WHO Sub-regional Ebola Operations Coordination Centre Output 1: Field coordination, collaboration and operational management of the outbreak response strengthened Output 2: Cross-border coordination strengthened 2.2. WHO's leadership and coordination of EVD outbreak response strengthened at all levels Output 1: Logistics management systems strengthened to support response activities Output 2: Disease-related and other content-based expert support provided for risk assessment and expert networks mobilized Output 3: Global communication and information provided Output 4: External relations strengthened Output 5: Clinical support strengthened Output 6: Development of new medical treatments and interventions against EVD advanced Output 1: Field coordination, collaboration and operational management of the outbreak response strengthened Output 2: Cross-border coordination strengthened Output 1: Logistics management systems strengthened to support response activities Output 2: Disease-related and other content-based expert support provided for risk assessment and expert networks mobilized Output 3: Global communication and information provided Output 4: External relations strengthened Output 5: Clinical support strengthened Output 6: Development of new medical treatments and interventions against EVD advanced B. Preparedness in countries at-risk Output 1: Preparedness plans activated and tested Output 2: Active surveillance strengthened Output 3: Laboratory diagnostic capacity strengthened Output 4: Public information and social mobilization enhanced Output 5: Case management and infection prevention and control capacities strengthened During October, WHO and UNMEER announced a comprehensive 90-day plan to control and reverse the epidemic of EVD. The immediate objective is to isolate at least 70% of EVD cases and safely bury at least 70% of patients who die from EVD by 1 December 2014 (the 60-day target) - this has become known as the 70:70:60 program. The ultimate goal is to have capacity in place for the isolation of 100% of EVD cases and the safe burial of 100% of casualties by 1 January 2015 (the 90-day target). Many nations and charitable organizations are cooperating to realise this plan. A WHO situation report in mid-December indicated that the international community was on track to meet the 90-day target. The following are the key headings from the WHO roadmap for the international response to the epidemic, published on 28 August. 1 Urgently strengthen the field response Output 1: A local response team is in place in each "hot spot" Output 2: Provision of field logistical support including Personal Protective Equipment supply and local laboratory facilities capacity Output 3: Provision of care to patients with effective infection prevention and control in health care settings Output 4: Chains of transmission broken through active surveillance, case investigation, contact tracing and follow-up Output 5: Public relations and reputation management, social mobilization, and risk communications strengthened 2. Coordinate the outbreak response 2.1. Manage the WHO Sub-regional Ebola Operations Coordination Centre Output 1: Field coordination, collaboration and operational management of the outbreak response strengthened Output 2: Cross-border coordination strengthened 2.2. WHO's leadership and coordination of EVD outbreak response strengthened at all levels Output 1: Logistics management systems strengthened to support response activities Output 2: Disease-related and other content-based expert support provided for risk assessment and expert networks mobilized Output 3: Global communication and information provided Output 4: External relations strengthened Output 5: Clinical support strengthened Output 6: Development of new medical treatments and interventions against EVD advanced Output 1: A local response team is in place in each "hot spot" Output 2: Provision of field logistical support including Personal Protective Equipment supply and local laboratory facilities capacity Output 3: Provision of care to patients with effective infection prevention and control in health care settings Output 4: Chains of transmission broken through active surveillance, case investigation, contact tracing and follow-up Output 5: Public relations and reputation management, social mobilization, and risk communications strengthened 2.1. Manage the WHO Sub-regional Ebola Operations Coordination Centre Output 1: Field coordination, collaboration and operational management of the outbreak response strengthened Output 2: Cross-border coordination strengthened 2.2. WHO's leadership and coordination of EVD outbreak response strengthened at all levels Output 1: Logistics management systems strengthened to support response activities Output 2: Disease-related and other content-based expert support provided for risk assessment and expert networks mobilized Output 3: Global communication and information provided Output 4: External relations strengthened Output 5: Clinical support strengthened Output 6: Development of new medical treatments and interventions against EVD advanced Output 1: Field coordination, collaboration and operational management of the outbreak response strengthened Output 2: Cross-border coordination strengthened Output 1: Logistics management systems strengthened to support response activities Output 2: Disease-related and other content-based expert support provided for risk assessment and expert networks mobilized Output 3: Global communication and information provided Output 4: External relations strengthened Output 5: Clinical support strengthened Output 6: Development of new medical treatments and interventions against EVD advanced B. Preparedness in countries at-risk Output 1: Preparedness plans activated and tested Output 2: Active surveillance strengthened Output 3: Laboratory diagnostic capacity strengthened Output 4: Public information and social mobilization enhanced Output 5: Case management and infection prevention and control capacities strengthenedDuring October, WHO and UNMEER announced a comprehensive 90-day plan to control and reverse the epidemic of EVD. The immediate objective is to isolate at least 70% of EVD cases and safely bury at least 70% of patients who die from EVD by 1 December 2014 (the 60-day target) - this has become known as the 70:70:60 program. The ultimate goal is to have capacity in place for the isolation of 100% of EVD cases and the safe burial of 100% of casualties by 1 January 2015 (the 90-day target). Many nations and charitable organizations are cooperating to realise this plan. A WHO situation report in mid-December indicated that the international community was on track to meet the 90-day target. On 18 August, the World Food Programme (WFP) of the United Nations announced plans to mobilize food assistance for an estimated 1 million people living in restricted access areas. In an 18 September WHO Ebola Response Roadmap Situation Report it was reported that as of that date the WFP have delivered an estimated 3,000 metric tonnes of food to the worst affected areas, enough to feed 147,500 people. They have also assisted in the transportation of 400 cubic meters of medical cargo. The WFP-led Logistics Cluster provides free logistics services, such as storage, transport, coordination and information management, to WHO and other health and humanitarian actors. WFP has launched a regional emergency operation to reach 1.3 million people in health centres and quarantine areas. WFP provides food and logistical assistance alongside national governments, the World Health Organization (WHO) and other partners to support the treatment of Ebola patients and mitigate the risk of the virus moving into new areas. The three pillars of WFP support in the Ebola crisis are to deliver food alongside the health response, ensure the movement of partner staff and equipment, and provide logistical services and infrastructure support for health partners. The Food and Agriculture Organization of the United Nations has launched a $30 million campaign to help stop the spread of the disease, meet immediate and long-term food and nutrition security needs and build resilience. In addition, it is training its network of field agents and extension staff to understand to how stop the spread of the disease by simple measures of control and hygiene, and to promulgate this knowledge in their communities. The FAO-led social mobilization campaign is expected to reach 9,000 households in Guinea; similar campaigns will follow in Liberia and Sierra Leone. The United Nations Children's Fund (UNICEF) has a $200 million program to respond to the Ebola outbreak - part of the $1 billion total UN program. Of this, $65 million will go to UNICEF's programmes in Liberia, $61 million to Sierra Leone and $55 million to Guinea. An additional $10 million will help neighbouring countries be prepared for a potential spread of the disease within their borders, with the remaining $9 million required for regional coordination efforts. UNICEF estimates that 8.5 million children and young people under the age of 20 live in areas affected by Ebola in Guinea, Sierra Leone and Liberia. Of these, 2.5 million are under the age of five. The program's immediate focus is to help contain the spread of the disease and address communities immediate needs. UNICEF is one of the largest agencies providing essential supplies for use in treatment and care centres and for continuity of basic services. By 8 October, more than 900 metric tonnes of supplies were delivered to the region in support of partners, through a total of 73 flights. The African Development Bank has contributed over $220 million. In October, the African Union appealed for its members to send health-care workers to the three West African countries. On October 28, it was announced that they had received substantial pledges; among others, the East African Community has promised 600 personnel, Ethiopia 210, and Congo 200. In total it is hoped that Africa's contribution will reach 2,000 personnel, of whom one-sixth are currently ready for deployment. In March, the Economic Community of West African States (ECOWAS) disbursed US$250,000 to deal with the outbreak. In response to the ECOWAS Special Fund for the Fight against Ebola, in July the Nigerian government donated us$3.5 million to Liberia, Guinea, Sierra Leone, the West African Health Organization, and the ECOWAS Pool Fund, to aid in the fight against the epidemic. The European Commission has committed €600 million ($760 million) funding to fight the outbreak, including the provision of mobile laboratories, funding to strengthen healthcare capacity, support to help cushion the macroeconomic impact, support to the deployment of medical missions by partner organisations, and funding for vaccine research and trials. On 24 October, the European Council announced that contributions by the European Commission and individual member states come to a combined total of €1 billion ($1.3 billion). By March 2015, the total contributed had reached €1.2bn ($1.3). The Innovative Medicines Initiative , which is part funded by the European Union, in January 2015 announced eight projects on Ebola, to accelerate all aspects of vaccine development and manufacturing as well as deployment and compliance with vaccine regimens and diagnostics. The total budget of the eight projects launched is €215 million. On October 9, 2014, the International Charter on Space and Major Disasters was activated by the USGS on behalf of the National Geospatial Agency to monitor the outbreak (in Sierra Leone , specifically), the first time its space assets have been used in an epidemiological role. The World Bank Group has pledged US$230 million in emergency funding to help Guinea, Liberia, and Sierra Leone contain the spread of Ebola infections, help their communities cope with the economic impact of the crisis, and improve public health systems throughout West Africa. On 25 September The World Bank made additional funding of $170 million available to help curtail the spread of the Ebola virus. The funds will be used to finance medical supplies and increase the number of healthcare workers. On 30 October a further $100 million funding was announced, bringing the cumulative total to $500 million. The latest tranche will go towards setting up a coordination hub to recruit, train and deploy qualified foreign health workers and support the three countries' efforts to isolate Ebola patients and bury the dead safely, the bank said. The African Development Bank has contributed over $220 million. In October, the African Union appealed for its members to send health-care workers to the three West African countries. On October 28, it was announced that they had received substantial pledges; among others, the East African Community has promised 600 personnel, Ethiopia 210, and Congo 200. In total it is hoped that Africa's contribution will reach 2,000 personnel, of whom one-sixth are currently ready for deployment. In March, the Economic Community of West African States (ECOWAS) disbursed US$250,000 to deal with the outbreak. In response to the ECOWAS Special Fund for the Fight against Ebola, in July the Nigerian government donated us$3.5 million to Liberia, Guinea, Sierra Leone, the West African Health Organization, and the ECOWAS Pool Fund, to aid in the fight against the epidemic. The European Commission has committed €600 million ($760 million) funding to fight the outbreak, including the provision of mobile laboratories, funding to strengthen healthcare capacity, support to help cushion the macroeconomic impact, support to the deployment of medical missions by partner organisations, and funding for vaccine research and trials. On 24 October, the European Council announced that contributions by the European Commission and individual member states come to a combined total of €1 billion ($1.3 billion). By March 2015, the total contributed had reached €1.2bn ($1.3). The Innovative Medicines Initiative , which is part funded by the European Union, in January 2015 announced eight projects on Ebola, to accelerate all aspects of vaccine development and manufacturing as well as deployment and compliance with vaccine regimens and diagnostics. The total budget of the eight projects launched is €215 million. On October 9, 2014, the International Charter on Space and Major Disasters was activated by the USGS on behalf of the National Geospatial Agency to monitor the outbreak (in Sierra Leone , specifically), the first time its space assets have been used in an epidemiological role. The World Bank Group has pledged US$230 million in emergency funding to help Guinea, Liberia, and Sierra Leone contain the spread of Ebola infections, help their communities cope with the economic impact of the crisis, and improve public health systems throughout West Africa. On 25 September The World Bank made additional funding of $170 million available to help curtail the spread of the Ebola virus. The funds will be used to finance medical supplies and increase the number of healthcare workers. On 30 October a further $100 million funding was announced, bringing the cumulative total to $500 million. The latest tranche will go towards setting up a coordination hub to recruit, train and deploy qualified foreign health workers and support the three countries' efforts to isolate Ebola patients and bury the dead safely, the bank said. Many governments across the world have put measures in place which are aimed at preventing the possible spread of Ebola into their countries, and to prepare an appropriate response in order to protect their populations from Ebola. These include: In August, the Ivory Coast , announced the closure of its land borders with neighbouring countries Guinea and Liberia affected by the Ebola outbreak. The sale and consumption of bushmeat has been banned. Mali , which shares a border with Guinea, has implemented a contingency plan for prevention of Ebola Virus Disease. This involves a strong prevention system in several locations along the border, screening of incoming air passengers, a toll free phone number for notifying suspected cases, and stockpiles of drugs and equipment. The following countries have pledged resources, expertise, or funds to the international effort in West Africa:- Australia announced on 17 September that it will commit an additional 7 million Australian dollars to help the international response to the Ebola outbreak in West Africa, bringing the total committed to AU$8 million. The funds will be divided between support to the British government's response, the World Health Organization, and Medecins Sans Frontieres. However MSF has declined the donation, saying that what's needed instead is a specialised deployment of civil and military assets. Subsequently, the Australian government has agreed to assist several hundred Australian expert volunteers to travel to one of the Ebola hotspots of Africa to help control the epidemic. In response to the request for international cooperation made by the World Health Organization, Brazil's Health Ministry has donated a number of medical kits to affected countries. Each kit comprises 1.2 tons of supplies including antibiotics, anti-inflammatories, gloves and masks, sufficient to treat 500 patients for three months. Four kits have been allocated to Guinea, five to Sierra Leone and five more to Liberia. On 12 August, the Public Health Agency of Canada (PHAC) announced that the country would donate between 800 and 1,000 doses of an untested vaccine ( VSV-EBOV ) to the WHO. The offer was made by the Minister of Health directly to the Director General of the WHO as part of the country's commitment to containment efforts. The Government of Canada holds the patent associated with the vaccine, but has licensed BioProtection Systems of Ames, Iowa to develop the product for use in humans. By 20 October, Canada had pledged 65.4 million Canadian dollars to the fight against Ebola. As part of its contribution, Canada has deployed two mobile diagnostic laboratories in Sierra Leone, and shipped the first batch of an experimental Ebola vaccine to the WHO in Geneva. In August, China sent their second donation of supplies to Guinea, Sierra Leone, and Liberia. The supplies, worth 30 million yuan (4.9 million US dollars), include medical protective clothes, disinfectants, thermo-detectors, and medicines. China has also sent three expert teams composed of epidemiologists and specialists in disinfection and protection. Some Chinese companies in West Africa have also joined the relief efforts. China Kingho Group , a leading exploration and mining company in Sierra Leone, donated 400 million leones (about $90,000) to the government and people of Sierra Leone on 15 August. On 16 August, Chinese President Xi Jinping and UN Secretary-General Ban Ki-moon discussed several issues, including Ebola, in their fourth meeting this year. Xi said China will continue to make joint efforts with the international community to prevent and control the Ebola virus outbreak that has hit West Africa. China's medical teams in the countries are working with local staff, according to Xi. Xi also spoke highly of the measures taken by the United Nations and WHO and its professional institutions, and called for more assistance and input for medical and health services in African countries. [ citation needed ] On 25 September, a second mobile lab landed at Lungi Airport in Sierra Leone. The lab will assist the 29 CDC workers experts from China already in the region to help fight the disease. On 24 October, China announced a fourth round of emergency funding bringing its commitments now to a total of 500 million yuan - to be used to set up a treatment center in Liberia, and to increase the number of Chinese medical staff working in West Africa to fight the epidemic. China has also contributed to the World Food Program activities in the area. On 31 October, China announced that a medical squad of the People's Liberation Army , which has experience from a 2002 outbreak of SARS , will build a 100-bed treatment center in Liberia. From 2014 to 2015, the PLA deployed 524 medical staff on a rotational basis to combat the outbreak in Liberia, Sierra Leone, Guinea, and Guinea-Bissau. : 245 On 10 September, Cuba announced its willingness to help curtail the spread of the disease with a plan to send 165 doctors, nurses and infection control specialists to Sierra Leone on a six-month rotation. Having completed a training program, the first group of these arrived in Freetown on 2 October. On 27 September, Cuba announced it is preparing to send a further 296 healthcare workers to Liberia and Guinea. In October, Egypt sent three tons of medical aid, consisting of medicine and medical equipment. In October 2014, it was announced that Ethiopia would send approximately 200 volunteer health workers to West Africa. The country also donated $500,000 to affected countries. France has committed €70 million in aid to fight the epidemic. This includes the provision of clinical testing facilities and the construction of a 50-bed treatment centre which will be managed by the French Red Cross. Additionally they are supporting other organisations working in the area and the wider international effort. The country also dispatched 20 experts from the EPRUS institute to Guinea to fight the spread of the events. The Pasteur Institute also plans to set up a center of expertise in Conakry in order to provide improved responses in the future. The German government announced on 19 September, that its contributions to the fight against Ebola had reached a total of euro 17 million to date. This includes contributions to the World Health Organization , Medecins sans Frontieres , and other agencies. Material contributions include air transport to the region and a treatment station for Liberia. On 22 September Ursula von der Leyen , the German defense minister, has asked volunteers from their military contingent to assist in staffing a clinic in the epidemic region. The minister appealed to soldiers to "voluntarily make yourselves available for this unusual mission." On 16 October the German government announced an increased contribution of €102 million for fighting the outbreak, following criticism that little had been done regarding Berlin's pledge to help the region deal with the Ebola outbreak. The new pledge represents a six-fold increase compared to its €17 million contribution. Then-Foreign Minister Frank-Walter Steinmeier stated that "We have underestimated the disastrous consequences of Ebola" and that "The race to catch up begins now." On 22 November Germany sent 400 specially adapted motorbikes to worst hit areas of West Africa. The bikes will be used in the remote areas to rush test samples to testing laboratories, thus reducing the result time from 9 or more days to less than 24 hours. Following a request made via the EU Civil Protection Mechanism , in January 2015 Germany dispatched a specialized medical airplane to West Africa in order to allow for speedy evacuation of EU volunteers to European hospitals. On 30 August, the Ghanaian Presidency released a press statement, announcing the country's willingness to use Accra as a support base to help fight Ebola in the stricken countries. This agreement follows a telephonic meeting with the United Nations chief, Ban Ki-moon and John Dramani Mahama , the President of Ghana. Accra will serve as a base for air lifting medical and other supplies to countries affected by the Ebola outbreak, as well as personnel to curtail the disease. In the coming months Ghana will play a major role in the fight against the disease in the region. The city of Accra will be the designated base for UNMEER, the newly formed mission by the UN. India has given 10 million dollars to the UN Secretary General`s Fund for Ebola and 2 million dollars for the purchase of protective gear for health workers in the affected regions. India has also offered to contribute to the research for developing affordable drugs for cure or vaccination. Prior to this, India had contributed $500,000 to augment the WHO efforts to prevent the spread of Ebola virus. Ireland has provided direct funding of almost €3 million for Ebola treatment facilities in both Sierra Leone and Liberia, as well as for contact-tracing, community sensitisation and child nutrition programmes. Israel has contributed $8.75 million to the UN's Ebola Response Multi-Partner Trust Fund to help stop the spread of the disease. In addition the Israeli government has sent six cargo containers full of special equipment used to set up portable field hospitals. The medical staff attached to the hospitals provided training to local medical professionals regarding the use of medical equipment, as well as focusing on "preventing the spread of the disease and raising awareness among populations with high potential for infection." In April, the Government of Japan gave $520,000 through the United Nations Children's Fund (UNICEF) to support the Ebola outbreak response in Guinea. In August, another $1.5 million in additional support was provided to be disbursed via the WHO, UNICEF and Red Cross , and will be used for measures to prevent Ebola infections and to provide medical supplies. On 25 August, Japanese authorities announced that they would be willing to provide access to an anti-influenza drug currently under development called favipiravir to try to treat EVD patients. Fujifilm Holdings Corp and MediVector have reportedly approached the U.S. Food and Drug Administration to request approval for this experimental use of favipiravir. Up to 20,000 doses of favipiravir would currently be available. Malaysia plans to send more than 20 million medical gloves to Guinea, Liberia, Nigeria and Sierra Leone to alleviate a shortage of medical supplies in the affected countries. Malaysia will also send medical gloves to the Democratic Republic of Congo which is also dealing with an Ebola outbreak unrelated to the one affecting West Africa. The Dutch government has pledged over €35 million to combat the disease. This includes donations to Médecins Sans Frontières (MSF), the Red Cross, the UN and UNICEF. In addition, a naval ship carrying relief supplies has deployed to West Africa on 6 November with a cargo which has been provided by nine EU member states. The supplies include a significant number of lorries , ambulances, mobile laboratories and other vehicles; generators, rubber gloves and boots, and other medical supplies. The New Zealand Government has agreed to send 24 doctors and nurses to Sierra Leone to join international efforts against Ebola, at a cost of $2 million. The volunteers would join the Australian-led mission. On Friday 5 November volunteer medical workers arrived in Liberia and Sierra Leone from Nigeria . The first arrivals included 100 volunteers in Freetown, Sierra Leone and a further 76 in Liberia. Nigeria has announced it will be sending 600 volunteers in the coming weeks to help stem the spread of the disease. On 31 October, Norway announced that they will send 200 medical workers to Sierra Leone, in 4 teams of 50 each. The workers will help to run a treatment centre which has been set up by the British government. Norway will also establish an accommodation camp for between 50 and 100 health workers in Moyamba. In a separate announcement, Norway has donated $2.7 million to the African Union Support to Ebola Outbreak in West Africa (ASEOWA). On the 18th of October, it was announced that Portugal would set up a medical base at the Hospital Militar in Bissau, the capital of Guinea-Bissau , to prevent and combat Ebola in case the epidemic crosses its border with Guinea . The base is intended to complement an Ebola treatment center which the Bissau government plans to set up in the Hospital Simão Mendes, the country's main hospital. However no date has been decided for this program to start. Russia has allocated $19 million to help fight the virus. The funds are to be divided between humanitarian aid projects, research, preparations for a national outbreak of Ebola, and strengthening international efforts to battle the virus, including those led by the World Health Organization. In January 2015, the mining company Rusal constructed and opened a treatment and research center in the city of Kindia in Guinea at a cost of $10 million. In February of that same year, Russia delivered 37 tonnes of humanitarian aid to Guinea, including food supplies and medical instruments. The Government of Taiwan gave $1 million to the U.S. Centers for Disease Control and Prevention (CDC). The donation was made to the CDC Foundation's Global Disaster Response Fund which provides materials from protective gear to vehicles used to provide transportation for medical workers. Taiwan also donated 100,000 units of coveralls and surgical masks to Guinea, Liberia, and Sierra Leone. In August 2014 a team of 14 health workers from Uganda, which has "strong experience" of working with domestic Ebola outbreaks, had been deployed by the WHO to JFK Hospital in Monrovia, Liberia. On 27 October 2014 it was announced that a further 30 health workers had been dispatched to affected countries in West Africa. The UK government announced it has pledged £427 million ($635 million) to lead the global effort in Sierra Leone to contain, control and defeat the disease in that country. Previously published information from the UK states this includes support for 700 Ebola treatment beds in at least five treatment centres that the UK will build. These centres will provide medical care for up to 8,800 patients per six months. Britain also said it will support the establishment of 200 community care centres where people who believe they may have contracted Ebola can get a diagnosis and medical care. On 2 October the UK hosted, alongside the Government of Sierra Leone , an international conference in London to rally the global community to provide an effective international response. The conference brought together more than 20 governments, a dozen charities and NGOs, the UN, World Bank, health experts and the private sector to pledge funds, equipment and health workers. In October 2014, the Ministry of Defence said 750 personnel will be deployed to help with the establishment of Ebola Treatment Centres and an Ebola Training Academy including: As of 12 October, the Department for International Development said aid supplies delivered so far include: 20 vehicles including ambulances; 75 water tanks; 3 incinerators for disposing of clothing and other materials; 12 generators; personal protection equipment; radio equipment; lighting sets; chlorine for sanitation; latrine slabs; temporary warehouse tents; 14 air conditioning units and isolator equipment. The UK government is co-funding clinical trials to find a safe vaccine for Ebola. Ten thousand doses of the drug are already being manufactured alongside the clinical trial in the hope that it will be approved for use in the coming months. A £6.5 million research initiative has been announced jointly by the Department for International Development and the Wellcome Trust to better inform the management of Ebola outbreaks. Prime Minister David Cameron wrote to members of the European Council in October 2014 asking leaders to agree a new package of measures to tackle the Ebola crisis. On 22 November over 30 NHS volunteers flew over to Freetown, Sierra Leone to assist with the Ebola epidemic. By January 2015, 1,600 British National Health Service (NHS) staff had volunteered to travel to west Africa and help those affected by Ebola. By the beginning of August, the United States Centers for Disease Control and Prevention (CDC) had placed staff in Guinea, Sierra Leone, Liberia, and Nigeria to assist the local Ministries of Health and WHO-led response to the outbreak. On 8 September, United States President Barack Obama announced that the United States government would send military personnel to the epidemic area. The military would assist in the setting up of isolation units and would provide additional safety to health workers in the area. The military would also assist in providing transportation of medical equipment. President Obama added that the steps are necessary to curtail the spread of the virus. The announcement came amid fears that the virus might mutate and become more virulent and "represents a serious national security concern." The United States also plans to send 400,000 home protective kits to the four counties in Liberia that have been hit the hardest by Ebola. The kit will include protective gear for family members, gloves and masks, disinfectants, and fever-reducing drugs. On 8 September, the Department of Defense announced that it had allocated $22 million to set up a 25-bed field hospital in Liberia to treat healthcare workers affected by the Ebola virus. On 9 September, the United States Agency for International Development (USAID) announced that it would support the African Union 's deployment of approximately 100 health workers to West Africa to manage and run Ebola treatment units. On 16 September, President Obama announced that the Department of Defense would take the lead in overseeing the response to the epidemic. The military would dispatch up to 3,000 personnel to West Africa in an effort that could cost up to $750 million over the next six months. U.S. Major General Darryl A. Williams , Commander, United States Army Africa , would be in place in Monrovia, Liberia, within the week to lead the effort. The general would head a regional command based in Liberia that would help oversee and coordinate U.S. and international relief efforts while a new, separate regional staging base in Senegal would help accelerate transportation of urgently needed equipment, supplies and personnel. In addition, the U.S. Department of Defense would send engineers to set up 17 treatment centers in Liberia — each with a 100-bed capacity — and would set up a site in the region to train up to 500 health-care workers a week. The President said that the armed forces "are going to bring their expertise in command and control, in logistics, in engineering" to help do tasks ranging from bringing in aid workers and medical equipment to distributing supplies and information kits to families in high-risk areas so they can take the appropriate precautions. However, the CDC warned on 20 September that there may be insufficient staff for the new treatment facilities that the international community was building. On October 6, the White House released a fact sheet detailing the key elements of the US response. These include: deployment of medical personnel, equipment, and military logistical resources generally to the area but with a focus on Liberia; construction of treatment, logistics and training centers measures to screen incoming travellers and prevent spread of the disease within the US. The United States Africa Command , working through United States Army Africa, has designated the Army's response to the epidemic as Operation United Assistance . Many governments across the world have put measures in place which are aimed at preventing the possible spread of Ebola into their countries, and to prepare an appropriate response in order to protect their populations from Ebola. These include:In August, the Ivory Coast , announced the closure of its land borders with neighbouring countries Guinea and Liberia affected by the Ebola outbreak. The sale and consumption of bushmeat has been banned. Mali , which shares a border with Guinea, has implemented a contingency plan for prevention of Ebola Virus Disease. This involves a strong prevention system in several locations along the border, screening of incoming air passengers, a toll free phone number for notifying suspected cases, and stockpiles of drugs and equipment. In August, the Ivory Coast , announced the closure of its land borders with neighbouring countries Guinea and Liberia affected by the Ebola outbreak. The sale and consumption of bushmeat has been banned. Mali , which shares a border with Guinea, has implemented a contingency plan for prevention of Ebola Virus Disease. This involves a strong prevention system in several locations along the border, screening of incoming air passengers, a toll free phone number for notifying suspected cases, and stockpiles of drugs and equipment. The following countries have pledged resources, expertise, or funds to the international effort in West Africa:- Australia announced on 17 September that it will commit an additional 7 million Australian dollars to help the international response to the Ebola outbreak in West Africa, bringing the total committed to AU$8 million. The funds will be divided between support to the British government's response, the World Health Organization, and Medecins Sans Frontieres. However MSF has declined the donation, saying that what's needed instead is a specialised deployment of civil and military assets. Subsequently, the Australian government has agreed to assist several hundred Australian expert volunteers to travel to one of the Ebola hotspots of Africa to help control the epidemic. In response to the request for international cooperation made by the World Health Organization, Brazil's Health Ministry has donated a number of medical kits to affected countries. Each kit comprises 1.2 tons of supplies including antibiotics, anti-inflammatories, gloves and masks, sufficient to treat 500 patients for three months. Four kits have been allocated to Guinea, five to Sierra Leone and five more to Liberia. On 12 August, the Public Health Agency of Canada (PHAC) announced that the country would donate between 800 and 1,000 doses of an untested vaccine ( VSV-EBOV ) to the WHO. The offer was made by the Minister of Health directly to the Director General of the WHO as part of the country's commitment to containment efforts. The Government of Canada holds the patent associated with the vaccine, but has licensed BioProtection Systems of Ames, Iowa to develop the product for use in humans. By 20 October, Canada had pledged 65.4 million Canadian dollars to the fight against Ebola. As part of its contribution, Canada has deployed two mobile diagnostic laboratories in Sierra Leone, and shipped the first batch of an experimental Ebola vaccine to the WHO in Geneva. In August, China sent their second donation of supplies to Guinea, Sierra Leone, and Liberia. The supplies, worth 30 million yuan (4.9 million US dollars), include medical protective clothes, disinfectants, thermo-detectors, and medicines. China has also sent three expert teams composed of epidemiologists and specialists in disinfection and protection. Some Chinese companies in West Africa have also joined the relief efforts. China Kingho Group , a leading exploration and mining company in Sierra Leone, donated 400 million leones (about $90,000) to the government and people of Sierra Leone on 15 August. On 16 August, Chinese President Xi Jinping and UN Secretary-General Ban Ki-moon discussed several issues, including Ebola, in their fourth meeting this year. Xi said China will continue to make joint efforts with the international community to prevent and control the Ebola virus outbreak that has hit West Africa. China's medical teams in the countries are working with local staff, according to Xi. Xi also spoke highly of the measures taken by the United Nations and WHO and its professional institutions, and called for more assistance and input for medical and health services in African countries. [ citation needed ] On 25 September, a second mobile lab landed at Lungi Airport in Sierra Leone. The lab will assist the 29 CDC workers experts from China already in the region to help fight the disease. On 24 October, China announced a fourth round of emergency funding bringing its commitments now to a total of 500 million yuan - to be used to set up a treatment center in Liberia, and to increase the number of Chinese medical staff working in West Africa to fight the epidemic. China has also contributed to the World Food Program activities in the area. On 31 October, China announced that a medical squad of the People's Liberation Army , which has experience from a 2002 outbreak of SARS , will build a 100-bed treatment center in Liberia. From 2014 to 2015, the PLA deployed 524 medical staff on a rotational basis to combat the outbreak in Liberia, Sierra Leone, Guinea, and Guinea-Bissau. : 245 On 10 September, Cuba announced its willingness to help curtail the spread of the disease with a plan to send 165 doctors, nurses and infection control specialists to Sierra Leone on a six-month rotation. Having completed a training program, the first group of these arrived in Freetown on 2 October. On 27 September, Cuba announced it is preparing to send a further 296 healthcare workers to Liberia and Guinea. In October, Egypt sent three tons of medical aid, consisting of medicine and medical equipment. In October 2014, it was announced that Ethiopia would send approximately 200 volunteer health workers to West Africa. The country also donated $500,000 to affected countries. France has committed €70 million in aid to fight the epidemic. This includes the provision of clinical testing facilities and the construction of a 50-bed treatment centre which will be managed by the French Red Cross. Additionally they are supporting other organisations working in the area and the wider international effort. The country also dispatched 20 experts from the EPRUS institute to Guinea to fight the spread of the events. The Pasteur Institute also plans to set up a center of expertise in Conakry in order to provide improved responses in the future. The German government announced on 19 September, that its contributions to the fight against Ebola had reached a total of euro 17 million to date. This includes contributions to the World Health Organization , Medecins sans Frontieres , and other agencies. Material contributions include air transport to the region and a treatment station for Liberia. On 22 September Ursula von der Leyen , the German defense minister, has asked volunteers from their military contingent to assist in staffing a clinic in the epidemic region. The minister appealed to soldiers to "voluntarily make yourselves available for this unusual mission." On 16 October the German government announced an increased contribution of €102 million for fighting the outbreak, following criticism that little had been done regarding Berlin's pledge to help the region deal with the Ebola outbreak. The new pledge represents a six-fold increase compared to its €17 million contribution. Then-Foreign Minister Frank-Walter Steinmeier stated that "We have underestimated the disastrous consequences of Ebola" and that "The race to catch up begins now." On 22 November Germany sent 400 specially adapted motorbikes to worst hit areas of West Africa. The bikes will be used in the remote areas to rush test samples to testing laboratories, thus reducing the result time from 9 or more days to less than 24 hours. Following a request made via the EU Civil Protection Mechanism , in January 2015 Germany dispatched a specialized medical airplane to West Africa in order to allow for speedy evacuation of EU volunteers to European hospitals. On 30 August, the Ghanaian Presidency released a press statement, announcing the country's willingness to use Accra as a support base to help fight Ebola in the stricken countries. This agreement follows a telephonic meeting with the United Nations chief, Ban Ki-moon and John Dramani Mahama , the President of Ghana. Accra will serve as a base for air lifting medical and other supplies to countries affected by the Ebola outbreak, as well as personnel to curtail the disease. In the coming months Ghana will play a major role in the fight against the disease in the region. The city of Accra will be the designated base for UNMEER, the newly formed mission by the UN. India has given 10 million dollars to the UN Secretary General`s Fund for Ebola and 2 million dollars for the purchase of protective gear for health workers in the affected regions. India has also offered to contribute to the research for developing affordable drugs for cure or vaccination. Prior to this, India had contributed $500,000 to augment the WHO efforts to prevent the spread of Ebola virus. Ireland has provided direct funding of almost €3 million for Ebola treatment facilities in both Sierra Leone and Liberia, as well as for contact-tracing, community sensitisation and child nutrition programmes. Israel has contributed $8.75 million to the UN's Ebola Response Multi-Partner Trust Fund to help stop the spread of the disease. In addition the Israeli government has sent six cargo containers full of special equipment used to set up portable field hospitals. The medical staff attached to the hospitals provided training to local medical professionals regarding the use of medical equipment, as well as focusing on "preventing the spread of the disease and raising awareness among populations with high potential for infection." In April, the Government of Japan gave $520,000 through the United Nations Children's Fund (UNICEF) to support the Ebola outbreak response in Guinea. In August, another $1.5 million in additional support was provided to be disbursed via the WHO, UNICEF and Red Cross , and will be used for measures to prevent Ebola infections and to provide medical supplies. On 25 August, Japanese authorities announced that they would be willing to provide access to an anti-influenza drug currently under development called favipiravir to try to treat EVD patients. Fujifilm Holdings Corp and MediVector have reportedly approached the U.S. Food and Drug Administration to request approval for this experimental use of favipiravir. Up to 20,000 doses of favipiravir would currently be available. Malaysia plans to send more than 20 million medical gloves to Guinea, Liberia, Nigeria and Sierra Leone to alleviate a shortage of medical supplies in the affected countries. Malaysia will also send medical gloves to the Democratic Republic of Congo which is also dealing with an Ebola outbreak unrelated to the one affecting West Africa. The Dutch government has pledged over €35 million to combat the disease. This includes donations to Médecins Sans Frontières (MSF), the Red Cross, the UN and UNICEF. In addition, a naval ship carrying relief supplies has deployed to West Africa on 6 November with a cargo which has been provided by nine EU member states. The supplies include a significant number of lorries , ambulances, mobile laboratories and other vehicles; generators, rubber gloves and boots, and other medical supplies. The New Zealand Government has agreed to send 24 doctors and nurses to Sierra Leone to join international efforts against Ebola, at a cost of $2 million. The volunteers would join the Australian-led mission. On Friday 5 November volunteer medical workers arrived in Liberia and Sierra Leone from Nigeria . The first arrivals included 100 volunteers in Freetown, Sierra Leone and a further 76 in Liberia. Nigeria has announced it will be sending 600 volunteers in the coming weeks to help stem the spread of the disease. On 31 October, Norway announced that they will send 200 medical workers to Sierra Leone, in 4 teams of 50 each. The workers will help to run a treatment centre which has been set up by the British government. Norway will also establish an accommodation camp for between 50 and 100 health workers in Moyamba. In a separate announcement, Norway has donated $2.7 million to the African Union Support to Ebola Outbreak in West Africa (ASEOWA). On the 18th of October, it was announced that Portugal would set up a medical base at the Hospital Militar in Bissau, the capital of Guinea-Bissau , to prevent and combat Ebola in case the epidemic crosses its border with Guinea . The base is intended to complement an Ebola treatment center which the Bissau government plans to set up in the Hospital Simão Mendes, the country's main hospital. However no date has been decided for this program to start. Russia has allocated $19 million to help fight the virus. The funds are to be divided between humanitarian aid projects, research, preparations for a national outbreak of Ebola, and strengthening international efforts to battle the virus, including those led by the World Health Organization. In January 2015, the mining company Rusal constructed and opened a treatment and research center in the city of Kindia in Guinea at a cost of $10 million. In February of that same year, Russia delivered 37 tonnes of humanitarian aid to Guinea, including food supplies and medical instruments. The Government of Taiwan gave $1 million to the U.S. Centers for Disease Control and Prevention (CDC). The donation was made to the CDC Foundation's Global Disaster Response Fund which provides materials from protective gear to vehicles used to provide transportation for medical workers. Taiwan also donated 100,000 units of coveralls and surgical masks to Guinea, Liberia, and Sierra Leone. In August 2014 a team of 14 health workers from Uganda, which has "strong experience" of working with domestic Ebola outbreaks, had been deployed by the WHO to JFK Hospital in Monrovia, Liberia. On 27 October 2014 it was announced that a further 30 health workers had been dispatched to affected countries in West Africa. The UK government announced it has pledged £427 million ($635 million) to lead the global effort in Sierra Leone to contain, control and defeat the disease in that country. Previously published information from the UK states this includes support for 700 Ebola treatment beds in at least five treatment centres that the UK will build. These centres will provide medical care for up to 8,800 patients per six months. Britain also said it will support the establishment of 200 community care centres where people who believe they may have contracted Ebola can get a diagnosis and medical care. On 2 October the UK hosted, alongside the Government of Sierra Leone , an international conference in London to rally the global community to provide an effective international response. The conference brought together more than 20 governments, a dozen charities and NGOs, the UN, World Bank, health experts and the private sector to pledge funds, equipment and health workers. In October 2014, the Ministry of Defence said 750 personnel will be deployed to help with the establishment of Ebola Treatment Centres and an Ebola Training Academy including: As of 12 October, the Department for International Development said aid supplies delivered so far include: 20 vehicles including ambulances; 75 water tanks; 3 incinerators for disposing of clothing and other materials; 12 generators; personal protection equipment; radio equipment; lighting sets; chlorine for sanitation; latrine slabs; temporary warehouse tents; 14 air conditioning units and isolator equipment. The UK government is co-funding clinical trials to find a safe vaccine for Ebola. Ten thousand doses of the drug are already being manufactured alongside the clinical trial in the hope that it will be approved for use in the coming months. A £6.5 million research initiative has been announced jointly by the Department for International Development and the Wellcome Trust to better inform the management of Ebola outbreaks. Prime Minister David Cameron wrote to members of the European Council in October 2014 asking leaders to agree a new package of measures to tackle the Ebola crisis. On 22 November over 30 NHS volunteers flew over to Freetown, Sierra Leone to assist with the Ebola epidemic. By January 2015, 1,600 British National Health Service (NHS) staff had volunteered to travel to west Africa and help those affected by Ebola. By the beginning of August, the United States Centers for Disease Control and Prevention (CDC) had placed staff in Guinea, Sierra Leone, Liberia, and Nigeria to assist the local Ministries of Health and WHO-led response to the outbreak. On 8 September, United States President Barack Obama announced that the United States government would send military personnel to the epidemic area. The military would assist in the setting up of isolation units and would provide additional safety to health workers in the area. The military would also assist in providing transportation of medical equipment. President Obama added that the steps are necessary to curtail the spread of the virus. The announcement came amid fears that the virus might mutate and become more virulent and "represents a serious national security concern." The United States also plans to send 400,000 home protective kits to the four counties in Liberia that have been hit the hardest by Ebola. The kit will include protective gear for family members, gloves and masks, disinfectants, and fever-reducing drugs. On 8 September, the Department of Defense announced that it had allocated $22 million to set up a 25-bed field hospital in Liberia to treat healthcare workers affected by the Ebola virus. On 9 September, the United States Agency for International Development (USAID) announced that it would support the African Union 's deployment of approximately 100 health workers to West Africa to manage and run Ebola treatment units. On 16 September, President Obama announced that the Department of Defense would take the lead in overseeing the response to the epidemic. The military would dispatch up to 3,000 personnel to West Africa in an effort that could cost up to $750 million over the next six months. U.S. Major General Darryl A. Williams , Commander, United States Army Africa , would be in place in Monrovia, Liberia, within the week to lead the effort. The general would head a regional command based in Liberia that would help oversee and coordinate U.S. and international relief efforts while a new, separate regional staging base in Senegal would help accelerate transportation of urgently needed equipment, supplies and personnel. In addition, the U.S. Department of Defense would send engineers to set up 17 treatment centers in Liberia — each with a 100-bed capacity — and would set up a site in the region to train up to 500 health-care workers a week. The President said that the armed forces "are going to bring their expertise in command and control, in logistics, in engineering" to help do tasks ranging from bringing in aid workers and medical equipment to distributing supplies and information kits to families in high-risk areas so they can take the appropriate precautions. However, the CDC warned on 20 September that there may be insufficient staff for the new treatment facilities that the international community was building. On October 6, the White House released a fact sheet detailing the key elements of the US response. These include: deployment of medical personnel, equipment, and military logistical resources generally to the area but with a focus on Liberia; construction of treatment, logistics and training centers measures to screen incoming travellers and prevent spread of the disease within the US. The United States Africa Command , working through United States Army Africa, has designated the Army's response to the epidemic as Operation United Assistance . Australia announced on 17 September that it will commit an additional 7 million Australian dollars to help the international response to the Ebola outbreak in West Africa, bringing the total committed to AU$8 million. The funds will be divided between support to the British government's response, the World Health Organization, and Medecins Sans Frontieres. However MSF has declined the donation, saying that what's needed instead is a specialised deployment of civil and military assets. Subsequently, the Australian government has agreed to assist several hundred Australian expert volunteers to travel to one of the Ebola hotspots of Africa to help control the epidemic. In response to the request for international cooperation made by the World Health Organization, Brazil's Health Ministry has donated a number of medical kits to affected countries. Each kit comprises 1.2 tons of supplies including antibiotics, anti-inflammatories, gloves and masks, sufficient to treat 500 patients for three months. Four kits have been allocated to Guinea, five to Sierra Leone and five more to Liberia. On 12 August, the Public Health Agency of Canada (PHAC) announced that the country would donate between 800 and 1,000 doses of an untested vaccine ( VSV-EBOV ) to the WHO. The offer was made by the Minister of Health directly to the Director General of the WHO as part of the country's commitment to containment efforts. The Government of Canada holds the patent associated with the vaccine, but has licensed BioProtection Systems of Ames, Iowa to develop the product for use in humans. By 20 October, Canada had pledged 65.4 million Canadian dollars to the fight against Ebola. As part of its contribution, Canada has deployed two mobile diagnostic laboratories in Sierra Leone, and shipped the first batch of an experimental Ebola vaccine to the WHO in Geneva. In August, China sent their second donation of supplies to Guinea, Sierra Leone, and Liberia. The supplies, worth 30 million yuan (4.9 million US dollars), include medical protective clothes, disinfectants, thermo-detectors, and medicines. China has also sent three expert teams composed of epidemiologists and specialists in disinfection and protection. Some Chinese companies in West Africa have also joined the relief efforts. China Kingho Group , a leading exploration and mining company in Sierra Leone, donated 400 million leones (about $90,000) to the government and people of Sierra Leone on 15 August. On 16 August, Chinese President Xi Jinping and UN Secretary-General Ban Ki-moon discussed several issues, including Ebola, in their fourth meeting this year. Xi said China will continue to make joint efforts with the international community to prevent and control the Ebola virus outbreak that has hit West Africa. China's medical teams in the countries are working with local staff, according to Xi. Xi also spoke highly of the measures taken by the United Nations and WHO and its professional institutions, and called for more assistance and input for medical and health services in African countries. [ citation needed ] On 25 September, a second mobile lab landed at Lungi Airport in Sierra Leone. The lab will assist the 29 CDC workers experts from China already in the region to help fight the disease. On 24 October, China announced a fourth round of emergency funding bringing its commitments now to a total of 500 million yuan - to be used to set up a treatment center in Liberia, and to increase the number of Chinese medical staff working in West Africa to fight the epidemic. China has also contributed to the World Food Program activities in the area. On 31 October, China announced that a medical squad of the People's Liberation Army , which has experience from a 2002 outbreak of SARS , will build a 100-bed treatment center in Liberia. From 2014 to 2015, the PLA deployed 524 medical staff on a rotational basis to combat the outbreak in Liberia, Sierra Leone, Guinea, and Guinea-Bissau. : 245On 10 September, Cuba announced its willingness to help curtail the spread of the disease with a plan to send 165 doctors, nurses and infection control specialists to Sierra Leone on a six-month rotation. Having completed a training program, the first group of these arrived in Freetown on 2 October. On 27 September, Cuba announced it is preparing to send a further 296 healthcare workers to Liberia and Guinea. In October, Egypt sent three tons of medical aid, consisting of medicine and medical equipment. In October 2014, it was announced that Ethiopia would send approximately 200 volunteer health workers to West Africa. The country also donated $500,000 to affected countries. France has committed €70 million in aid to fight the epidemic. This includes the provision of clinical testing facilities and the construction of a 50-bed treatment centre which will be managed by the French Red Cross. Additionally they are supporting other organisations working in the area and the wider international effort. The country also dispatched 20 experts from the EPRUS institute to Guinea to fight the spread of the events. The Pasteur Institute also plans to set up a center of expertise in Conakry in order to provide improved responses in the future. The German government announced on 19 September, that its contributions to the fight against Ebola had reached a total of euro 17 million to date. This includes contributions to the World Health Organization , Medecins sans Frontieres , and other agencies. Material contributions include air transport to the region and a treatment station for Liberia. On 22 September Ursula von der Leyen , the German defense minister, has asked volunteers from their military contingent to assist in staffing a clinic in the epidemic region. The minister appealed to soldiers to "voluntarily make yourselves available for this unusual mission." On 16 October the German government announced an increased contribution of €102 million for fighting the outbreak, following criticism that little had been done regarding Berlin's pledge to help the region deal with the Ebola outbreak. The new pledge represents a six-fold increase compared to its €17 million contribution. Then-Foreign Minister Frank-Walter Steinmeier stated that "We have underestimated the disastrous consequences of Ebola" and that "The race to catch up begins now." On 22 November Germany sent 400 specially adapted motorbikes to worst hit areas of West Africa. The bikes will be used in the remote areas to rush test samples to testing laboratories, thus reducing the result time from 9 or more days to less than 24 hours. Following a request made via the EU Civil Protection Mechanism , in January 2015 Germany dispatched a specialized medical airplane to West Africa in order to allow for speedy evacuation of EU volunteers to European hospitals. On 30 August, the Ghanaian Presidency released a press statement, announcing the country's willingness to use Accra as a support base to help fight Ebola in the stricken countries. This agreement follows a telephonic meeting with the United Nations chief, Ban Ki-moon and John Dramani Mahama , the President of Ghana. Accra will serve as a base for air lifting medical and other supplies to countries affected by the Ebola outbreak, as well as personnel to curtail the disease. In the coming months Ghana will play a major role in the fight against the disease in the region. The city of Accra will be the designated base for UNMEER, the newly formed mission by the UN. India has given 10 million dollars to the UN Secretary General`s Fund for Ebola and 2 million dollars for the purchase of protective gear for health workers in the affected regions. India has also offered to contribute to the research for developing affordable drugs for cure or vaccination. Prior to this, India had contributed $500,000 to augment the WHO efforts to prevent the spread of Ebola virus. Ireland has provided direct funding of almost €3 million for Ebola treatment facilities in both Sierra Leone and Liberia, as well as for contact-tracing, community sensitisation and child nutrition programmes. Israel has contributed $8.75 million to the UN's Ebola Response Multi-Partner Trust Fund to help stop the spread of the disease. In addition the Israeli government has sent six cargo containers full of special equipment used to set up portable field hospitals. The medical staff attached to the hospitals provided training to local medical professionals regarding the use of medical equipment, as well as focusing on "preventing the spread of the disease and raising awareness among populations with high potential for infection." In April, the Government of Japan gave $520,000 through the United Nations Children's Fund (UNICEF) to support the Ebola outbreak response in Guinea. In August, another $1.5 million in additional support was provided to be disbursed via the WHO, UNICEF and Red Cross , and will be used for measures to prevent Ebola infections and to provide medical supplies. On 25 August, Japanese authorities announced that they would be willing to provide access to an anti-influenza drug currently under development called favipiravir to try to treat EVD patients. Fujifilm Holdings Corp and MediVector have reportedly approached the U.S. Food and Drug Administration to request approval for this experimental use of favipiravir. Up to 20,000 doses of favipiravir would currently be available. Malaysia plans to send more than 20 million medical gloves to Guinea, Liberia, Nigeria and Sierra Leone to alleviate a shortage of medical supplies in the affected countries. Malaysia will also send medical gloves to the Democratic Republic of Congo which is also dealing with an Ebola outbreak unrelated to the one affecting West Africa. The Dutch government has pledged over €35 million to combat the disease. This includes donations to Médecins Sans Frontières (MSF), the Red Cross, the UN and UNICEF. In addition, a naval ship carrying relief supplies has deployed to West Africa on 6 November with a cargo which has been provided by nine EU member states. The supplies include a significant number of lorries , ambulances, mobile laboratories and other vehicles; generators, rubber gloves and boots, and other medical supplies. The New Zealand Government has agreed to send 24 doctors and nurses to Sierra Leone to join international efforts against Ebola, at a cost of $2 million. The volunteers would join the Australian-led mission. On Friday 5 November volunteer medical workers arrived in Liberia and Sierra Leone from Nigeria . The first arrivals included 100 volunteers in Freetown, Sierra Leone and a further 76 in Liberia. Nigeria has announced it will be sending 600 volunteers in the coming weeks to help stem the spread of the disease. On 31 October, Norway announced that they will send 200 medical workers to Sierra Leone, in 4 teams of 50 each. The workers will help to run a treatment centre which has been set up by the British government. Norway will also establish an accommodation camp for between 50 and 100 health workers in Moyamba. In a separate announcement, Norway has donated $2.7 million to the African Union Support to Ebola Outbreak in West Africa (ASEOWA). On the 18th of October, it was announced that Portugal would set up a medical base at the Hospital Militar in Bissau, the capital of Guinea-Bissau , to prevent and combat Ebola in case the epidemic crosses its border with Guinea . The base is intended to complement an Ebola treatment center which the Bissau government plans to set up in the Hospital Simão Mendes, the country's main hospital. However no date has been decided for this program to start. Russia has allocated $19 million to help fight the virus. The funds are to be divided between humanitarian aid projects, research, preparations for a national outbreak of Ebola, and strengthening international efforts to battle the virus, including those led by the World Health Organization. In January 2015, the mining company Rusal constructed and opened a treatment and research center in the city of Kindia in Guinea at a cost of $10 million. In February of that same year, Russia delivered 37 tonnes of humanitarian aid to Guinea, including food supplies and medical instruments. The Government of Taiwan gave $1 million to the U.S. Centers for Disease Control and Prevention (CDC). The donation was made to the CDC Foundation's Global Disaster Response Fund which provides materials from protective gear to vehicles used to provide transportation for medical workers. Taiwan also donated 100,000 units of coveralls and surgical masks to Guinea, Liberia, and Sierra Leone. In August 2014 a team of 14 health workers from Uganda, which has "strong experience" of working with domestic Ebola outbreaks, had been deployed by the WHO to JFK Hospital in Monrovia, Liberia. On 27 October 2014 it was announced that a further 30 health workers had been dispatched to affected countries in West Africa. The UK government announced it has pledged £427 million ($635 million) to lead the global effort in Sierra Leone to contain, control and defeat the disease in that country. Previously published information from the UK states this includes support for 700 Ebola treatment beds in at least five treatment centres that the UK will build. These centres will provide medical care for up to 8,800 patients per six months. Britain also said it will support the establishment of 200 community care centres where people who believe they may have contracted Ebola can get a diagnosis and medical care. On 2 October the UK hosted, alongside the Government of Sierra Leone , an international conference in London to rally the global community to provide an effective international response. The conference brought together more than 20 governments, a dozen charities and NGOs, the UN, World Bank, health experts and the private sector to pledge funds, equipment and health workers. In October 2014, the Ministry of Defence said 750 personnel will be deployed to help with the establishment of Ebola Treatment Centres and an Ebola Training Academy including: As of 12 October, the Department for International Development said aid supplies delivered so far include: 20 vehicles including ambulances; 75 water tanks; 3 incinerators for disposing of clothing and other materials; 12 generators; personal protection equipment; radio equipment; lighting sets; chlorine for sanitation; latrine slabs; temporary warehouse tents; 14 air conditioning units and isolator equipment. The UK government is co-funding clinical trials to find a safe vaccine for Ebola. Ten thousand doses of the drug are already being manufactured alongside the clinical trial in the hope that it will be approved for use in the coming months. A £6.5 million research initiative has been announced jointly by the Department for International Development and the Wellcome Trust to better inform the management of Ebola outbreaks. Prime Minister David Cameron wrote to members of the European Council in October 2014 asking leaders to agree a new package of measures to tackle the Ebola crisis. On 22 November over 30 NHS volunteers flew over to Freetown, Sierra Leone to assist with the Ebola epidemic. By January 2015, 1,600 British National Health Service (NHS) staff had volunteered to travel to west Africa and help those affected by Ebola. By the beginning of August, the United States Centers for Disease Control and Prevention (CDC) had placed staff in Guinea, Sierra Leone, Liberia, and Nigeria to assist the local Ministries of Health and WHO-led response to the outbreak. On 8 September, United States President Barack Obama announced that the United States government would send military personnel to the epidemic area. The military would assist in the setting up of isolation units and would provide additional safety to health workers in the area. The military would also assist in providing transportation of medical equipment. President Obama added that the steps are necessary to curtail the spread of the virus. The announcement came amid fears that the virus might mutate and become more virulent and "represents a serious national security concern." The United States also plans to send 400,000 home protective kits to the four counties in Liberia that have been hit the hardest by Ebola. The kit will include protective gear for family members, gloves and masks, disinfectants, and fever-reducing drugs. On 8 September, the Department of Defense announced that it had allocated $22 million to set up a 25-bed field hospital in Liberia to treat healthcare workers affected by the Ebola virus. On 9 September, the United States Agency for International Development (USAID) announced that it would support the African Union 's deployment of approximately 100 health workers to West Africa to manage and run Ebola treatment units. On 16 September, President Obama announced that the Department of Defense would take the lead in overseeing the response to the epidemic. The military would dispatch up to 3,000 personnel to West Africa in an effort that could cost up to $750 million over the next six months. U.S. Major General Darryl A. Williams , Commander, United States Army Africa , would be in place in Monrovia, Liberia, within the week to lead the effort. The general would head a regional command based in Liberia that would help oversee and coordinate U.S. and international relief efforts while a new, separate regional staging base in Senegal would help accelerate transportation of urgently needed equipment, supplies and personnel. In addition, the U.S. Department of Defense would send engineers to set up 17 treatment centers in Liberia — each with a 100-bed capacity — and would set up a site in the region to train up to 500 health-care workers a week. The President said that the armed forces "are going to bring their expertise in command and control, in logistics, in engineering" to help do tasks ranging from bringing in aid workers and medical equipment to distributing supplies and information kits to families in high-risk areas so they can take the appropriate precautions. However, the CDC warned on 20 September that there may be insufficient staff for the new treatment facilities that the international community was building. On October 6, the White House released a fact sheet detailing the key elements of the US response. These include: deployment of medical personnel, equipment, and military logistical resources generally to the area but with a focus on Liberia; construction of treatment, logistics and training centers measures to screen incoming travellers and prevent spread of the disease within the US. The United States Africa Command , working through United States Army Africa, has designated the Army's response to the epidemic as Operation United Assistance . According to a WHO report released on 18 September, the humanitarian aid organisation Médecins Sans Frontières ( Doctors Without Borders ) is the leading organization responding to the crisis. Médecins Sans Frontières has campaigned since the beginning of the epidemic for a better response from governments and international agencies. Speaking at a United Nations (UN) briefing on 2 September, Joanne Liu , international president of Médecins Sans Frontières, criticized the lack of assistance from UN member countries. Médecins Sans Frontières has collaborated since March 2014 with CartONG and the Humanitarian OpenStreetMap Team (HOT) to map the areas impacted by the Ebola outbreak, especially roads, buildings, and place names. These efforts started in Guinea, then were extended to Sierra Leone and Liberia. The data and maps are also being used by the Red Cross. On 30 October, MSF announced that its budget for Ebola response was €51 million for 2014, with further budget requirement for 2015. They currently have a total of 3,347 staff working in Guinea, Liberia and Sierra Leone, operating 6 treatment centres. The Lasker-Bloomberg Public Service Award for 2015 was awarded to MSF for its leadership role in a public health emergency. This included their efforts against the Ebola outbreak. The International Federation of Red Cross and Red Crescent Societies has allocated a budget of more than 100 million Swiss francs to the Ebola crisis. It is running an Ebola Treatment Centre in Kenema, Sierra Leone as well as focusing on community engagement and safe burials throughout the region. The humanitarian charity GOAL is working in Sierra Leone, focused on public health information dissemination and establishing and supporting child protection systems, while also providing critical logistic and material support to health facilities, surveillance teams and partner organisations. The International Medical Corps is operating two Ebola Treatment Units - one in Sierra Leone and another in Liberia - as well as conducting community awareness programs and training of teachers and health workers. On 10 September, the Bill & Melinda Gates Foundation released $50 million to the United Nations and other international aid agencies fighting the epidemic. The foundation also donated $2 million to the CDC to assist them with their burden. Previous donations consisted of $5 million to the WHO and $5 million to UNICEF to buy medical supplies and fund support efforts in the region. "We are working urgently with our partners to identify the most effective ways to help them save lives now and stop transmission of this deadly disease," the Foundation CEO said in a statement. On September 20, Direct Relief , in coordination with Clinton Global Initiative Members, chartered a 747 filled with 100 tons of supplies for Ebola-hit regions. Valued at $6 million, the cargo of 2.8 million surgical and exam gloves, 170,000 coverall gowns, 120,000 masks, 40,000 liters of pre-mixed oral rehydration solution, and 9.8 million doses of essential medications was the largest single emergency shipment to date from the U.S. to the region. On 11 September, the Paul G. Allen Family Foundation pledged $9 million to the CDC. The funds will be appropriated to build treatment co-ordination centers and assist in training programs. This follows their earlier donation of $2.8 million, in August, to the Red Cross . On 23 October Paul Allen , co-founder of Microsoft Inc., announced a personal pledge of US$100 million to provide for medevac facilities, training of health workers, supplies and medical personnel to combat the outbreak. The funds will be donated to a number of established aid and emergency organisations, including UNICEF , MSF , American Red Cross , and CDC Foundation . On 6 November the Paul G. Allen Family Foundation announced $3.25 million in grants in support of Ebola relief efforts. The grants were issued to Direct Relief , Action Against Hunger, and Americares. Samaritan's Purse has provided direct patient care in multiple locations in Liberia. On 1 October, Samaritan's purse airlifted 100 tons of supplies to Liberia, including tents, infection control kits, and caregiver kits intended to equip Community Care Centers and facilitate safe home-based support. The flight signals a new focus on establishing and supervising community-based treatment in the area. The Wellcome Trust announced on 23 September, a £3.2 million grant to fast-track trials of the most promising Ebola treatments. This will enable multiple partners around the world to quickly establish clinical trials at existing Ebola treatment centres in West Africa, where treatments can be formally evaluated in patients with Ebola virus disease. On 29 October, the Wellcome Trust announced that it is funding multiple vaccine trials in Europe, Gabon, Kenya, and the USA. This brings the Trust's total funding of Ebola research to approximately £10m. Gavi , the Vaccine Alliance, has committed up to US$300 million to procure vaccines, which could be used to immunise at risk populations. Gavi will be ready to act as soon as a safe, effective vaccine is recommended for use by the World Health Organization. Up to an additional US$90 million could be used to support countries to introduce the vaccines and to rebuild and restore immunisation services for all vaccines in Ebola-affected countries. In December 2016, it was announced that an experimental Ebola vaccine produced by Merck was found to be "highly protective" against the virus after trial runs involving 11,000 people in Guinea. Previously, a 2015 study in medical journal The Lancet reported that the vaccine was 100 percent effective after tests on 4000 people in Guinea who had been in close contact with Ebola patients. Gavi global alliance signed a $5 million advance to buy the vaccine and help expedite the licensing and WHO approval process. In April 2017, a panel of researchers from U.S. National Academy of Medicine questioned the vaccine's effectiveness in preventing Ebola contractions in a study sponsored by the National Institutes of Health , the Food and Drug Administration and the U.S. Department of Health and Human Services . The panel argued that the methodology of the patient trail was flawed, and concluded that while the vaccine may provide some protection, it could be lower than officially announced. Oxfam announced in November that it has scaled up its response to £30 million, working in Sierra Leone and Liberia to develop new healthcare facilities, improve access to clean water and toilets, as increase awareness. The objective is to improve the quality and quantity of health care facilities, and stop the chain of infection by creating hygienic communities who understand how to minimise and eradicate onwards infection. HealthMap , part of Boston Children's Hospital Informatics Group, was able to detect the first signs of hemorrhagic fever, subsequently identified as Ebola, in Guinea on March 14, 2014, through a digital disease detection software algorithm which monitors online news and social media. As the outbreak expanded, a designated site was created to present a centralized source of data regarding situational context and disease spread. The Ebola timeline website, which represents the highlights of over 10,000 unique news articles coming into the HealthMap database, is updated in real-time. The outbreak timeline website provides a centralized source of official, media, and 'innovative' information on the 2014 West African EVD outbreak. This tool may help to inform the general public and communicate outbreak response methods and protocols. The timeline website's goal is to provide fact- and science-based information to as broad an audience as possible. At the Ebola Open Data Jam held on 18 October 2014, a group of volunteers initiated an open data repository, EbolaData.org, containing the wide variety of data sources related to the Ebola response that are publicly available. Data-driven decision making and planning, which is enabled by this repository, has much promise for effectively responding to the EVD epidemic. EbolaData.org is currently being curated by the Data Science Group of the Thomas J. Watson Research Center . International Mutual Aid is a US-based 501 (c) (3) nonprofit, conducting Ebola treatment, surveillance, contact tracing, and case investigation in Kono District, Sierra Leone, during the epidemic. According to a WHO report released on 18 September, the humanitarian aid organisation Médecins Sans Frontières ( Doctors Without Borders ) is the leading organization responding to the crisis. Médecins Sans Frontières has campaigned since the beginning of the epidemic for a better response from governments and international agencies. Speaking at a United Nations (UN) briefing on 2 September, Joanne Liu , international president of Médecins Sans Frontières, criticized the lack of assistance from UN member countries. Médecins Sans Frontières has collaborated since March 2014 with CartONG and the Humanitarian OpenStreetMap Team (HOT) to map the areas impacted by the Ebola outbreak, especially roads, buildings, and place names. These efforts started in Guinea, then were extended to Sierra Leone and Liberia. The data and maps are also being used by the Red Cross. On 30 October, MSF announced that its budget for Ebola response was €51 million for 2014, with further budget requirement for 2015. They currently have a total of 3,347 staff working in Guinea, Liberia and Sierra Leone, operating 6 treatment centres. The Lasker-Bloomberg Public Service Award for 2015 was awarded to MSF for its leadership role in a public health emergency. This included their efforts against the Ebola outbreak. The International Federation of Red Cross and Red Crescent Societies has allocated a budget of more than 100 million Swiss francs to the Ebola crisis. It is running an Ebola Treatment Centre in Kenema, Sierra Leone as well as focusing on community engagement and safe burials throughout the region. The humanitarian charity GOAL is working in Sierra Leone, focused on public health information dissemination and establishing and supporting child protection systems, while also providing critical logistic and material support to health facilities, surveillance teams and partner organisations. The International Medical Corps is operating two Ebola Treatment Units - one in Sierra Leone and another in Liberia - as well as conducting community awareness programs and training of teachers and health workers. On 10 September, the Bill & Melinda Gates Foundation released $50 million to the United Nations and other international aid agencies fighting the epidemic. The foundation also donated $2 million to the CDC to assist them with their burden. Previous donations consisted of $5 million to the WHO and $5 million to UNICEF to buy medical supplies and fund support efforts in the region. "We are working urgently with our partners to identify the most effective ways to help them save lives now and stop transmission of this deadly disease," the Foundation CEO said in a statement. On September 20, Direct Relief , in coordination with Clinton Global Initiative Members, chartered a 747 filled with 100 tons of supplies for Ebola-hit regions. Valued at $6 million, the cargo of 2.8 million surgical and exam gloves, 170,000 coverall gowns, 120,000 masks, 40,000 liters of pre-mixed oral rehydration solution, and 9.8 million doses of essential medications was the largest single emergency shipment to date from the U.S. to the region. On 11 September, the Paul G. Allen Family Foundation pledged $9 million to the CDC. The funds will be appropriated to build treatment co-ordination centers and assist in training programs. This follows their earlier donation of $2.8 million, in August, to the Red Cross . On 23 October Paul Allen , co-founder of Microsoft Inc., announced a personal pledge of US$100 million to provide for medevac facilities, training of health workers, supplies and medical personnel to combat the outbreak. The funds will be donated to a number of established aid and emergency organisations, including UNICEF , MSF , American Red Cross , and CDC Foundation . On 6 November the Paul G. Allen Family Foundation announced $3.25 million in grants in support of Ebola relief efforts. The grants were issued to Direct Relief , Action Against Hunger, and Americares. Samaritan's Purse has provided direct patient care in multiple locations in Liberia. On 1 October, Samaritan's purse airlifted 100 tons of supplies to Liberia, including tents, infection control kits, and caregiver kits intended to equip Community Care Centers and facilitate safe home-based support. The flight signals a new focus on establishing and supervising community-based treatment in the area. The Wellcome Trust announced on 23 September, a £3.2 million grant to fast-track trials of the most promising Ebola treatments. This will enable multiple partners around the world to quickly establish clinical trials at existing Ebola treatment centres in West Africa, where treatments can be formally evaluated in patients with Ebola virus disease. On 29 October, the Wellcome Trust announced that it is funding multiple vaccine trials in Europe, Gabon, Kenya, and the USA. This brings the Trust's total funding of Ebola research to approximately £10m. Gavi , the Vaccine Alliance, has committed up to US$300 million to procure vaccines, which could be used to immunise at risk populations. Gavi will be ready to act as soon as a safe, effective vaccine is recommended for use by the World Health Organization. Up to an additional US$90 million could be used to support countries to introduce the vaccines and to rebuild and restore immunisation services for all vaccines in Ebola-affected countries. In December 2016, it was announced that an experimental Ebola vaccine produced by Merck was found to be "highly protective" against the virus after trial runs involving 11,000 people in Guinea. Previously, a 2015 study in medical journal The Lancet reported that the vaccine was 100 percent effective after tests on 4000 people in Guinea who had been in close contact with Ebola patients. Gavi global alliance signed a $5 million advance to buy the vaccine and help expedite the licensing and WHO approval process. In April 2017, a panel of researchers from U.S. National Academy of Medicine questioned the vaccine's effectiveness in preventing Ebola contractions in a study sponsored by the National Institutes of Health , the Food and Drug Administration and the U.S. Department of Health and Human Services . The panel argued that the methodology of the patient trail was flawed, and concluded that while the vaccine may provide some protection, it could be lower than officially announced. Oxfam announced in November that it has scaled up its response to £30 million, working in Sierra Leone and Liberia to develop new healthcare facilities, improve access to clean water and toilets, as increase awareness. The objective is to improve the quality and quantity of health care facilities, and stop the chain of infection by creating hygienic communities who understand how to minimise and eradicate onwards infection. HealthMap , part of Boston Children's Hospital Informatics Group, was able to detect the first signs of hemorrhagic fever, subsequently identified as Ebola, in Guinea on March 14, 2014, through a digital disease detection software algorithm which monitors online news and social media. As the outbreak expanded, a designated site was created to present a centralized source of data regarding situational context and disease spread. The Ebola timeline website, which represents the highlights of over 10,000 unique news articles coming into the HealthMap database, is updated in real-time. The outbreak timeline website provides a centralized source of official, media, and 'innovative' information on the 2014 West African EVD outbreak. This tool may help to inform the general public and communicate outbreak response methods and protocols. The timeline website's goal is to provide fact- and science-based information to as broad an audience as possible. At the Ebola Open Data Jam held on 18 October 2014, a group of volunteers initiated an open data repository, EbolaData.org, containing the wide variety of data sources related to the Ebola response that are publicly available. Data-driven decision making and planning, which is enabled by this repository, has much promise for effectively responding to the EVD epidemic. EbolaData.org is currently being curated by the Data Science Group of the Thomas J. Watson Research Center . International Mutual Aid is a US-based 501 (c) (3) nonprofit, conducting Ebola treatment, surveillance, contact tracing, and case investigation in Kono District, Sierra Leone, during the epidemic. Response from big business has played a significant role when trying to stop the virus in Western Africa. Facebook founder Mark Zuckerberg and his wife Priscilla Chan have announced a donation of $25 million to the CDC Foundation to fight the Ebola crisis. The containment of the disease was partly due to the commitment of Oleg Deripaska , the founder of the second-largest aluminium producers RUSAL, that has been working in Guinea for almost 20 years. He mobilized all available resources to halt the spread of the virus and assisted medical institutions and helped isolate the sick. He invested over $10 million in the construction of the clinical and diagnostic research centre of epidemiology and microbiology in Kindia . Vaccine trials later took place at this center. This substantial investment in the construction of the center and the development of additional medical infrastructure had helped to stop the epidemic when the national's healthcare system was not prepared for it. Saudi King Abdullah has donated $35 million to the Islamic Development Bank to support its Ebola fighting programme, funding equipment and treatment centres in four West African countries. On 14 August, the Nigerian government said Aliko Dangote had donated $1 million to halt the spread of the Ebola virus outbreak. On 29 October a South African businessman, Patrice Motsepe , donated $1 million on behalf of the Motsepe Foundation and African Rainbow Minerals to Guinea to help fight the disease. A lot of international companies donated substantial amounts of money (over $50 million by May 2014) and medical equipment to help fight the Ebola disease. To name a few Google donated up to $17.5 million; IKEA Foundation pledged over $6 million to Médecins Sans Frontières ; Volvo Group donated $1,5 million to the United Nations Ebola Response Fund ; Samsung provided 3,000 smartphones (approximately $1 million) to the United Nations Office for the Coordination of Humanitarian Affairs ; Johnson & Johnson committed $1 million to the Centers for Disease Control Foundation and other NGOs ; the Bridgestone Group pledged $1 million. Among the commercial organizations that sponsored WHO or offered donations to combat the Ebola virus, there also were FedEx ($620k); UPS ($500k); American Express ($200k); Xerox Foundation ($100k); Vale International Holdings GmbH ($100k); Société des Mines de Fer de Guinée ($25k); Société Anglogold Ashanti de Guinée ($25k) and others. . In spring 2014 McKesson Account Manager Toby Capps donated 200 pallets of basic protection for under-equipped health centers in Sierra Leone, which were enough to meet needs for five months.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Guinée_forestière/html

Guinée forestière

Guinée forestière (Forested Guinea) is a forested mountainous region in southeastern Guinea , extending into northeastern Sierra Leone . It is one of four natural regions into which Guinea is divided and covers 23% of the country. It includes all of the Nzérékoré administrative region , and shares a border with Sierra Leone and Liberia . Its rocky topology contains several mountain ranges and has an average elevation of 460m. Forested Guinea contains important areas of biological diversity such as the UNESCO World Heritage site Mount Nimba Strict Nature Reserve and biosphere reserve Ziama Massif . The Guéckédou prefectures also recorded the initial case of the 2014 Ebola outbreak in Meliandou, a rural village. The virus subsequently spread to urban areas and neighbouring countries Sierra Leone and Liberia .Forested Guinea was established around 1000AD by native peoples with the advent of agriculture and stationary settlements. Indigenous linguistic groups began to arrive later from neighbouring areas; their tribes were established from the 15th century onwards. In the 1850s, Samori Ture founded the Wassoulou empire , including Forested Guinea. Ture was a military leader who seized control of the Guinea Highlands, and ultimately expanded his empire to reach Ghana , Côte d'Ivoire and Mali . The expansion of his empire led to the forced religious conversion of indigenous peoples in Forested Guinea through the establishment of mosques and destruction of local religious symbols. The extent of his religious conversion was widespread, having decreed that all people in the kingdom would have to become Muslims. Christianity has had a lesser historical influence on Forested Guinea. The missionary group White Fathers first attempted to convert indigenous people in the 1920s, which had varying degrees of success with local populations. It remained unpopular after WWII due to conflict between Catholicism and Protestantism, as well as the competition with the spread of Islam. In the 1880s, the French colonisation of Africa had reached the Forest Region, part of Samori Ture's territory; this led to a treaty of friendship, in which Ture gave up his Guinean territory. Local people resisted French colonisation until 1911. The French colonists altered the societal foundations through the introduction of the western educational system and French culture. This included establishing village schools which offered to teach basic maths and literacy in the French language. These changes were in tandem with structural political alterations such as the suppression of village elders' judicial power, and the creation of separate courts for indigenous people and Europeans. The creation of the French Union in 1946 removed colonial status of Guinea and combined France and its other overseas components into a single union. Forested Guinea was represented by its indigenous party, the Union Forestière. After Guinean independence in 1958, colonial policies that exploited tensions between the Forest region and other ethnic groups were dismantled by the ruling Democratic Party of Guinea . The party also promised equal representation for the groups in the political arena and removal of chiefs established to uphold colonial power. Forested Guinea's immigration was heavily impacted by the neighbouring First Liberian Civil War in 1989. The common border between the two regions caused the refugee crisis in which a total of 500,000 refugees fleeing from civil unrest had crossed into Forested Guinea by the year 2000. This initial phase was characterised by four major waves until 1992, followed by a series of minor waves. The main groups fleeing civil unrest were mostly rural ethnic groups, such as the Kpelle , Loma and Kissi with some inflow from urban cities in Liberia. These inflows led to the establishment of refugee camps along the border between Liberia and Forested Guinea in the 1990s. Most of the refugees were directed towards the Forest Region due to the Guinean Government and UNHCR restricting assistance to only the Forest Region. The decisions were designed to contain the refugee system to Forested Guinea due to its remoteness and may have been politically motivated. The refugee crisis was further exacerbated by the Second Liberian Civil War in the middle of 2002, where an additional 100,000 refugees crossed into Forested Guinea. In the 1850s, Samori Ture founded the Wassoulou empire , including Forested Guinea. Ture was a military leader who seized control of the Guinea Highlands, and ultimately expanded his empire to reach Ghana , Côte d'Ivoire and Mali . The expansion of his empire led to the forced religious conversion of indigenous peoples in Forested Guinea through the establishment of mosques and destruction of local religious symbols. The extent of his religious conversion was widespread, having decreed that all people in the kingdom would have to become Muslims. Christianity has had a lesser historical influence on Forested Guinea. The missionary group White Fathers first attempted to convert indigenous people in the 1920s, which had varying degrees of success with local populations. It remained unpopular after WWII due to conflict between Catholicism and Protestantism, as well as the competition with the spread of Islam.In the 1880s, the French colonisation of Africa had reached the Forest Region, part of Samori Ture's territory; this led to a treaty of friendship, in which Ture gave up his Guinean territory. Local people resisted French colonisation until 1911. The French colonists altered the societal foundations through the introduction of the western educational system and French culture. This included establishing village schools which offered to teach basic maths and literacy in the French language. These changes were in tandem with structural political alterations such as the suppression of village elders' judicial power, and the creation of separate courts for indigenous people and Europeans. The creation of the French Union in 1946 removed colonial status of Guinea and combined France and its other overseas components into a single union. Forested Guinea was represented by its indigenous party, the Union Forestière. After Guinean independence in 1958, colonial policies that exploited tensions between the Forest region and other ethnic groups were dismantled by the ruling Democratic Party of Guinea . The party also promised equal representation for the groups in the political arena and removal of chiefs established to uphold colonial power. Forested Guinea's immigration was heavily impacted by the neighbouring First Liberian Civil War in 1989. The common border between the two regions caused the refugee crisis in which a total of 500,000 refugees fleeing from civil unrest had crossed into Forested Guinea by the year 2000. This initial phase was characterised by four major waves until 1992, followed by a series of minor waves. The main groups fleeing civil unrest were mostly rural ethnic groups, such as the Kpelle , Loma and Kissi with some inflow from urban cities in Liberia. These inflows led to the establishment of refugee camps along the border between Liberia and Forested Guinea in the 1990s. Most of the refugees were directed towards the Forest Region due to the Guinean Government and UNHCR restricting assistance to only the Forest Region. The decisions were designed to contain the refugee system to Forested Guinea due to its remoteness and may have been politically motivated. The refugee crisis was further exacerbated by the Second Liberian Civil War in the middle of 2002, where an additional 100,000 refugees crossed into Forested Guinea. Forested Guinea has a total population of 2.1 million (2011). The demographics of Forested Guinea are split between people living in urban and rural areas with one-fifth of the population living in urban areas. The two most populated urban areas are Guéckédou with 290,000 and Nzérékoré , with 195,000 inhabitants as of the 2014 census. [ citation needed ] Forested Guinea has the highest population density of the four regions of Guinea, with 55 people per kilometre squared in 2009. However, it is much lower than the capital city of Guinea, Conakry , with over 3440 people per kilometre squared. Approximately 67% of Forested Guinea lives below the poverty line, among the highest rates of the Guinean regions. This correlates with a tendency to live in rural areas, which contain 65% of cases, possess low levels of education and have livelihoods in agriculture. Guinée forestière is known for its diverse ethnic population, including the Toma and Kissi groups, and also shelters a large number of refugees from the Sierra Leone Civil War , the Liberian Civil Wars and the Ivorian Civil Wars . Nzérékoré is the largest city. Both former President Moussa Dadis Camara and former Prime Minister Jean-Marie Doré are from the Guinée forestière . The linguistic areas of Forested Guinea contain the main groups of the Kpelle, Loma and Kisi. [ citation needed ] The Kpelle migrated from West Sudan in the 16th century. Their social structure is arranged under paramount chiefs, who settle disputes and mediate between the Guinean government and their people. The Kpelle region overlaps with the bordering country of Liberia and has 100,000 native speakers in Forested Guinea itself. This is a result of the Kpelle seeking refuge in Forested Guinea from First Liberian Civil War. The Loma tribe began in the 15th century, as a result of the breakdown of the Mande empire . They migrated to Liberia and Guinea, due to conflict with the French and other neighbouring tribes. The Loma people, much like the Kpelle, share a common region of Forested Guinea and Liberia, with their total population exceeding 400,000. However, the Guinean and Liberian Loma people are distinct in culture, dialect and history. The Kissi people migrated from the highland region, Fouta Djallon , in the 17th century. The Kissi people also inhabit an area that encompasses Guinea, Liberia and Sierra Leone; however they are mainly concentrated in the Guéckédou region. Their villages usually do not contain more than 150 people and are organised under a senior member of each village. They are mainly farmers that produce rice, coffee and kola; rice cultivation began in the 18th century and constitutes an important part of their culture. The Kpelle migrated from West Sudan in the 16th century. Their social structure is arranged under paramount chiefs, who settle disputes and mediate between the Guinean government and their people. The Kpelle region overlaps with the bordering country of Liberia and has 100,000 native speakers in Forested Guinea itself. This is a result of the Kpelle seeking refuge in Forested Guinea from First Liberian Civil War. The Loma tribe began in the 15th century, as a result of the breakdown of the Mande empire . They migrated to Liberia and Guinea, due to conflict with the French and other neighbouring tribes. The Loma people, much like the Kpelle, share a common region of Forested Guinea and Liberia, with their total population exceeding 400,000. However, the Guinean and Liberian Loma people are distinct in culture, dialect and history. The Kissi people migrated from the highland region, Fouta Djallon , in the 17th century. The Kissi people also inhabit an area that encompasses Guinea, Liberia and Sierra Leone; however they are mainly concentrated in the Guéckédou region. Their villages usually do not contain more than 150 people and are organised under a senior member of each village. They are mainly farmers that produce rice, coffee and kola; rice cultivation began in the 18th century and constitutes an important part of their culture. Forested Guinea possesses unique wildlife and geological diversity. It is characterized by undulating lowlands, which are frequently disrupted by suddenly rising high mountain ranges and eroded plateaux of the Guinea Highlands . In general, the lowland areas are covered by forest-savanna mosaics and lowland forests; but all ridges and plateaux are covered by montane forests above 600 meters. Forested Guinea also contains over half of West Africa's rivers such as the Niger River, Saint Paul River, and Lofa River; other limnological features include tributaries and basins. The Forest Region drains over 1/3 of Guinea's water, as it forms the drainage divide between the Niger River basin and western rivers. These rivers contain animal species such as pygmy hippopotamuses and manatees. Remarkable sky islands are the Mount Nimba (1720 meters), Simandou Massif (1658 meters), Ziama Massif (1387 meters), Mount Tétini (1257 meters), Kourandou Massif (1236 meters), and Mount Béro (1210 meters). All of them belong to the south-eastern part of the Guinea Highlands, and remained poorly discovered by science. The most prominent protected areas in Forested Guinea are the Mount Nimba Strict Nature Reserve, the Ziama Massif, and the Diécké Classified Forest. The Mount Nimba Strict Nature Reserve is a 12 540 hectares-large UNESCO Natural World Heritage Site which is threatened by local subsistence pressures (hunting, farming, fire, logging, grazing) and potential future iron-ore mining (see here ). The nature reserve shares its area between Forested Guinea and Côte d'Ivoire. It is mostly mountainous, with forested areas at the foot of the mountain ranges. Mount Nimba is the highest point of the Nimba range, at an elevation of 1752m. About two-thirds of the reserve is covered by rainforest, and it is home to more than 2,000 vascular plant species, 107 mammal species, 210 bird species, and 2,500 invertebrate species with exceptionally strong level of endemism. Its dynamic and seasonal ecosystems have produced "one of the most remarkable diversities of the whole West African region". It meets criteria IX and X of the UNESCO Criteria for Selection , reflecting the importance of its processes of evolution and development of flora and fauna, and conserving its biological diversity. These qualities are evidenced in species such as the Nimba otter shrew, the viviparous toad, and observed tool use by chimpanzees. Since the 1960s, the Nimba Range has become a source for iron and diamond ore mining, which has led to the degradation of the nature reserve. The Ziama Massif is a 116 200 hectares-large Biosphere Reserve , which is considered to be a relict of the once continuous West African rainforest belt. It is a tropical, forested mountainous area located about 100 km from Nzérékoré in the Guinean Highlands. It was designated Bioreserve status by UNESCO in 1980 and is home to 22 species of threatened fauna included in the CITES Appendices. It is home to 1 300 vascular plant species, 124 mammal species, and 286 bird species. The Ziama Massif provides shelter to the threatened West African rainforest megafauna , such as the forest elephant , the forest buffalo , the pygmy hippopotamus , the bongo antelope , and the critically endangered western chimpanzee . Its local population is around 29,000, and some areas of this reserve are allocated for local economic activities, as the activities provides income to the residents. This includes forestry and quinine processing stations. However, the innermost 60,000 hectares are protected from human activity such as logging and hunting. The Diécké Classified Forest is a 64 000 hectares-large forest reserve, which is characterized by lowland and swamp forests. In fact, it is one of the least discovered protected areas of West Africa; however, some studies suggest, that Diécké is the stronghold of the pygmy hippopotamus and the critically endangered western chimpanzee. The Diécké Classified Forest forms part of the Western Guinean Lowland forests , south of Nzérékoré, sharing this region with neighbouring countries Sierra Leone and Liberia. It is considered a major site for biodiversity in Africa and the WWF notes "outstanding biological importance" in the area. Its wildlife includes 141 species of birds, with suggestions that more could be found, as well as endemic fauna such as the Dwarf crocodile , the Bay duiker and species of endangered primates such as the Diana monkey , and Western Red colobus . This area is split into evergreen and deciduous forests and contains plant species unique to the area. Its forest composition is mainly lowland mature rainforest, with swamps in some regions. It has heavy rainfall with this region receiving 1900-3000mm of rainfall each year, making it one of the wettest parts of West Africa. Human activity has also disturbed the ecological region due to previous slash-and-burn farming , logging and mining activities. Despite the Diécké Classified Forest being used for logging, swamp-forest regions have hindered commercial exploitation due to its difficulty of access. The Mount Nimba Strict Nature Reserve is a 12 540 hectares-large UNESCO Natural World Heritage Site which is threatened by local subsistence pressures (hunting, farming, fire, logging, grazing) and potential future iron-ore mining (see here ). The nature reserve shares its area between Forested Guinea and Côte d'Ivoire. It is mostly mountainous, with forested areas at the foot of the mountain ranges. Mount Nimba is the highest point of the Nimba range, at an elevation of 1752m. About two-thirds of the reserve is covered by rainforest, and it is home to more than 2,000 vascular plant species, 107 mammal species, 210 bird species, and 2,500 invertebrate species with exceptionally strong level of endemism. Its dynamic and seasonal ecosystems have produced "one of the most remarkable diversities of the whole West African region". It meets criteria IX and X of the UNESCO Criteria for Selection , reflecting the importance of its processes of evolution and development of flora and fauna, and conserving its biological diversity. These qualities are evidenced in species such as the Nimba otter shrew, the viviparous toad, and observed tool use by chimpanzees. Since the 1960s, the Nimba Range has become a source for iron and diamond ore mining, which has led to the degradation of the nature reserve. The Ziama Massif is a 116 200 hectares-large Biosphere Reserve , which is considered to be a relict of the once continuous West African rainforest belt. It is a tropical, forested mountainous area located about 100 km from Nzérékoré in the Guinean Highlands. It was designated Bioreserve status by UNESCO in 1980 and is home to 22 species of threatened fauna included in the CITES Appendices. It is home to 1 300 vascular plant species, 124 mammal species, and 286 bird species. The Ziama Massif provides shelter to the threatened West African rainforest megafauna , such as the forest elephant , the forest buffalo , the pygmy hippopotamus , the bongo antelope , and the critically endangered western chimpanzee . Its local population is around 29,000, and some areas of this reserve are allocated for local economic activities, as the activities provides income to the residents. This includes forestry and quinine processing stations. However, the innermost 60,000 hectares are protected from human activity such as logging and hunting.The Diécké Classified Forest is a 64 000 hectares-large forest reserve, which is characterized by lowland and swamp forests. In fact, it is one of the least discovered protected areas of West Africa; however, some studies suggest, that Diécké is the stronghold of the pygmy hippopotamus and the critically endangered western chimpanzee. The Diécké Classified Forest forms part of the Western Guinean Lowland forests , south of Nzérékoré, sharing this region with neighbouring countries Sierra Leone and Liberia. It is considered a major site for biodiversity in Africa and the WWF notes "outstanding biological importance" in the area. Its wildlife includes 141 species of birds, with suggestions that more could be found, as well as endemic fauna such as the Dwarf crocodile , the Bay duiker and species of endangered primates such as the Diana monkey , and Western Red colobus . This area is split into evergreen and deciduous forests and contains plant species unique to the area. Its forest composition is mainly lowland mature rainforest, with swamps in some regions. It has heavy rainfall with this region receiving 1900-3000mm of rainfall each year, making it one of the wettest parts of West Africa. Human activity has also disturbed the ecological region due to previous slash-and-burn farming , logging and mining activities. Despite the Diécké Classified Forest being used for logging, swamp-forest regions have hindered commercial exploitation due to its difficulty of access. The origin of the 2014 Ebola outbreak has been traced back to Forested Guinea: it was the first country in Western Africa to record an Ebola virus outbreak. The initial case of the outbreak was attributed to a 2-year-old boy located in Meliandou, Guéckédou Prefecture with the Zaire strain of Ebola who died 6 December 2013. This subsequently spread to neighbouring countries Liberia and Sierra Leone due to the village's proximity to their borders and the free flow of people between the three countries. Ebola also spread to Conakry from Guéckédou, the first urban area in Guinea to be affected, with the first case recorded on 17 March 2014. The Ebola Crisis affected 3811 people in total in Guinea. Guinea was declared "Ebola-free" in its entirety in December 2015; however, on 17 March 2016, Nzérékoré recorded two additional cases of Ebola. The Forest Region was one of the regions most severely affected by the Ebola crisis, and the weakened healthcare system had incidental effects such as reducing treatment attendance, increased used sub-standard drugs and distrust towards the healthcare system. The Ebola crisis was said to have "brought a number of additional burdens" to the healthcare system in Forested Guinea. There was a noted decrease in attendance to outpatient clinics and reduction in hospital revenue which weakened the financial stability of healthcare institutions. The impact was also witnessed in the decline of non-ebola-related treatment programs for diseases such as malaria and AIDS , which raised the threat of other health problems. Researchers observed social resistance to Ebola treatment in Forested Guinea, which exacerbated the outbreak's impact at the beginning. Social practices such as burials and caring for patients were associated with 60% of infections. The cultural practices surrounding mortuary rites such as preparing the body of the deceased, and exhumations conflicted with the Ebola treatment centres' control of the body. This caused tension between foreign humanitarian aid and patients' families, which manifested in violent attacks towards Médecins Sans Frontières , as well as physical barricades put in place by the local population near villages to prevent access. Other cultural aspects such as belief in sorcery contributed further to the resistance. Behaviour such as seclusion and anti-social conduct sparked suspicion. Both foreign and community members could be viewed as sorcerers, and due to the negative connotations were ostracised. This negative perception towards those sorcery consequently sparked anger at Ebola treatment centres, which advocated anti-social behaviour to prevent the spread of Ebola. The Forest Region was one of the regions most severely affected by the Ebola crisis, and the weakened healthcare system had incidental effects such as reducing treatment attendance, increased used sub-standard drugs and distrust towards the healthcare system. The Ebola crisis was said to have "brought a number of additional burdens" to the healthcare system in Forested Guinea. There was a noted decrease in attendance to outpatient clinics and reduction in hospital revenue which weakened the financial stability of healthcare institutions. The impact was also witnessed in the decline of non-ebola-related treatment programs for diseases such as malaria and AIDS , which raised the threat of other health problems.Researchers observed social resistance to Ebola treatment in Forested Guinea, which exacerbated the outbreak's impact at the beginning. Social practices such as burials and caring for patients were associated with 60% of infections. The cultural practices surrounding mortuary rites such as preparing the body of the deceased, and exhumations conflicted with the Ebola treatment centres' control of the body. This caused tension between foreign humanitarian aid and patients' families, which manifested in violent attacks towards Médecins Sans Frontières , as well as physical barricades put in place by the local population near villages to prevent access. Other cultural aspects such as belief in sorcery contributed further to the resistance. Behaviour such as seclusion and anti-social conduct sparked suspicion. Both foreign and community members could be viewed as sorcerers, and due to the negative connotations were ostracised. This negative perception towards those sorcery consequently sparked anger at Ebola treatment centres, which advocated anti-social behaviour to prevent the spread of Ebola.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Africa_Cup_of_Nations/html

Africa Cup of Nations

The Africa Cup of Nations commonly referred to as the TotalEnergies Africa Cup of Nations for sponsorship reasons, or simply AFCON or CAN , is the main international men's association football competition in Africa . It is sanctioned by the Confederation of African Football (CAF) and was first held in 1957 . Since 1968 , it has been held every two years, switching to odd-numbered years [n 1] in 2013. In the first tournament in 1957, there were only three participating nations: Egypt , Sudan , and Ethiopia . South Africa was originally scheduled to join, but was disqualified due to the apartheid policies of the government then in power. Since then, the tournament has expanded greatly, making it necessary to hold a qualifying tournament. The number of participants in the final tournament reached 16 in 1998 (16 teams were to compete in 1996, but Nigeria withdrew, reducing the field to 15, and the same happened with Togo 's withdrawal in 2010), and until 2017, the format had been unchanged, with the 16 teams being drawn into four groups of four teams each, with the top two teams of each group advancing to a "knock-out" stage. On 20 July 2017, the Africa Cup of Nations was moved from January to June and expanded from 16 to 24 teams. Egypt is the most successful nation in the cup's history, winning the tournament seven times, with Cameroon winning five times and Ghana four times. Three trophies have been awarded during the tournament's history; the current trophy was first awarded in 2002. Egypt won an unprecedented three consecutive titles in 2006, 2008, and 2010. In 2013, the tournament format was switched to being held in odd-numbered years so as not to interfere with the FIFA World Cup . Ivory Coast are the tournament's current champions, having beaten Nigeria 2–1 in the 2023 final .The origin of the African Nations Cup dates from June 1956, when the creation of the Confederation of African Football was proposed during the third FIFA congress in Lisbon . There were immediate plans for a continental tournament to be held and, in February 1957, the first Africa Cup of Nations was held in Khartoum , Sudan . There was no qualification for this tournament, the field being made up of the four founding nations of CAF ( Egypt , Sudan , Ethiopia , and South Africa ). South Africa's insistence on selecting only white players for its squad due to its apartheid policy led to its disqualification, and as a consequence Ethiopia were handed a bye straight to the final. Hence only two matches were played, with Egypt being crowned as the first continental champion after defeating hosts Sudan in the semi-final and Ethiopia in the final. Two years later Egypt hosted the second ANC in Cairo with the participation of the same three teams. Host and defending champions Egypt again won, after defeating Sudan. The field grew to include nine teams for the third ANC in 1962 in Addis Ababa , and for the first time there was a qualification round to determine which four teams would play for the title. Host Ethiopia and reigning champion Egypt received automatic berths and were joined in the final four by Nigeria and Tunisia . Egypt made its third consecutive final appearance, but the Ethiopia team emerged as victors, first beating Tunisia and then downing Egypt in extra time . In 1963, Ghana made its first appearance as it hosted the event and won the title after beating Sudan in the final. They repeated that as they became champions two years later in Tunisia —equalling Egypt as two-time winners—with a squad that included only two returning members from the 1963 team. In 1965, the CAF introduced a rule that limited the number of overseas players in each team to two. The rule persisted until 1982. The 1968, competition 's final tournament format expanded to include eight of the 22 teams entered in the preliminary rounds. The qualifying teams were distributed in two groups of four to play single round-robin tournaments , with the top two teams of each group advancing to semi-finals, a system that remained in use for the finals until 1992. The Democratic Republic of Congo won its first title, beating Ghana in the final. Starting with the 1968 tournament, the competition was regularly held every two years in even-numbered years; this ended with the 2012 tournament, which was followed by a tournament in 2013, and successor editions in each odd-numbered year. Ivory Coast forward Laurent Pokou led the 1968 and 1970 tournaments in scoring, with six and eight goals respectively, and his total of 14 goals remained the all-time record until 2008. Play was covered for television for the first time during the 1970 tournament in Sudan, as the hosts lifted the trophy after defeating Ghana – who were playing their fourth consecutive final. Six nations won titles from 1970 to 1980: Sudan , Congo-Brazzaville , Zaire , Morocco , Ghana, and Nigeria. Zaire's second title in the 1974 edition (it won its first as the Democratic Republic of Congo ) came after facing Zambia in the final. For the only time to date in the history of the competition, the match had to be replayed as the first contest between the two sides ended in a 2–2 draw after extra time. The final was re-staged two days later with Zaire winning 2–0. Forward Mulamba Ndaye scored all four of Zaire's goals in these two matches: he was also the top scorer of the tournament with nine goals, setting a single-tournament record that remains unmatched. Three months earlier, Zaire had become the first Sub-Saharan African nation to qualify to the FIFA World Cup . Morocco won their first title in the 1976 ANC held in Ethiopia and Ghana took its third championship in 1978, becoming the first nation to win three titles. Between 1980 and 1990, Cameroon managed to reach the final of the Africa Cup three times in a row, winning the competition twice in 1984 and 1988 and losing once on penalties against Egypt in the 1986 edition , the other dominant team during this period was Algeria , along with their solid 1982 and decent 1986 World Cup appearances, the North African nation lost in the final against hosts Nigeria in the 1980 tournament allowing the Super Eagles to capture their first championship. After the 1980 edition , Algeria reached the semi-finals of every edition except the 1986 cup until they eventually won the competition in 1990 . Ghana's fourth continental title came in the 1982 cup tournament , where they beat host Libya in the final. The match ended in a 1–1 draw after 120 minutes and Ghana national football team won the penalty shootout to become champions. In 1990, the 1990 African Cup of Nations was the 17th edition of the Africa Cup of Nations, the football championship of Africa (CAF). It was hosted by Algeria . Just like in 1988, the field of eight teams was split into two groups of four. Algeria won its first championship, beating Nigeria in the final 1–0. Nigeria lost once again as they made their third final appearance in four tournaments, this time falling to host Algeria . The 1992 Cup of Nations expanded the number of final tournament participants to 12; the teams were divided into four groups of three, with the top two teams of each group advancing to quarter-finals. Ghanaian midfielder Abedi "Pele" Ayew , who scored three goals, was named the best player of the tournament after his contributions helped Ghana reach the final; he was, however, suspended for that match and Ghana lost to Ivory Coast in a penalty shootout that saw each side make 11 attempts to determine the winner. Ivory Coast set a record for the competition by holding each of their opponents scoreless in the six matches of the final tournament. The 12-team, three-group format was used again two years later, where hosts Tunisia were humiliated by their first-round elimination. Nigeria , who had just qualified to the World Cup for the first time in their history, won the tournament , beating Zambia , who a year before had been struck by disaster when most of their national squad died in a plane crash while traveling to play a 1994 World Cup qualification match. Nigerian forward Rashidi Yekini , who had led the 1992 tournament with four goals, repeated as the top scorer with five goals. South Africa hosted the 20th ACN competition in 1996, marking its first ever appearance after a decades-long ban was lifted with the end of apartheid in the country, which had been followed by a failed attempt to qualify in 1994. The number of final-round participants in 1996 was expanded to 16, split into four groups. However, the actual number of teams playing in the final was only 15, because Nigeria withdrew from the tournament at the final moment for political reasons. Bafana Bafana won their first title on home soil, defeating Tunisia in the final. The South Africans would reach the final again two years later in Burkina Faso , but were unable to defend their title, losing to Egypt who claimed their fourth cup. The 2000 edition was hosted jointly by Ghana and Nigeria , who replaced the originally designated host Zimbabwe . Following a 2–2 draw after extra time in the final, Cameroon defeated Nigeria on penalty kicks. In 2002, Cameroon's Indomitable Lions won their second consecutive title. This was the first repeat since Ghana had done it in the 1960s and after Egypt had done it before in 1957 and 1959. The Cameroonians beat first-time finalists Senegal , who also debuted in the World Cup later that year, via penalty kicks . Both finalists were eliminated in the quarter-finals two years later in Tunisia , where the hosts won their first title, beating Morocco 2–1 in the final. The 2006 tournament was also won by the hosts, Egypt , who reached a continental-record fifth title. Ahead of the 2008 Africa Cup of Nations several European clubs called for a rethink of the tournament's schedule. Given that it takes place during the European season, players who are involved miss several matches for their clubs. In January 2008, FIFA president Sepp Blatter announced that he wanted the tournament to be held in either June or July by 2016, to fit in the international calendar, although this would preclude many countries in central and west Africa from hosting the competition (for these months occur during their wet season ). The 2008 tournament was hosted by Ghana, and saw Egypt retain the trophy, winning its record-extending sixth tournament by defeating Cameroon 1–0 in the final. Egypt set a new record in the 2010 tournament (hosted by Angola ) by winning its third consecutive title in an unprecedented achievement on the African level after defeating Ghana 1–0 in the final, retaining the gold-plated cup indefinitely and extending its record to seven continental titles (including when Egypt was known as UAR between 1958 and 1961). Egypt became the first African nation to win three consecutive cups and joined Mexico , Argentina , and Iran who also won their continent cup three times in a row. On 31 January 2010, Egypt set a new African record, not being defeated for 19 consecutive Cup of Nations matches, since a 2–1 loss against Algeria in Tunisia in 2004 , [ citation needed ] and a record 9 consecutive win streak. [ citation needed ] In May 2010, it was announced that the tournament would be moved to odd-numbered years from 2013 in order to prevent the tournament from taking place in the same year as the World Cup . It also meant there were two tournaments within twelve months in January 2012 ( co-hosted by Gabon and Equatorial Guinea ) and January 2013 ( hosted by South Africa ). The change of FIFA Confederations Cup from a biennial to a quadrennial tournament, and the switching of the Africa Cup of Nations from even to odd-number years, meant that some previous Africa Cup of Nations champions such as Egypt , Zambia , and Ivory Coast (winners of the 2010, 2012, and 2015 tournaments respectively) were deprived from participating in the Confederations Cup tournament . In 2011, Morocco won the bid to host the 2015 edition , and Libya won the right to host the 2013 tournament , but the 2011 Libyan civil war prompted Libya and South Africa to trade years, with South Africa hosting in 2013 and Libya hosting in 2017. Ongoing fighting in Libya ultimately prompted CAF to move the 2017 tournament to Gabon ). In 2012, Zambia won the final after a penalty shootout against Ivory Coast. This drew increased media attention since the match took place in Gabon, only a few hundred meters from the crash site of the 1993 air disaster of their national team. The 2013 tournament was won by Nigeria, beating first time finalists Burkina Faso. In 2014–15, the West African Ebola virus epidemic disrupted the tournament. All football activities in Liberia were suspended, and the Antoinette Tubman Stadium in Monrovia was converted into an Ebola treatment unit. The 2015 Africa Cup of Nations was scheduled to be held in Morocco, but they refused to hold the tournament on the allotted dates due to concerns of the Ebola outbreak, so it was moved to Equatorial Guinea. In July 2016, Total secured the rights to an eight-year sponsorship package to support 10 of CAF 's principal competitions. This began with the 2017 Africa Cup of Nations in Gabon which was renamed the "Total Africa Cup of Nations". Under Ahmad Ahmad 's presidency, there were discussions regarding further changes to the Africa Cup of Nations. In July 2017, two changes were proposed: switching the timing of the competition from January to the Northern Hemisphere summer and expanding from 16 to 24 teams (effective from the 2019 Africa Cup of Nations ). On 20 July 2017, the CAF Executive Commission approved the propositions at a meeting in Rabat, Morocco . Algeria won the African Cup of Nations 2019 , achieving a 1–0 victory against Senegal in the final. The title was Algeria's second ever and first since 1990. Nigeria came third after beating Tunisia 1–0 in their third-place decider match. The prize money awarded to the 2019 Africa Cup of Nations winner amounted to $4.5 million while runners-up Senegal got $2.5 million. Match days 3 and 4 of the 2021 Africa Cup of Nations qualifiers , which was slated from 25 to 30 March 2020, were postponed due to the COVID-19 pandemic . The 2021 Africa Cup of Nations tournament, hosted by Cameroon , and was postponed to 2022 due to the COVID-19 pandemic . The Confederation of African Football increased the cash prize for the winner from $4.5 million to $5 million for 2021 Africa Cup of Nations while the second-best team will get $2.75 million. Senegal won the tournament for the first time after beating Egypt on penalties in the final . The origin of the African Nations Cup dates from June 1956, when the creation of the Confederation of African Football was proposed during the third FIFA congress in Lisbon . There were immediate plans for a continental tournament to be held and, in February 1957, the first Africa Cup of Nations was held in Khartoum , Sudan . There was no qualification for this tournament, the field being made up of the four founding nations of CAF ( Egypt , Sudan , Ethiopia , and South Africa ). South Africa's insistence on selecting only white players for its squad due to its apartheid policy led to its disqualification, and as a consequence Ethiopia were handed a bye straight to the final. Hence only two matches were played, with Egypt being crowned as the first continental champion after defeating hosts Sudan in the semi-final and Ethiopia in the final. Two years later Egypt hosted the second ANC in Cairo with the participation of the same three teams. Host and defending champions Egypt again won, after defeating Sudan. The field grew to include nine teams for the third ANC in 1962 in Addis Ababa , and for the first time there was a qualification round to determine which four teams would play for the title. Host Ethiopia and reigning champion Egypt received automatic berths and were joined in the final four by Nigeria and Tunisia . Egypt made its third consecutive final appearance, but the Ethiopia team emerged as victors, first beating Tunisia and then downing Egypt in extra time .In 1963, Ghana made its first appearance as it hosted the event and won the title after beating Sudan in the final. They repeated that as they became champions two years later in Tunisia —equalling Egypt as two-time winners—with a squad that included only two returning members from the 1963 team. In 1965, the CAF introduced a rule that limited the number of overseas players in each team to two. The rule persisted until 1982. The 1968, competition 's final tournament format expanded to include eight of the 22 teams entered in the preliminary rounds. The qualifying teams were distributed in two groups of four to play single round-robin tournaments , with the top two teams of each group advancing to semi-finals, a system that remained in use for the finals until 1992. The Democratic Republic of Congo won its first title, beating Ghana in the final. Starting with the 1968 tournament, the competition was regularly held every two years in even-numbered years; this ended with the 2012 tournament, which was followed by a tournament in 2013, and successor editions in each odd-numbered year. Ivory Coast forward Laurent Pokou led the 1968 and 1970 tournaments in scoring, with six and eight goals respectively, and his total of 14 goals remained the all-time record until 2008. Play was covered for television for the first time during the 1970 tournament in Sudan, as the hosts lifted the trophy after defeating Ghana – who were playing their fourth consecutive final.Six nations won titles from 1970 to 1980: Sudan , Congo-Brazzaville , Zaire , Morocco , Ghana, and Nigeria. Zaire's second title in the 1974 edition (it won its first as the Democratic Republic of Congo ) came after facing Zambia in the final. For the only time to date in the history of the competition, the match had to be replayed as the first contest between the two sides ended in a 2–2 draw after extra time. The final was re-staged two days later with Zaire winning 2–0. Forward Mulamba Ndaye scored all four of Zaire's goals in these two matches: he was also the top scorer of the tournament with nine goals, setting a single-tournament record that remains unmatched. Three months earlier, Zaire had become the first Sub-Saharan African nation to qualify to the FIFA World Cup . Morocco won their first title in the 1976 ANC held in Ethiopia and Ghana took its third championship in 1978, becoming the first nation to win three titles.Between 1980 and 1990, Cameroon managed to reach the final of the Africa Cup three times in a row, winning the competition twice in 1984 and 1988 and losing once on penalties against Egypt in the 1986 edition , the other dominant team during this period was Algeria , along with their solid 1982 and decent 1986 World Cup appearances, the North African nation lost in the final against hosts Nigeria in the 1980 tournament allowing the Super Eagles to capture their first championship. After the 1980 edition , Algeria reached the semi-finals of every edition except the 1986 cup until they eventually won the competition in 1990 . Ghana's fourth continental title came in the 1982 cup tournament , where they beat host Libya in the final. The match ended in a 1–1 draw after 120 minutes and Ghana national football team won the penalty shootout to become champions.In 1990, the 1990 African Cup of Nations was the 17th edition of the Africa Cup of Nations, the football championship of Africa (CAF). It was hosted by Algeria . Just like in 1988, the field of eight teams was split into two groups of four. Algeria won its first championship, beating Nigeria in the final 1–0. Nigeria lost once again as they made their third final appearance in four tournaments, this time falling to host Algeria . The 1992 Cup of Nations expanded the number of final tournament participants to 12; the teams were divided into four groups of three, with the top two teams of each group advancing to quarter-finals. Ghanaian midfielder Abedi "Pele" Ayew , who scored three goals, was named the best player of the tournament after his contributions helped Ghana reach the final; he was, however, suspended for that match and Ghana lost to Ivory Coast in a penalty shootout that saw each side make 11 attempts to determine the winner. Ivory Coast set a record for the competition by holding each of their opponents scoreless in the six matches of the final tournament. The 12-team, three-group format was used again two years later, where hosts Tunisia were humiliated by their first-round elimination. Nigeria , who had just qualified to the World Cup for the first time in their history, won the tournament , beating Zambia , who a year before had been struck by disaster when most of their national squad died in a plane crash while traveling to play a 1994 World Cup qualification match. Nigerian forward Rashidi Yekini , who had led the 1992 tournament with four goals, repeated as the top scorer with five goals. South Africa hosted the 20th ACN competition in 1996, marking its first ever appearance after a decades-long ban was lifted with the end of apartheid in the country, which had been followed by a failed attempt to qualify in 1994. The number of final-round participants in 1996 was expanded to 16, split into four groups. However, the actual number of teams playing in the final was only 15, because Nigeria withdrew from the tournament at the final moment for political reasons. Bafana Bafana won their first title on home soil, defeating Tunisia in the final. The South Africans would reach the final again two years later in Burkina Faso , but were unable to defend their title, losing to Egypt who claimed their fourth cup.The 2000 edition was hosted jointly by Ghana and Nigeria , who replaced the originally designated host Zimbabwe . Following a 2–2 draw after extra time in the final, Cameroon defeated Nigeria on penalty kicks. In 2002, Cameroon's Indomitable Lions won their second consecutive title. This was the first repeat since Ghana had done it in the 1960s and after Egypt had done it before in 1957 and 1959. The Cameroonians beat first-time finalists Senegal , who also debuted in the World Cup later that year, via penalty kicks . Both finalists were eliminated in the quarter-finals two years later in Tunisia , where the hosts won their first title, beating Morocco 2–1 in the final. The 2006 tournament was also won by the hosts, Egypt , who reached a continental-record fifth title. Ahead of the 2008 Africa Cup of Nations several European clubs called for a rethink of the tournament's schedule. Given that it takes place during the European season, players who are involved miss several matches for their clubs. In January 2008, FIFA president Sepp Blatter announced that he wanted the tournament to be held in either June or July by 2016, to fit in the international calendar, although this would preclude many countries in central and west Africa from hosting the competition (for these months occur during their wet season ). The 2008 tournament was hosted by Ghana, and saw Egypt retain the trophy, winning its record-extending sixth tournament by defeating Cameroon 1–0 in the final. Egypt set a new record in the 2010 tournament (hosted by Angola ) by winning its third consecutive title in an unprecedented achievement on the African level after defeating Ghana 1–0 in the final, retaining the gold-plated cup indefinitely and extending its record to seven continental titles (including when Egypt was known as UAR between 1958 and 1961). Egypt became the first African nation to win three consecutive cups and joined Mexico , Argentina , and Iran who also won their continent cup three times in a row. On 31 January 2010, Egypt set a new African record, not being defeated for 19 consecutive Cup of Nations matches, since a 2–1 loss against Algeria in Tunisia in 2004 , [ citation needed ] and a record 9 consecutive win streak. [ citation needed ] In May 2010, it was announced that the tournament would be moved to odd-numbered years from 2013 in order to prevent the tournament from taking place in the same year as the World Cup . It also meant there were two tournaments within twelve months in January 2012 ( co-hosted by Gabon and Equatorial Guinea ) and January 2013 ( hosted by South Africa ). The change of FIFA Confederations Cup from a biennial to a quadrennial tournament, and the switching of the Africa Cup of Nations from even to odd-number years, meant that some previous Africa Cup of Nations champions such as Egypt , Zambia , and Ivory Coast (winners of the 2010, 2012, and 2015 tournaments respectively) were deprived from participating in the Confederations Cup tournament . In 2011, Morocco won the bid to host the 2015 edition , and Libya won the right to host the 2013 tournament , but the 2011 Libyan civil war prompted Libya and South Africa to trade years, with South Africa hosting in 2013 and Libya hosting in 2017. Ongoing fighting in Libya ultimately prompted CAF to move the 2017 tournament to Gabon ). In 2012, Zambia won the final after a penalty shootout against Ivory Coast. This drew increased media attention since the match took place in Gabon, only a few hundred meters from the crash site of the 1993 air disaster of their national team. The 2013 tournament was won by Nigeria, beating first time finalists Burkina Faso. In 2014–15, the West African Ebola virus epidemic disrupted the tournament. All football activities in Liberia were suspended, and the Antoinette Tubman Stadium in Monrovia was converted into an Ebola treatment unit. The 2015 Africa Cup of Nations was scheduled to be held in Morocco, but they refused to hold the tournament on the allotted dates due to concerns of the Ebola outbreak, so it was moved to Equatorial Guinea. In July 2016, Total secured the rights to an eight-year sponsorship package to support 10 of CAF 's principal competitions. This began with the 2017 Africa Cup of Nations in Gabon which was renamed the "Total Africa Cup of Nations". Under Ahmad Ahmad 's presidency, there were discussions regarding further changes to the Africa Cup of Nations. In July 2017, two changes were proposed: switching the timing of the competition from January to the Northern Hemisphere summer and expanding from 16 to 24 teams (effective from the 2019 Africa Cup of Nations ). On 20 July 2017, the CAF Executive Commission approved the propositions at a meeting in Rabat, Morocco . Algeria won the African Cup of Nations 2019 , achieving a 1–0 victory against Senegal in the final. The title was Algeria's second ever and first since 1990. Nigeria came third after beating Tunisia 1–0 in their third-place decider match. The prize money awarded to the 2019 Africa Cup of Nations winner amounted to $4.5 million while runners-up Senegal got $2.5 million. Match days 3 and 4 of the 2021 Africa Cup of Nations qualifiers , which was slated from 25 to 30 March 2020, were postponed due to the COVID-19 pandemic . The 2021 Africa Cup of Nations tournament, hosted by Cameroon , and was postponed to 2022 due to the COVID-19 pandemic . The Confederation of African Football increased the cash prize for the winner from $4.5 million to $5 million for 2021 Africa Cup of Nations while the second-best team will get $2.75 million. Senegal won the tournament for the first time after beating Egypt on penalties in the final . The number of teams and the format of each final tournament have varied over the years. In most tournaments, the tournament consists of a round-robin group stage followed by a single-elimination knockout stage. Since the 1962 edition , this competition has been held in two phases: a qualification phase (or called the elimination phase) and a final tournament. The host country of the final tournament is automatically qualified, and in the first editions the defending champion was also qualified for the following tournament. The qualification phase has evolved over time according to the increasing number of nations affiliated to the Confederation of African Football (CAF). It was set up from 1962 , during the first two editions of the Africa Cup of Nations, the founding nations of the CAF participated in the final tournament, namely Egypt , Ethiopia and Sudan ( South Africa was excluded just after its foundation due to Apartheid ). In 1962, new nations were affiliated and forced CAF to set up a qualifying phase for the final tournament in the form of knockout matches. This system was used until the 1992 edition , when the organization of the qualifying phase became closer to that of the UEFA European Championship , with qualifying groups of four to seven teams depending on the editions where each selection plays a round-trip opposition against each of its opponents, the qualified country being decided according to its classification within its group. Only the hosts received an automatic qualification spot, with the other 23 teams qualifying through a qualification tournament . At the finals, the 24 teams were drawn into six groups of four teams each. The teams in each group played a single round robin. After the group stage, the top two teams and the four best third-placed teams advanced to the round of 16. The winners advanced to the quarter-finals. The winners of the quarter-finals advanced to the semi-finals. The losers of the semi-finals played in a third-place play-off, while winners of the semi-finals played in the final. The qualification phase has evolved over time according to the increasing number of nations affiliated to the Confederation of African Football (CAF). It was set up from 1962 , during the first two editions of the Africa Cup of Nations, the founding nations of the CAF participated in the final tournament, namely Egypt , Ethiopia and Sudan ( South Africa was excluded just after its foundation due to Apartheid ). In 1962, new nations were affiliated and forced CAF to set up a qualifying phase for the final tournament in the form of knockout matches. This system was used until the 1992 edition , when the organization of the qualifying phase became closer to that of the UEFA European Championship , with qualifying groups of four to seven teams depending on the editions where each selection plays a round-trip opposition against each of its opponents, the qualified country being decided according to its classification within its group.Only the hosts received an automatic qualification spot, with the other 23 teams qualifying through a qualification tournament . At the finals, the 24 teams were drawn into six groups of four teams each. The teams in each group played a single round robin. After the group stage, the top two teams and the four best third-placed teams advanced to the round of 16. The winners advanced to the quarter-finals. The winners of the quarter-finals advanced to the semi-finals. The losers of the semi-finals played in a third-place play-off, while winners of the semi-finals played in the final. Throughout the history of the Africa Cup of Nations, three trophies have been awarded to the winners of the competition. The original trophy, made of silver, was the Abdelaziz Abdallah Salem Trophy, named after the first CAF president, Egyptian Abdelaziz Abdallah Salem . As the first winner of three Africa Cup of Nations tournaments, Ghana obtained the right to permanently hold the trophy in 1978. The second trophy was awarded from 1980 to 2000 and was named "Trophy of African Unity" or "African Unity Cup". It was given to CAF by the Supreme Council for Sports in Africa prior to the 1980 tournament and it was a cylindrical piece with the Olympic rings over a map of the continent engraved on it. It sat on a squared base and had stylized triangular handles. Cameroon won the Unity Cup indefinitely after they became three-time champions in 2000. In 2001, the third trophy was revealed, a gold-plated cup designed and made in Italy . Cameroon, permanent holders of the previous trophy, were the first nation to be awarded the new trophy after they won the 2002 edition. Egypt won the gold-plated cup indefinitely after they became three-time champions in 2010. Unlike previous winners who would have then taken the trophy home, Egypt was presented with a special full-size replica that they were allowed to keep. The winner of each edition receives a replica whose dimensions are equal to that of the original trophy. CAF give 30 gold medals to the winning team, 30 silver medals to the runners-up, 30 bronze medals to the team ranked third and 30 diplomas to the team ranked fourth in the final tournament.a.e.t.: after extra time p: penalty shoot-out awd: awarded result. TBD: to be determined.Teams that have won the Africa Cup of Nations consecutively and have become two-time champions (two consecutive titles) or three-time champions (three consecutive titles). Bold indicate tournament hostsTeams that have won the Africa Cup of Nations consecutively and have become two-time champions (two consecutive titles) or three-time champions (three consecutive titles). Bold indicate tournament hostsThere are currently six post-tournament awards the Best Player for most valuable player ; the Top Goal-scorer for most prolific goal scorer; the Best Goalkeeper for most outstanding goalkeeper; the Best Young Player for most outstanding young player; the Team of the Tournament for best combined team of players at the tournament; the Fair Play Award for the team with the best record of fair play.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/COVID-19_pandemic/html

COVID-19 pandemic

>10% 3–10% 1–3% 0.3–1% 0.1–0.3% 0.03–0.1% 0–0.03% None or no data The COVID-19 pandemic , also known as the coronavirus pandemic , is a global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identified in an outbreak in Wuhan , the capital of Hubei , China, in December 2019, before it spread to other areas of Asia, and then worldwide in early 2020. The World Health Organization (WHO) declared the outbreak a public health emergency of international concern (PHEIC) on 30 January 2020, and assessed the outbreak had become a pandemic on 11 March 2020. The WHO ended the PHEIC on 5 May 2023. As of 19 April 2024 , the pandemic has caused 7,043,660 confirmed deaths, making it the fifth- deadliest pandemic or epidemic in history . COVID-19 symptoms range from asymptomatic to deadly, but most commonly include fever, sore throat , nocturnal cough , and fatigue. Transmission of the virus is often through airborne particles . Mutations have produced many strains (variants) with varying degrees of infectivity and virulence . COVID-19 vaccines were widely deployed in various countries beginning in December 2020. Treatments include novel antiviral drugs and symptom control. Common mitigation measures during the public health emergency included travel restrictions , lockdowns , business restrictions and closures, workplace hazard controls , mask mandates , quarantines, testing systems, and contact tracing of the infected. The pandemic caused severe social and economic disruption around the world, including the largest global recession since the Great Depression . Widespread supply shortages , including food shortages , were caused by supply chain disruptions and panic buying . Reduced human activity led to an unprecedented temporary decrease in pollution . Educational institutions and public areas were partially or fully closed in many jurisdictions, and many events were cancelled or postponed during 2020 and 2021. Telework became much more common for white-collar workers as the pandemic evolved. Misinformation circulated through social media and mass media , and political tensions intensified . The pandemic raised issues of racial and geographic discrimination , health equity , and the balance between public health imperatives and individual rights.In epidemiology , a pandemic is defined as "an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people". During the COVID-19 pandemic, as with other pandemics, the meaning of this term has been challenged. During the initial outbreak in Wuhan , the virus and disease were commonly referred to as "coronavirus", "Wuhan coronavirus", "the coronavirus outbreak" and the "Wuhan coronavirus outbreak", with the disease sometimes called "Wuhan pneumonia ". In January 2020, the WHO recommended 2019-nCoV and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma . WHO finalized the official names COVID-19 and SARS-CoV-2 on 11 February 2020. Tedros Adhanom Ghebreyesus explained: CO for corona , VI for virus , D for disease and 19 for when the outbreak was first identified (31 December 2019). WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications. WHO named variants of concern and variants of interest using Greek letters . The initial practice of naming them according to where the variants were identified (e.g. Delta began as the "Indian variant") is no longer common. A more systematic naming scheme reflects the variant's PANGO lineage (e.g., Omicron 's lineage is B.1.1.529) and is used for other variants. SARS-CoV-2 is a virus closely related to bat coronaviruses , pangolin coronaviruses, and SARS-CoV . The first known outbreak (the 2019–2020 COVID-19 outbreak in mainland China ) started in Wuhan , Hubei, China, in December 2019. Many early cases were linked to people who had visited the Huanan Seafood Wholesale Market there, but it is possible that human-to-human transmission began earlier. Molecular clock analysis suggests that the first cases were likely to have been between October and November 2019. The scientific consensus is that the virus is most likely of a zoonotic origin, from bats or another closely related mammal. While other explanations such as speculations that SARS-CoV-2 was accidentally released from a laboratory have been proposed, these are not supported by evidence. Official "case" counts refer to the number of people who have been tested for COVID-19 and whose test has been confirmed positive according to official protocols whether or not they experienced symptomatic disease. Due to the effect of sampling bias , studies which obtain a more accurate number by extrapolating from a random sample have consistently found that total infections considerably exceed the reported case counts. Many countries, early on, had official policies to not test those with only mild symptoms. The strongest risk factors for severe illness are obesity, complications of diabetes , anxiety disorders, and the total number of conditions. During the start of the COVID-19 pandemic it was not clear whether young people were less likely to be infected, or less likely to develop symptoms and be tested. A retrospective cohort study in China found that children and adults were just as likely to be infected. Among more thorough studies, preliminary results from 9 April 2020, found that in Gangelt , the centre of a major infection cluster in Germany, 15 percent of a population sample tested positive for antibodies . Screening for COVID-19 in pregnant women in New York City , and blood donors in the Netherlands, found rates of positive antibody tests that indicated more infections than reported. Seroprevalence -based estimates are conservative as some studies show that persons with mild symptoms do not have detectable antibodies. Initial estimates of the basic reproduction number (R 0 ) for COVID-19 in January 2020 were between 1.4 and 2.5, but a subsequent analysis claimed that it may be about 5.7 (with a 95 percent confidence interval of 3.8 to 8.9). In December 2021, the number of cases continued to climb due to several factors, including new COVID-19 variants. As of that 28 December, 282,790,822 individuals worldwide had been confirmed as infected. As of 14 April 2022 [ update ] , over 500 million cases were confirmed globally. Most cases are unconfirmed, with the Institute for Health Metrics and Evaluation estimating the true number of cases as of early 2022 to be in the billions. As of 10 March 2023 , more than 6.88 million deaths had been attributed to COVID-19. The first confirmed death was in Wuhan on 9 January 2020. These numbers vary by region and over time, influenced by testing volume, healthcare system quality, treatment options, government response, time since the initial outbreak, and population characteristics, such as age, sex, and overall health. Multiple measures are used to quantify mortality. Official death counts typically include people who died after testing positive. Such counts exclude deaths without a test. Conversely, deaths of people who died from underlying conditions following a positive test may be included. Countries such as Belgium include deaths from suspected cases, including those without a test, thereby increasing counts. Official death counts have been claimed to underreport the actual death toll, because excess mortality (the number of deaths in a period compared to a long-term average) data show an increase in deaths that is not explained by COVID-19 deaths alone. Using such data, estimates of the true number of deaths from COVID-19 worldwide have included a range from 18.2 to 33.5 million (≈27.4 million) by 18 November 2023 by The Economist , as well as over 18.5 million by 1 April 2023 by the Institute for Health Metrics and Evaluation and ≈18.2 million (earlier) deaths between 1 January 2020, and 31 December 2021, by a comprehensive international study. Such deaths include deaths due to healthcare capacity constraints and priorities, as well as reluctance to seek care (to avoid possible infection). Further research may help distinguish the proportions directly caused by COVID-19 from those caused by indirect consequences of the pandemic. In May 2022, the WHO estimated the number of excess deaths by the end of 2021 to be 14.9 million compared to 5.4 million reported COVID-19 deaths, with the majority of the unreported 9.5 million deaths believed to be direct deaths due the virus, rather than indirect deaths. Some deaths were because people with other conditions could not access medical services . A December 2022 WHO study estimated excess deaths from the pandemic during 2020 and 2021, again concluding ≈14.8 million excess early deaths occurred, reaffirming and detailing their prior calculations from May as well as updating them, addressing criticisms. These numbers do not include measures like years of potential life lost and may make the pandemic 2021's leading cause of death . The time between symptom onset and death ranges from 6 to 41 days, typically about 14 days. Mortality rates increase as a function of age. People at the greatest mortality risk are the elderly and those with underlying conditions. The infection fatality ratio (IFR) is the cumulative number of deaths attributed to the disease divided by the cumulative number of infected individuals (including asymptomatic and undiagnosed infections and excluding vaccinated infected individuals). It is expressed in percentage points. Other studies refer to this metric as the infection fatality risk . In November 2020, a review article in Nature reported estimates of population-weighted IFRs for various countries, excluding deaths in elderly care facilities, and found a median range of 0.24% to 1.49%. IFRs rise as a function of age (from 0.002% at age 10 and 0.01% at age 25, to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85). These rates vary by a factor of ≈10,000 across the age groups. For comparison, the IFR for middle-aged adults is two orders of magnitude higher than the annualised risk of a fatal automobile accident and much higher than the risk of dying from seasonal influenza . In December 2020, a systematic review and meta-analysis estimated that population-weighted IFR was 0.5% to 1% in some countries (France, Netherlands, New Zealand, and Portugal), 1% to 2% in other countries (Australia, England, Lithuania, and Spain), and about 2.5% in Italy. This study reported that most of the differences reflected corresponding differences in the population's age structure and the age-specific pattern of infections. There have also been reviews that have compared the fatality rate of this pandemic with prior pandemics, such as MERS-CoV. For comparison the infection mortality rate of seasonal flu in the United States is 0.1%, which is 13 times lower than COVID-19. Another metric in assessing death rate is the case fatality ratio (CFR), [lower-alpha 1] which is the ratio of deaths to diagnoses. This metric can be misleading because of the delay between symptom onset and death and because testing focuses on symptomatic individuals. Based on Johns Hopkins University statistics, the global CFR is 1.02 percent ( 6,881,955 deaths for 676,609,955 cases) as of 10 March 2023 . The number varies by region and has generally declined over time. SARS-CoV-2 is a virus closely related to bat coronaviruses , pangolin coronaviruses, and SARS-CoV . The first known outbreak (the 2019–2020 COVID-19 outbreak in mainland China ) started in Wuhan , Hubei, China, in December 2019. Many early cases were linked to people who had visited the Huanan Seafood Wholesale Market there, but it is possible that human-to-human transmission began earlier. Molecular clock analysis suggests that the first cases were likely to have been between October and November 2019. The scientific consensus is that the virus is most likely of a zoonotic origin, from bats or another closely related mammal. While other explanations such as speculations that SARS-CoV-2 was accidentally released from a laboratory have been proposed, these are not supported by evidence. Official "case" counts refer to the number of people who have been tested for COVID-19 and whose test has been confirmed positive according to official protocols whether or not they experienced symptomatic disease. Due to the effect of sampling bias , studies which obtain a more accurate number by extrapolating from a random sample have consistently found that total infections considerably exceed the reported case counts. Many countries, early on, had official policies to not test those with only mild symptoms. The strongest risk factors for severe illness are obesity, complications of diabetes , anxiety disorders, and the total number of conditions. During the start of the COVID-19 pandemic it was not clear whether young people were less likely to be infected, or less likely to develop symptoms and be tested. A retrospective cohort study in China found that children and adults were just as likely to be infected. Among more thorough studies, preliminary results from 9 April 2020, found that in Gangelt , the centre of a major infection cluster in Germany, 15 percent of a population sample tested positive for antibodies . Screening for COVID-19 in pregnant women in New York City , and blood donors in the Netherlands, found rates of positive antibody tests that indicated more infections than reported. Seroprevalence -based estimates are conservative as some studies show that persons with mild symptoms do not have detectable antibodies. Initial estimates of the basic reproduction number (R 0 ) for COVID-19 in January 2020 were between 1.4 and 2.5, but a subsequent analysis claimed that it may be about 5.7 (with a 95 percent confidence interval of 3.8 to 8.9). In December 2021, the number of cases continued to climb due to several factors, including new COVID-19 variants. As of that 28 December, 282,790,822 individuals worldwide had been confirmed as infected. As of 14 April 2022 [ update ] , over 500 million cases were confirmed globally. Most cases are unconfirmed, with the Institute for Health Metrics and Evaluation estimating the true number of cases as of early 2022 to be in the billions. As of 10 March 2023 , more than 6.88 million deaths had been attributed to COVID-19. The first confirmed death was in Wuhan on 9 January 2020. These numbers vary by region and over time, influenced by testing volume, healthcare system quality, treatment options, government response, time since the initial outbreak, and population characteristics, such as age, sex, and overall health. Multiple measures are used to quantify mortality. Official death counts typically include people who died after testing positive. Such counts exclude deaths without a test. Conversely, deaths of people who died from underlying conditions following a positive test may be included. Countries such as Belgium include deaths from suspected cases, including those without a test, thereby increasing counts. Official death counts have been claimed to underreport the actual death toll, because excess mortality (the number of deaths in a period compared to a long-term average) data show an increase in deaths that is not explained by COVID-19 deaths alone. Using such data, estimates of the true number of deaths from COVID-19 worldwide have included a range from 18.2 to 33.5 million (≈27.4 million) by 18 November 2023 by The Economist , as well as over 18.5 million by 1 April 2023 by the Institute for Health Metrics and Evaluation and ≈18.2 million (earlier) deaths between 1 January 2020, and 31 December 2021, by a comprehensive international study. Such deaths include deaths due to healthcare capacity constraints and priorities, as well as reluctance to seek care (to avoid possible infection). Further research may help distinguish the proportions directly caused by COVID-19 from those caused by indirect consequences of the pandemic. In May 2022, the WHO estimated the number of excess deaths by the end of 2021 to be 14.9 million compared to 5.4 million reported COVID-19 deaths, with the majority of the unreported 9.5 million deaths believed to be direct deaths due the virus, rather than indirect deaths. Some deaths were because people with other conditions could not access medical services . A December 2022 WHO study estimated excess deaths from the pandemic during 2020 and 2021, again concluding ≈14.8 million excess early deaths occurred, reaffirming and detailing their prior calculations from May as well as updating them, addressing criticisms. These numbers do not include measures like years of potential life lost and may make the pandemic 2021's leading cause of death . The time between symptom onset and death ranges from 6 to 41 days, typically about 14 days. Mortality rates increase as a function of age. People at the greatest mortality risk are the elderly and those with underlying conditions. The infection fatality ratio (IFR) is the cumulative number of deaths attributed to the disease divided by the cumulative number of infected individuals (including asymptomatic and undiagnosed infections and excluding vaccinated infected individuals). It is expressed in percentage points. Other studies refer to this metric as the infection fatality risk . In November 2020, a review article in Nature reported estimates of population-weighted IFRs for various countries, excluding deaths in elderly care facilities, and found a median range of 0.24% to 1.49%. IFRs rise as a function of age (from 0.002% at age 10 and 0.01% at age 25, to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85). These rates vary by a factor of ≈10,000 across the age groups. For comparison, the IFR for middle-aged adults is two orders of magnitude higher than the annualised risk of a fatal automobile accident and much higher than the risk of dying from seasonal influenza . In December 2020, a systematic review and meta-analysis estimated that population-weighted IFR was 0.5% to 1% in some countries (France, Netherlands, New Zealand, and Portugal), 1% to 2% in other countries (Australia, England, Lithuania, and Spain), and about 2.5% in Italy. This study reported that most of the differences reflected corresponding differences in the population's age structure and the age-specific pattern of infections. There have also been reviews that have compared the fatality rate of this pandemic with prior pandemics, such as MERS-CoV. For comparison the infection mortality rate of seasonal flu in the United States is 0.1%, which is 13 times lower than COVID-19. Another metric in assessing death rate is the case fatality ratio (CFR), [lower-alpha 1] which is the ratio of deaths to diagnoses. This metric can be misleading because of the delay between symptom onset and death and because testing focuses on symptomatic individuals. Based on Johns Hopkins University statistics, the global CFR is 1.02 percent ( 6,881,955 deaths for 676,609,955 cases) as of 10 March 2023 . The number varies by region and has generally declined over time. The infection fatality ratio (IFR) is the cumulative number of deaths attributed to the disease divided by the cumulative number of infected individuals (including asymptomatic and undiagnosed infections and excluding vaccinated infected individuals). It is expressed in percentage points. Other studies refer to this metric as the infection fatality risk . In November 2020, a review article in Nature reported estimates of population-weighted IFRs for various countries, excluding deaths in elderly care facilities, and found a median range of 0.24% to 1.49%. IFRs rise as a function of age (from 0.002% at age 10 and 0.01% at age 25, to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85). These rates vary by a factor of ≈10,000 across the age groups. For comparison, the IFR for middle-aged adults is two orders of magnitude higher than the annualised risk of a fatal automobile accident and much higher than the risk of dying from seasonal influenza . In December 2020, a systematic review and meta-analysis estimated that population-weighted IFR was 0.5% to 1% in some countries (France, Netherlands, New Zealand, and Portugal), 1% to 2% in other countries (Australia, England, Lithuania, and Spain), and about 2.5% in Italy. This study reported that most of the differences reflected corresponding differences in the population's age structure and the age-specific pattern of infections. There have also been reviews that have compared the fatality rate of this pandemic with prior pandemics, such as MERS-CoV. For comparison the infection mortality rate of seasonal flu in the United States is 0.1%, which is 13 times lower than COVID-19. Another metric in assessing death rate is the case fatality ratio (CFR), [lower-alpha 1] which is the ratio of deaths to diagnoses. This metric can be misleading because of the delay between symptom onset and death and because testing focuses on symptomatic individuals. Based on Johns Hopkins University statistics, the global CFR is 1.02 percent ( 6,881,955 deaths for 676,609,955 cases) as of 10 March 2023 . The number varies by region and has generally declined over time. Several variants have been named by WHO and labelled as a variant of concern (VoC) or a variant of interest (VoI). Many of these variants have shared the more infectious D614G . As of May 2023, the WHO had downgraded all variants of concern to previously circulating as these were no longer detected in new infections. Sub-lineages of the Omicron variant (BA.1 – BA.5) were considered separate VoCs by the WHO until they were downgraded in March 2023 as no longer widely circulating. Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste , nasal congestion and runny nose , cough, muscle pain , sore throat , fever, diarrhoea , and breathing difficulties . People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum , shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhoea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19 and is reported in as many as 88% of cases. The disease is mainly transmitted via the respiratory route when people inhale droplets and small airborne particles (that form an aerosol ) that infected people exhale as they breathe, talk, cough, sneeze, or sing. Infected people are more likely to transmit COVID-19 when they are physically close to other non-infected individuals. However, infection can occur over longer distances, particularly indoors. SARS‑CoV‑2 belongs to the broad family of viruses known as coronaviruses . It is a positive-sense single-stranded RNA (+ssRNA) virus, with a single linear RNA segment. Coronaviruses infect humans, other mammals, including livestock and companion animals, and avian species. Human coronaviruses are capable of causing illnesses ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS, fatality rate ≈34%). SARS-CoV-2 is the seventh known coronavirus to infect people, after 229E , NL63 , OC43 , HKU1 , MERS-CoV , and the original SARS-CoV . The standard method of testing for presence of SARS-CoV-2 is a nucleic acid test , which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab ; however, a nasal swab or sputum sample may also be used. The WHO has published several testing protocols for the disease. Preventive measures to reduce the chances of infection include getting vaccinated, staying at home or spending more time outdoors, avoiding crowded places, keeping distance from others, wearing a mask in public, ventilating indoor spaces, managing potential exposure durations, washing hands with soap and water often and for at least twenty seconds, practicing good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands. Those diagnosed with COVID-19 or who believe they may be infected are advised by healthcare authorities to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items. A COVID-19 vaccine is intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 ( COVID-19 ). Prior to the COVID-19 pandemic, an established body of knowledge existed about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). This knowledge accelerated the development of various vaccine platforms during early 2020. The initial focus of SARS-CoV-2 vaccines was on preventing symptomatic and severe illness. The COVID-19 vaccines are widely credited for their role in reducing the severity and death caused by COVID-19. As of March 2023, more than 5.5 billion people had received one or more doses (11.8 billion in total) in over 197 countries. The Oxford-AstraZeneca vaccine was the most widely used. According to a June 2022 study, COVID-19 vaccines prevented an additional 14.4 million to 19.8 million deaths in 185 countries and territories from 8 December 2020 to 8 December 2021. On 8 November 2022, the first recombinant protein-based COVID-19 vaccine (Novavax's booster Nuvaxovid ) was authorized for use in adults in the United Kingdom. It has subsequently received endorsement/authorization from the WHO, US, European Union, and Australia. On 12 November 2022, the WHO released its Global Vaccine Market Report. The report indicated that "inequitable distribution is not unique to COVID-19 vaccines"; countries that are not economically strong struggle to obtain vaccines. On 14 November 2022, the first inhalable vaccine was introduced, developed by Chinese biopharmaceutical company CanSino Biologics , in the city of Shanghai, China. For the first two years of the pandemic, no specific and effective treatment or cure was available. In 2021, the European Medicines Agency's (EMA) Committee for Medicinal Products for Human Use (CHMP) approved the oral antiviral protease inhibitor , Paxlovid (nirmatrelvir plus the HIV antiviral ritonavir ), to treat adult patients. FDA later gave it an EUA. Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), adequate intake of oral fluids and rest. Good personal hygiene and a healthy diet are also recommended. Supportive care in severe cases includes treatment to relieve symptoms , fluid therapy , oxygen support and prone positioning , and medications or devices to support other affected vital organs. More severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is recommended to reduce mortality. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure. Existing drugs such as hydroxychloroquine , lopinavir/ritonavir , and ivermectin are not recommended by US or European health authorities, as there is no good evidence they have any useful effect. The antiviral remdesivir is available in the US, Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for use with mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy. The severity of COVID-19 varies. It may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold . In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to intensive care units (ICU). Between 5% and 50% of COVID-19 patients experience long COVID , a condition characterized by long-term consequences persisting after the typical convalescence period of the disease. The most commonly reported clinical presentations are fatigue and memory problems, as well as malaise , headaches, shortness of breath , loss of smell, muscle weakness , low fever and cognitive dysfunction . Several variants have been named by WHO and labelled as a variant of concern (VoC) or a variant of interest (VoI). Many of these variants have shared the more infectious D614G . As of May 2023, the WHO had downgraded all variants of concern to previously circulating as these were no longer detected in new infections. Sub-lineages of the Omicron variant (BA.1 – BA.5) were considered separate VoCs by the WHO until they were downgraded in March 2023 as no longer widely circulating. Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste , nasal congestion and runny nose , cough, muscle pain , sore throat , fever, diarrhoea , and breathing difficulties . People with the same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum , shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhoea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19 and is reported in as many as 88% of cases. The disease is mainly transmitted via the respiratory route when people inhale droplets and small airborne particles (that form an aerosol ) that infected people exhale as they breathe, talk, cough, sneeze, or sing. Infected people are more likely to transmit COVID-19 when they are physically close to other non-infected individuals. However, infection can occur over longer distances, particularly indoors. SARS‑CoV‑2 belongs to the broad family of viruses known as coronaviruses . It is a positive-sense single-stranded RNA (+ssRNA) virus, with a single linear RNA segment. Coronaviruses infect humans, other mammals, including livestock and companion animals, and avian species. Human coronaviruses are capable of causing illnesses ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS, fatality rate ≈34%). SARS-CoV-2 is the seventh known coronavirus to infect people, after 229E , NL63 , OC43 , HKU1 , MERS-CoV , and the original SARS-CoV . The standard method of testing for presence of SARS-CoV-2 is a nucleic acid test , which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test is typically done on respiratory samples obtained by a nasopharyngeal swab ; however, a nasal swab or sputum sample may also be used. The WHO has published several testing protocols for the disease. Preventive measures to reduce the chances of infection include getting vaccinated, staying at home or spending more time outdoors, avoiding crowded places, keeping distance from others, wearing a mask in public, ventilating indoor spaces, managing potential exposure durations, washing hands with soap and water often and for at least twenty seconds, practicing good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands. Those diagnosed with COVID-19 or who believe they may be infected are advised by healthcare authorities to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items. A COVID-19 vaccine is intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 ( COVID-19 ). Prior to the COVID-19 pandemic, an established body of knowledge existed about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). This knowledge accelerated the development of various vaccine platforms during early 2020. The initial focus of SARS-CoV-2 vaccines was on preventing symptomatic and severe illness. The COVID-19 vaccines are widely credited for their role in reducing the severity and death caused by COVID-19. As of March 2023, more than 5.5 billion people had received one or more doses (11.8 billion in total) in over 197 countries. The Oxford-AstraZeneca vaccine was the most widely used. According to a June 2022 study, COVID-19 vaccines prevented an additional 14.4 million to 19.8 million deaths in 185 countries and territories from 8 December 2020 to 8 December 2021. On 8 November 2022, the first recombinant protein-based COVID-19 vaccine (Novavax's booster Nuvaxovid ) was authorized for use in adults in the United Kingdom. It has subsequently received endorsement/authorization from the WHO, US, European Union, and Australia. On 12 November 2022, the WHO released its Global Vaccine Market Report. The report indicated that "inequitable distribution is not unique to COVID-19 vaccines"; countries that are not economically strong struggle to obtain vaccines. On 14 November 2022, the first inhalable vaccine was introduced, developed by Chinese biopharmaceutical company CanSino Biologics , in the city of Shanghai, China. A COVID-19 vaccine is intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 ( COVID-19 ). Prior to the COVID-19 pandemic, an established body of knowledge existed about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). This knowledge accelerated the development of various vaccine platforms during early 2020. The initial focus of SARS-CoV-2 vaccines was on preventing symptomatic and severe illness. The COVID-19 vaccines are widely credited for their role in reducing the severity and death caused by COVID-19. As of March 2023, more than 5.5 billion people had received one or more doses (11.8 billion in total) in over 197 countries. The Oxford-AstraZeneca vaccine was the most widely used. According to a June 2022 study, COVID-19 vaccines prevented an additional 14.4 million to 19.8 million deaths in 185 countries and territories from 8 December 2020 to 8 December 2021. On 8 November 2022, the first recombinant protein-based COVID-19 vaccine (Novavax's booster Nuvaxovid ) was authorized for use in adults in the United Kingdom. It has subsequently received endorsement/authorization from the WHO, US, European Union, and Australia. On 12 November 2022, the WHO released its Global Vaccine Market Report. The report indicated that "inequitable distribution is not unique to COVID-19 vaccines"; countries that are not economically strong struggle to obtain vaccines. On 14 November 2022, the first inhalable vaccine was introduced, developed by Chinese biopharmaceutical company CanSino Biologics , in the city of Shanghai, China. For the first two years of the pandemic, no specific and effective treatment or cure was available. In 2021, the European Medicines Agency's (EMA) Committee for Medicinal Products for Human Use (CHMP) approved the oral antiviral protease inhibitor , Paxlovid (nirmatrelvir plus the HIV antiviral ritonavir ), to treat adult patients. FDA later gave it an EUA. Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), adequate intake of oral fluids and rest. Good personal hygiene and a healthy diet are also recommended. Supportive care in severe cases includes treatment to relieve symptoms , fluid therapy , oxygen support and prone positioning , and medications or devices to support other affected vital organs. More severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is recommended to reduce mortality. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure. Existing drugs such as hydroxychloroquine , lopinavir/ritonavir , and ivermectin are not recommended by US or European health authorities, as there is no good evidence they have any useful effect. The antiviral remdesivir is available in the US, Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for use with mechanical ventilation, and is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy. The severity of COVID-19 varies. It may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold . In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to intensive care units (ICU). Between 5% and 50% of COVID-19 patients experience long COVID , a condition characterized by long-term consequences persisting after the typical convalescence period of the disease. The most commonly reported clinical presentations are fatigue and memory problems, as well as malaise , headaches, shortness of breath , loss of smell, muscle weakness , low fever and cognitive dysfunction . Many countries attempted to slow or stop the spread of COVID-19 by recommending, mandating or prohibiting behaviour changes, while others relied primarily on providing information. Measures ranged from public advisories to stringent lockdowns. Outbreak control strategies are divided into elimination and mitigation. Experts differentiate between elimination strategies (known as " zero-COVID ") that aim to completely stop the spread of the virus within the community, and mitigation strategies (commonly known as " flattening the curve ") that attempt to lessen the effects of the virus on society, but which still tolerate some level of transmission within the community. These initial strategies can be pursued sequentially or simultaneously during the acquired immunity phase through natural and vaccine-induced immunity . Nature reported in 2021 that 90 percent of researchers who responded to a survey "think that the coronavirus will become endemic ". Containment is undertaken to stop an outbreak from spreading into the general population. Infected individuals are isolated while they are infectious. The people they have interacted with are contacted and isolated for long enough to ensure that they are either not infected or no longer contagious. Screening is the starting point for containment. Screening is done by checking for symptoms to identify infected individuals, who can then be isolated or offered treatment. The Zero-COVID strategy involves using public health measures such as contact tracing , mass testing , border quarantine , lockdowns and mitigation software to stop community transmission of COVID-19 as soon as it is detected, with the goal of getting the area back to zero detected infections and resuming normal economic and social activities. Successful containment or suppression reduces Rt to less than 1. Should containment fail, efforts focus on mitigation: measures taken to slow the spread and limit its effects on the healthcare system and society. Successful mitigation delays and decreases the epidemic peak, known as "flattening the epidemic curve ". This decreases the risk of overwhelming health services and provides more time for developing vaccines and treatments. Individual behaviour changed in many jurisdictions. Many people worked from home instead of at their traditional workplaces. Non-pharmaceutical interventions that may reduce spread include personal actions such as wearing face masks , self-quarantine, and hand hygiene ; community measures aimed at reducing interpersonal contacts such as closing workplaces and schools and cancelling large gatherings; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such as surface cleaning. More drastic actions, such as quarantining entire populations and strict travel bans have been attempted in various jurisdictions. The Chinese and Australian government approaches have included many lockdowns and are widely considered the most strict. The New Zealand government response included the most severe travel restrictions. As part of its K-Quarantine program, South Korea introduced mass screening and localised quarantines, and issued alerts on the movements of infected individuals. The Singaporean government's response included so-called " circuit breaker lockdowns " and financial support for those affected while also imposing large fines for those who broke quarantine. Contact tracing attempts to identify recent contacts of newly infected individuals, and to screen them for infection; the traditional approach is to request a list of contacts from infectees, and then telephone or visit the contacts. Contact tracing was widely used during the Western African Ebola virus epidemic in 2014. Another approach is to collect location data from mobile devices to identify those who have come in significant contact with infectees, which prompted privacy concerns. On 10 April 2020, Google and Apple announced an initiative for privacy-preserving contact tracing. In Europe and in the US, Palantir Technologies initially provided COVID-19 tracking services. WHO described increasing capacity and adapting healthcare as a fundamental mitigation. The ECDC and WHO's European regional office issued guidelines for hospitals and primary healthcare services for shifting resources at multiple levels, including focusing laboratory services towards testing, cancelling elective procedures, separating and isolating patients, and increasing intensive care capabilities by training personnel and increasing ventilators and beds. The pandemic drove widespread adoption of telehealth . Due to supply chain capacity limitations, some manufacturers began 3D printing material such as nasal swabs and ventilator parts. In one example, an Italian startup received legal threats due to alleged patent infringement after reverse-engineering and printing one hundred requested ventilator valves overnight. Individuals and groups of makers created and shared open source designs, and manufacturing devices using locally sourced materials, sewing, and 3D printing. Millions of face shields , protective gowns, and masks were made. Other ad hoc medical supplies included shoe covers, surgical caps, powered air-purifying respirators , and hand sanitizer . Novel devices were created such as ear savers , non-invasive ventilation helmets, and ventilator splitters. In July 2021, several experts expressed concern that achieving herd immunity may not be possible because Delta can transmit among vaccinated individuals. CDC published data showing that vaccinated people could transmit Delta, something officials believed was less likely with other variants. Consequently, WHO and CDC encouraged vaccinated people to continue with non-pharmaceutical interventions such as masking, social distancing, and quarantining if exposed. Containment is undertaken to stop an outbreak from spreading into the general population. Infected individuals are isolated while they are infectious. The people they have interacted with are contacted and isolated for long enough to ensure that they are either not infected or no longer contagious. Screening is the starting point for containment. Screening is done by checking for symptoms to identify infected individuals, who can then be isolated or offered treatment. The Zero-COVID strategy involves using public health measures such as contact tracing , mass testing , border quarantine , lockdowns and mitigation software to stop community transmission of COVID-19 as soon as it is detected, with the goal of getting the area back to zero detected infections and resuming normal economic and social activities. Successful containment or suppression reduces Rt to less than 1. Should containment fail, efforts focus on mitigation: measures taken to slow the spread and limit its effects on the healthcare system and society. Successful mitigation delays and decreases the epidemic peak, known as "flattening the epidemic curve ". This decreases the risk of overwhelming health services and provides more time for developing vaccines and treatments. Individual behaviour changed in many jurisdictions. Many people worked from home instead of at their traditional workplaces. Non-pharmaceutical interventions that may reduce spread include personal actions such as wearing face masks , self-quarantine, and hand hygiene ; community measures aimed at reducing interpersonal contacts such as closing workplaces and schools and cancelling large gatherings; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such as surface cleaning. More drastic actions, such as quarantining entire populations and strict travel bans have been attempted in various jurisdictions. The Chinese and Australian government approaches have included many lockdowns and are widely considered the most strict. The New Zealand government response included the most severe travel restrictions. As part of its K-Quarantine program, South Korea introduced mass screening and localised quarantines, and issued alerts on the movements of infected individuals. The Singaporean government's response included so-called " circuit breaker lockdowns " and financial support for those affected while also imposing large fines for those who broke quarantine. Contact tracing attempts to identify recent contacts of newly infected individuals, and to screen them for infection; the traditional approach is to request a list of contacts from infectees, and then telephone or visit the contacts. Contact tracing was widely used during the Western African Ebola virus epidemic in 2014. Another approach is to collect location data from mobile devices to identify those who have come in significant contact with infectees, which prompted privacy concerns. On 10 April 2020, Google and Apple announced an initiative for privacy-preserving contact tracing. In Europe and in the US, Palantir Technologies initially provided COVID-19 tracking services. Non-pharmaceutical interventions that may reduce spread include personal actions such as wearing face masks , self-quarantine, and hand hygiene ; community measures aimed at reducing interpersonal contacts such as closing workplaces and schools and cancelling large gatherings; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such as surface cleaning. More drastic actions, such as quarantining entire populations and strict travel bans have been attempted in various jurisdictions. The Chinese and Australian government approaches have included many lockdowns and are widely considered the most strict. The New Zealand government response included the most severe travel restrictions. As part of its K-Quarantine program, South Korea introduced mass screening and localised quarantines, and issued alerts on the movements of infected individuals. The Singaporean government's response included so-called " circuit breaker lockdowns " and financial support for those affected while also imposing large fines for those who broke quarantine. Contact tracing attempts to identify recent contacts of newly infected individuals, and to screen them for infection; the traditional approach is to request a list of contacts from infectees, and then telephone or visit the contacts. Contact tracing was widely used during the Western African Ebola virus epidemic in 2014. Another approach is to collect location data from mobile devices to identify those who have come in significant contact with infectees, which prompted privacy concerns. On 10 April 2020, Google and Apple announced an initiative for privacy-preserving contact tracing. In Europe and in the US, Palantir Technologies initially provided COVID-19 tracking services. WHO described increasing capacity and adapting healthcare as a fundamental mitigation. The ECDC and WHO's European regional office issued guidelines for hospitals and primary healthcare services for shifting resources at multiple levels, including focusing laboratory services towards testing, cancelling elective procedures, separating and isolating patients, and increasing intensive care capabilities by training personnel and increasing ventilators and beds. The pandemic drove widespread adoption of telehealth . Due to supply chain capacity limitations, some manufacturers began 3D printing material such as nasal swabs and ventilator parts. In one example, an Italian startup received legal threats due to alleged patent infringement after reverse-engineering and printing one hundred requested ventilator valves overnight. Individuals and groups of makers created and shared open source designs, and manufacturing devices using locally sourced materials, sewing, and 3D printing. Millions of face shields , protective gowns, and masks were made. Other ad hoc medical supplies included shoe covers, surgical caps, powered air-purifying respirators , and hand sanitizer . Novel devices were created such as ear savers , non-invasive ventilation helmets, and ventilator splitters. Due to supply chain capacity limitations, some manufacturers began 3D printing material such as nasal swabs and ventilator parts. In one example, an Italian startup received legal threats due to alleged patent infringement after reverse-engineering and printing one hundred requested ventilator valves overnight. Individuals and groups of makers created and shared open source designs, and manufacturing devices using locally sourced materials, sewing, and 3D printing. Millions of face shields , protective gowns, and masks were made. Other ad hoc medical supplies included shoe covers, surgical caps, powered air-purifying respirators , and hand sanitizer . Novel devices were created such as ear savers , non-invasive ventilation helmets, and ventilator splitters. In July 2021, several experts expressed concern that achieving herd immunity may not be possible because Delta can transmit among vaccinated individuals. CDC published data showing that vaccinated people could transmit Delta, something officials believed was less likely with other variants. Consequently, WHO and CDC encouraged vaccinated people to continue with non-pharmaceutical interventions such as masking, social distancing, and quarantining if exposed. The outbreak was discovered in Wuhan in November 2019. It is possible that human-to-human transmission was happening before the discovery. Based on a retrospective analysis starting from December 2019, the number of cases in Hubei gradually increased, reaching 60 by 20 December and at least 266 by 31 December. A pneumonia cluster was observed on 26 December and treated by Chinese pulmonologist Zhang Jixian . She informed the Wuhan Jianghan CDC on 27 December. After analyzing pneumonia patient samples, a genetic sequencing company named Vision Medicals reported the discovery of a novel coronavirus to the China CDC (CCDC) on 28 December. On 30 December, a test report from CapitalBio Medlab addressed to Wuhan Central Hospital reported an erroneous positive result for SARS , causing doctors there to alert authorities. Eight of those doctors, including Li Wenliang (who was also punished on 3 January), were later admonished by the police for spreading false rumours. Director of the Emergency Department at the Central Hospital of Wuhan, Ai Fen, was also reprimanded. That evening, Wuhan Municipal Health Commission (WMHC) issued a notice about "the treatment of pneumonia of unknown cause". The next day, WMHC made the announcement public, confirming 27 cases —enough to trigger an investigation. On 31 December, the WHO office in China was notified about the cluster of unknown pneumonia cases and immediately launched an investigation. Official Chinese sources claimed that the early cases were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020, CCDC director George Gao initially ruled out the market as a possible origin, as animal samples collected there had tested negative. On 11 January, WHO was notified by the Chinese National Health Commission that the outbreak was associated with exposures in the market, and that China had identified a new type of coronavirus, which it isolated on 7 January. Initially, the number of cases doubled approximately every seven and a half days. In early and mid-January, the virus spread to other Chinese provinces , helped by the Chinese New Year migration . Wuhan was a transport hub and major rail interchange. On 10 January, the virus' genome was shared publicly. A retrospective study published in March found that 6,174 people had reported symptoms by 20 January. A 24 January report indicated human transmission was likely occurring, and recommended personal protective equipment for health workers. It also advocated testing, given the outbreak's "pandemic potential". On 31 January, the first published modelling study warned of inevitable "independent self-sustaining outbreaks in major cities globally" and called for "large-scale public health interventions." On 30 January, 7,818 infections had been confirmed, leading WHO to declare the outbreak a Public Health Emergency of International Concern (PHEIC). On 11 March, WHO announced its assessment that the situation could be characterized as a pandemic. By 31 January, Italy indicated its first confirmed infections had occurred, in two tourists from China. On 19 March, Italy overtook China as the country with the most reported deaths. By 26 March, the United States had overtaken China and Italy as the country with the highest number of confirmed infections. Genomic analysis indicated that the majority of New York 's confirmed infections came from Europe, rather than directly from Asia. Testing of prior samples revealed a person who was infected in France on 27 December 2019 and a person in the United States who died from the disease on 6 February. In October, WHO reported that one in ten people around the world may have been infected, or 780 million people, while only 35 million infections had been confirmed. On 9 November, Pfizer released trial results for a candidate vaccine, showing a 90 percent effectiveness in preventing infection. That day, Novavax submitted an FDA Fast Track application for their vaccine. On 14 December, Public Health England reported that a variant had been discovered in the UK's southeast, predominantly in Kent . The variant, later named Alpha , showed changes to the spike protein that could make the virus more infectious. As of 13 December, 1,108 infections had been confirmed in the UK. On 4 February 2020, US Secretary of Health and Human Services Alex Azar waived liability for vaccine manufacturers in all cases except those involving "willful misconduct". On 2 January, the Alpha variant, first discovered in the UK, had been identified in 33 countries. On 6 January, the Gamma variant was first identified in Japanese travellers returning from Brazil. On 29 January, it was reported that the Novavax vaccine was 49 percent effective against the Beta variant in a clinical trial in South Africa. The CoronaVac vaccine was reported to be 50.4 percent effective in a Brazil clinical trial. On 12 March, several countries stopped using the Oxford-AstraZeneca COVID-19 vaccine - due to blood clotting problems, specifically cerebral venous sinus thrombosis (CVST). On 20 March, the WHO and European Medicines Agency found no link to thrombosis , leading several countries to resume administering the vaccine. In March WHO reported that an animal host was the most likely origin, without ruling out other possibilities. The Delta variant was first identified in India. In mid-April, the variant was first detected in the UK and two months later it had become a full-fledged third wave in the country, forcing the government to delay reopening that was originally scheduled for June. On 10 November, Germany advised against the Moderna vaccine for people under 30, due to a possible association with myocarditis . On 24 November, the Omicron variant was detected in South Africa; a few days later the World Health Organization declared it a VoC (variant of concern). The new variant is more infectious than the Delta variant. On 1 January, Europe passed 100 million cases amidst a surge in the Omicron variant . Later that month, the WHO recommended the rheumatoid arthritis drug Baricitinib for severe or critical patients. It also recommended the monoclonal antibody Sotrovimab in patients with non-severe disease, but only those who are at highest risk of hospitalization. On 24 January, the Institute for Health Metrics and Evaluation estimated that about 57% of the world's population had been infected by COVID-19. By 6 March, it was reported that the total worldwide death count had surpassed 6 million people. By 6 July, Omicron subvariants BA.4 and BA.5 had spread worldwide. WHO Director-General Tedros Ghebreyesus stated on 14 September 2022, that "[The world has] never been in a better position to end the pandemic", citing the lowest number of weekly reported deaths since March 2020. He continued, "We are not there yet. But the end is in sight—we can see the finish line". On 21 October, the United States surpassed 99 million cases of COVID-19, the most cases of any country. By 30 October, the worldwide daily death toll was 424, the lowest since 385 deaths were reported on 12 March 2020. 17 November marked the three-year anniversary since health officials in China first detected COVID-19. On 11 November, the WHO reported that deaths since the month of February had dropped 90 percent. Director-General Tedros said this was "cause for optimism". On 3 December, the WHO indicated that, "at least 90% of the world's population has some level of immunity to Sars-CoV-2". In early December, China began lifting some of its most stringent lockdown measures. Subsequent data from China's health authorities revealed that 248 million people, nearly 18 percent of its population, had been infected in the first 20 days of that month. On 29 December, the US joined Italy, Japan, Taiwan and India in requiring negative COVID-19 test results from all people traveling from China due to the new surge in cases. The EU refused similar measures, stating that the BF7 omicron variant had already spread throughout Europe without becoming dominant. On 4 January 2023, the World Health Organization said the information shared by China during the recent surge in infections lacked data, such as hospitalization rates. On 10 January, the WHO's Europe office said the recent viral surge in China posed "no immediate threat." On 16 January, the WHO recommended that China monitor excess mortality to provide "a more comprehensive understanding of the impact of COVID-19." On 30 January, the three-year anniversary of the original declaration, the World Health Organization determined that COVID-19 still met the criteria for a public health emergency of international concern (PHEIC). On 19 March, WHO Director-General Tedros indicated he was "confident" the COVID-19 pandemic would cease to be a public health emergency by the end of the year. On 5 May, the WHO downgraded COVID-19 from being a global health emergency, though it continued to refer to it as a pandemic. The WHO does not make official declarations of when pandemics end. The decision came after Tedros convened with the International Health Regulations Emergency Committee, wherein the Committee noted that due to the decrease in deaths and hospitalisations, and the prevalence of vaccinations and the level of general immunity, it was time to remove the emergency designation and "transition to long-term management". Tedros agreed, and the WHO reduced the classification to an "established and ongoing health issue". In a press conference, Tedros remarked that the diminishing threat from COVID-19 had "allowed most countries to return to life as we knew it before COVID-19". In September the WHO said it had observed "concerning" trends in COVID-19 case numbers and hospitalisations, although analysis was hampered because many countries were no longer recording COVID-19 case statistics. In November 2023, in response to viral mutations and changing characteristics of infection, the WHO adjusted its treatment guidelines. Among other changes, remdesivir and molnupiravir were now recommended only for the most severe cases, and deuremidevir and ivermectin were recommended against. The outbreak was discovered in Wuhan in November 2019. It is possible that human-to-human transmission was happening before the discovery. Based on a retrospective analysis starting from December 2019, the number of cases in Hubei gradually increased, reaching 60 by 20 December and at least 266 by 31 December. A pneumonia cluster was observed on 26 December and treated by Chinese pulmonologist Zhang Jixian . She informed the Wuhan Jianghan CDC on 27 December. After analyzing pneumonia patient samples, a genetic sequencing company named Vision Medicals reported the discovery of a novel coronavirus to the China CDC (CCDC) on 28 December. On 30 December, a test report from CapitalBio Medlab addressed to Wuhan Central Hospital reported an erroneous positive result for SARS , causing doctors there to alert authorities. Eight of those doctors, including Li Wenliang (who was also punished on 3 January), were later admonished by the police for spreading false rumours. Director of the Emergency Department at the Central Hospital of Wuhan, Ai Fen, was also reprimanded. That evening, Wuhan Municipal Health Commission (WMHC) issued a notice about "the treatment of pneumonia of unknown cause". The next day, WMHC made the announcement public, confirming 27 cases —enough to trigger an investigation. On 31 December, the WHO office in China was notified about the cluster of unknown pneumonia cases and immediately launched an investigation. Official Chinese sources claimed that the early cases were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals. In May 2020, CCDC director George Gao initially ruled out the market as a possible origin, as animal samples collected there had tested negative. On 11 January, WHO was notified by the Chinese National Health Commission that the outbreak was associated with exposures in the market, and that China had identified a new type of coronavirus, which it isolated on 7 January. Initially, the number of cases doubled approximately every seven and a half days. In early and mid-January, the virus spread to other Chinese provinces , helped by the Chinese New Year migration . Wuhan was a transport hub and major rail interchange. On 10 January, the virus' genome was shared publicly. A retrospective study published in March found that 6,174 people had reported symptoms by 20 January. A 24 January report indicated human transmission was likely occurring, and recommended personal protective equipment for health workers. It also advocated testing, given the outbreak's "pandemic potential". On 31 January, the first published modelling study warned of inevitable "independent self-sustaining outbreaks in major cities globally" and called for "large-scale public health interventions." On 30 January, 7,818 infections had been confirmed, leading WHO to declare the outbreak a Public Health Emergency of International Concern (PHEIC). On 11 March, WHO announced its assessment that the situation could be characterized as a pandemic. By 31 January, Italy indicated its first confirmed infections had occurred, in two tourists from China. On 19 March, Italy overtook China as the country with the most reported deaths. By 26 March, the United States had overtaken China and Italy as the country with the highest number of confirmed infections. Genomic analysis indicated that the majority of New York 's confirmed infections came from Europe, rather than directly from Asia. Testing of prior samples revealed a person who was infected in France on 27 December 2019 and a person in the United States who died from the disease on 6 February. In October, WHO reported that one in ten people around the world may have been infected, or 780 million people, while only 35 million infections had been confirmed. On 9 November, Pfizer released trial results for a candidate vaccine, showing a 90 percent effectiveness in preventing infection. That day, Novavax submitted an FDA Fast Track application for their vaccine. On 14 December, Public Health England reported that a variant had been discovered in the UK's southeast, predominantly in Kent . The variant, later named Alpha , showed changes to the spike protein that could make the virus more infectious. As of 13 December, 1,108 infections had been confirmed in the UK. On 4 February 2020, US Secretary of Health and Human Services Alex Azar waived liability for vaccine manufacturers in all cases except those involving "willful misconduct". On 2 January, the Alpha variant, first discovered in the UK, had been identified in 33 countries. On 6 January, the Gamma variant was first identified in Japanese travellers returning from Brazil. On 29 January, it was reported that the Novavax vaccine was 49 percent effective against the Beta variant in a clinical trial in South Africa. The CoronaVac vaccine was reported to be 50.4 percent effective in a Brazil clinical trial. On 12 March, several countries stopped using the Oxford-AstraZeneca COVID-19 vaccine - due to blood clotting problems, specifically cerebral venous sinus thrombosis (CVST). On 20 March, the WHO and European Medicines Agency found no link to thrombosis , leading several countries to resume administering the vaccine. In March WHO reported that an animal host was the most likely origin, without ruling out other possibilities. The Delta variant was first identified in India. In mid-April, the variant was first detected in the UK and two months later it had become a full-fledged third wave in the country, forcing the government to delay reopening that was originally scheduled for June. On 10 November, Germany advised against the Moderna vaccine for people under 30, due to a possible association with myocarditis . On 24 November, the Omicron variant was detected in South Africa; a few days later the World Health Organization declared it a VoC (variant of concern). The new variant is more infectious than the Delta variant. On 1 January, Europe passed 100 million cases amidst a surge in the Omicron variant . Later that month, the WHO recommended the rheumatoid arthritis drug Baricitinib for severe or critical patients. It also recommended the monoclonal antibody Sotrovimab in patients with non-severe disease, but only those who are at highest risk of hospitalization. On 24 January, the Institute for Health Metrics and Evaluation estimated that about 57% of the world's population had been infected by COVID-19. By 6 March, it was reported that the total worldwide death count had surpassed 6 million people. By 6 July, Omicron subvariants BA.4 and BA.5 had spread worldwide. WHO Director-General Tedros Ghebreyesus stated on 14 September 2022, that "[The world has] never been in a better position to end the pandemic", citing the lowest number of weekly reported deaths since March 2020. He continued, "We are not there yet. But the end is in sight—we can see the finish line". On 21 October, the United States surpassed 99 million cases of COVID-19, the most cases of any country. By 30 October, the worldwide daily death toll was 424, the lowest since 385 deaths were reported on 12 March 2020. 17 November marked the three-year anniversary since health officials in China first detected COVID-19. On 11 November, the WHO reported that deaths since the month of February had dropped 90 percent. Director-General Tedros said this was "cause for optimism". On 3 December, the WHO indicated that, "at least 90% of the world's population has some level of immunity to Sars-CoV-2". In early December, China began lifting some of its most stringent lockdown measures. Subsequent data from China's health authorities revealed that 248 million people, nearly 18 percent of its population, had been infected in the first 20 days of that month. On 29 December, the US joined Italy, Japan, Taiwan and India in requiring negative COVID-19 test results from all people traveling from China due to the new surge in cases. The EU refused similar measures, stating that the BF7 omicron variant had already spread throughout Europe without becoming dominant. On 4 January 2023, the World Health Organization said the information shared by China during the recent surge in infections lacked data, such as hospitalization rates. On 10 January, the WHO's Europe office said the recent viral surge in China posed "no immediate threat." On 16 January, the WHO recommended that China monitor excess mortality to provide "a more comprehensive understanding of the impact of COVID-19." On 30 January, the three-year anniversary of the original declaration, the World Health Organization determined that COVID-19 still met the criteria for a public health emergency of international concern (PHEIC). On 19 March, WHO Director-General Tedros indicated he was "confident" the COVID-19 pandemic would cease to be a public health emergency by the end of the year. On 5 May, the WHO downgraded COVID-19 from being a global health emergency, though it continued to refer to it as a pandemic. The WHO does not make official declarations of when pandemics end. The decision came after Tedros convened with the International Health Regulations Emergency Committee, wherein the Committee noted that due to the decrease in deaths and hospitalisations, and the prevalence of vaccinations and the level of general immunity, it was time to remove the emergency designation and "transition to long-term management". Tedros agreed, and the WHO reduced the classification to an "established and ongoing health issue". In a press conference, Tedros remarked that the diminishing threat from COVID-19 had "allowed most countries to return to life as we knew it before COVID-19". In September the WHO said it had observed "concerning" trends in COVID-19 case numbers and hospitalisations, although analysis was hampered because many countries were no longer recording COVID-19 case statistics. In November 2023, in response to viral mutations and changing characteristics of infection, the WHO adjusted its treatment guidelines. Among other changes, remdesivir and molnupiravir were now recommended only for the most severe cases, and deuremidevir and ivermectin were recommended against. National reactions ranged from strict lockdowns to public education campaigns. WHO recommended that curfews and lockdowns should be short-term measures to reorganise, regroup, rebalance resources, and protect the health care system. As of 26 March 2020, 1.7 billion people worldwide were under some form of lockdown. This increased to 3.9 billion people by the first week of April—more than half the world's population . In several countries, protests rose against restrictions such as lockdowns. A February 2021 study found that protests against restrictions were likely to directly increase the spread of the virus. As of the end of 2021, Asia's peak had come at the same time and at the same level as the world as a whole, in May 2021. However, cumulatively they had experienced only half of the global average in cases. China opted for containment, instituting strict lockdowns to eliminate viral spread. The vaccines distributed in China included the BIBP , WIBP , and CoronaVac . It was reported on 11 December 2021, that China had vaccinated 1.162 billion of its citizens, or 82.5% of the total population of the country against COVID-19. China's large-scale adoption of zero-COVID had largely contained the first waves of infections of the disease. When the waves of infections due to the Omicron variant followed, China was almost alone in pursuing the strategy of zero-Covid to combat the spread of the virus in 2022. Lockdown continued to be employed in November to combat a new wave of cases; however, protests erupted in cities across China over the country's stringent measures, and in December that year, the country relaxed its zero-COVID policy. On 20 December 2022, the Chinese State Council narrowed its definition of what would be counted as a COVID-19 death to include solely respiratory failure, which led to skepticism by health experts of the government's total death count at a time when hospitals reported being overwhelmed with cases following the abrupt discontinuation of zero-COVID. The first case in India was reported on 30 January 2020. India ordered a nationwide lockdown starting 24 March 2020, with a phased unlock beginning 1 June 2020. Six cities accounted for around half of reported cases— Mumbai , Delhi , Ahmedabad , Chennai , Pune and Kolkata . Post-lockdown, the Government of India introduced a contact tracking app called Aarogya Setu to help authorities manage contact tracing and vaccine distribution. India's vaccination program was considered to be the world's largest and most successful with over 90% of citizens getting the first dose and another 65% getting the second dose. A second wave hit India in April 2021, straining healthcare services. On 21 October 2021, it was reported that the country had surpassed 1 billion vaccinations. Iran reported its first confirmed cases on 19 February 2020, in Qom . Early measures included the cancellation/closure of concerts and other cultural events, Friday prayers, and school and university campuses. Iran became a centre of the pandemic in February 2020. More than ten countries had traced their outbreaks to Iran by 28 February, indicating a more severe outbreak than the 388 reported cases. The Iranian Parliament closed, after 23 of its 290 members tested positive on 3 March 2020. At least twelve sitting or former Iranian politicians and government officials had died by 17 March 2020. By August 2021, the pandemic's fifth wave peaked, with more than 400 deaths in 1 day. COVID-19 was confirmed in South Korea on 20 January 2020. Military bases were quarantined after tests showed three infected soldiers. South Korea introduced what was then considered the world's largest and best-organised screening programme, isolating infected people, and tracing and quarantining contacts. Screening methods included mandatory self-reporting by new international arrivals through mobile application, combined with drive-through testing, and increasing testing capability to 20,000 people/day. Despite some early criticisms, South Korea's programme was considered a success in controlling the outbreak without quarantining entire cities. The COVID-19 pandemic arrived in Europe with its first confirmed case in Bordeaux , France , on 24 January 2020, and subsequently spread widely across the continent. By 17 March 2020, every country in Europe had confirmed a case, and all had reported at least one death, with the exception of Vatican City . Italy was the first European nation to experience a major outbreak in early 2020, becoming the first country worldwide to introduce a national lockdown . By 13 March 2020, the World Health Organization (WHO) declared Europe the epicentre of the pandemic and it remained so until the WHO announced it had been overtaken by South America on 22 May. By 18 March 2020, more than 250 million people were in lockdown in Europe. Despite deployment of COVID-19 vaccines , Europe became the pandemic's epicentre once again in late 2021. The Italian outbreak began on 31 January 2020, when two Chinese tourists tested positive for SARS-CoV-2 in Rome. Cases began to rise sharply, which prompted the government to suspend flights to and from China and declare a state of emergency. On 22 February 2020, the Council of Ministers announced a new decree-law to contain the outbreak, which quarantined more than 50,000 people in northern Italy. On 4 March, the Italian government ordered schools and universities closed as Italy reached a hundred deaths. Sport was suspended completely for at least one month. On 11 March, Italian Prime Minister Giuseppe Conte closed down nearly all commercial activity except supermarkets and pharmacies. On 19 April, the first wave ebbed, as 7-day deaths declined to 433. On 13 October, the Italian government again issued restrictive rules to contain the second wave. On 10 November, Italy surpassed 1 million confirmed infections. On 23 November, it was reported that the second wave of the virus had led some hospitals to stop accepting patients. The virus was first confirmed to have spread to Spain on 31 January 2020, when a German tourist tested positive for SARS-CoV-2 on La Gomera in the Canary Islands. Post-hoc genetic analysis has shown that at least 15 strains of the virus had been imported, and community transmission began by mid-February. On 29 March, it was announced that, beginning the following day, all non-essential workers were ordered to remain at home for the next 14 days. The number of cases increased again in July in a number of cities including Barcelona , Zaragoza and Madrid , which led to reimposition of some restrictions but no national lockdown. By September 2021, Spain was one of the countries with the highest percentage of its population vaccinated (76% fully vaccinated and 79% with the first dose). Italy is ranked second at 75%. Sweden differed from most other European countries in that it mostly remained open. Per the Swedish constitution , the Public Health Agency of Sweden has autonomy that prevents political interference and the agency favoured remaining open. The Swedish strategy focused on longer-term measures, based on the assumption that after lockdown the virus would resume spreading, with the same result. By the end of June, Sweden no longer had excess mortality . Devolution in the United Kingdom meant that each of its four countries developed its own response. England's restrictions were shorter-lived than the others. The UK government started enforcing social distancing and quarantine measures on 18 March 2020. On 16 March, Prime Minister Boris Johnson advised against non-essential travel and social contact, praising work from home and avoiding venues such as pubs, restaurants, and theatres. On 20 March, the government ordered all leisure establishments to close, and promised to prevent unemployment. On 23 March, Johnson banned gatherings and restricted non-essential travel and outdoor activity. Unlike previous measures, these restrictions were enforceable by police through fines and dispersal of gatherings. Most non-essential businesses were ordered to close. On 24 April 2020, it was reported that a promising vaccine trial had begun in England; the government pledged more than £50 million towards research. On 16 April 2020, it was reported that the UK would have first access to the Oxford vaccine, due to a prior contract; should the trial be successful, some 30 million doses would be available. On 2 December 2020, the UK became the first developed country to approve the Pfizer vaccine; 800,000 doses were immediately available for use. In August 2022 it was reported that viral infection cases had declined in the UK. The virus arrived in the United States on 13 January 2020. Cases were reported in all North American countries after Saint Kitts and Nevis confirmed a case on 25 March, and in all North American territories after Bonaire confirmed a case on 16 April. Per Our World in Data , 103,436,829 confirmed cases have been reported in the United States with 1,184,148 deaths, the most of any country, and the nineteenth-highest per capita worldwide. COVID-19 is the deadliest pandemic in US history ; it was the third-leading cause of death in the US in 2020, behind heart disease and cancer. From 2019 to 2020, US life expectancy dropped by 3 years for Hispanic Americans, 2.9 years for African Americans, and 1.2 years for white Americans. These effects have persisted as US deaths due to COVID-19 in 2021 exceeded those in 2020. In the United States, COVID-19 vaccines became available under emergency use in December 2020, beginning the national vaccination program . The first COVID-19 vaccine was officially approved by the Food and Drug Administration on 23 August 2021. By 18 November 2022, while cases in the U.S. had declined, COVID variants BQ.1/BQ.1.1 had become dominant in the country. In March 2020, as cases of community transmission were confirmed across Canada , all of its provinces and territories declared states of emergency. Provinces and territories, to varying degrees, implemented school and daycare closures, prohibitions on gatherings, closures of non-essential businesses and restrictions on entry. Canada severely restricted its border access, barring travellers from all countries with some exceptions. Cases surged across Canada, notably in the provinces of British Columbia , Alberta , Quebec and Ontario , with the formation of the Atlantic Bubble , a travel-restricted area of the country (formed of the four Atlantic provinces ). Vaccine passports were adopted in all provinces and two of the territories. Per a report on 11 November 2022, Canadian health authorities saw a surge in influenza, while COVID-19 was expected to rise during winter. The COVID-19 pandemic was confirmed to have reached South America on 26 February 2020, when Brazil confirmed a case in São Paulo . By 3 April, all countries and territories in South America had recorded at least one case. On 13 May 2020, it was reported that Latin America and the Caribbean had reported over 400,000 cases of COVID-19 infection with 23,091 deaths. On 22 May 2020, citing the rapid increase of infections in Brazil , the World Health Organization WHO declared South America the epicentre of the pandemic. As of 16 July 2021, South America had recorded 34,359,631 confirmed cases and 1,047,229 deaths from COVID-19. Due to a shortage of testing and medical facilities, it is believed that the outbreak is far larger than the official numbers show. The virus was confirmed to have spread to Brazil on 25 February 2020, when a man from São Paulo who had traveled to Italy tested positive for the virus. The disease had spread to every federative unit of Brazil by 21 March. On 19 June 2020, the country reported its one millionth case and nearly 49,000 reported deaths. One estimate of under-reporting was 22.62% of total reported COVID-19 mortality in 2020. As of 19 April 2024 , Brazil, with 37,519,960 confirmed cases and 702,116 deaths, has the third-highest number of confirmed cases and second-highest death toll from COVID-19 in the world, behind only those of the United States and India . The COVID-19 pandemic was confirmed to have spread to Africa on 14 February 2020, with the first confirmed case announced in Egypt . The first confirmed case in sub-Saharan Africa was announced in Nigeria at the end of February 2020. Within three months, the virus had spread throughout the continent; Lesotho , the last African sovereign state to have remained free of the virus, reported its first case on 13 May 2020. By 26 May, it appeared that most African countries were experiencing community transmission, although testing capacity was limited. Most of the identified imported cases arrived from Europe and the United States rather than from China where the virus originated. Many preventive measures were implemented by different countries in Africa including travel restrictions, flight cancellations, and event cancellations. Despite fears, Africa reported lower death rates than other, more economically developed regions. In early June 2021, Africa faced a third wave of COVID infections with cases rising in 14 countries. By 4 July the continent recorded more than 251,000 new COVID cases, a 20% increase from the prior week and a 12% increase from the January peak. More than sixteen African countries, including Malawi and Senegal , recorded an uptick in new cases. The World Health Organization labelled it Africa's 'Worst Pandemic Week Ever'. In October 2022, WHO reported that most countries on the African continent will miss the goal of 70 percent vaccination by the end of 2022. The COVID-19 pandemic was confirmed to have reached Oceania on 25 January 2020, with the first confirmed case reported in Melbourne , Australia . It has since spread elsewhere in the region. Australia and New Zealand were praised for their handling of the pandemic in comparison to other Western nations, with New Zealand and each state in Australia wiping out all community transmission of the virus several times even after re-introduction into the community. As a result of the high transmissibility of the Delta variant, however, by August 2021, the Australian states of New South Wales and Victoria had conceded defeat in their eradication efforts. In early October 2021, New Zealand also abandoned its elimination strategy. In November and December, following vaccination efforts, the remaining states of Australia, excluding Western Australia, voluntarily gave up COVID-zero to open up state and international borders. The open borders allowed the Omicron Variant of COVID-19 to enter quickly and cases subsequently exceeded 120,000 a day. By early March 2022, with cases exceeding 1,000 a day, Western Australia conceded defeat in its eradication strategy and opened its borders. Despite record cases, Australian jurisdictions slowly removed restrictions such as close contact isolation, mask wearing and density limits by April 2022. On 9 September 2022 restrictions were significantly relaxed. The aircraft mask mandate was scrapped nationwide and daily reporting transitioned to weekly reporting. On 14 September, COVID-19 disaster payment for isolating persons was extended for mandatory isolation. By 22 September, all states had ended mask mandates on public transport, including in Victoria, where the mandate had lasted for approximately 800 days. On 30 September 2022, all Australian leaders declared the emergency response finished and announced the end of isolation requirements. These changes were due in part to high levels of 'hybrid immunity' and low case numbers. Due to its remoteness and sparse population, Antarctica was the last continent to have confirmed cases of COVID-19. The first cases were reported in December 2020, almost a year after the first cases of COVID-19 were detected in China. At least 36 people were infected in the first outbreak in 2020, with several other outbreaks taking place in 2021 and 2022. The United Nations Conference on Trade and Development (UNSC) was criticised for its slow response, especially regarding the UN's global ceasefire , which aimed to open up humanitarian access to conflict zones. The United Nations Security Council was criticized due to the inadequate manner in which it dealt with the COVID-19 pandemic, namely the poor ability to create international collaboration during this crisis. On 23 March 2020, United Nations Secretary-General António Manuel de Oliveira Guterres appealed for a global ceasefire ; 172 UN member states and observers signed a non-binding supporting statement in June, and the UN Security Council passed a resolution supporting it in July. On 29 September 2020, Guterres urged the International Monetary Fund to help certain countries via debt relief and also call for countries to increase contributions to develop vaccines. The WHO spearheaded initiatives such as the COVID-19 Solidarity Response Fund to raise money for the pandemic response, the UN COVID-19 Supply Chain Task Force , and the solidarity trial for investigating potential treatment options for the disease. The COVAX program, co-led by the WHO, GAVI , and the Coalition for Epidemic Preparedness Innovations (CEPI), aimed to accelerate the development, manufacture, and distribution of COVID-19 vaccines, and to guarantee fair and equitable access across the world. As of the end of 2021, Asia's peak had come at the same time and at the same level as the world as a whole, in May 2021. However, cumulatively they had experienced only half of the global average in cases. China opted for containment, instituting strict lockdowns to eliminate viral spread. The vaccines distributed in China included the BIBP , WIBP , and CoronaVac . It was reported on 11 December 2021, that China had vaccinated 1.162 billion of its citizens, or 82.5% of the total population of the country against COVID-19. China's large-scale adoption of zero-COVID had largely contained the first waves of infections of the disease. When the waves of infections due to the Omicron variant followed, China was almost alone in pursuing the strategy of zero-Covid to combat the spread of the virus in 2022. Lockdown continued to be employed in November to combat a new wave of cases; however, protests erupted in cities across China over the country's stringent measures, and in December that year, the country relaxed its zero-COVID policy. On 20 December 2022, the Chinese State Council narrowed its definition of what would be counted as a COVID-19 death to include solely respiratory failure, which led to skepticism by health experts of the government's total death count at a time when hospitals reported being overwhelmed with cases following the abrupt discontinuation of zero-COVID. The first case in India was reported on 30 January 2020. India ordered a nationwide lockdown starting 24 March 2020, with a phased unlock beginning 1 June 2020. Six cities accounted for around half of reported cases— Mumbai , Delhi , Ahmedabad , Chennai , Pune and Kolkata . Post-lockdown, the Government of India introduced a contact tracking app called Aarogya Setu to help authorities manage contact tracing and vaccine distribution. India's vaccination program was considered to be the world's largest and most successful with over 90% of citizens getting the first dose and another 65% getting the second dose. A second wave hit India in April 2021, straining healthcare services. On 21 October 2021, it was reported that the country had surpassed 1 billion vaccinations. Iran reported its first confirmed cases on 19 February 2020, in Qom . Early measures included the cancellation/closure of concerts and other cultural events, Friday prayers, and school and university campuses. Iran became a centre of the pandemic in February 2020. More than ten countries had traced their outbreaks to Iran by 28 February, indicating a more severe outbreak than the 388 reported cases. The Iranian Parliament closed, after 23 of its 290 members tested positive on 3 March 2020. At least twelve sitting or former Iranian politicians and government officials had died by 17 March 2020. By August 2021, the pandemic's fifth wave peaked, with more than 400 deaths in 1 day. COVID-19 was confirmed in South Korea on 20 January 2020. Military bases were quarantined after tests showed three infected soldiers. South Korea introduced what was then considered the world's largest and best-organised screening programme, isolating infected people, and tracing and quarantining contacts. Screening methods included mandatory self-reporting by new international arrivals through mobile application, combined with drive-through testing, and increasing testing capability to 20,000 people/day. Despite some early criticisms, South Korea's programme was considered a success in controlling the outbreak without quarantining entire cities. The COVID-19 pandemic arrived in Europe with its first confirmed case in Bordeaux , France , on 24 January 2020, and subsequently spread widely across the continent. By 17 March 2020, every country in Europe had confirmed a case, and all had reported at least one death, with the exception of Vatican City . Italy was the first European nation to experience a major outbreak in early 2020, becoming the first country worldwide to introduce a national lockdown . By 13 March 2020, the World Health Organization (WHO) declared Europe the epicentre of the pandemic and it remained so until the WHO announced it had been overtaken by South America on 22 May. By 18 March 2020, more than 250 million people were in lockdown in Europe. Despite deployment of COVID-19 vaccines , Europe became the pandemic's epicentre once again in late 2021. The Italian outbreak began on 31 January 2020, when two Chinese tourists tested positive for SARS-CoV-2 in Rome. Cases began to rise sharply, which prompted the government to suspend flights to and from China and declare a state of emergency. On 22 February 2020, the Council of Ministers announced a new decree-law to contain the outbreak, which quarantined more than 50,000 people in northern Italy. On 4 March, the Italian government ordered schools and universities closed as Italy reached a hundred deaths. Sport was suspended completely for at least one month. On 11 March, Italian Prime Minister Giuseppe Conte closed down nearly all commercial activity except supermarkets and pharmacies. On 19 April, the first wave ebbed, as 7-day deaths declined to 433. On 13 October, the Italian government again issued restrictive rules to contain the second wave. On 10 November, Italy surpassed 1 million confirmed infections. On 23 November, it was reported that the second wave of the virus had led some hospitals to stop accepting patients. The virus was first confirmed to have spread to Spain on 31 January 2020, when a German tourist tested positive for SARS-CoV-2 on La Gomera in the Canary Islands. Post-hoc genetic analysis has shown that at least 15 strains of the virus had been imported, and community transmission began by mid-February. On 29 March, it was announced that, beginning the following day, all non-essential workers were ordered to remain at home for the next 14 days. The number of cases increased again in July in a number of cities including Barcelona , Zaragoza and Madrid , which led to reimposition of some restrictions but no national lockdown. By September 2021, Spain was one of the countries with the highest percentage of its population vaccinated (76% fully vaccinated and 79% with the first dose). Italy is ranked second at 75%. Sweden differed from most other European countries in that it mostly remained open. Per the Swedish constitution , the Public Health Agency of Sweden has autonomy that prevents political interference and the agency favoured remaining open. The Swedish strategy focused on longer-term measures, based on the assumption that after lockdown the virus would resume spreading, with the same result. By the end of June, Sweden no longer had excess mortality . Devolution in the United Kingdom meant that each of its four countries developed its own response. England's restrictions were shorter-lived than the others. The UK government started enforcing social distancing and quarantine measures on 18 March 2020. On 16 March, Prime Minister Boris Johnson advised against non-essential travel and social contact, praising work from home and avoiding venues such as pubs, restaurants, and theatres. On 20 March, the government ordered all leisure establishments to close, and promised to prevent unemployment. On 23 March, Johnson banned gatherings and restricted non-essential travel and outdoor activity. Unlike previous measures, these restrictions were enforceable by police through fines and dispersal of gatherings. Most non-essential businesses were ordered to close. On 24 April 2020, it was reported that a promising vaccine trial had begun in England; the government pledged more than £50 million towards research. On 16 April 2020, it was reported that the UK would have first access to the Oxford vaccine, due to a prior contract; should the trial be successful, some 30 million doses would be available. On 2 December 2020, the UK became the first developed country to approve the Pfizer vaccine; 800,000 doses were immediately available for use. In August 2022 it was reported that viral infection cases had declined in the UK. The virus arrived in the United States on 13 January 2020. Cases were reported in all North American countries after Saint Kitts and Nevis confirmed a case on 25 March, and in all North American territories after Bonaire confirmed a case on 16 April. Per Our World in Data , 103,436,829 confirmed cases have been reported in the United States with 1,184,148 deaths, the most of any country, and the nineteenth-highest per capita worldwide. COVID-19 is the deadliest pandemic in US history ; it was the third-leading cause of death in the US in 2020, behind heart disease and cancer. From 2019 to 2020, US life expectancy dropped by 3 years for Hispanic Americans, 2.9 years for African Americans, and 1.2 years for white Americans. These effects have persisted as US deaths due to COVID-19 in 2021 exceeded those in 2020. In the United States, COVID-19 vaccines became available under emergency use in December 2020, beginning the national vaccination program . The first COVID-19 vaccine was officially approved by the Food and Drug Administration on 23 August 2021. By 18 November 2022, while cases in the U.S. had declined, COVID variants BQ.1/BQ.1.1 had become dominant in the country. In March 2020, as cases of community transmission were confirmed across Canada , all of its provinces and territories declared states of emergency. Provinces and territories, to varying degrees, implemented school and daycare closures, prohibitions on gatherings, closures of non-essential businesses and restrictions on entry. Canada severely restricted its border access, barring travellers from all countries with some exceptions. Cases surged across Canada, notably in the provinces of British Columbia , Alberta , Quebec and Ontario , with the formation of the Atlantic Bubble , a travel-restricted area of the country (formed of the four Atlantic provinces ). Vaccine passports were adopted in all provinces and two of the territories. Per a report on 11 November 2022, Canadian health authorities saw a surge in influenza, while COVID-19 was expected to rise during winter. The COVID-19 pandemic was confirmed to have reached South America on 26 February 2020, when Brazil confirmed a case in São Paulo . By 3 April, all countries and territories in South America had recorded at least one case. On 13 May 2020, it was reported that Latin America and the Caribbean had reported over 400,000 cases of COVID-19 infection with 23,091 deaths. On 22 May 2020, citing the rapid increase of infections in Brazil , the World Health Organization WHO declared South America the epicentre of the pandemic. As of 16 July 2021, South America had recorded 34,359,631 confirmed cases and 1,047,229 deaths from COVID-19. Due to a shortage of testing and medical facilities, it is believed that the outbreak is far larger than the official numbers show. The virus was confirmed to have spread to Brazil on 25 February 2020, when a man from São Paulo who had traveled to Italy tested positive for the virus. The disease had spread to every federative unit of Brazil by 21 March. On 19 June 2020, the country reported its one millionth case and nearly 49,000 reported deaths. One estimate of under-reporting was 22.62% of total reported COVID-19 mortality in 2020. As of 19 April 2024 , Brazil, with 37,519,960 confirmed cases and 702,116 deaths, has the third-highest number of confirmed cases and second-highest death toll from COVID-19 in the world, behind only those of the United States and India . The COVID-19 pandemic was confirmed to have spread to Africa on 14 February 2020, with the first confirmed case announced in Egypt . The first confirmed case in sub-Saharan Africa was announced in Nigeria at the end of February 2020. Within three months, the virus had spread throughout the continent; Lesotho , the last African sovereign state to have remained free of the virus, reported its first case on 13 May 2020. By 26 May, it appeared that most African countries were experiencing community transmission, although testing capacity was limited. Most of the identified imported cases arrived from Europe and the United States rather than from China where the virus originated. Many preventive measures were implemented by different countries in Africa including travel restrictions, flight cancellations, and event cancellations. Despite fears, Africa reported lower death rates than other, more economically developed regions. In early June 2021, Africa faced a third wave of COVID infections with cases rising in 14 countries. By 4 July the continent recorded more than 251,000 new COVID cases, a 20% increase from the prior week and a 12% increase from the January peak. More than sixteen African countries, including Malawi and Senegal , recorded an uptick in new cases. The World Health Organization labelled it Africa's 'Worst Pandemic Week Ever'. In October 2022, WHO reported that most countries on the African continent will miss the goal of 70 percent vaccination by the end of 2022. The COVID-19 pandemic was confirmed to have reached Oceania on 25 January 2020, with the first confirmed case reported in Melbourne , Australia . It has since spread elsewhere in the region. Australia and New Zealand were praised for their handling of the pandemic in comparison to other Western nations, with New Zealand and each state in Australia wiping out all community transmission of the virus several times even after re-introduction into the community. As a result of the high transmissibility of the Delta variant, however, by August 2021, the Australian states of New South Wales and Victoria had conceded defeat in their eradication efforts. In early October 2021, New Zealand also abandoned its elimination strategy. In November and December, following vaccination efforts, the remaining states of Australia, excluding Western Australia, voluntarily gave up COVID-zero to open up state and international borders. The open borders allowed the Omicron Variant of COVID-19 to enter quickly and cases subsequently exceeded 120,000 a day. By early March 2022, with cases exceeding 1,000 a day, Western Australia conceded defeat in its eradication strategy and opened its borders. Despite record cases, Australian jurisdictions slowly removed restrictions such as close contact isolation, mask wearing and density limits by April 2022. On 9 September 2022 restrictions were significantly relaxed. The aircraft mask mandate was scrapped nationwide and daily reporting transitioned to weekly reporting. On 14 September, COVID-19 disaster payment for isolating persons was extended for mandatory isolation. By 22 September, all states had ended mask mandates on public transport, including in Victoria, where the mandate had lasted for approximately 800 days. On 30 September 2022, all Australian leaders declared the emergency response finished and announced the end of isolation requirements. These changes were due in part to high levels of 'hybrid immunity' and low case numbers. Due to its remoteness and sparse population, Antarctica was the last continent to have confirmed cases of COVID-19. The first cases were reported in December 2020, almost a year after the first cases of COVID-19 were detected in China. At least 36 people were infected in the first outbreak in 2020, with several other outbreaks taking place in 2021 and 2022. The United Nations Conference on Trade and Development (UNSC) was criticised for its slow response, especially regarding the UN's global ceasefire , which aimed to open up humanitarian access to conflict zones. The United Nations Security Council was criticized due to the inadequate manner in which it dealt with the COVID-19 pandemic, namely the poor ability to create international collaboration during this crisis. On 23 March 2020, United Nations Secretary-General António Manuel de Oliveira Guterres appealed for a global ceasefire ; 172 UN member states and observers signed a non-binding supporting statement in June, and the UN Security Council passed a resolution supporting it in July. On 29 September 2020, Guterres urged the International Monetary Fund to help certain countries via debt relief and also call for countries to increase contributions to develop vaccines. The WHO spearheaded initiatives such as the COVID-19 Solidarity Response Fund to raise money for the pandemic response, the UN COVID-19 Supply Chain Task Force , and the solidarity trial for investigating potential treatment options for the disease. The COVAX program, co-led by the WHO, GAVI , and the Coalition for Epidemic Preparedness Innovations (CEPI), aimed to accelerate the development, manufacture, and distribution of COVID-19 vaccines, and to guarantee fair and equitable access across the world. The pandemic shook the world's economy, with especially severe economic damage in the United States, Europe and Latin America. A consensus report by American intelligence agencies in April 2021 concluded, "Efforts to contain and manage the virus have reinforced nationalist trends globally, as some states turned inward to protect their citizens and sometimes cast blame on marginalized groups." COVID-19 inflamed partisanship and polarisation around the world as bitter arguments exploded over how to respond. International trade was disrupted amid the formation of no-entry enclaves. The pandemic led many countries and regions to impose quarantines, entry bans, or other restrictions, either for citizens, recent travellers to affected areas, or for all travellers. Travel collapsed worldwide, damaging the travel sector. The effectiveness of travel restrictions was questioned as the virus spread across the world. One study found that travel restrictions only modestly affected the initial spread, unless combined with other infection prevention and control measures. Researchers concluded that "travel restrictions are most useful in the early and late phase of an epidemic" and "restrictions of travel from Wuhan unfortunately came too late". The European Union rejected the idea of suspending the Schengen free travel zone . Several countries repatriated their citizens and diplomatic staff from Wuhan and surrounding areas, primarily through charter flights . Canada, the United States, Japan, India, Sri Lanka, Australia, France, Argentina, Germany and Thailand were among the first to do so. Brazil and New Zealand evacuated their own nationals and others. On 14 March, South Africa repatriated 112 South Africans who tested negative, while four who showed symptoms were left behind. Pakistan declined to evacuate its citizens. On 15 February, the US announced it would evacuate Americans aboard the Diamond Princess cruise ship, and on 21 February, Canada evacuated 129 Canadians from the ship. In early March, the Indian government began repatriating its citizens from Iran. On 20 March, the United States began to withdraw some troops from Iraq. The pandemic led many countries and regions to impose quarantines, entry bans, or other restrictions, either for citizens, recent travellers to affected areas, or for all travellers. Travel collapsed worldwide, damaging the travel sector. The effectiveness of travel restrictions was questioned as the virus spread across the world. One study found that travel restrictions only modestly affected the initial spread, unless combined with other infection prevention and control measures. Researchers concluded that "travel restrictions are most useful in the early and late phase of an epidemic" and "restrictions of travel from Wuhan unfortunately came too late". The European Union rejected the idea of suspending the Schengen free travel zone . Several countries repatriated their citizens and diplomatic staff from Wuhan and surrounding areas, primarily through charter flights . Canada, the United States, Japan, India, Sri Lanka, Australia, France, Argentina, Germany and Thailand were among the first to do so. Brazil and New Zealand evacuated their own nationals and others. On 14 March, South Africa repatriated 112 South Africans who tested negative, while four who showed symptoms were left behind. Pakistan declined to evacuate its citizens. On 15 February, the US announced it would evacuate Americans aboard the Diamond Princess cruise ship, and on 21 February, Canada evacuated 129 Canadians from the ship. In early March, the Indian government began repatriating its citizens from Iran. On 20 March, the United States began to withdraw some troops from Iraq. The pandemic and responses to it damaged the global economy. On 27 February 2020, worries about the outbreak crushed US stock indexes, which posted their sharpest falls since 2008. Tourism collapsed due to travel restrictions, closing of public places including travel attractions, and advice of governments against travel. Airlines cancelled flights, while British regional airline Flybe collapsed. The cruise line industry was hard hit, and train stations and ferry ports closed. International mail stopped or was delayed. The retail sector faced reductions in store hours or closures. Retailers in Europe and Latin America faced traffic declines of 40 percent. North America and Middle East retailers saw a 50–60 percent drop. Shopping centres faced a 33–43 percent drop in foot traffic in March compared to February. Mall operators around the world coped by increasing sanitation, installing thermal scanners to check the temperature of shoppers, and cancelling events. Hundreds of millions of jobs were lost, including more than 40 million jobs in the US. According to a report by Yelp , about 60% of US businesses that closed will stay shut permanently. The International Labour Organization (ILO) reported that the income generated in the first nine months of 2020 from work across the world dropped by 10.7 percent, or $3.5 trillion. Pandemic fears led to panic buying , emptying groceries of essentials such as food, toilet paper, and bottled water. Panic buying stemmed from perceived threat, perceived scarcity, fear of the unknown, coping behaviour and social psychological factors (e.g. social influence and trust). Supply shortages were due to disruption to factory and logistic operations; shortages were worsened by supply chain disruptions from factory and port shutdowns, and labour shortages. Shortages continued as managers underestimated the speed of economic recovery after the initial economic crash. The technology industry, in particular, warned of delays from underestimates of semiconductor demand for vehicles and other products. According to WHO Secretary-General Tedros Ghebreyesus, demand for personal protective equipment (PPE) rose one hundredfold, pushing prices up twentyfold. PPE stocks were exhausted everywhere. In September 2021, the World Bank reported that food prices remained generally stable and the supply outlook remained positive. However, the poorest countries witnessed a sharp increase in food prices, reaching the highest level since the pandemic began. The Agricultural Commodity Price Index stabilized in the third quarter but remained 17% higher than in January 2021. By contrast, petroleum products were in surplus at the beginning of the pandemic, as demand for gasoline and other products collapsed due to reduced commuting and other trips. The 2021 global energy crisis was driven by a global surge in demand as the world economy recovered. Energy demand was particularly strong in Asia. The performing arts and cultural heritage sectors were profoundly affected by the pandemic. Both organisations' and individuals' operations have been impacted globally. By March 2020, across the world and to varying degrees, museums, libraries, performance venues, and other cultural institutions had been indefinitely closed with their exhibitions, events and performances cancelled or postponed. A 2021 UNESCO report estimated ten million job losses worldwide in the culture and creative industries. Some services continued through digital platforms, such as live streaming concerts or web-based arts festivals. The pandemic affected political systems, causing suspensions of legislative activities, isolations or deaths of politicians, and rescheduled elections. Although they developed broad support among epidemiologists, NPIs (non-pharmaceutical interventions) were controversial in many countries. Intellectual opposition came primarily from other fields, along with heterodox epidemiologists. The pandemic (and the response of Brazilian politicians to it) led to widespread panic, confusion, and pessimism in Brazil. When questioned regarding record deaths in the country in April 2020, Brazilian President Jair Bolsonaro said "So what? I'm sorry. What do you want me to do about it?" Bolsonaro disregarded WHO-recommended mitigation techniques and instead downplayed the risks of the virus , promoted increased economic activity, spread misinformation about the efficacy of masks, vaccines and public health measures, and distributed unproven treatments including hydroxychloroquine and ivermectin . A series of federal health ministers resigned or were dismissed after they refused to implement Bolsonaro's policies. Disagreements between federal and state governments led to a chaotic and delayed response to the rapid spread of the virus, exacerbated by preexisting social and economic disparities in the country. Employment, investment and valuation of the Brazilian real plummeted to record lows. Brazil was also heavily affected by the Delta and Omicron variants. At the height of the outbreak in the spring of 2021, 3,000+ Brazilians were dying per day. Bolsonaro's loss to Lula da Silva in the 2022 presidential election is widely credited to the former's mishandling of the pandemic . Multiple provincial-level administrators of the Chinese Communist Party (CCP) were dismissed over their handling of quarantine measures. Some commentators claimed this move was intended to protect CCP General Secretary Xi Jinping . The US intelligence community claimed that China intentionally under-reported its COVID-19 caseload. The Chinese government maintained that it acted swiftly and transparently. Journalists and activists in China who reported on the pandemic were detained by authorities, including Zhang Zhan , who was arrested and tortured. In early March 2020, the Italian government criticised the EU's lack of solidarity with Italy. On 22 March 2020, after a phone call with Italian Prime Minister Giuseppe Conte , Russian President Vladimir Putin ordered the Russian army to send military medics, disinfection vehicles, and other medical equipment to Italy. In early April, Norway and EU states like Romania and Austria started to offer help by sending medical personnel and disinfectant, and European Commission President Ursula von der Leyen offered an official apology to the country . Beginning in mid-April 2020, protestors objected to government-imposed business closures and restrictions on personal movement and assembly. Simultaneously, essential workers protested unsafe conditions and low wages by participating in a brief general strike . Some political analysts claimed that the pandemic contributed to President Donald Trump 's 2020 defeat. The COVID-19 pandemic in the United States prompted calls for the United States to adopt social policies common in other wealthy countries, including universal health care , universal child care , paid sick leave , and higher levels of funding for public health. The Kaiser Family Foundation estimated that preventable hospitalizations of unvaccinated Americans in the second half of 2021 cost US$13.8 billion. There were also protest in regards to vaccine mandates in the United States. In January 2022, the US Supreme Court struck down an OSHA rule that mandated vaccination or a testing regimen for all companies with greater than 100 employees. The number of journalists imprisoned or detained increased worldwide; some detentions were related to the pandemic. The planned NATO " Defender 2020 " military exercise in Germany, Poland and the Baltic states , the largest NATO war exercise since the end of the Cold War , was held on a reduced scale. The Iranian government was heavily affected by the virus, which infected some two dozen parliament members and political figures. Iran President Hassan Rouhani wrote a public letter to world leaders asking for help on 14 March 2020, due to a lack of access to international markets. Saudi Arabia, which had launched a military intervention in Yemen in March 2015, declared a ceasefire. Diplomatic relations between Japan and South Korea worsened. South Korea criticised Japan's "ambiguous and passive quarantine efforts" after Japan announced travellers from South Korea must quarantine for two weeks. South Korean society was initially polarised on President Moon Jae-in 's response to the crisis; many Koreans signed petitions calling for Moon's impeachment or praising his response. Some countries passed emergency legislation. Some commentators expressed concern that it could allow governments to strengthen their grip on power. In Hungary, the parliament voted to allow Prime Minister Viktor Orbán to rule by decree indefinitely, suspend parliament and elections, and punish those deemed to have spread false information. In countries such as Egypt , Turkey , and Thailand , opposition activists and government critics were arrested for allegedly spreading fake news . In India, journalists criticising the government's response were arrested or issued warnings by police and authorities. The pandemic disrupted food systems worldwide, hitting at a time when hunger and undernourishment were rising- an estimated 690 million people lacked food security in 2019. Food access fell – driven by falling incomes, lost remittances, and disruptions to food production. In some cases, food prices rose. The pandemic and its accompanying lockdowns and travel restrictions slowed movement of food aid. According to the WHO, 811 million people were undernourished in 2020, "likely related to the fallout of COVID-19". The pandemic impacted educational systems in many countries. Many governments temporarily closed educational institutions, often replaced by online education . Other countries, such as Sweden, kept their schools open. As of September 2020, approximately 1.077 billion learners were affected due to school closures. School closures impacted students, teachers, and families with far-reaching economic and societal consequences. They shed light on social and economic issues, including student debt , digital learning , food insecurity, and homelessness , as well as access to childcare , health care, housing, internet, and disability services . The impact was more severe for disadvantaged children. The Higher Education Policy Institute reported that around 63% of students claimed worsened mental health as a result of the pandemic. The pandemic impacted global health for many conditions. Hospital visits fell. Visits for heart attack symptoms declined by 38% in the US and 40% in Spain. The head of cardiology at the University of Arizona said, "My worry is some of these people are dying at home because they're too scared to go to the hospital." People with strokes and appendicitis were less likely to seek treatment. Medical supply shortages impacted many people. The pandemic impacted mental health , increasing anxiety , depression, and post-traumatic stress disorder , affecting healthcare workers, patients and quarantined individuals. In late 2022, during the first northern hemisphere autumn and winter seasons following the widespread relaxation of global public health measures, North America and Europe experienced a surge in respiratory viruses and coinfections in both adults and children. This formed the beginnings of the 2022–2023 pediatric care crisis and what some experts have termed a " tripledemic " of seasonal influenza, Respiratory Syncytial Virus (RSV) , and SARS-CoV-2 throughout North America. In the United Kingdom, pediatric infections also began to spike beyond pre-pandemic levels, albeit with different illnesses, such as Group A streptococcal infection and resultant scarlet fever . As of mid-December 2022, 19 children in the UK had died due to Strep A and the wave of infections had begun to spread into North America and Mainland Europe. The B/Yamagata lineage of influenza B might have become extinct in 2020/2021 due to COVID-19 pandemic measures. There have been no naturally occurring cases confirmed since March 2020. In 2023, the World Health Organization concluded that protection against the Yamagata lineage was no longer necessary in the seasonal flu vaccine , reducing the number of lineages targeted by the vaccine from four to three. The pandemic and the reaction to it positively affected the environment and climate as a result of reduced human activity. During the " anthropause ", fossil fuel use decreased, resource consumption declined, and waste disposal improved, generating less pollution. Planned air travel and vehicle transportation declined. In China, lockdowns and other measures resulted in a 26% decrease in coal consumption, and a 50% reduction in nitrogen oxides emissions. In 2020, a worldwide study on mammalian wildlife responses to human presence during COVID lockdowns found complex patterns of animal behavior. Carnivores were generally less active when humans were around, while herbivores in developed areas were more active. Among other findings, this suggested that herbivores may view humans as a shield against predators, highlighting the importance of location and human presence history in understanding wildlife responses to changes in human activity in a given area. A wide variety of largely mammalian species, both captive and wild, have been shown to be susceptible to SARS-CoV-2, with some encountering a particularly high degree of fatal outcomes. In particular, both farmed and wild mink have developed highly symptomatic and severe COVID-19 infections, with a mortality rate as high as 35–55% according to one study. White-tailed deer , on the other hand, have largely avoided severe outcomes but have effectively become natural reservoirs of the virus, with large numbers of free-ranging deer infected throughout the US and Canada, including approximately 80% of Iowa 's wild deer herd. An August 2023 study appeared to confirm the status of white-tailed deer as a disease reservoir, noting that the viral evolution of SARS-CoV-2 in deer occurs at triple the rate of its evolution in humans and that infection rates remained high, even in areas rarely frequented by humans. Heightened prejudice, xenophobia , and racism toward people of Chinese and East Asian descent were documented around the world. Reports from February 2020, when most confirmed cases were confined to China, cited racist sentiments about Chinese people 'deserving' the virus. Individuals of Asian descent in Europe and North America reported increasing instances of racially-motivated abuse and assaults as a result of the pandemic. US President Donald Trump was criticised for referring to SARS-CoV-2 as the "Chinese Virus" and "Kung Flu", terms which were condemned as being racist and xenophobic. Age-based discrimination against older adults increased during the pandemic. This was attributed to their perceived vulnerability and subsequent physical and social isolation measures, which, coupled with their reduced social activity, increased dependency on others. Similarly, limited digital literacy left the elderly more vulnerable to isolation, depression, and loneliness. In a correspondence published in The Lancet in 2021, German epidemiologist Günter Kampf described the harmful effects of "inappropriate stigmatisation of unvaccinated people, who include our patients, colleagues, and other fellow citizens", noting the evidence that vaccinated individuals play a large role in transmission. American bioethicist Arthur Caplan responded to Kampf, writing "Criticising [the unvaccinated] who... wind up in hospitals and morgues in huge numbers, put stress on finite resources, and prolong the pandemic... is not stigmatising, it is deserved moral condemnation." In January 2022, Amnesty International urged Italy to change their anti-COVID-19 restrictions to avoid discrimination against unvaccinated people, saying that "the government must continue to ensure that the entire population can enjoy its fundamental rights." The restrictions included mandatory vaccination over the age of 50, and mandatory vaccination to use public transport. The pandemic triggered massive changes in behaviour, from increased Internet commerce to cultural changes in the workplace. Online retailers in the US posted $791.70 billion in sales in 2020, an increase of 32.4% from $598.02 billion the year before. Home delivery orders increased, while indoor restaurant dining shut down due to lockdown orders or low sales. Hackers, cybercriminals and scammers took advantage of the changes to launch new online attacks. Education in some countries temporarily shifted from physical attendance to video conferencing. Massive layoffs shrank the airline, travel, hospitality, and other industries. Despite most corporations implementing measures to address COVID-19 in the workplace, a poll from Catalyst found that as many as 68% of employees around the world felt that these policies were only performative and "not genuine". The pandemic led to a surge in remote work . According to a Gallup poll , only 4% of US employees were fully remote before the pandemic, compared to 43% in May 2020. Among white collar workers, that shift was more pronounced, with 6% increasing to 65% in the same period. That trend continued in later stages of the pandemic, with many workers choosing to remain remote even after workplaces reopened. Many Nordic, European, and Asian companies increased their recruitment of international remote workers even as the pandemic waned, partially to save on labor costs. This also led to a talent drain in the global south and in remote areas in the global north. High cost of living and dense urban areas also lost office real estate value due to remote worker exodus. By May 2023, due to increasing layoffs and concerns over productivity, some white collar workplaces in the US had resorted to performance review penalties and indirect incentives (e.g. donations to charity) to encourage workers to return to the office. A 2021 study noted that the COVID-19 pandemic had increased interest in epidemics and infectious diseases among both historians and the general public. Prior to the pandemic, these topics were usually overlooked by "general" history and only received attention in the history of medicine . Many comparisons were made between the COVID-19 and 1918 influenza pandemics , including the development of anti-mask movements, the widespread promotion of misinformation and the impact of socioeconomic disparities . In some areas, religious groups exacerbated the spread of the virus, through large gatherings and the dissemination of misinformation. Some religious leaders decried what they saw as violations of religious freedom. In other cases, religious identity was a beneficial factor for health, increasing compliance with public health measures and protecting against the negative effects of isolation on mental wellbeing. The pandemic and responses to it damaged the global economy. On 27 February 2020, worries about the outbreak crushed US stock indexes, which posted their sharpest falls since 2008. Tourism collapsed due to travel restrictions, closing of public places including travel attractions, and advice of governments against travel. Airlines cancelled flights, while British regional airline Flybe collapsed. The cruise line industry was hard hit, and train stations and ferry ports closed. International mail stopped or was delayed. The retail sector faced reductions in store hours or closures. Retailers in Europe and Latin America faced traffic declines of 40 percent. North America and Middle East retailers saw a 50–60 percent drop. Shopping centres faced a 33–43 percent drop in foot traffic in March compared to February. Mall operators around the world coped by increasing sanitation, installing thermal scanners to check the temperature of shoppers, and cancelling events. Hundreds of millions of jobs were lost, including more than 40 million jobs in the US. According to a report by Yelp , about 60% of US businesses that closed will stay shut permanently. The International Labour Organization (ILO) reported that the income generated in the first nine months of 2020 from work across the world dropped by 10.7 percent, or $3.5 trillion. Pandemic fears led to panic buying , emptying groceries of essentials such as food, toilet paper, and bottled water. Panic buying stemmed from perceived threat, perceived scarcity, fear of the unknown, coping behaviour and social psychological factors (e.g. social influence and trust). Supply shortages were due to disruption to factory and logistic operations; shortages were worsened by supply chain disruptions from factory and port shutdowns, and labour shortages. Shortages continued as managers underestimated the speed of economic recovery after the initial economic crash. The technology industry, in particular, warned of delays from underestimates of semiconductor demand for vehicles and other products. According to WHO Secretary-General Tedros Ghebreyesus, demand for personal protective equipment (PPE) rose one hundredfold, pushing prices up twentyfold. PPE stocks were exhausted everywhere. In September 2021, the World Bank reported that food prices remained generally stable and the supply outlook remained positive. However, the poorest countries witnessed a sharp increase in food prices, reaching the highest level since the pandemic began. The Agricultural Commodity Price Index stabilized in the third quarter but remained 17% higher than in January 2021. By contrast, petroleum products were in surplus at the beginning of the pandemic, as demand for gasoline and other products collapsed due to reduced commuting and other trips. The 2021 global energy crisis was driven by a global surge in demand as the world economy recovered. Energy demand was particularly strong in Asia. Pandemic fears led to panic buying , emptying groceries of essentials such as food, toilet paper, and bottled water. Panic buying stemmed from perceived threat, perceived scarcity, fear of the unknown, coping behaviour and social psychological factors (e.g. social influence and trust). Supply shortages were due to disruption to factory and logistic operations; shortages were worsened by supply chain disruptions from factory and port shutdowns, and labour shortages. Shortages continued as managers underestimated the speed of economic recovery after the initial economic crash. The technology industry, in particular, warned of delays from underestimates of semiconductor demand for vehicles and other products. According to WHO Secretary-General Tedros Ghebreyesus, demand for personal protective equipment (PPE) rose one hundredfold, pushing prices up twentyfold. PPE stocks were exhausted everywhere. In September 2021, the World Bank reported that food prices remained generally stable and the supply outlook remained positive. However, the poorest countries witnessed a sharp increase in food prices, reaching the highest level since the pandemic began. The Agricultural Commodity Price Index stabilized in the third quarter but remained 17% higher than in January 2021. By contrast, petroleum products were in surplus at the beginning of the pandemic, as demand for gasoline and other products collapsed due to reduced commuting and other trips. The 2021 global energy crisis was driven by a global surge in demand as the world economy recovered. Energy demand was particularly strong in Asia. The performing arts and cultural heritage sectors were profoundly affected by the pandemic. Both organisations' and individuals' operations have been impacted globally. By March 2020, across the world and to varying degrees, museums, libraries, performance venues, and other cultural institutions had been indefinitely closed with their exhibitions, events and performances cancelled or postponed. A 2021 UNESCO report estimated ten million job losses worldwide in the culture and creative industries. Some services continued through digital platforms, such as live streaming concerts or web-based arts festivals. The pandemic affected political systems, causing suspensions of legislative activities, isolations or deaths of politicians, and rescheduled elections. Although they developed broad support among epidemiologists, NPIs (non-pharmaceutical interventions) were controversial in many countries. Intellectual opposition came primarily from other fields, along with heterodox epidemiologists. The pandemic (and the response of Brazilian politicians to it) led to widespread panic, confusion, and pessimism in Brazil. When questioned regarding record deaths in the country in April 2020, Brazilian President Jair Bolsonaro said "So what? I'm sorry. What do you want me to do about it?" Bolsonaro disregarded WHO-recommended mitigation techniques and instead downplayed the risks of the virus , promoted increased economic activity, spread misinformation about the efficacy of masks, vaccines and public health measures, and distributed unproven treatments including hydroxychloroquine and ivermectin . A series of federal health ministers resigned or were dismissed after they refused to implement Bolsonaro's policies. Disagreements between federal and state governments led to a chaotic and delayed response to the rapid spread of the virus, exacerbated by preexisting social and economic disparities in the country. Employment, investment and valuation of the Brazilian real plummeted to record lows. Brazil was also heavily affected by the Delta and Omicron variants. At the height of the outbreak in the spring of 2021, 3,000+ Brazilians were dying per day. Bolsonaro's loss to Lula da Silva in the 2022 presidential election is widely credited to the former's mishandling of the pandemic . Multiple provincial-level administrators of the Chinese Communist Party (CCP) were dismissed over their handling of quarantine measures. Some commentators claimed this move was intended to protect CCP General Secretary Xi Jinping . The US intelligence community claimed that China intentionally under-reported its COVID-19 caseload. The Chinese government maintained that it acted swiftly and transparently. Journalists and activists in China who reported on the pandemic were detained by authorities, including Zhang Zhan , who was arrested and tortured. In early March 2020, the Italian government criticised the EU's lack of solidarity with Italy. On 22 March 2020, after a phone call with Italian Prime Minister Giuseppe Conte , Russian President Vladimir Putin ordered the Russian army to send military medics, disinfection vehicles, and other medical equipment to Italy. In early April, Norway and EU states like Romania and Austria started to offer help by sending medical personnel and disinfectant, and European Commission President Ursula von der Leyen offered an official apology to the country . Beginning in mid-April 2020, protestors objected to government-imposed business closures and restrictions on personal movement and assembly. Simultaneously, essential workers protested unsafe conditions and low wages by participating in a brief general strike . Some political analysts claimed that the pandemic contributed to President Donald Trump 's 2020 defeat. The COVID-19 pandemic in the United States prompted calls for the United States to adopt social policies common in other wealthy countries, including universal health care , universal child care , paid sick leave , and higher levels of funding for public health. The Kaiser Family Foundation estimated that preventable hospitalizations of unvaccinated Americans in the second half of 2021 cost US$13.8 billion. There were also protest in regards to vaccine mandates in the United States. In January 2022, the US Supreme Court struck down an OSHA rule that mandated vaccination or a testing regimen for all companies with greater than 100 employees. The number of journalists imprisoned or detained increased worldwide; some detentions were related to the pandemic. The planned NATO " Defender 2020 " military exercise in Germany, Poland and the Baltic states , the largest NATO war exercise since the end of the Cold War , was held on a reduced scale. The Iranian government was heavily affected by the virus, which infected some two dozen parliament members and political figures. Iran President Hassan Rouhani wrote a public letter to world leaders asking for help on 14 March 2020, due to a lack of access to international markets. Saudi Arabia, which had launched a military intervention in Yemen in March 2015, declared a ceasefire. Diplomatic relations between Japan and South Korea worsened. South Korea criticised Japan's "ambiguous and passive quarantine efforts" after Japan announced travellers from South Korea must quarantine for two weeks. South Korean society was initially polarised on President Moon Jae-in 's response to the crisis; many Koreans signed petitions calling for Moon's impeachment or praising his response. Some countries passed emergency legislation. Some commentators expressed concern that it could allow governments to strengthen their grip on power. In Hungary, the parliament voted to allow Prime Minister Viktor Orbán to rule by decree indefinitely, suspend parliament and elections, and punish those deemed to have spread false information. In countries such as Egypt , Turkey , and Thailand , opposition activists and government critics were arrested for allegedly spreading fake news . In India, journalists criticising the government's response were arrested or issued warnings by police and authorities. The pandemic (and the response of Brazilian politicians to it) led to widespread panic, confusion, and pessimism in Brazil. When questioned regarding record deaths in the country in April 2020, Brazilian President Jair Bolsonaro said "So what? I'm sorry. What do you want me to do about it?" Bolsonaro disregarded WHO-recommended mitigation techniques and instead downplayed the risks of the virus , promoted increased economic activity, spread misinformation about the efficacy of masks, vaccines and public health measures, and distributed unproven treatments including hydroxychloroquine and ivermectin . A series of federal health ministers resigned or were dismissed after they refused to implement Bolsonaro's policies. Disagreements between federal and state governments led to a chaotic and delayed response to the rapid spread of the virus, exacerbated by preexisting social and economic disparities in the country. Employment, investment and valuation of the Brazilian real plummeted to record lows. Brazil was also heavily affected by the Delta and Omicron variants. At the height of the outbreak in the spring of 2021, 3,000+ Brazilians were dying per day. Bolsonaro's loss to Lula da Silva in the 2022 presidential election is widely credited to the former's mishandling of the pandemic . Multiple provincial-level administrators of the Chinese Communist Party (CCP) were dismissed over their handling of quarantine measures. Some commentators claimed this move was intended to protect CCP General Secretary Xi Jinping . The US intelligence community claimed that China intentionally under-reported its COVID-19 caseload. The Chinese government maintained that it acted swiftly and transparently. Journalists and activists in China who reported on the pandemic were detained by authorities, including Zhang Zhan , who was arrested and tortured. In early March 2020, the Italian government criticised the EU's lack of solidarity with Italy. On 22 March 2020, after a phone call with Italian Prime Minister Giuseppe Conte , Russian President Vladimir Putin ordered the Russian army to send military medics, disinfection vehicles, and other medical equipment to Italy. In early April, Norway and EU states like Romania and Austria started to offer help by sending medical personnel and disinfectant, and European Commission President Ursula von der Leyen offered an official apology to the country . Beginning in mid-April 2020, protestors objected to government-imposed business closures and restrictions on personal movement and assembly. Simultaneously, essential workers protested unsafe conditions and low wages by participating in a brief general strike . Some political analysts claimed that the pandemic contributed to President Donald Trump 's 2020 defeat. The COVID-19 pandemic in the United States prompted calls for the United States to adopt social policies common in other wealthy countries, including universal health care , universal child care , paid sick leave , and higher levels of funding for public health. The Kaiser Family Foundation estimated that preventable hospitalizations of unvaccinated Americans in the second half of 2021 cost US$13.8 billion. There were also protest in regards to vaccine mandates in the United States. In January 2022, the US Supreme Court struck down an OSHA rule that mandated vaccination or a testing regimen for all companies with greater than 100 employees. The number of journalists imprisoned or detained increased worldwide; some detentions were related to the pandemic. The planned NATO " Defender 2020 " military exercise in Germany, Poland and the Baltic states , the largest NATO war exercise since the end of the Cold War , was held on a reduced scale. The Iranian government was heavily affected by the virus, which infected some two dozen parliament members and political figures. Iran President Hassan Rouhani wrote a public letter to world leaders asking for help on 14 March 2020, due to a lack of access to international markets. Saudi Arabia, which had launched a military intervention in Yemen in March 2015, declared a ceasefire. Diplomatic relations between Japan and South Korea worsened. South Korea criticised Japan's "ambiguous and passive quarantine efforts" after Japan announced travellers from South Korea must quarantine for two weeks. South Korean society was initially polarised on President Moon Jae-in 's response to the crisis; many Koreans signed petitions calling for Moon's impeachment or praising his response. Some countries passed emergency legislation. Some commentators expressed concern that it could allow governments to strengthen their grip on power. In Hungary, the parliament voted to allow Prime Minister Viktor Orbán to rule by decree indefinitely, suspend parliament and elections, and punish those deemed to have spread false information. In countries such as Egypt , Turkey , and Thailand , opposition activists and government critics were arrested for allegedly spreading fake news . In India, journalists criticising the government's response were arrested or issued warnings by police and authorities. The pandemic disrupted food systems worldwide, hitting at a time when hunger and undernourishment were rising- an estimated 690 million people lacked food security in 2019. Food access fell – driven by falling incomes, lost remittances, and disruptions to food production. In some cases, food prices rose. The pandemic and its accompanying lockdowns and travel restrictions slowed movement of food aid. According to the WHO, 811 million people were undernourished in 2020, "likely related to the fallout of COVID-19". The pandemic impacted educational systems in many countries. Many governments temporarily closed educational institutions, often replaced by online education . Other countries, such as Sweden, kept their schools open. As of September 2020, approximately 1.077 billion learners were affected due to school closures. School closures impacted students, teachers, and families with far-reaching economic and societal consequences. They shed light on social and economic issues, including student debt , digital learning , food insecurity, and homelessness , as well as access to childcare , health care, housing, internet, and disability services . The impact was more severe for disadvantaged children. The Higher Education Policy Institute reported that around 63% of students claimed worsened mental health as a result of the pandemic. The pandemic impacted global health for many conditions. Hospital visits fell. Visits for heart attack symptoms declined by 38% in the US and 40% in Spain. The head of cardiology at the University of Arizona said, "My worry is some of these people are dying at home because they're too scared to go to the hospital." People with strokes and appendicitis were less likely to seek treatment. Medical supply shortages impacted many people. The pandemic impacted mental health , increasing anxiety , depression, and post-traumatic stress disorder , affecting healthcare workers, patients and quarantined individuals. In late 2022, during the first northern hemisphere autumn and winter seasons following the widespread relaxation of global public health measures, North America and Europe experienced a surge in respiratory viruses and coinfections in both adults and children. This formed the beginnings of the 2022–2023 pediatric care crisis and what some experts have termed a " tripledemic " of seasonal influenza, Respiratory Syncytial Virus (RSV) , and SARS-CoV-2 throughout North America. In the United Kingdom, pediatric infections also began to spike beyond pre-pandemic levels, albeit with different illnesses, such as Group A streptococcal infection and resultant scarlet fever . As of mid-December 2022, 19 children in the UK had died due to Strep A and the wave of infections had begun to spread into North America and Mainland Europe. The B/Yamagata lineage of influenza B might have become extinct in 2020/2021 due to COVID-19 pandemic measures. There have been no naturally occurring cases confirmed since March 2020. In 2023, the World Health Organization concluded that protection against the Yamagata lineage was no longer necessary in the seasonal flu vaccine , reducing the number of lineages targeted by the vaccine from four to three. The pandemic and the reaction to it positively affected the environment and climate as a result of reduced human activity. During the " anthropause ", fossil fuel use decreased, resource consumption declined, and waste disposal improved, generating less pollution. Planned air travel and vehicle transportation declined. In China, lockdowns and other measures resulted in a 26% decrease in coal consumption, and a 50% reduction in nitrogen oxides emissions. In 2020, a worldwide study on mammalian wildlife responses to human presence during COVID lockdowns found complex patterns of animal behavior. Carnivores were generally less active when humans were around, while herbivores in developed areas were more active. Among other findings, this suggested that herbivores may view humans as a shield against predators, highlighting the importance of location and human presence history in understanding wildlife responses to changes in human activity in a given area. A wide variety of largely mammalian species, both captive and wild, have been shown to be susceptible to SARS-CoV-2, with some encountering a particularly high degree of fatal outcomes. In particular, both farmed and wild mink have developed highly symptomatic and severe COVID-19 infections, with a mortality rate as high as 35–55% according to one study. White-tailed deer , on the other hand, have largely avoided severe outcomes but have effectively become natural reservoirs of the virus, with large numbers of free-ranging deer infected throughout the US and Canada, including approximately 80% of Iowa 's wild deer herd. An August 2023 study appeared to confirm the status of white-tailed deer as a disease reservoir, noting that the viral evolution of SARS-CoV-2 in deer occurs at triple the rate of its evolution in humans and that infection rates remained high, even in areas rarely frequented by humans. Heightened prejudice, xenophobia , and racism toward people of Chinese and East Asian descent were documented around the world. Reports from February 2020, when most confirmed cases were confined to China, cited racist sentiments about Chinese people 'deserving' the virus. Individuals of Asian descent in Europe and North America reported increasing instances of racially-motivated abuse and assaults as a result of the pandemic. US President Donald Trump was criticised for referring to SARS-CoV-2 as the "Chinese Virus" and "Kung Flu", terms which were condemned as being racist and xenophobic. Age-based discrimination against older adults increased during the pandemic. This was attributed to their perceived vulnerability and subsequent physical and social isolation measures, which, coupled with their reduced social activity, increased dependency on others. Similarly, limited digital literacy left the elderly more vulnerable to isolation, depression, and loneliness. In a correspondence published in The Lancet in 2021, German epidemiologist Günter Kampf described the harmful effects of "inappropriate stigmatisation of unvaccinated people, who include our patients, colleagues, and other fellow citizens", noting the evidence that vaccinated individuals play a large role in transmission. American bioethicist Arthur Caplan responded to Kampf, writing "Criticising [the unvaccinated] who... wind up in hospitals and morgues in huge numbers, put stress on finite resources, and prolong the pandemic... is not stigmatising, it is deserved moral condemnation." In January 2022, Amnesty International urged Italy to change their anti-COVID-19 restrictions to avoid discrimination against unvaccinated people, saying that "the government must continue to ensure that the entire population can enjoy its fundamental rights." The restrictions included mandatory vaccination over the age of 50, and mandatory vaccination to use public transport. The pandemic triggered massive changes in behaviour, from increased Internet commerce to cultural changes in the workplace. Online retailers in the US posted $791.70 billion in sales in 2020, an increase of 32.4% from $598.02 billion the year before. Home delivery orders increased, while indoor restaurant dining shut down due to lockdown orders or low sales. Hackers, cybercriminals and scammers took advantage of the changes to launch new online attacks. Education in some countries temporarily shifted from physical attendance to video conferencing. Massive layoffs shrank the airline, travel, hospitality, and other industries. Despite most corporations implementing measures to address COVID-19 in the workplace, a poll from Catalyst found that as many as 68% of employees around the world felt that these policies were only performative and "not genuine". The pandemic led to a surge in remote work . According to a Gallup poll , only 4% of US employees were fully remote before the pandemic, compared to 43% in May 2020. Among white collar workers, that shift was more pronounced, with 6% increasing to 65% in the same period. That trend continued in later stages of the pandemic, with many workers choosing to remain remote even after workplaces reopened. Many Nordic, European, and Asian companies increased their recruitment of international remote workers even as the pandemic waned, partially to save on labor costs. This also led to a talent drain in the global south and in remote areas in the global north. High cost of living and dense urban areas also lost office real estate value due to remote worker exodus. By May 2023, due to increasing layoffs and concerns over productivity, some white collar workplaces in the US had resorted to performance review penalties and indirect incentives (e.g. donations to charity) to encourage workers to return to the office. A 2021 study noted that the COVID-19 pandemic had increased interest in epidemics and infectious diseases among both historians and the general public. Prior to the pandemic, these topics were usually overlooked by "general" history and only received attention in the history of medicine . Many comparisons were made between the COVID-19 and 1918 influenza pandemics , including the development of anti-mask movements, the widespread promotion of misinformation and the impact of socioeconomic disparities . In some areas, religious groups exacerbated the spread of the virus, through large gatherings and the dissemination of misinformation. Some religious leaders decried what they saw as violations of religious freedom. In other cases, religious identity was a beneficial factor for health, increasing compliance with public health measures and protecting against the negative effects of isolation on mental wellbeing. Some news organizations removed their online paywalls for some or all of their pandemic-related articles and posts. Many scientific publishers provided pandemic-related journal articles to the public free of charge as part of the National Institutes of Health's COVID-19 Public Health Emergency Initiative. According to one estimate from researchers at the University of Rome, 89.5% of COVID-19-related papers were open access, compared to an average of 48.8% for the ten most deadly human diseases. The share of papers published on preprint servers prior to peer review increased dramatically. Misinformation and conspiracy theories about the pandemic have been widespread; they travel through mass media , social media and text messaging. In March 2020, WHO declared an " infodemic " of incorrect information. Cognitive biases , such as confirmation bias , are linked to conspiracy beliefs, including COVID-19 vaccine hesitancy . Misinformation and conspiracy theories about the pandemic have been widespread; they travel through mass media , social media and text messaging. In March 2020, WHO declared an " infodemic " of incorrect information. Cognitive biases , such as confirmation bias , are linked to conspiracy beliefs, including COVID-19 vaccine hesitancy . The COVID-19 pandemic had a major impact on popular culture. It was included in the narratives of ongoing pre-pandemic television series and become a central narrative in new ones, with mixed results. Writing for The New York Times about the then-upcoming BBC sitcom Pandemonium on 16 December 2020, David Segal asked, "Are we ready to laugh about Covid-19? Or rather, is there anything amusing, or recognizable in a humorous way, about life during a plague, with all of its indignities and setbacks, not to mention its rituals and rules." The pandemic had driven some people to seek peaceful escapism in media, while others were drawn towards fictional pandemics (e.g. zombie apocalypses ) as an alternate form of escapism. Common themes have included contagion , isolation and loss of control . Many drew comparisons to the fictional film Contagion (2011), praising its accuracies while noting some differences, such as the lack of an orderly vaccine rollout. As people turned to music to relieve emotions evoked by the pandemic, Spotify listenership showed that classical, ambient and children's genres grew, while pop, country and dance remained relatively stable. On 5 May 2023, the WHO declared that the pandemic was no longer a public health emergency of international concern . This led several media outlets to incorrectly report that this meant the pandemic was "over". The WHO commented to Full Fact that it was unlikely to declare the pandemic over "in the near future" and mentioned cholera , which it considers to have continued to be a pandemic since 1961 . The WHO does not have an official category for pandemics or make declarations of when pandemics start or end. In June 2023, Hans Kluge , director of the WHO in Europe, commented that "While the international public health emergency may have ended, the pandemic certainly has not". The WHO in Europe launched a transition plan to manage the public health response to COVID-19 in the coming years and prepare for possible future emergencies. In June 2022, an article in Human Genomics said that the pandemic was still "raging", but that "now is the time to explore the transition from the pandemic to the endemic phase." A March 2022 review declared the transition to endemic status to be "inevitable". A June 2022 review predicted that the virus that causes COVID-19 would become the fifth endemic seasonal coronavirus, alongside four other human coronaviruses . A February 2023 review of the four common cold coronaviruses concluded that the virus would become seasonal and, like the common cold, cause less severe disease for most people. As of 2023 [ update ] the transition to endemic COVID-19 may take years or decades. In June 2022, an article in Human Genomics said that the pandemic was still "raging", but that "now is the time to explore the transition from the pandemic to the endemic phase." A March 2022 review declared the transition to endemic status to be "inevitable". A June 2022 review predicted that the virus that causes COVID-19 would become the fifth endemic seasonal coronavirus, alongside four other human coronaviruses . A February 2023 review of the four common cold coronaviruses concluded that the virus would become seasonal and, like the common cold, cause less severe disease for most people. As of 2023 [ update ] the transition to endemic COVID-19 may take years or decades. Despite strong economic rebounds following the initial lockdowns in early 2020, towards the latter phases of the pandemic, many countries began to experience long-term economic effects. Several countries saw high inflation rates which had global impacts, particularly in developing countries. Some economic impacts such as supply chain and trade operations were seen as more permanent as the pandemic exposed major weaknesses in these systems. In Australia, the pandemic caused an increase in occupational burnout in 2022. During the pandemic, a large percentage of workers in Canada came to prefer working from home, which had an impact on the traditional work model. Some corporations made efforts to force workers to return to work on-site, while some embraced the idea. There was a "travel boom" causing air travel to recover at rates faster than anticipated, and the aviation industry became profitable in 2023 for the first time since 2019, before the pandemic. However, economic issues meant some predicted that the boom would begin to slow down. Business travel on airlines was still below pre-pandemic levels and is predicted not to recover. An increase in excess deaths from underlying causes not related to COVID-19 has been largely blamed on systematic issues causing delays in health care and screening during the pandemic, which has resulted in an increase of non-COVID-19 related deaths. During the pandemic, millions of children missed out on vaccinations as countries focused efforts on combating COVID-19. Efforts were made to increase vaccination rates among children in low-income countries . These efforts were successful in increasing vaccination rates for some diseases, though the UN noted that post-pandemic measles vaccinations were still falling behind. Some of the decrease in immunization was driven by an increase in mistrust of public health officials. This was seen in both low-income and high-income countries. Several African countries saw a decline in vaccinations due to misinformation around the pandemic flowing into other areas. Immunization rates have yet to recover in the United States and the United Kingdom. Despite strong economic rebounds following the initial lockdowns in early 2020, towards the latter phases of the pandemic, many countries began to experience long-term economic effects. Several countries saw high inflation rates which had global impacts, particularly in developing countries. Some economic impacts such as supply chain and trade operations were seen as more permanent as the pandemic exposed major weaknesses in these systems. In Australia, the pandemic caused an increase in occupational burnout in 2022. During the pandemic, a large percentage of workers in Canada came to prefer working from home, which had an impact on the traditional work model. Some corporations made efforts to force workers to return to work on-site, while some embraced the idea. There was a "travel boom" causing air travel to recover at rates faster than anticipated, and the aviation industry became profitable in 2023 for the first time since 2019, before the pandemic. However, economic issues meant some predicted that the boom would begin to slow down. Business travel on airlines was still below pre-pandemic levels and is predicted not to recover. An increase in excess deaths from underlying causes not related to COVID-19 has been largely blamed on systematic issues causing delays in health care and screening during the pandemic, which has resulted in an increase of non-COVID-19 related deaths. During the pandemic, millions of children missed out on vaccinations as countries focused efforts on combating COVID-19. Efforts were made to increase vaccination rates among children in low-income countries . These efforts were successful in increasing vaccination rates for some diseases, though the UN noted that post-pandemic measles vaccinations were still falling behind. Some of the decrease in immunization was driven by an increase in mistrust of public health officials. This was seen in both low-income and high-income countries. Several African countries saw a decline in vaccinations due to misinformation around the pandemic flowing into other areas. Immunization rates have yet to recover in the United States and the United Kingdom.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/HHMI_Tangled_Bank_Studios/html

HHMI Tangled Bank Studios

HHMI Tangled Bank Studios is a film studio founded in 2012 by the Howard Hughes Medical Institute . The studio works with filmmakers to create films about science for broadcast, theatrical and digital distribution. The studio's films focus primarily on the life sciences, and are centered around four main themes: Pioneers of Science, Frontiers in Medicine, The Health of Our Planet and Countering Denialism (films that present scientific evidence on topics such as evolution and vaccination).

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Bombali_ebolavirus/html

Bombali ebolavirus

Bombali virus Bombali ebolavirus or Bombali virus (BOMV) is a species of the genus Ebolavirus , first reported on 27 July 2018. It was discovered and sequenced by a PREDICT research team from the U.S. in the Bombali area in the north of Sierra Leone , west Africa. The virus was found in the Angolan free-tailed bat and the Little free-tailed bat . In 2019, the virus was demonstrated in Angolan free-tailed bats in southeast Kenya and southeast Guinea . Bombali ebolavirus has the capacity to infect human cells , although it has not yet been shown to be pathogenic. The team reporting the virus also published its full genome sequence (NC_039345).

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Médecins_Sans_Frontières/html

Médecins Sans Frontières

Global : Geneva Operational Centres : Amsterdam (OCA) Barcelona-Athens (OCBA) Brussels (OCB) Paris (OCP) Geneva (OCG) West and Central Africa (WaCA) Amsterdam (OCA) Barcelona-Athens (OCBA) Brussels (OCB) Paris (OCP) Geneva (OCG) West and Central Africa (WaCA) Médecins Sans Frontières ( MSF ; pronounced [ medsɛ̃ sɑ̃ fʁɔ̃tjɛʁ ] ⓘ ), also known as Doctors Without Borders , is a charity that provides humanitarian medical care. It is a non-governmental organisation (NGO) of French origin known for its projects in conflict zones and in countries affected by endemic diseases . The organisation provides care for diabetes , drug-resistant infections , HIV/AIDS , hepatitis C , tropical and neglected diseases, tuberculosis , vaccines and COVID-19 . In 2019, the charity was active in 70 countries with over 35,000 personnel; mostly local doctors, nurses and other medical professionals, logistical experts, water and sanitation engineers, and administrators. Private donors provide about 90% of the organisation's funding, while corporate donations provide the rest, giving MSF an annual budget of approximately US$1.63 billion. MSF was founded in 1971, in the aftermath of the Biafran famine of the Nigerian Civil War , by a small group of French doctors and journalists who sought to expand accessibility to medical care across national boundaries and irrespective of race , religion , creed or political affiliation. MSF's principles and operational guidelines are highlighted in its Charter, the Chantilly Principles, and the later La Mancha Agreement. Governance is addressed in Section 2 of the Rules portion of this final document. MSF has an associative, rather chaotic structure [ according to whom? ] , where operational decisions are made, independently, by the six operational centres ( Amsterdam , Barcelona - Athens , Brussels , Geneva , Paris and West and Central Africa – with Headquarter office in Abidjan, Ivory Coast ). Common policies on core issues are coordinated by the International Council, in which each of the 24 sections (national offices) is represented. The International Council meets in Geneva, Switzerland, where the International Office, which coordinates international activities common to the operational centres, is based. MSF has general consultative status with the United Nations Economic and Social Council . It received the 1999 Nobel Peace Prize in recognition of its members' continued efforts to provide medical care in acute crises, as well as raising international awareness of potential humanitarian disasters. James Orbinski , who was the president of the organisation at the time, accepted the prize on behalf of MSF. Prior to this, MSF also received the 1996 Seoul Peace Prize . Christos Christou succeeded Joanne Liu as international president in June 2019. During the Nigerian Civil War of 1967 to 1970, the Nigerian military formed a blockade around the nation's newly independent south-eastern region, Biafra . At this time, France was one of the few major countries supportive of the Biafrans (the United Kingdom, the Soviet Union and the United States sided with the Nigerian government), and the conditions within the blockade were unknown to the world. A number of French doctors volunteered with the French Red Cross to work in hospitals and feeding centers in besieged Biafra. One of the co-founders of the organisation was Bernard Kouchner , who later had a career in French politics, rising to the position of Minister for Europe and Foreign Affairs , which he held 2007–2010. [ citation needed ] After entering the country, the volunteers, in addition to Biafran health workers and hospitals, were subjected to attacks by the Nigerian Armed Forces , and witnessed civilians being murdered and starved by the blockading forces. The doctors publicly criticised the Nigerian government and the Red Cross for their seemingly complicit behaviour. These doctors concluded that a new aid organisation was needed that would ignore political/religious boundaries and prioritise the welfare of survivors. Apart from Nigeria, MSF exists in several African countries including Benin, Zambia, Uganda, Kenya, South Africa, Rwanda, Sudan, Sierra Leone, and others. The Groupe d'intervention médicale et chirurgicale en urgence ("Emergency Medical and Surgical Intervention Group") was formed in 1971 by French doctors who had worked in Biafra, to provide aid and to emphasize the importance of survivors' rights. At the same time, Raymond Borel , the editor of the French medical journal TONUS , had started a group called Secours Médical Français ("French Medical Relief") in response to the 1970 Bhola cyclone , which killed at least 625,000 in East Pakistan (now Bangladesh). Borel had intended to recruit doctors to provide aid to survivors of natural disasters. On 22 December 1971, the two groups of colleagues merged to form Médecins Sans Frontières . MSF's first mission was to the Nicaraguan capital, Managua , where a 1972 earthquake had destroyed most of the city and killed between 10,000 and 30,000 people. The organisation, today known for its quick response in an emergency, arrived three days after the Red Cross had set up a relief mission. On 18 and 19 September 1974, Hurricane Fifi caused major flooding in Honduras and killed thousands of people (estimates vary), and MSF set up its first long-term medical relief mission. Between 1975 and 1979, after South Vietnam had fallen to North Vietnam , millions of Cambodians immigrated to Thailand to avoid the Khmer Rouge . In response, MSF set up its first refugee camp missions in Thailand. When Vietnam withdrew from Cambodia in 1989, MSF started long-term relief missions to help survivors of the mass killings and reconstruct the country's health care system. Although its missions to Thailand to help victims of war in Southeast Asia could arguably be seen as its first wartime mission, MSF saw its first mission to a true war zone, including exposure to hostile fire, in 1976. MSF spent nine years (1976–1984) assisting surgeries in the hospitals of various cities in Lebanon, during the Lebanese Civil War , and established a reputation for its neutrality and willingness to work under fire. Throughout the war, MSF helped both Christian and Muslim soldiers alike, helping whichever group required the most medical aid at the time. In 1984, as the situation in Lebanon deteriorated further and security for aid groups was minimised, MSF withdrew its volunteers. [ citation needed ] Jacques Bérès Philippe Bernier Raymond Borel Jean Cabrol Marcel Delcourt Xavier Emmanuelli Pascal Grellety Bosviel Gérard Illiouz Bernard Kouchner Gérard Pigeon Vladan Radoman Max Récamier Claude Malhuret was elected as the new president of Médecins Sans Frontières in 1977, and soon after debates began over the future of the organisation. In particular, the concept of témoignage ("witnessing"), which refers to speaking out about the suffering that one sees as opposed to remaining silent, was being opposed or played down by Malhuret and his supporters. Malhuret thought MSF should avoid criticism of the governments of countries in which they were working, while Kouchner believed that documenting and broadcasting the suffering in a country was the most effective way to solve a problem. In 1979, after four years of refugee movement from South Vietnam and the surrounding countries by foot and by boat , French intellectuals made an appeal in Le Monde for "A Boat for Vietnam", a project intended to provide medical aid to the refugees. Although the project did not receive support from the majority of MSF, some, including later Minister Bernard Kouchner , chartered a ship called L'Île de Lumière ("The Island of Light"), and, along with doctors, journalists and photographers, sailed to the South China Sea and provided some medical aid to the boat people. The splinter organisation that undertook this, Médecins du Monde , later developed the idea of humanitarian intervention as a duty, in particular on the part of Western nations such as France. In 2007 MSF clarified that for nearly 30 years MSF and Kouchner have had public disagreements on such issues as the right to intervene and the use of armed force for humanitarian reasons. Kouchner is in favour of the latter, whereas MSF stands up for an impartial humanitarian action, independent from all political, economic and religious powers. In 1982, Malhuret and Rony Brauman (who became the organisation's president in 1982) brought increased financial independence to MSF by introducing fundraising-by-mail to better collect donations. The 1980s also saw the establishment of the other operational sections from MSF-France (1971): MSF-Belgium (1980), MSF-Switzerland (1981), MSF-Holland (1984), and MSF-Spain (1986). MSF-Luxembourg was the first support section, created in 1986. The early 1990s saw the establishment of the majority of the support sections: MSF-Greece (1990), MSF-USA (1990), MSF-Canada (1991), MSF-Japan (1992), MSF-UK (1993), MSF-Italy (1993), MSF-Australia (1994), as well as Germany, Austria, Denmark, Sweden, Norway, and Hong Kong (MSF-UAE was formed later). Malhuret and Brauman were instrumental in professionalising MSF. In December 1979, after the Soviet army had invaded Afghanistan , field missions were immediately set up to provide medical aid to the mujahideen , and in February 1980, MSF publicly denounced the Khmer Rouge . During the 1983–1985 famine in Ethiopia , MSF set up nutrition programmes in the country in 1984, but was expelled in 1985 after denouncing the abuse of international aid and the forced resettlements. MSF's explicit attacks on the Ethiopian government led to other NGOs criticizing their abandonment of their supposed neutrality and contributed to a series of debates in France around humanitarian ethics. The group also set up equipment to produce clean drinking water for the population of San Salvador , capital of El Salvador, after 10 October 1986 earthquake that struck the city. The early 1990s saw MSF open a number of new national sections, and at the same time, set up field missions in some of the most dangerous and distressing situations it had ever encountered. [ citation needed ] In 1990, MSF first entered Liberia to help civilians and refugees affected by the Liberian Civil War . Constant fighting throughout the 1990s and the Second Liberian Civil War have kept MSF volunteers actively providing nutrition, basic health care, and mass vaccinations, and speaking out against attacks on hospitals and feeding stations, especially in Monrovia . Field missions were set up to provide relief to Kurdish refugees who had survived the al-Anfal Campaign , for which evidence of atrocities was being collected in 1991. 1991 also saw the beginning of the civil war in Somalia , during which MSF set up field missions in 1992 alongside a UN peacekeeping mission. Although the UN-aborted operations by 1993, MSF representatives continued with their relief work, running clinics and hospitals for civilians. MSF first began work in Srebrenica (in Bosnia and Herzegovina) as part of a UN convoy in 1993, one year after the Bosnian War had begun. The city had become surrounded by the Bosnian Serb Army and, containing about 60,000 Bosniaks , had become an enclave guarded by a United Nations Protection Force . MSF was the only organisation providing medical care to the surrounded civilians, and as such, did not denounce the genocide for fear of being expelled from the country (it did, however, denounce the lack of access for other organisations). MSF was forced to leave the area in 1995 when the Bosnian Serb Army captured the town. 40,000 Bosniak civilian inhabitants were deported, and approximately 7,000 were killed in mass executions. When the genocide in Rwanda began in April 1994, some delegates of MSF working in the country were incorporated into the International Committee of the Red Cross (ICRC) medical team for protection. Both groups succeeded in keeping all main hospitals in Rwanda's capital Kigali operational throughout the main period of the genocide. MSF, together with several other aid organisations, had to leave the country in 1995, although many MSF and ICRC volunteers worked together under the ICRC's rules of engagement, which held that neutrality was of the utmost importance. These events led to a debate within the organisation about the concept of balancing neutrality of humanitarian aid workers against their witnessing role. As a result of its Rwanda mission, the position of MSF with respect to neutrality moved closer to that of the ICRC, a remarkable development in the light of the origin of the organisation. The ICRC lost 56 and MSF lost almost one hundred of their respective local staff in Rwanda, and MSF-France, which had chosen to evacuate its team from the country (the local staff were forced to stay), denounced the murders and demanded that a French military intervention stop the genocide. MSF-France introduced the slogan "One cannot stop a genocide with doctors" to the media, and the controversial Opération Turquoise followed less than one month later. This intervention directly or indirectly resulted in movements of hundreds of thousands of Rwandan refugees to Zaire and Tanzania in what became known as the Great Lakes refugee crisis , and subsequent cholera epidemics, starvation and more mass killings in the large groups of civilians. MSF-France returned to the area and provided medical aid to refugees in Goma . At the time of the genocide, competition between the medical efforts of MSF, the ICRC, and other aid groups had reached an all-time high, but the conditions in Rwanda prompted a drastic change in the way humanitarian organisations approached aid missions. The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief Programmes was created by the ICRC in 1994 to provide a framework for humanitarian missions and MSF is a signatory of this code. The code advocates the provision of humanitarian aid only, and groups are urged not to serve any political or religious interest, or be used as a tool for foreign governments. MSF has since still found it necessary to condemn the actions of governments, such as in Chechnya in 1999, but has not demanded another military intervention since then. More than a thousand staffers accused the charity of white supremacy when they voiced their concerns in a 2020 petition. One staffer from Cameroon detailed her experiences with racism from the group's leaders. Many concerns involved different treatment of expatriate staff from Europe and North America, who are typically white, compared to national staff. In an interview with NPR, the president of the organisation acknowledged Doctors Without Borders was founded in racism and pledged to do better. MSF played an important role for including snakebite as a WHO Category A Neglected Tropical Disease (NTD) status in, a WHO resolution and development of global strategy to decrease burden of snakebite. MSF highlighted the scarcity of anti-venom in Africa due to stoppage of manufacturing and brought urgency to the scenario and led media advocacy efforts. During the Nigerian Civil War of 1967 to 1970, the Nigerian military formed a blockade around the nation's newly independent south-eastern region, Biafra . At this time, France was one of the few major countries supportive of the Biafrans (the United Kingdom, the Soviet Union and the United States sided with the Nigerian government), and the conditions within the blockade were unknown to the world. A number of French doctors volunteered with the French Red Cross to work in hospitals and feeding centers in besieged Biafra. One of the co-founders of the organisation was Bernard Kouchner , who later had a career in French politics, rising to the position of Minister for Europe and Foreign Affairs , which he held 2007–2010. [ citation needed ] After entering the country, the volunteers, in addition to Biafran health workers and hospitals, were subjected to attacks by the Nigerian Armed Forces , and witnessed civilians being murdered and starved by the blockading forces. The doctors publicly criticised the Nigerian government and the Red Cross for their seemingly complicit behaviour. These doctors concluded that a new aid organisation was needed that would ignore political/religious boundaries and prioritise the welfare of survivors. Apart from Nigeria, MSF exists in several African countries including Benin, Zambia, Uganda, Kenya, South Africa, Rwanda, Sudan, Sierra Leone, and others.The Groupe d'intervention médicale et chirurgicale en urgence ("Emergency Medical and Surgical Intervention Group") was formed in 1971 by French doctors who had worked in Biafra, to provide aid and to emphasize the importance of survivors' rights. At the same time, Raymond Borel , the editor of the French medical journal TONUS , had started a group called Secours Médical Français ("French Medical Relief") in response to the 1970 Bhola cyclone , which killed at least 625,000 in East Pakistan (now Bangladesh). Borel had intended to recruit doctors to provide aid to survivors of natural disasters. On 22 December 1971, the two groups of colleagues merged to form Médecins Sans Frontières . MSF's first mission was to the Nicaraguan capital, Managua , where a 1972 earthquake had destroyed most of the city and killed between 10,000 and 30,000 people. The organisation, today known for its quick response in an emergency, arrived three days after the Red Cross had set up a relief mission. On 18 and 19 September 1974, Hurricane Fifi caused major flooding in Honduras and killed thousands of people (estimates vary), and MSF set up its first long-term medical relief mission. Between 1975 and 1979, after South Vietnam had fallen to North Vietnam , millions of Cambodians immigrated to Thailand to avoid the Khmer Rouge . In response, MSF set up its first refugee camp missions in Thailand. When Vietnam withdrew from Cambodia in 1989, MSF started long-term relief missions to help survivors of the mass killings and reconstruct the country's health care system. Although its missions to Thailand to help victims of war in Southeast Asia could arguably be seen as its first wartime mission, MSF saw its first mission to a true war zone, including exposure to hostile fire, in 1976. MSF spent nine years (1976–1984) assisting surgeries in the hospitals of various cities in Lebanon, during the Lebanese Civil War , and established a reputation for its neutrality and willingness to work under fire. Throughout the war, MSF helped both Christian and Muslim soldiers alike, helping whichever group required the most medical aid at the time. In 1984, as the situation in Lebanon deteriorated further and security for aid groups was minimised, MSF withdrew its volunteers. [ citation needed ] Jacques Bérès Philippe Bernier Raymond Borel Jean Cabrol Marcel Delcourt Xavier Emmanuelli Pascal Grellety Bosviel Gérard Illiouz Bernard Kouchner Gérard Pigeon Vladan Radoman Max RécamierJacques Bérès Philippe Bernier Raymond Borel Jean Cabrol Marcel Delcourt Xavier Emmanuelli Pascal Grellety Bosviel Gérard Illiouz Bernard Kouchner Gérard Pigeon Vladan Radoman Max RécamierClaude Malhuret was elected as the new president of Médecins Sans Frontières in 1977, and soon after debates began over the future of the organisation. In particular, the concept of témoignage ("witnessing"), which refers to speaking out about the suffering that one sees as opposed to remaining silent, was being opposed or played down by Malhuret and his supporters. Malhuret thought MSF should avoid criticism of the governments of countries in which they were working, while Kouchner believed that documenting and broadcasting the suffering in a country was the most effective way to solve a problem. In 1979, after four years of refugee movement from South Vietnam and the surrounding countries by foot and by boat , French intellectuals made an appeal in Le Monde for "A Boat for Vietnam", a project intended to provide medical aid to the refugees. Although the project did not receive support from the majority of MSF, some, including later Minister Bernard Kouchner , chartered a ship called L'Île de Lumière ("The Island of Light"), and, along with doctors, journalists and photographers, sailed to the South China Sea and provided some medical aid to the boat people. The splinter organisation that undertook this, Médecins du Monde , later developed the idea of humanitarian intervention as a duty, in particular on the part of Western nations such as France. In 2007 MSF clarified that for nearly 30 years MSF and Kouchner have had public disagreements on such issues as the right to intervene and the use of armed force for humanitarian reasons. Kouchner is in favour of the latter, whereas MSF stands up for an impartial humanitarian action, independent from all political, economic and religious powers. In 1982, Malhuret and Rony Brauman (who became the organisation's president in 1982) brought increased financial independence to MSF by introducing fundraising-by-mail to better collect donations. The 1980s also saw the establishment of the other operational sections from MSF-France (1971): MSF-Belgium (1980), MSF-Switzerland (1981), MSF-Holland (1984), and MSF-Spain (1986). MSF-Luxembourg was the first support section, created in 1986. The early 1990s saw the establishment of the majority of the support sections: MSF-Greece (1990), MSF-USA (1990), MSF-Canada (1991), MSF-Japan (1992), MSF-UK (1993), MSF-Italy (1993), MSF-Australia (1994), as well as Germany, Austria, Denmark, Sweden, Norway, and Hong Kong (MSF-UAE was formed later). Malhuret and Brauman were instrumental in professionalising MSF. In December 1979, after the Soviet army had invaded Afghanistan , field missions were immediately set up to provide medical aid to the mujahideen , and in February 1980, MSF publicly denounced the Khmer Rouge . During the 1983–1985 famine in Ethiopia , MSF set up nutrition programmes in the country in 1984, but was expelled in 1985 after denouncing the abuse of international aid and the forced resettlements. MSF's explicit attacks on the Ethiopian government led to other NGOs criticizing their abandonment of their supposed neutrality and contributed to a series of debates in France around humanitarian ethics. The group also set up equipment to produce clean drinking water for the population of San Salvador , capital of El Salvador, after 10 October 1986 earthquake that struck the city. The early 1990s saw MSF open a number of new national sections, and at the same time, set up field missions in some of the most dangerous and distressing situations it had ever encountered. [ citation needed ] In 1990, MSF first entered Liberia to help civilians and refugees affected by the Liberian Civil War . Constant fighting throughout the 1990s and the Second Liberian Civil War have kept MSF volunteers actively providing nutrition, basic health care, and mass vaccinations, and speaking out against attacks on hospitals and feeding stations, especially in Monrovia . Field missions were set up to provide relief to Kurdish refugees who had survived the al-Anfal Campaign , for which evidence of atrocities was being collected in 1991. 1991 also saw the beginning of the civil war in Somalia , during which MSF set up field missions in 1992 alongside a UN peacekeeping mission. Although the UN-aborted operations by 1993, MSF representatives continued with their relief work, running clinics and hospitals for civilians. MSF first began work in Srebrenica (in Bosnia and Herzegovina) as part of a UN convoy in 1993, one year after the Bosnian War had begun. The city had become surrounded by the Bosnian Serb Army and, containing about 60,000 Bosniaks , had become an enclave guarded by a United Nations Protection Force . MSF was the only organisation providing medical care to the surrounded civilians, and as such, did not denounce the genocide for fear of being expelled from the country (it did, however, denounce the lack of access for other organisations). MSF was forced to leave the area in 1995 when the Bosnian Serb Army captured the town. 40,000 Bosniak civilian inhabitants were deported, and approximately 7,000 were killed in mass executions. When the genocide in Rwanda began in April 1994, some delegates of MSF working in the country were incorporated into the International Committee of the Red Cross (ICRC) medical team for protection. Both groups succeeded in keeping all main hospitals in Rwanda's capital Kigali operational throughout the main period of the genocide. MSF, together with several other aid organisations, had to leave the country in 1995, although many MSF and ICRC volunteers worked together under the ICRC's rules of engagement, which held that neutrality was of the utmost importance. These events led to a debate within the organisation about the concept of balancing neutrality of humanitarian aid workers against their witnessing role. As a result of its Rwanda mission, the position of MSF with respect to neutrality moved closer to that of the ICRC, a remarkable development in the light of the origin of the organisation. The ICRC lost 56 and MSF lost almost one hundred of their respective local staff in Rwanda, and MSF-France, which had chosen to evacuate its team from the country (the local staff were forced to stay), denounced the murders and demanded that a French military intervention stop the genocide. MSF-France introduced the slogan "One cannot stop a genocide with doctors" to the media, and the controversial Opération Turquoise followed less than one month later. This intervention directly or indirectly resulted in movements of hundreds of thousands of Rwandan refugees to Zaire and Tanzania in what became known as the Great Lakes refugee crisis , and subsequent cholera epidemics, starvation and more mass killings in the large groups of civilians. MSF-France returned to the area and provided medical aid to refugees in Goma . At the time of the genocide, competition between the medical efforts of MSF, the ICRC, and other aid groups had reached an all-time high, but the conditions in Rwanda prompted a drastic change in the way humanitarian organisations approached aid missions. The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief Programmes was created by the ICRC in 1994 to provide a framework for humanitarian missions and MSF is a signatory of this code. The code advocates the provision of humanitarian aid only, and groups are urged not to serve any political or religious interest, or be used as a tool for foreign governments. MSF has since still found it necessary to condemn the actions of governments, such as in Chechnya in 1999, but has not demanded another military intervention since then. When the genocide in Rwanda began in April 1994, some delegates of MSF working in the country were incorporated into the International Committee of the Red Cross (ICRC) medical team for protection. Both groups succeeded in keeping all main hospitals in Rwanda's capital Kigali operational throughout the main period of the genocide. MSF, together with several other aid organisations, had to leave the country in 1995, although many MSF and ICRC volunteers worked together under the ICRC's rules of engagement, which held that neutrality was of the utmost importance. These events led to a debate within the organisation about the concept of balancing neutrality of humanitarian aid workers against their witnessing role. As a result of its Rwanda mission, the position of MSF with respect to neutrality moved closer to that of the ICRC, a remarkable development in the light of the origin of the organisation. The ICRC lost 56 and MSF lost almost one hundred of their respective local staff in Rwanda, and MSF-France, which had chosen to evacuate its team from the country (the local staff were forced to stay), denounced the murders and demanded that a French military intervention stop the genocide. MSF-France introduced the slogan "One cannot stop a genocide with doctors" to the media, and the controversial Opération Turquoise followed less than one month later. This intervention directly or indirectly resulted in movements of hundreds of thousands of Rwandan refugees to Zaire and Tanzania in what became known as the Great Lakes refugee crisis , and subsequent cholera epidemics, starvation and more mass killings in the large groups of civilians. MSF-France returned to the area and provided medical aid to refugees in Goma . At the time of the genocide, competition between the medical efforts of MSF, the ICRC, and other aid groups had reached an all-time high, but the conditions in Rwanda prompted a drastic change in the way humanitarian organisations approached aid missions. The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief Programmes was created by the ICRC in 1994 to provide a framework for humanitarian missions and MSF is a signatory of this code. The code advocates the provision of humanitarian aid only, and groups are urged not to serve any political or religious interest, or be used as a tool for foreign governments. MSF has since still found it necessary to condemn the actions of governments, such as in Chechnya in 1999, but has not demanded another military intervention since then. More than a thousand staffers accused the charity of white supremacy when they voiced their concerns in a 2020 petition. One staffer from Cameroon detailed her experiences with racism from the group's leaders. Many concerns involved different treatment of expatriate staff from Europe and North America, who are typically white, compared to national staff. In an interview with NPR, the president of the organisation acknowledged Doctors Without Borders was founded in racism and pledged to do better. MSF played an important role for including snakebite as a WHO Category A Neglected Tropical Disease (NTD) status in, a WHO resolution and development of global strategy to decrease burden of snakebite. MSF highlighted the scarcity of anti-venom in Africa due to stoppage of manufacturing and brought urgency to the scenario and led media advocacy efforts. More than a thousand staffers accused the charity of white supremacy when they voiced their concerns in a 2020 petition. One staffer from Cameroon detailed her experiences with racism from the group's leaders. Many concerns involved different treatment of expatriate staff from Europe and North America, who are typically white, compared to national staff. In an interview with NPR, the president of the organisation acknowledged Doctors Without Borders was founded in racism and pledged to do better. MSF played an important role for including snakebite as a WHO Category A Neglected Tropical Disease (NTD) status in, a WHO resolution and development of global strategy to decrease burden of snakebite. MSF highlighted the scarcity of anti-venom in Africa due to stoppage of manufacturing and brought urgency to the scenario and led media advocacy efforts. In 1999, the organisation spoke out about the lack of humanitarian support in Kosovo and Chechnya, having set up field missions to help civilians affected by the respective political situations. Although MSF had worked in the Kosovo region since 1993, the onset of the Kosovo War prompted the movement of tens of thousands of refugees, and a decline in suitable living conditions. MSF provided shelter, water and health care to civilians affected by NATO's strategic bombing campaigns . A serious crisis within MSF erupted in connection with the organisation's work in Kosovo when the Greek section of MSF was expelled from the organisation. The Greek MSF section had gained access to Serbia at the cost of accepting Serb government imposed limits on where it could go and what it could see – terms that the rest of the MSF movement had refused. A non-MSF source alleged that the exclusion of the Greek section happened because its members extended aid to both Albanian and Serbian civilians in Pristina during NATO's bombing. The rift was healed only in 2005 with the re-admission of the Greek section to MSF. A similar situation was found in Chechnya, whose civilian population was largely forced from their homes into unhealthy conditions and subjected to the violence of the Second Chechen War . MSF has been working in Haiti since 1991, but since President Jean-Bertrand Aristide was forced from power, the country has seen a large increase in civilian attacks and rape by armed groups. In addition to providing surgical and psychological support in existing hospitals – offering the only free surgery available in Port-au-Prince – field missions have been set up to rebuild water and waste management systems and treat survivors of major flooding caused by Hurricane Jeanne ; patients with HIV/AIDS and malaria, both of which are widespread in the country, also receive better treatment and monitoring. As a result of 12 January 2010 Haiti earthquake , reports from Haiti indicated that all three of the organisation's hospitals had been severely damaged; one collapsing completely and the other two having to be abandoned. Following the quake, MSF sent about nine planes loaded with medical equipment and a field hospital to help treat the victims. However, the landings of some of the planes had to be delayed due to the massive number of humanitarian and military flights coming in. The Kashmir conflict in North India resulted in a more recent MSF intervention (the first field mission was set up in 1999) to help civilians displaced by fighting in Jammu and Kashmir , as well as in Manipur . Psychological support is a major target of missions, but teams have also set up programmes to treat tuberculosis, HIV/AIDS and malaria. Mental health support has been of significant importance for MSF in much of southern Asia since the 2004 Indian Ocean earthquake . MSF went through a long process of self-examination and discussion in 2005–2006. Many issues were debated, including the treatment of "nationals" as well as "fair employment" and self-criticism. MSF issued a statement for safe abortion following Dobbs v. Jackson Women's Health Organization . MSF has been active in a large number of African countries for decades, sometimes serving as the sole provider of health care, food, and water. Although MSF has consistently attempted to increase media coverage of the situation in Africa to increase international support, long-term field missions are still necessary. Treating and educating the public about HIV/AIDS in sub-Saharan Africa , which sees the most deaths and cases of the disease in the world, is a major task for volunteers. Of the 14.6 million people in need of anti-retroviral treatment the WHO estimated that only 5.25 million people were receiving it in developing countries, and MSF continues to urge governments and companies to increase research and development into HIV/AIDS treatments to decrease cost and increase availability. In the late 1990s, MSF missions were set up to treat tuberculosis and anaemia in residents of the Aral Sea area, and look after civilians affected by drug-resistant disease, famine, and epidemics of cholera and AIDS. They vaccinated 3 million Nigerians against meningitis during an epidemic in 1996 and denounced the Taliban's neglect of health care for women in 1997. Arguably, the most significant country in which MSF set up field missions in the late 1990s was Sierra Leone, which was involved in a civil war at the time. In 1998, volunteers began assisting in surgeries in Freetown to help with an increasing number of amputees , and collecting statistics on civilians (men, women and children) being attacked by large groups of men claiming to represent ECOMOG . The groups of men were travelling between villages and systematically chopping off one or both of each resident's arms, raping women, gunning down families, razing houses, and forcing survivors to leave the area. Long-term projects following the end of the civil war included psychological support and phantom limb pain management. Since 1979, MSF has been providing medical humanitarian assistance in Sudan , a nation plagued by starvation and the civil war , prevalent malnutrition and one of the highest maternal mortality rates in the world. In March 2009, it is reported that MSF has employed 4,590 field staff in Sudan tackling issues such as armed conflicts, epidemic diseases, health care and social exclusion. MSF's continued presence and work in Sudan is one of the organisation's largest interventions. MSF provides a range of health care services including nutritional support, reproductive healthcare, Kala-Azar treatment, counselling services and surgery to the people living in Sudan . Common diseases prevalent in Sudan include tuberculosis , kala-azar also known as visceral leishmaniasis , meningitis , measles , cholera , and malaria . Kala-azar , also known as visceral leishmaniasis , has been one of the major health problems in Sudan . After the Comprehensive Peace Agreement between North and Southern Sudan on 9 January 2005, the increase in stability within the region helped further efforts in healthcare delivery. Médicins Sans Frontières tested a combination of sodium stibogluconate and paromomycin, which would reduce treatment duration (from 30 to 17 days) and cost in 2008. In March 2010, MSF set up its first Kala-Azar treatment centre in Eastern Sudan, providing free treatment for this otherwise deadly disease. If left untreated, there is a fatality rate of 99% within 1–4 months of infection. Since the treatment centre was set up, MSF has cured more than 27,000 Kala-Azar patients with a success rate of approximately 90–95%. There are plans to open an additional Kala-Azar treatment centre in Malakal , Southern Sudan, to cope with the overwhelming number of patients that are seeking treatment. MSF has been providing necessary medical supplies to hospitals and training Sudanese health professionals to help them deal with Kala-Azar. MSF, Sudanese Ministry of Health and other national and international institutions are combining efforts to improve on the treatment and diagnosis of Kala-Azar. Research on its cures and vaccines are currently being conducted. In December 2010, South Sudan was hit with the worst outbreak of Kala-Azar in eight years. The number of patients seeking treatment increased eight-fold as compared to the year before. Sudan's latest civil war began in 1983 and ended in 2005 when a peace agreement was signed between North Sudan and South Sudan . MSF medical teams were active throughout and prior to the civil war, providing emergency medical humanitarian assistance in multiple locations. The situation of poor infrastructure in the South was aggravated by the civil war and resulted in the worsening of the region's appalling health indicators. An estimated 75 percent of people in the nascent nation has no access to basic medical care and 1 in seven women dies during childbirth. Malnutrition and disease outbreaks are perennial concerns as well. In 2011, MSF clinic in Jonglei State , South Sudan, was looted and attacked by raiders. Hundreds, including women and children were killed. Valuable items including medical equipment and drugs were lost during the raid and parts of the MSF facilities were destroyed in a fire. The incident had serious repercussions as MSF is the only primary health care provider in this part of Jonglei State. Although active in the Congo region of Africa since 1985, the First and Second Congo War brought increased violence and instability to the area. MSF has had to evacuate its teams from areas such as around Bunia , in the Ituri district due to extreme violence, but continues to work in other areas to provide food to tens of thousands of displaced civilians, as well as treat survivors of mass rapes and widespread fighting. The treatment and possible vaccination against diseases such as cholera , measles , polio , Marburg fever , sleeping sickness , HIV/AIDS , and bubonic plague is also important to prevent or slow down epidemics. MSF has been active in Uganda since 1980, and provided relief to civilians during the country's guerrilla war during the Second Obote Period . However, the formation of the Lord's Resistance Army saw the beginning of a long campaign of violence in northern Uganda and southern Sudan. Civilians were subjected to mass killings and rapes, torture, and abductions of children, who would later serve as sex slaves or child soldiers . Faced with more than 1.5 million people displaced from their homes, MSF set up relief programmes in internally displaced person (IDP) camps to provide clean water, food and sanitation. Diseases such as tuberculosis , measles, polio, cholera, ebola , and HIV/AIDS occur in epidemics in the country, and volunteers provide vaccinations (in the cases of measles and polio) and/or treatment to the residents. Mental health is also an important aspect of medical treatment for MSF teams in Uganda since most people refuse to leave the IDP camps for constant fear of being attacked. MSF first camp set up a field mission in Côte d'Ivoire in 1990, but ongoing violence and the 2002 division of the country by rebel groups and the government led to several massacres, and MSF teams have even begun to suspect that an ethnic cleansing is occurring. Mass measles vaccinations, tuberculosis treatment and the re-opening of hospitals closed by fighting are projects run by MSF, which is the only group providing aid in much of the country. MSF has strongly promoted the use of contraception in Africa. During the Ebola outbreak in West Africa in 2014, MSF met serious medical demands largely on its own, after the organisation's early warnings were largely ignored. MSF-Burundi has aided in attending to casualties suffered in the 2019 Burundi landslides . MSF is involved in Sri Lanka, where a 26-year civil war ended in 2009 and MSF has adapted its activities there to continue its mission. For example, it helps with physical therapy for patients with spinal cord injuries. It conducts counseling sessions, and has set up an "operating theatre for reconstructive orthopaedic surgery and supplied specialist surgeons, anaesthetists and nurses to operate on patients with complicated war-related injuries". MSF first provided medical help to civilians and refugees who have escaped to camps along the Thai-Cambodian border in 1979. Due to long decades of war, a proper health care system in the country was severely lacking and MSF moved inland in 1989 to help restructure basic medical facilities. In 1999, Cambodia was hit with a malaria epidemic. The situation of the epidemic was aggravated by a lack of qualified practitioners and poor quality control which led to a market of fake antimalarial drugs. Counterfeit antimalarial drugs were responsible for the deaths of at least 30 people during the epidemic. This has prompted efforts by MSF to set up and fund a malaria outreach project and utilise Village Malaria Workers. MSF also introduced a switching of first-line treatment to a combination therapy (Artesunate and Mefloquine) to combat resistance and fatality of old drugs that were used to treat the disease traditionally. Cambodia is one of the hardest hit HIV/AIDS countries in Southeast Asia. In 2001, MSF started introducing antiretroviral (ARV) therapy to AIDS patients for free. This therapy prolongs the patients' lives and is a long-term treatment. In 2002, MSF established chronic diseases clinics with the Cambodian Ministry of Health in various provinces to integrate HIV/AIDS treatment, alongside hypertension, diabetes, and arthritis which have high prevalence rate. This aims to reduce facility-related stigma as patients are able to seek treatment in a multi-purpose clinic in contrast to a HIV/AIDS specialised treatment centre. MSF also provided humanitarian aid in times of natural disaster such as a major flood in 2002 which affected up to 1.47 million people. MSF introduced a community-based tuberculosis programme in 2004 in remote villages, where village volunteers are delegated to facilitate the medication of patients. In partnership with local health authorities and other NGOs, MSF encouraged decentralized clinics and rendered localized treatments to more rural areas from 2006. Since 2007, MSF has extended general health care, counselling, HIV/AIDS and TB treatment to prisons in Phnom Penh via mobile clinics. However, poor sanitation and lack of health care still prevails in most Cambodian prisons as they remain as some of the world's most crowded prisons. In 2007, MSF worked with the Cambodian Ministry of Health to provide psychosocial and technical support in offering pediatric HIV/AIDS treatment to affected children. MSF also provided medical supplies and staff to help in one of the worst dengue outbreaks in 2007, which had more than 40,000 people hospitalized, killing 407 people, primarily children. In 2010, Southern and Eastern provinces of Cambodia were hit with a cholera epidemic and MSF responded by providing medical support that were adapted for usage in the country. Cambodia is one of 22 countries listed by WHO as having a high burden of tuberculosis. WHO estimates that 64% of all Cambodians carry the tuberculosis mycobacterium. Hence, MSF has since shifted its focus away from HIV/AIDS to tuberculosis, handing over most HIV-related programs to local health authorities. The 2011 Libyan civil war has prompted efforts by MSF to set up a hospital and mental health services to help locals affected by the conflict. The fighting created a backlog of patients that needed surgery. With parts of the country slowly returning to livable, MSF has started working with local health personnel to address the needs. The need for psychological counseling has increased and MSF has set up mental health services to address the fears and stress of people living in tents without water and electricity. Currently MSF is the only International Aid organisation with actual presence in the country. MSF is providing Maritime Search And Rescue (SAR) services on the Mediterranean Sea to save the lives of migrants attempting to cross with unseaworthy boats. The Mission started in 2015 after the EU ended its major SAR operation Mare Nostrum severely diminishing much needed SAR capacities in the Mediterranean. Throughout the mission MSF has operated its own vessels like the Bourbon Argos (2015–2016), Dignity 1 (2015–2016) and VOS Prudence (2016–2017). MSF has also provided medical teams to support other NGOs and their ships like the MOAS Phoenix (2015) or the Aquarius (2017–2018) and Ocean Viking (2019–2020) with SOS Méditerranée and Mediterranea Saving Humans . In August 2017 MSF decided to suspend the activities of the VOS Prudence protesting restrictions and threats by the Libyan "Coast Guard". In December 2018 MSF and SOS Méditerranée were forced to end operations of the Aquarius , at that date the last remaining vessel supported by MSF. This came after attacks by EU states that stripped the vessel of its registration and produced criminal accusations against MSF. Up to then 80,000 people had been rescued or assisted since the beginning of the mission. Operations resumed with Ocean Viking in July 2019, but the ship was seized in Sicily in July 2020. In May 2021, MSF returned to refugee rescue operations in the Mediterranean with a new vessel, the Geo Barents . Within a month this resulted in the rescue of some 400 people. MSF is involved in trying to help with the humanitarian crisis caused by the Yemeni Civil War . The organisation operates eleven hospitals and health centres in Yemen and provides support to another 18 hospitals or health centres. According to MSF, since October 2015, four of its hospitals and one ambulance have been destroyed by Saudi-led coalition airstrikes. In August 2016, an airstrike on Abs hospital killed 19 people, including one MSF staff member, and wounded 24. According to MSF, the GPS coordinates of the hospital were repeatedly shared with all parties to the conflict, including the Saudi-led coalition, and its location was well-known. In August and September 2022, MSF provided medical care to asylum seekers staying outside the overcrowded migration centre in Ter Apel , the Netherlands. MSF has been active in a large number of African countries for decades, sometimes serving as the sole provider of health care, food, and water. Although MSF has consistently attempted to increase media coverage of the situation in Africa to increase international support, long-term field missions are still necessary. Treating and educating the public about HIV/AIDS in sub-Saharan Africa , which sees the most deaths and cases of the disease in the world, is a major task for volunteers. Of the 14.6 million people in need of anti-retroviral treatment the WHO estimated that only 5.25 million people were receiving it in developing countries, and MSF continues to urge governments and companies to increase research and development into HIV/AIDS treatments to decrease cost and increase availability. In the late 1990s, MSF missions were set up to treat tuberculosis and anaemia in residents of the Aral Sea area, and look after civilians affected by drug-resistant disease, famine, and epidemics of cholera and AIDS. They vaccinated 3 million Nigerians against meningitis during an epidemic in 1996 and denounced the Taliban's neglect of health care for women in 1997. Arguably, the most significant country in which MSF set up field missions in the late 1990s was Sierra Leone, which was involved in a civil war at the time. In 1998, volunteers began assisting in surgeries in Freetown to help with an increasing number of amputees , and collecting statistics on civilians (men, women and children) being attacked by large groups of men claiming to represent ECOMOG . The groups of men were travelling between villages and systematically chopping off one or both of each resident's arms, raping women, gunning down families, razing houses, and forcing survivors to leave the area. Long-term projects following the end of the civil war included psychological support and phantom limb pain management. Since 1979, MSF has been providing medical humanitarian assistance in Sudan , a nation plagued by starvation and the civil war , prevalent malnutrition and one of the highest maternal mortality rates in the world. In March 2009, it is reported that MSF has employed 4,590 field staff in Sudan tackling issues such as armed conflicts, epidemic diseases, health care and social exclusion. MSF's continued presence and work in Sudan is one of the organisation's largest interventions. MSF provides a range of health care services including nutritional support, reproductive healthcare, Kala-Azar treatment, counselling services and surgery to the people living in Sudan . Common diseases prevalent in Sudan include tuberculosis , kala-azar also known as visceral leishmaniasis , meningitis , measles , cholera , and malaria . Kala-azar , also known as visceral leishmaniasis , has been one of the major health problems in Sudan . After the Comprehensive Peace Agreement between North and Southern Sudan on 9 January 2005, the increase in stability within the region helped further efforts in healthcare delivery. Médicins Sans Frontières tested a combination of sodium stibogluconate and paromomycin, which would reduce treatment duration (from 30 to 17 days) and cost in 2008. In March 2010, MSF set up its first Kala-Azar treatment centre in Eastern Sudan, providing free treatment for this otherwise deadly disease. If left untreated, there is a fatality rate of 99% within 1–4 months of infection. Since the treatment centre was set up, MSF has cured more than 27,000 Kala-Azar patients with a success rate of approximately 90–95%. There are plans to open an additional Kala-Azar treatment centre in Malakal , Southern Sudan, to cope with the overwhelming number of patients that are seeking treatment. MSF has been providing necessary medical supplies to hospitals and training Sudanese health professionals to help them deal with Kala-Azar. MSF, Sudanese Ministry of Health and other national and international institutions are combining efforts to improve on the treatment and diagnosis of Kala-Azar. Research on its cures and vaccines are currently being conducted. In December 2010, South Sudan was hit with the worst outbreak of Kala-Azar in eight years. The number of patients seeking treatment increased eight-fold as compared to the year before. Sudan's latest civil war began in 1983 and ended in 2005 when a peace agreement was signed between North Sudan and South Sudan . MSF medical teams were active throughout and prior to the civil war, providing emergency medical humanitarian assistance in multiple locations. The situation of poor infrastructure in the South was aggravated by the civil war and resulted in the worsening of the region's appalling health indicators. An estimated 75 percent of people in the nascent nation has no access to basic medical care and 1 in seven women dies during childbirth. Malnutrition and disease outbreaks are perennial concerns as well. In 2011, MSF clinic in Jonglei State , South Sudan, was looted and attacked by raiders. Hundreds, including women and children were killed. Valuable items including medical equipment and drugs were lost during the raid and parts of the MSF facilities were destroyed in a fire. The incident had serious repercussions as MSF is the only primary health care provider in this part of Jonglei State. Although active in the Congo region of Africa since 1985, the First and Second Congo War brought increased violence and instability to the area. MSF has had to evacuate its teams from areas such as around Bunia , in the Ituri district due to extreme violence, but continues to work in other areas to provide food to tens of thousands of displaced civilians, as well as treat survivors of mass rapes and widespread fighting. The treatment and possible vaccination against diseases such as cholera , measles , polio , Marburg fever , sleeping sickness , HIV/AIDS , and bubonic plague is also important to prevent or slow down epidemics. MSF has been active in Uganda since 1980, and provided relief to civilians during the country's guerrilla war during the Second Obote Period . However, the formation of the Lord's Resistance Army saw the beginning of a long campaign of violence in northern Uganda and southern Sudan. Civilians were subjected to mass killings and rapes, torture, and abductions of children, who would later serve as sex slaves or child soldiers . Faced with more than 1.5 million people displaced from their homes, MSF set up relief programmes in internally displaced person (IDP) camps to provide clean water, food and sanitation. Diseases such as tuberculosis , measles, polio, cholera, ebola , and HIV/AIDS occur in epidemics in the country, and volunteers provide vaccinations (in the cases of measles and polio) and/or treatment to the residents. Mental health is also an important aspect of medical treatment for MSF teams in Uganda since most people refuse to leave the IDP camps for constant fear of being attacked. MSF first camp set up a field mission in Côte d'Ivoire in 1990, but ongoing violence and the 2002 division of the country by rebel groups and the government led to several massacres, and MSF teams have even begun to suspect that an ethnic cleansing is occurring. Mass measles vaccinations, tuberculosis treatment and the re-opening of hospitals closed by fighting are projects run by MSF, which is the only group providing aid in much of the country. MSF has strongly promoted the use of contraception in Africa. During the Ebola outbreak in West Africa in 2014, MSF met serious medical demands largely on its own, after the organisation's early warnings were largely ignored. MSF-Burundi has aided in attending to casualties suffered in the 2019 Burundi landslides . In the late 1990s, MSF missions were set up to treat tuberculosis and anaemia in residents of the Aral Sea area, and look after civilians affected by drug-resistant disease, famine, and epidemics of cholera and AIDS. They vaccinated 3 million Nigerians against meningitis during an epidemic in 1996 and denounced the Taliban's neglect of health care for women in 1997. Arguably, the most significant country in which MSF set up field missions in the late 1990s was Sierra Leone, which was involved in a civil war at the time. In 1998, volunteers began assisting in surgeries in Freetown to help with an increasing number of amputees , and collecting statistics on civilians (men, women and children) being attacked by large groups of men claiming to represent ECOMOG . The groups of men were travelling between villages and systematically chopping off one or both of each resident's arms, raping women, gunning down families, razing houses, and forcing survivors to leave the area. Long-term projects following the end of the civil war included psychological support and phantom limb pain management. Since 1979, MSF has been providing medical humanitarian assistance in Sudan , a nation plagued by starvation and the civil war , prevalent malnutrition and one of the highest maternal mortality rates in the world. In March 2009, it is reported that MSF has employed 4,590 field staff in Sudan tackling issues such as armed conflicts, epidemic diseases, health care and social exclusion. MSF's continued presence and work in Sudan is one of the organisation's largest interventions. MSF provides a range of health care services including nutritional support, reproductive healthcare, Kala-Azar treatment, counselling services and surgery to the people living in Sudan . Common diseases prevalent in Sudan include tuberculosis , kala-azar also known as visceral leishmaniasis , meningitis , measles , cholera , and malaria . Kala-azar , also known as visceral leishmaniasis , has been one of the major health problems in Sudan . After the Comprehensive Peace Agreement between North and Southern Sudan on 9 January 2005, the increase in stability within the region helped further efforts in healthcare delivery. Médicins Sans Frontières tested a combination of sodium stibogluconate and paromomycin, which would reduce treatment duration (from 30 to 17 days) and cost in 2008. In March 2010, MSF set up its first Kala-Azar treatment centre in Eastern Sudan, providing free treatment for this otherwise deadly disease. If left untreated, there is a fatality rate of 99% within 1–4 months of infection. Since the treatment centre was set up, MSF has cured more than 27,000 Kala-Azar patients with a success rate of approximately 90–95%. There are plans to open an additional Kala-Azar treatment centre in Malakal , Southern Sudan, to cope with the overwhelming number of patients that are seeking treatment. MSF has been providing necessary medical supplies to hospitals and training Sudanese health professionals to help them deal with Kala-Azar. MSF, Sudanese Ministry of Health and other national and international institutions are combining efforts to improve on the treatment and diagnosis of Kala-Azar. Research on its cures and vaccines are currently being conducted. In December 2010, South Sudan was hit with the worst outbreak of Kala-Azar in eight years. The number of patients seeking treatment increased eight-fold as compared to the year before. Sudan's latest civil war began in 1983 and ended in 2005 when a peace agreement was signed between North Sudan and South Sudan . MSF medical teams were active throughout and prior to the civil war, providing emergency medical humanitarian assistance in multiple locations. The situation of poor infrastructure in the South was aggravated by the civil war and resulted in the worsening of the region's appalling health indicators. An estimated 75 percent of people in the nascent nation has no access to basic medical care and 1 in seven women dies during childbirth. Malnutrition and disease outbreaks are perennial concerns as well. In 2011, MSF clinic in Jonglei State , South Sudan, was looted and attacked by raiders. Hundreds, including women and children were killed. Valuable items including medical equipment and drugs were lost during the raid and parts of the MSF facilities were destroyed in a fire. The incident had serious repercussions as MSF is the only primary health care provider in this part of Jonglei State. Kala-azar , also known as visceral leishmaniasis , has been one of the major health problems in Sudan . After the Comprehensive Peace Agreement between North and Southern Sudan on 9 January 2005, the increase in stability within the region helped further efforts in healthcare delivery. Médicins Sans Frontières tested a combination of sodium stibogluconate and paromomycin, which would reduce treatment duration (from 30 to 17 days) and cost in 2008. In March 2010, MSF set up its first Kala-Azar treatment centre in Eastern Sudan, providing free treatment for this otherwise deadly disease. If left untreated, there is a fatality rate of 99% within 1–4 months of infection. Since the treatment centre was set up, MSF has cured more than 27,000 Kala-Azar patients with a success rate of approximately 90–95%. There are plans to open an additional Kala-Azar treatment centre in Malakal , Southern Sudan, to cope with the overwhelming number of patients that are seeking treatment. MSF has been providing necessary medical supplies to hospitals and training Sudanese health professionals to help them deal with Kala-Azar. MSF, Sudanese Ministry of Health and other national and international institutions are combining efforts to improve on the treatment and diagnosis of Kala-Azar. Research on its cures and vaccines are currently being conducted. In December 2010, South Sudan was hit with the worst outbreak of Kala-Azar in eight years. The number of patients seeking treatment increased eight-fold as compared to the year before. Sudan's latest civil war began in 1983 and ended in 2005 when a peace agreement was signed between North Sudan and South Sudan . MSF medical teams were active throughout and prior to the civil war, providing emergency medical humanitarian assistance in multiple locations. The situation of poor infrastructure in the South was aggravated by the civil war and resulted in the worsening of the region's appalling health indicators. An estimated 75 percent of people in the nascent nation has no access to basic medical care and 1 in seven women dies during childbirth. Malnutrition and disease outbreaks are perennial concerns as well. In 2011, MSF clinic in Jonglei State , South Sudan, was looted and attacked by raiders. Hundreds, including women and children were killed. Valuable items including medical equipment and drugs were lost during the raid and parts of the MSF facilities were destroyed in a fire. The incident had serious repercussions as MSF is the only primary health care provider in this part of Jonglei State. Although active in the Congo region of Africa since 1985, the First and Second Congo War brought increased violence and instability to the area. MSF has had to evacuate its teams from areas such as around Bunia , in the Ituri district due to extreme violence, but continues to work in other areas to provide food to tens of thousands of displaced civilians, as well as treat survivors of mass rapes and widespread fighting. The treatment and possible vaccination against diseases such as cholera , measles , polio , Marburg fever , sleeping sickness , HIV/AIDS , and bubonic plague is also important to prevent or slow down epidemics. MSF has been active in Uganda since 1980, and provided relief to civilians during the country's guerrilla war during the Second Obote Period . However, the formation of the Lord's Resistance Army saw the beginning of a long campaign of violence in northern Uganda and southern Sudan. Civilians were subjected to mass killings and rapes, torture, and abductions of children, who would later serve as sex slaves or child soldiers . Faced with more than 1.5 million people displaced from their homes, MSF set up relief programmes in internally displaced person (IDP) camps to provide clean water, food and sanitation. Diseases such as tuberculosis , measles, polio, cholera, ebola , and HIV/AIDS occur in epidemics in the country, and volunteers provide vaccinations (in the cases of measles and polio) and/or treatment to the residents. Mental health is also an important aspect of medical treatment for MSF teams in Uganda since most people refuse to leave the IDP camps for constant fear of being attacked. MSF first camp set up a field mission in Côte d'Ivoire in 1990, but ongoing violence and the 2002 division of the country by rebel groups and the government led to several massacres, and MSF teams have even begun to suspect that an ethnic cleansing is occurring. Mass measles vaccinations, tuberculosis treatment and the re-opening of hospitals closed by fighting are projects run by MSF, which is the only group providing aid in much of the country. MSF has strongly promoted the use of contraception in Africa. During the Ebola outbreak in West Africa in 2014, MSF met serious medical demands largely on its own, after the organisation's early warnings were largely ignored. MSF-Burundi has aided in attending to casualties suffered in the 2019 Burundi landslides . During the Ebola outbreak in West Africa in 2014, MSF met serious medical demands largely on its own, after the organisation's early warnings were largely ignored. MSF-Burundi has aided in attending to casualties suffered in the 2019 Burundi landslides . MSF is involved in Sri Lanka, where a 26-year civil war ended in 2009 and MSF has adapted its activities there to continue its mission. For example, it helps with physical therapy for patients with spinal cord injuries. It conducts counseling sessions, and has set up an "operating theatre for reconstructive orthopaedic surgery and supplied specialist surgeons, anaesthetists and nurses to operate on patients with complicated war-related injuries". MSF first provided medical help to civilians and refugees who have escaped to camps along the Thai-Cambodian border in 1979. Due to long decades of war, a proper health care system in the country was severely lacking and MSF moved inland in 1989 to help restructure basic medical facilities. In 1999, Cambodia was hit with a malaria epidemic. The situation of the epidemic was aggravated by a lack of qualified practitioners and poor quality control which led to a market of fake antimalarial drugs. Counterfeit antimalarial drugs were responsible for the deaths of at least 30 people during the epidemic. This has prompted efforts by MSF to set up and fund a malaria outreach project and utilise Village Malaria Workers. MSF also introduced a switching of first-line treatment to a combination therapy (Artesunate and Mefloquine) to combat resistance and fatality of old drugs that were used to treat the disease traditionally. Cambodia is one of the hardest hit HIV/AIDS countries in Southeast Asia. In 2001, MSF started introducing antiretroviral (ARV) therapy to AIDS patients for free. This therapy prolongs the patients' lives and is a long-term treatment. In 2002, MSF established chronic diseases clinics with the Cambodian Ministry of Health in various provinces to integrate HIV/AIDS treatment, alongside hypertension, diabetes, and arthritis which have high prevalence rate. This aims to reduce facility-related stigma as patients are able to seek treatment in a multi-purpose clinic in contrast to a HIV/AIDS specialised treatment centre. MSF also provided humanitarian aid in times of natural disaster such as a major flood in 2002 which affected up to 1.47 million people. MSF introduced a community-based tuberculosis programme in 2004 in remote villages, where village volunteers are delegated to facilitate the medication of patients. In partnership with local health authorities and other NGOs, MSF encouraged decentralized clinics and rendered localized treatments to more rural areas from 2006. Since 2007, MSF has extended general health care, counselling, HIV/AIDS and TB treatment to prisons in Phnom Penh via mobile clinics. However, poor sanitation and lack of health care still prevails in most Cambodian prisons as they remain as some of the world's most crowded prisons. In 2007, MSF worked with the Cambodian Ministry of Health to provide psychosocial and technical support in offering pediatric HIV/AIDS treatment to affected children. MSF also provided medical supplies and staff to help in one of the worst dengue outbreaks in 2007, which had more than 40,000 people hospitalized, killing 407 people, primarily children. In 2010, Southern and Eastern provinces of Cambodia were hit with a cholera epidemic and MSF responded by providing medical support that were adapted for usage in the country. Cambodia is one of 22 countries listed by WHO as having a high burden of tuberculosis. WHO estimates that 64% of all Cambodians carry the tuberculosis mycobacterium. Hence, MSF has since shifted its focus away from HIV/AIDS to tuberculosis, handing over most HIV-related programs to local health authorities. MSF is involved in Sri Lanka, where a 26-year civil war ended in 2009 and MSF has adapted its activities there to continue its mission. For example, it helps with physical therapy for patients with spinal cord injuries. It conducts counseling sessions, and has set up an "operating theatre for reconstructive orthopaedic surgery and supplied specialist surgeons, anaesthetists and nurses to operate on patients with complicated war-related injuries". MSF first provided medical help to civilians and refugees who have escaped to camps along the Thai-Cambodian border in 1979. Due to long decades of war, a proper health care system in the country was severely lacking and MSF moved inland in 1989 to help restructure basic medical facilities. In 1999, Cambodia was hit with a malaria epidemic. The situation of the epidemic was aggravated by a lack of qualified practitioners and poor quality control which led to a market of fake antimalarial drugs. Counterfeit antimalarial drugs were responsible for the deaths of at least 30 people during the epidemic. This has prompted efforts by MSF to set up and fund a malaria outreach project and utilise Village Malaria Workers. MSF also introduced a switching of first-line treatment to a combination therapy (Artesunate and Mefloquine) to combat resistance and fatality of old drugs that were used to treat the disease traditionally. Cambodia is one of the hardest hit HIV/AIDS countries in Southeast Asia. In 2001, MSF started introducing antiretroviral (ARV) therapy to AIDS patients for free. This therapy prolongs the patients' lives and is a long-term treatment. In 2002, MSF established chronic diseases clinics with the Cambodian Ministry of Health in various provinces to integrate HIV/AIDS treatment, alongside hypertension, diabetes, and arthritis which have high prevalence rate. This aims to reduce facility-related stigma as patients are able to seek treatment in a multi-purpose clinic in contrast to a HIV/AIDS specialised treatment centre. MSF also provided humanitarian aid in times of natural disaster such as a major flood in 2002 which affected up to 1.47 million people. MSF introduced a community-based tuberculosis programme in 2004 in remote villages, where village volunteers are delegated to facilitate the medication of patients. In partnership with local health authorities and other NGOs, MSF encouraged decentralized clinics and rendered localized treatments to more rural areas from 2006. Since 2007, MSF has extended general health care, counselling, HIV/AIDS and TB treatment to prisons in Phnom Penh via mobile clinics. However, poor sanitation and lack of health care still prevails in most Cambodian prisons as they remain as some of the world's most crowded prisons. In 2007, MSF worked with the Cambodian Ministry of Health to provide psychosocial and technical support in offering pediatric HIV/AIDS treatment to affected children. MSF also provided medical supplies and staff to help in one of the worst dengue outbreaks in 2007, which had more than 40,000 people hospitalized, killing 407 people, primarily children. In 2010, Southern and Eastern provinces of Cambodia were hit with a cholera epidemic and MSF responded by providing medical support that were adapted for usage in the country. Cambodia is one of 22 countries listed by WHO as having a high burden of tuberculosis. WHO estimates that 64% of all Cambodians carry the tuberculosis mycobacterium. Hence, MSF has since shifted its focus away from HIV/AIDS to tuberculosis, handing over most HIV-related programs to local health authorities. The 2011 Libyan civil war has prompted efforts by MSF to set up a hospital and mental health services to help locals affected by the conflict. The fighting created a backlog of patients that needed surgery. With parts of the country slowly returning to livable, MSF has started working with local health personnel to address the needs. The need for psychological counseling has increased and MSF has set up mental health services to address the fears and stress of people living in tents without water and electricity. Currently MSF is the only International Aid organisation with actual presence in the country. MSF is providing Maritime Search And Rescue (SAR) services on the Mediterranean Sea to save the lives of migrants attempting to cross with unseaworthy boats. The Mission started in 2015 after the EU ended its major SAR operation Mare Nostrum severely diminishing much needed SAR capacities in the Mediterranean. Throughout the mission MSF has operated its own vessels like the Bourbon Argos (2015–2016), Dignity 1 (2015–2016) and VOS Prudence (2016–2017). MSF has also provided medical teams to support other NGOs and their ships like the MOAS Phoenix (2015) or the Aquarius (2017–2018) and Ocean Viking (2019–2020) with SOS Méditerranée and Mediterranea Saving Humans . In August 2017 MSF decided to suspend the activities of the VOS Prudence protesting restrictions and threats by the Libyan "Coast Guard". In December 2018 MSF and SOS Méditerranée were forced to end operations of the Aquarius , at that date the last remaining vessel supported by MSF. This came after attacks by EU states that stripped the vessel of its registration and produced criminal accusations against MSF. Up to then 80,000 people had been rescued or assisted since the beginning of the mission. Operations resumed with Ocean Viking in July 2019, but the ship was seized in Sicily in July 2020. In May 2021, MSF returned to refugee rescue operations in the Mediterranean with a new vessel, the Geo Barents . Within a month this resulted in the rescue of some 400 people. MSF is involved in trying to help with the humanitarian crisis caused by the Yemeni Civil War . The organisation operates eleven hospitals and health centres in Yemen and provides support to another 18 hospitals or health centres. According to MSF, since October 2015, four of its hospitals and one ambulance have been destroyed by Saudi-led coalition airstrikes. In August 2016, an airstrike on Abs hospital killed 19 people, including one MSF staff member, and wounded 24. According to MSF, the GPS coordinates of the hospital were repeatedly shared with all parties to the conflict, including the Saudi-led coalition, and its location was well-known.The 2011 Libyan civil war has prompted efforts by MSF to set up a hospital and mental health services to help locals affected by the conflict. The fighting created a backlog of patients that needed surgery. With parts of the country slowly returning to livable, MSF has started working with local health personnel to address the needs. The need for psychological counseling has increased and MSF has set up mental health services to address the fears and stress of people living in tents without water and electricity. Currently MSF is the only International Aid organisation with actual presence in the country.MSF is providing Maritime Search And Rescue (SAR) services on the Mediterranean Sea to save the lives of migrants attempting to cross with unseaworthy boats. The Mission started in 2015 after the EU ended its major SAR operation Mare Nostrum severely diminishing much needed SAR capacities in the Mediterranean. Throughout the mission MSF has operated its own vessels like the Bourbon Argos (2015–2016), Dignity 1 (2015–2016) and VOS Prudence (2016–2017). MSF has also provided medical teams to support other NGOs and their ships like the MOAS Phoenix (2015) or the Aquarius (2017–2018) and Ocean Viking (2019–2020) with SOS Méditerranée and Mediterranea Saving Humans . In August 2017 MSF decided to suspend the activities of the VOS Prudence protesting restrictions and threats by the Libyan "Coast Guard". In December 2018 MSF and SOS Méditerranée were forced to end operations of the Aquarius , at that date the last remaining vessel supported by MSF. This came after attacks by EU states that stripped the vessel of its registration and produced criminal accusations against MSF. Up to then 80,000 people had been rescued or assisted since the beginning of the mission. Operations resumed with Ocean Viking in July 2019, but the ship was seized in Sicily in July 2020. In May 2021, MSF returned to refugee rescue operations in the Mediterranean with a new vessel, the Geo Barents . Within a month this resulted in the rescue of some 400 people. MSF is involved in trying to help with the humanitarian crisis caused by the Yemeni Civil War . The organisation operates eleven hospitals and health centres in Yemen and provides support to another 18 hospitals or health centres. According to MSF, since October 2015, four of its hospitals and one ambulance have been destroyed by Saudi-led coalition airstrikes. In August 2016, an airstrike on Abs hospital killed 19 people, including one MSF staff member, and wounded 24. According to MSF, the GPS coordinates of the hospital were repeatedly shared with all parties to the conflict, including the Saudi-led coalition, and its location was well-known.In August and September 2022, MSF provided medical care to asylum seekers staying outside the overcrowded migration centre in Ter Apel , the Netherlands. In August and September 2022, MSF provided medical care to asylum seekers staying outside the overcrowded migration centre in Ter Apel , the Netherlands. Before a field mission is established in a country, an MSF team visits the area to determine the nature of the humanitarian emergency, the level of safety in the area and what type of aid is needed (this is called an "exploratory mission"). Medical aid is the main objective of most missions, although some missions help in such areas as water purification and nutrition. A field mission team usually consists of a small number of coordinators to head each component of a field mission, and a "head of mission". The head of mission usually has the most experience in humanitarian situations of the members of the team, and it is their job to deal with the media, national governments and other humanitarian organisations. The head of mission does not necessarily have a medical background. Medical volunteers include physicians, surgeons, nurses, and various other specialists. In addition to operating the medical and nutrition components of the field mission, these volunteers are sometimes in charge of a group of local medical staff and provide training for them. Although the medical volunteers almost always receive the most media attention when the world becomes aware of an MSF field mission, there are a number of non-medical volunteers who help keep the field mission functioning. Logisticians are responsible for providing everything that the medical component of a mission needs, ranging from security and vehicle maintenance to food and electricity supplies. They may be engineers and/or foremen , but they usually also help with setting up treatment centres and supervising local staff. Other non-medical staff are water/sanitation specialists, who are usually experienced engineers in the fields of water treatment and management and financial/administration/human resources experts who are placed with field missions. Vaccination campaigns are a major part of the medical care provided during MSF missions. Diseases such as diphtheria , measles , meningitis , tetanus , pertussis , yellow fever , polio , and cholera , all of which are uncommon in developed countries, may be prevented with vaccination . Some of these diseases, such as cholera and measles, spread rapidly in large populations living in close proximity, such as in a refugee camp, and people must be immunised by the hundreds or thousands in a short period of time. For example, in Beira, Mozambique , in 2004, an experimental cholera vaccine was received twice by approximately 50,000 residents in about one month. An equally important part of the medical care provided during MSF missions is AIDS treatment (with antiretroviral drugs ), AIDS testing, and education. MSF is the only source of treatment for many countries in Africa, whose citizens make up the majority of people with HIV and AIDS worldwide. Because antiretroviral drugs (ARVs) are not readily available, MSF usually provides treatment for opportunistic infections and educates the public on how to slow transmission of the disease. In most countries, MSF increases the capabilities of local hospitals by improving sanitation, providing equipment and drugs, and training local hospital staff. When the local staff is overwhelmed, MSF may open new specialised clinics for treatment of an endemic disease or surgery for victims of war. International staff start these clinics but MSF strives to increase the local staff's ability to run the clinics themselves through training and supervision. In some countries, like Nicaragua, MSF provides public education to increase awareness of reproductive health care and venereal disease . Since most of the areas that require field missions have been affected by a natural disaster, civil war, or endemic disease, the residents usually require psychological support as well. Although the presence of an MSF medical team may decrease stress somewhat among survivors, often a team of psychologists or psychiatrists help people who have depression, survivors of domestic violence and those with substance use disorder . The doctors may also train local mental health staff. Such cases include Palestinian refugee camps , where long-term displacement and geopolitical circumstances have left many residents without long-term purpose or clear strategies for action. Humanitarian actors, like Médecins Sans Frontières, have sometimes responded by proferring coping skills to residents as a humanitarian aim and outcome. In the late 2000s, Médecins Sans Frontières launched a mental health program in Burj al Barajneh camp in Lebanon, providing sexual and reproductive health services, mental health support, and health promotion activities. Often in situations where an MSF mission is set up, there is moderate or severe malnutrition as a result of war, drought, or government economic mismanagement. Intentional starvation is also sometimes used during a war as a weapon, and MSF, in addition to providing food, brings awareness to the situation and insists on foreign government intervention. Infectious diseases and diarrhoea , both of which cause weight loss and weakening of a person's body (especially in children), must be treated with medication and proper nutrition to prevent further infections and weight loss. A combination of the above situations, as when a civil war is fought during times of drought and infectious disease outbreaks, can create famine. In emergency situations where there is a lack of nutritious food, but not to the level of a true famine, protein-energy malnutrition is most common among young children. Marasmus , a form of calorie deficiency, is the most common form of childhood malnutrition and is characterised by severe wasting and often fatal weakening of the immune system. Kwashiorkor , a form of calorie and protein deficiency, is a more serious type of malnutrition in young children, and can negatively affect physical and mental development . Both types of malnutrition can make opportunistic infections fatal. In these situations, MSF sets up Therapeutic Feeding Centres for monitoring the children and any other malnourished individuals. A Therapeutic Feeding Centre (or Therapeutic Feeding Programme) is designed to treat severe malnutrition through the gradual introduction of a special diet intended to promote weight gain after the individual has been treated for other health problems. The treatment programme is split between two phases: Phase 1 lasts for 24 hours and involves basic health care and several small meals of low energy/protein food spaced over the day. Phase 2 involves monitoring of the patient and several small meals of high energy/protein food spaced over each day until the individual's weight approaches normal. MSF uses foods designed specifically for treatment of severe malnutrition. During phase 1, a type of therapeutic milk called F-75 is fed to patients. F-75 is a relatively low energy, low fat/protein milk powder that must be mixed with water and given to patients to prepare their bodies for phase 2. During phase 2, therapeutic milk called F-100 , which is higher in energy/fat/protein content than F-75, is given to patients, usually along with a peanut butter mixture called Plumpy'nut . F-100 and Plumpy'nut are designed to quickly provide large amounts of nutrients so that patients can be treated efficiently. Other special food fed to populations in danger of starvation includes enriched flour and porridge , as well as a high protein biscuit called BP5 . BP5 is a popular food for treating populations because it can be distributed easily and sent home with individuals, or it can be crushed and mixed with therapeutic milk for specific treatments. Dehydration , sometimes due to diarrhoea or cholera, may also be present in a population, and MSF set up rehydration centres to combat this. A special solution called Oral Rehydration Solution (ORS), which contains glucose and electrolytes , is given to patients to replace fluids lost . Antibiotics are also sometimes given to individuals with diarrhoea if it is known that they have cholera or dysentery . Clean water is essential for hygiene , for consumption and for feeding programmes (for mixing with powdered therapeutic milk or porridge), as well as for preventing the spread of water-borne disease . As such, MSF water engineers and volunteers must create a source of clean water. This is usually achieved by modifying an existing water well , by digging a new well and/or starting a water treatment project to obtain clean water for a population. Water treatment in these situations may consist of storage sedimentation, filtration and/or chlorination depending on available resources. Sanitation is an essential part of field missions, and it may include education of local medical staff in proper sterilisation techniques, sewage treatment projects, proper waste disposal , and education of the population in personal hygiene. Proper wastewater treatment and water sanitation are the best way to prevent the spread of serious water-borne diseases, such as cholera. Simple wastewater treatment systems can be set up by volunteers to protect drinking water from contamination. Garbage disposal could include pits for normal waste and incineration for medical waste . However, the most important subject in sanitation is the education of the local population, so that proper waste and water treatment can continue once MSF has left the area. In order to accurately report the conditions of a humanitarian emergency to the rest of the world and to governing bodies, data on a number of factors are collected during each field mission. The rate of malnutrition in children is used to determine the malnutrition rate in the population, and then to determine the need for feeding centres. Various types of mortality rates are used to report the seriousness of a humanitarian emergency, and a common method used to measure mortality in a population is to have staff constantly monitoring the number of burials at cemeteries. By compiling data on the frequency of diseases in hospitals, MSF can track the occurrence and location of epidemic increases (or "seasons") and stockpile vaccines and other drugs. For example, the "Meningitis Belt" (sub-Saharan Africa, which sees the most cases of meningitis in the world) has been "mapped" and the meningitis season occurs between December and June. Shifts in the location of the Belt and the timing of the season can be predicted using cumulative data over many years. In addition to epidemiological surveys, MSF also uses population surveys to determine the rates of violence in various regions. By estimating the scopes of massacres , and determining the rate of kidnappings, rapes, and killings, psychosocial programmes can be implemented to lower the suicide rate and increase the sense of security in a population. Large-scale forced migrations , excessive civilian casualties and massacres can be quantified using surveys, and MSF can use the results to put pressure on governments to provide help, or even expose genocide. MSF conducted the first comprehensive mortality survey in Darfur in 2004. However, there may be ethical problems in collecting these statistics. In 2014 MSF partnered with satellite operator SES , other NGOs Archemed, Fondation Follereau, Friendship Luxembourg and German Doctors , and the Luxembourg government in the pilot phase of SATMED , a project to use satellite broadband technology to bring eHealth and telemedicine to isolated areas of developing countries. SATMED was first deployed in Sierra Leone in support of the fight against Ebola. A field mission team usually consists of a small number of coordinators to head each component of a field mission, and a "head of mission". The head of mission usually has the most experience in humanitarian situations of the members of the team, and it is their job to deal with the media, national governments and other humanitarian organisations. The head of mission does not necessarily have a medical background. Medical volunteers include physicians, surgeons, nurses, and various other specialists. In addition to operating the medical and nutrition components of the field mission, these volunteers are sometimes in charge of a group of local medical staff and provide training for them. Although the medical volunteers almost always receive the most media attention when the world becomes aware of an MSF field mission, there are a number of non-medical volunteers who help keep the field mission functioning. Logisticians are responsible for providing everything that the medical component of a mission needs, ranging from security and vehicle maintenance to food and electricity supplies. They may be engineers and/or foremen , but they usually also help with setting up treatment centres and supervising local staff. Other non-medical staff are water/sanitation specialists, who are usually experienced engineers in the fields of water treatment and management and financial/administration/human resources experts who are placed with field missions.Vaccination campaigns are a major part of the medical care provided during MSF missions. Diseases such as diphtheria , measles , meningitis , tetanus , pertussis , yellow fever , polio , and cholera , all of which are uncommon in developed countries, may be prevented with vaccination . Some of these diseases, such as cholera and measles, spread rapidly in large populations living in close proximity, such as in a refugee camp, and people must be immunised by the hundreds or thousands in a short period of time. For example, in Beira, Mozambique , in 2004, an experimental cholera vaccine was received twice by approximately 50,000 residents in about one month. An equally important part of the medical care provided during MSF missions is AIDS treatment (with antiretroviral drugs ), AIDS testing, and education. MSF is the only source of treatment for many countries in Africa, whose citizens make up the majority of people with HIV and AIDS worldwide. Because antiretroviral drugs (ARVs) are not readily available, MSF usually provides treatment for opportunistic infections and educates the public on how to slow transmission of the disease. In most countries, MSF increases the capabilities of local hospitals by improving sanitation, providing equipment and drugs, and training local hospital staff. When the local staff is overwhelmed, MSF may open new specialised clinics for treatment of an endemic disease or surgery for victims of war. International staff start these clinics but MSF strives to increase the local staff's ability to run the clinics themselves through training and supervision. In some countries, like Nicaragua, MSF provides public education to increase awareness of reproductive health care and venereal disease . Since most of the areas that require field missions have been affected by a natural disaster, civil war, or endemic disease, the residents usually require psychological support as well. Although the presence of an MSF medical team may decrease stress somewhat among survivors, often a team of psychologists or psychiatrists help people who have depression, survivors of domestic violence and those with substance use disorder . The doctors may also train local mental health staff. Such cases include Palestinian refugee camps , where long-term displacement and geopolitical circumstances have left many residents without long-term purpose or clear strategies for action. Humanitarian actors, like Médecins Sans Frontières, have sometimes responded by proferring coping skills to residents as a humanitarian aim and outcome. In the late 2000s, Médecins Sans Frontières launched a mental health program in Burj al Barajneh camp in Lebanon, providing sexual and reproductive health services, mental health support, and health promotion activities. Often in situations where an MSF mission is set up, there is moderate or severe malnutrition as a result of war, drought, or government economic mismanagement. Intentional starvation is also sometimes used during a war as a weapon, and MSF, in addition to providing food, brings awareness to the situation and insists on foreign government intervention. Infectious diseases and diarrhoea , both of which cause weight loss and weakening of a person's body (especially in children), must be treated with medication and proper nutrition to prevent further infections and weight loss. A combination of the above situations, as when a civil war is fought during times of drought and infectious disease outbreaks, can create famine. In emergency situations where there is a lack of nutritious food, but not to the level of a true famine, protein-energy malnutrition is most common among young children. Marasmus , a form of calorie deficiency, is the most common form of childhood malnutrition and is characterised by severe wasting and often fatal weakening of the immune system. Kwashiorkor , a form of calorie and protein deficiency, is a more serious type of malnutrition in young children, and can negatively affect physical and mental development . Both types of malnutrition can make opportunistic infections fatal. In these situations, MSF sets up Therapeutic Feeding Centres for monitoring the children and any other malnourished individuals. A Therapeutic Feeding Centre (or Therapeutic Feeding Programme) is designed to treat severe malnutrition through the gradual introduction of a special diet intended to promote weight gain after the individual has been treated for other health problems. The treatment programme is split between two phases: Phase 1 lasts for 24 hours and involves basic health care and several small meals of low energy/protein food spaced over the day. Phase 2 involves monitoring of the patient and several small meals of high energy/protein food spaced over each day until the individual's weight approaches normal. MSF uses foods designed specifically for treatment of severe malnutrition. During phase 1, a type of therapeutic milk called F-75 is fed to patients. F-75 is a relatively low energy, low fat/protein milk powder that must be mixed with water and given to patients to prepare their bodies for phase 2. During phase 2, therapeutic milk called F-100 , which is higher in energy/fat/protein content than F-75, is given to patients, usually along with a peanut butter mixture called Plumpy'nut . F-100 and Plumpy'nut are designed to quickly provide large amounts of nutrients so that patients can be treated efficiently. Other special food fed to populations in danger of starvation includes enriched flour and porridge , as well as a high protein biscuit called BP5 . BP5 is a popular food for treating populations because it can be distributed easily and sent home with individuals, or it can be crushed and mixed with therapeutic milk for specific treatments. Dehydration , sometimes due to diarrhoea or cholera, may also be present in a population, and MSF set up rehydration centres to combat this. A special solution called Oral Rehydration Solution (ORS), which contains glucose and electrolytes , is given to patients to replace fluids lost . Antibiotics are also sometimes given to individuals with diarrhoea if it is known that they have cholera or dysentery . Clean water is essential for hygiene , for consumption and for feeding programmes (for mixing with powdered therapeutic milk or porridge), as well as for preventing the spread of water-borne disease . As such, MSF water engineers and volunteers must create a source of clean water. This is usually achieved by modifying an existing water well , by digging a new well and/or starting a water treatment project to obtain clean water for a population. Water treatment in these situations may consist of storage sedimentation, filtration and/or chlorination depending on available resources. Sanitation is an essential part of field missions, and it may include education of local medical staff in proper sterilisation techniques, sewage treatment projects, proper waste disposal , and education of the population in personal hygiene. Proper wastewater treatment and water sanitation are the best way to prevent the spread of serious water-borne diseases, such as cholera. Simple wastewater treatment systems can be set up by volunteers to protect drinking water from contamination. Garbage disposal could include pits for normal waste and incineration for medical waste . However, the most important subject in sanitation is the education of the local population, so that proper waste and water treatment can continue once MSF has left the area.In order to accurately report the conditions of a humanitarian emergency to the rest of the world and to governing bodies, data on a number of factors are collected during each field mission. The rate of malnutrition in children is used to determine the malnutrition rate in the population, and then to determine the need for feeding centres. Various types of mortality rates are used to report the seriousness of a humanitarian emergency, and a common method used to measure mortality in a population is to have staff constantly monitoring the number of burials at cemeteries. By compiling data on the frequency of diseases in hospitals, MSF can track the occurrence and location of epidemic increases (or "seasons") and stockpile vaccines and other drugs. For example, the "Meningitis Belt" (sub-Saharan Africa, which sees the most cases of meningitis in the world) has been "mapped" and the meningitis season occurs between December and June. Shifts in the location of the Belt and the timing of the season can be predicted using cumulative data over many years. In addition to epidemiological surveys, MSF also uses population surveys to determine the rates of violence in various regions. By estimating the scopes of massacres , and determining the rate of kidnappings, rapes, and killings, psychosocial programmes can be implemented to lower the suicide rate and increase the sense of security in a population. Large-scale forced migrations , excessive civilian casualties and massacres can be quantified using surveys, and MSF can use the results to put pressure on governments to provide help, or even expose genocide. MSF conducted the first comprehensive mortality survey in Darfur in 2004. However, there may be ethical problems in collecting these statistics. In 2014 MSF partnered with satellite operator SES , other NGOs Archemed, Fondation Follereau, Friendship Luxembourg and German Doctors , and the Luxembourg government in the pilot phase of SATMED , a project to use satellite broadband technology to bring eHealth and telemedicine to isolated areas of developing countries. SATMED was first deployed in Sierra Leone in support of the fight against Ebola. List of international presidents: In addition to the Geneva global headquarters and five regional operational centers, as of 2020 MSF had national offices as follows: MSF Australia MSF Austria MSF Belgium MSF Brazil MSF Canada MSF Czech Republic MSF Denmark MSF Eastern Africa MSF Finland MSF France MSF Germany MSF Greece MSF Hong Kong MSF Ireland MSF Italy MSF Japan MSF Republic of Korea MSF Lat (Spanish Speaking South America) MSF Luxembourg MSF Mexico MSF Netherlands MSF Norway MSF South Africa MSF SARA (South Asia Regional Association: India, Pakistan, Afghanistan, Sri Lanka, Bangladesh) MSF Spain MSF Sweden MSF Switzerland MSF Taiwan MSF United Kingdom MSF United States MSF West and Central AfricaIn 1986, MSF created Epicentre, an in-house research organisation, to support its activities. Epicentre conducts training, publishes scientific papers and develops new techniques for MSF. It performs epidemiological research, conducts clinical vaccine trials during outbreaks MSF is responding to, experiments on vaccine stability, and analysis of vaccine deployment strategy. The Campaign for Access to Essential Medicines was initiated in 1999 to increase access to essential medicines in developing countries. "Essential medicines" are those drugs that are needed in sufficient supply to treat a disease common to a population. However, most diseases common to populations in developing countries are no longer common to populations in developed countries; therefore, pharmaceutical companies find that producing these drugs is no longer profitable and may raise the price per treatment, decrease development of the drug (and new treatments) or even stop production of the drug. MSF often lacks effective drugs during field missions, and started the campaign to put pressure on governments and pharmaceutical companies to increase funding for essential medicines. In 2006, MSF tried to use its influence to urge the drug maker Novartis to drop its case against India's patent law that prevents Novartis from patenting its drugs in India . A few years earlier, Novartis also sued South Africa to prevent it from importing cheaper AIDS drugs. On 1 April 2013, it was announced that the Indian court invalidated Novartis's patent on imatinib (Gleevec). This decision makes the drug available via generics on the Indian market at a considerably lower price. In March 2017, Els Torreele who had been leading the campaign from 1999 to 2003 returned to MSF as the executive director of the Access Campaign. For the following three years she led a global analysis and advocacy team whose goal was to guarantee that appropriate medicines, vaccines and diagnostics are developed, available, affordable and adapted to people's needs. As of 2022, the most critical subjects of the campaign were rising antimicrobial resistance and outbreaks of epidemic diseases such as Ebola and COVID. Still, a lot of vaccines, diagnostics and medicines were inaccessible for people in need. In 1986, MSF created Epicentre, an in-house research organisation, to support its activities. Epicentre conducts training, publishes scientific papers and develops new techniques for MSF. It performs epidemiological research, conducts clinical vaccine trials during outbreaks MSF is responding to, experiments on vaccine stability, and analysis of vaccine deployment strategy. The Campaign for Access to Essential Medicines was initiated in 1999 to increase access to essential medicines in developing countries. "Essential medicines" are those drugs that are needed in sufficient supply to treat a disease common to a population. However, most diseases common to populations in developing countries are no longer common to populations in developed countries; therefore, pharmaceutical companies find that producing these drugs is no longer profitable and may raise the price per treatment, decrease development of the drug (and new treatments) or even stop production of the drug. MSF often lacks effective drugs during field missions, and started the campaign to put pressure on governments and pharmaceutical companies to increase funding for essential medicines. In 2006, MSF tried to use its influence to urge the drug maker Novartis to drop its case against India's patent law that prevents Novartis from patenting its drugs in India . A few years earlier, Novartis also sued South Africa to prevent it from importing cheaper AIDS drugs. On 1 April 2013, it was announced that the Indian court invalidated Novartis's patent on imatinib (Gleevec). This decision makes the drug available via generics on the Indian market at a considerably lower price. In March 2017, Els Torreele who had been leading the campaign from 1999 to 2003 returned to MSF as the executive director of the Access Campaign. For the following three years she led a global analysis and advocacy team whose goal was to guarantee that appropriate medicines, vaccines and diagnostics are developed, available, affordable and adapted to people's needs. As of 2022, the most critical subjects of the campaign were rising antimicrobial resistance and outbreaks of epidemic diseases such as Ebola and COVID. Still, a lot of vaccines, diagnostics and medicines were inaccessible for people in need. MSF staff are sometimes attacked or kidnapped. In some countries, humanitarian-aid organisations are viewed as helping the enemy. If an aid mission is perceived to be exclusively set up for victims on one side of the conflict, it may come under attack. However, the War on Terrorism has generated attitudes among some groups in US-occupied countries that non-governmental aid organisations such as MSF are allied with or even work for the Coalition forces . Insecurity in cities in Afghanistan and Iraq rose significantly following United States operations, and MSF has declared that providing aid in these countries was too dangerous. The organisation was forced to evacuate its teams from Afghanistan on 28 July 2004, after five staff (Afghans Fasil Ahmad and Besmillah, Belgian Hélène de Beir, Norwegian Egil Tynæs , and Dutchman Willem Kwint) were killed on 2 June in an ambush by unidentified militia near Khair Khāna in Badghis Province . In June 2007, Elsa Serfass, a staff member with MSF-France, was killed in the Central African Republic and in January 2008, two expatriate staff (Damien Lehalle and Victor Okumu) and a national staff member (Mohammed Bidhaan Ali) were killed in an organised attack in Somalia resulting in the closing of the project. Arrests and abductions in politically unstable regions can also occur for volunteers, and in some cases, MSF field missions can be expelled entirely from a country. Arjan Erkel , Head of Mission in Dagestan in the North Caucasus , was kidnapped and held hostage in an unknown location by unknown abductors from 12 August 2002 until 11 April 2004. Paul Foreman, head of MSF-Holland, was arrested in Sudan in May 2005 for refusing to divulge documents used in compiling a report on rapes carried out by the pro-government Janjaweed militias (see Darfur conflict ). Foreman cited the privacy of the women involved, and MSF alleged that the Sudanese government had arrested him because it disliked the bad publicity generated by the report. Below is a partial list of notable incidents of direct violence against MSF staff or facilities, in chronological order:Below is a partial list of notable incidents of direct violence against MSF staff or facilities, in chronological order:The then president of MSF, James Orbinski , gave the Nobel Peace Prize speech on behalf of the organisation. In the opening, he discusses the conditions of the victims of the Rwandan genocide and focuses on one of his woman patients: There were hundreds of women, children and men brought to the hospital that day, so many that we had to lay them out on the street and even operate on some of them there. The gutters around the hospital ran red with blood. The woman had not just been attacked with a machete, but her entire body rationally and systematically mutilated. Her ears had been cut off. And her face had been so carefully disfigured that a pattern was obvious in the slashes. She was one among many—living an inhuman and simply indescribable suffering. We could do little more for her at the moment than stop the bleeding with a few necessary sutures. We were completely overwhelmed, and she knew that there were so many others. She said to me in the clearest voice I have ever heard, 'Allez, allez...ummera, ummerasha'—'Go, go...my friend, find and let live your courage.' Orbinski affirmed the organisation's commitment to publicising the issues MSF encountered, stating Silence has long been confused with neutrality, and has been presented as a necessary condition for humanitarian action. From its beginning, MSF was created in opposition to this assumption. We are not sure that words can always save lives, but we know that silence can certainly kill.The then president of MSF, James Orbinski , gave the Nobel Peace Prize speech on behalf of the organisation. In the opening, he discusses the conditions of the victims of the Rwandan genocide and focuses on one of his woman patients: There were hundreds of women, children and men brought to the hospital that day, so many that we had to lay them out on the street and even operate on some of them there. The gutters around the hospital ran red with blood. The woman had not just been attacked with a machete, but her entire body rationally and systematically mutilated. Her ears had been cut off. And her face had been so carefully disfigured that a pattern was obvious in the slashes. She was one among many—living an inhuman and simply indescribable suffering. We could do little more for her at the moment than stop the bleeding with a few necessary sutures. We were completely overwhelmed, and she knew that there were so many others. She said to me in the clearest voice I have ever heard, 'Allez, allez...ummera, ummerasha'—'Go, go...my friend, find and let live your courage.' Orbinski affirmed the organisation's commitment to publicising the issues MSF encountered, stating Silence has long been confused with neutrality, and has been presented as a necessary condition for humanitarian action. From its beginning, MSF was created in opposition to this assumption. We are not sure that words can always save lives, but we know that silence can certainly kill.A number of other unrelated non-governmental organisations have adopted names ending in " Sans Frontières " or "Without Borders", inspired by Médecins Sans Frontières , for example: Engineers Without Borders , Avocats Sans Frontières ('Lawyers Without Borders'), Reporters sans frontières ('Reporters Without Borders'), Payasos Sin Fronteras ('Clowns Without Borders'), Bibliothèques Sans Frontières ('Libraries Without Borders'), and Homeopaths Without Borders . The French game show Jeux Sans Frontières ('Games Without Borders') is older than MSF, being first broadcast in Europe in 1965.Questions about the ethical treatment of MSF staff, clients and communities by MSF as a result of some of its policies and practices have arisen, with issues being canvassed by employees, others in the development sector, and the media. MSF has maintained separate employment conditions and pay for its "national staff" (those employed locally for field missions) and its "international staff" (those deployed from regional or national units to field missions in other countries). The international staff tend to hold the senior posts on a mission, with the national staff most often reporting to the senior staff who have come from elsewhere. There are ongoing complaints from national staff that they are treated less favourably, employed on more dangerous tasks, paid considerably less, and are without access to benefits of housing, health care, and other advantages afforded incoming expatriate staff. MSF stated in 2020 that this policy would be reviewed with the intent to eliminate differential treatment. These practices, amongst other concerns, were the catalyst for a 2020 statement by 1,000 of its current and former employees outlining their concerns regarding the organisation's perceived structural racism. Included in the collective staff statement was testimony of personal experiences of racism within MSF, both in the form of adverse treatment in the workplace, and what is perceived as a white supremacist and colonial mindset expressed in the formation and implementation of programmes. While MSF hires ninety percent of its staff for missions "in-country", the organisation continues to have a preponderance of Europeans in its higher management. Despite the percentage of its international programme coordinators originating from the Global South rising from 24 percent to 46 percent over the decade 2012−2022, the international president Christos Christou acknowledged that the highest echelons of MSF were still dominated by those from the Global North. With its headquarters and five operational units located in western Europe, MSF's policies and operations were characterised in the 2020 MSF-staff statement as "Eurocentric". In 2018, there were revelations of sexual misconduct by MSF employees, including sexual harassment and abuse of patients, local community members or other MSF staff. Nineteen people were fired as a result of MSF's investigations of complaints. The complaints ranged from sexual harassment by MSF colleagues; exploitation of local (and possibly underage or solely " survival sex ") sex workers by field staff, against MSF policy; and disparaging attitudes and remarks from staff regarding the supposed sexual availability of patients or community members, or an expressed intent to barter medical treatment for sex. Nearly all the resulting dismissals related to inter-staff sexual misconduct. Another controversy involved images taken without informed consent of vulnerable patients, some of whom were minors without adult guardians. Some images were criticised as exploitative and objectifying. They included a photograph of a mother mourning the death of her baby, with the boy's body visible; child rape survivors and sexual and domestic abuse survivors, with details of their experiences included. Intended to increase awareness of dire conditions prevailing in places where MSF works and the need for their programmes, the images were used on MSF and community websites and in print publications. Licensing of the images were available for sale to image databases. The ethics of exposing devastated or victimised individuals, sometimes with partially identifying information was questioned. Following the criticism, MSF decided to cease use of the images. The removal of the images was in turn also criticised. MSF's funding model has come under scrutiny after BlackRock donated $500,000 towards its COVID-19 crisis fund, leading to calls of hypocrisy from staff and other humanitarian organisations.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/2004_Indian_Ocean_earthquake_and_tsunami/html

2004 Indian Ocean earthquake and tsunami

On 26 December 2004, at 07:58:53 local time ( UTC+7 ) , a major earthquake with a magnitude of 9.1–9.3 M w struck with an epicentre off the west coast of northern Sumatra , Indonesia . The undersea megathrust earthquake , known by the scientific community as the Sumatra–Andaman earthquake , was caused by a rupture along the fault between the Burma Plate and the Indian Plate , and reached a Mercalli intensity up to IX in some areas. A massive tsunami with waves up to 30 m (100 ft) high, known in some countries as the Boxing Day Tsunami after the Boxing Day holiday, devastated communities along the surrounding coasts of the Indian Ocean, killing an estimated 227,898 people in 14 countries in one of the deadliest natural disasters in recorded history . The direct results caused major disruptions to living conditions and commerce in coastal provinces of surrounded countries, including Aceh (Indonesia), Sri Lanka , Tamil Nadu ( India ) and Khao Lak (Thailand). Banda Aceh reported the largest number of deaths. It remains the deadliest natural disaster of the 21st century . It was the most powerful earthquake ever recorded in Asia, the most powerful earthquake in the 21st century, and at least the third most powerful earthquake ever recorded in the world since modern seismography began in 1900. It had the longest fault rupture ever observed, between 1,200 km to 1,300 km (720 mi to 780 mi), and had the longest duration of faulting ever observed, at least ten minutes. It caused the planet to vibrate as much as 10 mm (0.4 in) , and also remotely triggered earthquakes as far away as Alaska . Its epicentre was between Simeulue and mainland Sumatra. The plight of the affected people and countries prompted a worldwide humanitarian response , with donations totalling more than US$14 billion (equivalent to US$ 23 billion in 2023 currency).The 2004 Indian Ocean earthquake was initially documented as having a moment magnitude of 8.8. In February 2005, scientists revised the estimate of the magnitude to 9.0. Although the Pacific Tsunami Warning Center has accepted these new numbers, the United States Geological Survey has, as of 2022, so far not changed its estimate of 9.1. A 2006 study estimated a magnitude of M w 9.1–9.3; Hiroo Kanamori of the California Institute of Technology estimates that M w 9.2 is representative of the earthquake's size. The hypocentre of the main earthquake was approximately 160 km (100 mi) off the western coast of northern Sumatra, in the Indian Ocean just north of Simeulue island at a depth of 30 km (19 mi) below mean sea level (initially reported as 10 km or 6.2 mi ). The northern section of the Sunda megathrust ruptured over a length of 1,300 km (810 mi) . The earthquake (followed by the tsunami) was felt in Bangladesh , India , Malaysia , Myanmar , Thailand , Sri Lanka and the Maldives . Splay faults, or secondary "pop up faults", caused long, narrow parts of the seafloor to pop up in seconds. This quickly elevated the height and increased the speed of waves, destroying the nearby Indonesian town of Lhoknga . Indonesia lies between the Pacific Ring of Fire along the north-eastern islands adjacent to New Guinea , and the Alpide belt that runs along the south and west from Sumatra, Java , Bali , Flores to Timor . The 2002 Sumatra earthquake is believed to have been a foreshock , preceding the main event by over two years. Great earthquakes, such as the 2004 Indian Ocean earthquake, are associated with megathrust events in subduction zones. Their seismic moments can account for a significant fraction of the global seismic moment across century-scale periods. Of all the moment released by earthquakes in the 100 years from 1906 through 2005, roughly one eighth was due to the 2004 Indian Ocean earthquake. This quake, together with the Great Alaskan earthquake (1964) and the Great Chilean earthquake (1960), account for almost half of the total moment. Since 1900, the only earthquakes recorded with a greater magnitude were the 1960 Valdivia earthquake (magnitude 9.5) and the 1964 Alaska earthquake in Prince William Sound (magnitude 9.2). The only other recorded earthquakes of magnitude 9.0 or greater were off Kamchatka , Russia, on 5 November 1952 (magnitude 9.0) and Tōhoku, Japan (magnitude 9.1) in March 2011 . Each of these megathrust earthquakes also spawned tsunamis in the Pacific Ocean. In comparison to the 2004 Indian Ocean earthquake, the death toll from these earthquakes and tsunamis was significantly lower, primarily because of the lower population density along the coasts near affected areas. Comparisons with earlier earthquakes are difficult, as earthquake strength were not measured systematically until the 1930s. However, historical earthquake strength can sometimes be estimated by examining historical descriptions of the damage caused, and the geological records of the areas where they occurred. Some examples of significant historical megathrust earthquakes are the 1868 Arica earthquake in Peru and the 1700 Cascadia earthquake in western North America. The 2004 Indian Ocean earthquake was unusually large in geographical and geological extent. An estimated 1,600 km (1,000 mi) of fault surface slipped (or ruptured) about 15 m (50 ft) along the subduction zone where the Indian Plate slides under (or subducts) the overriding Burma Plate. The slip did not happen instantaneously but took place in two phases over several minutes: Seismographic and acoustic data indicate that the first phase involved a rupture about 400 km (250 mi) long and 100 km (60 mi) wide, 30 km (19 mi) beneath the sea bed—the largest rupture ever known to have been caused by an earthquake. The rupture proceeded at about 2.8 km/s (1.74 mi/s; 10,100 km/h; 6,260 mph) , beginning off the coast of Aceh and proceeding north-westerly over about 100 seconds. After a pause of about another 100 seconds, the rupture continued northwards towards the Andaman and Nicobar Islands . The northern rupture occurred more slowly than in the south, at about 2.1 km/s (1.3 mi/s; 7,600 km/h; 4,700 mph) , continuing north for another five minutes to a plate boundary where the fault type changes from subduction to strike-slip (the two plates slide past one another in opposite directions). The Indian Plate is part of the Indo-Australian Plate , which underlies the Indian Ocean and Bay of Bengal , and is moving north-east at an average of 60 mm/a (0.075 in/Ms) . The India Plate meets the Burma Plate (which is considered a portion of the great Eurasian Plate ) at the Sunda Trench . At this point, the India Plate subducts beneath the Burma Plate, which carries the Nicobar Islands, the Andaman Islands, and northern Sumatra. The India Plate sinks deeper and deeper beneath the Burma Plate until the increasing temperature and pressure drive volatiles out of the subducting plate. These volatiles rise into the overlying plate, causing partial melting and the formation of magma. The rising magma intrudes into the crust above and exits the Earth's crust through volcanoes in the form of a volcanic arc . The volcanic activity that results as the Indo-Australian Plate subducts the Eurasian Plate has created the Sunda Arc . As well as the sideways movement between the plates, the 2004 Indian Ocean earthquake resulted in a rise of the seafloor by several metres, displacing an estimated 30 km 3 (7.2 cu mi) of water and triggering devastating tsunami waves. The waves radiated outwards along the entire 1,600 km (1,000 mi) length of the rupture (acting as a line source ). This greatly increased the geographical area over which the waves were observed, reaching as far as Mexico, Chile, and the Arctic. The raising of the seafloor significantly reduced the capacity of the Indian Ocean, producing a permanent rise in the global sea level by an estimated 0.1 mm (0.004 in) . Numerous aftershocks were reported off the Andaman Islands , the Nicobar Islands and the region of the original epicentre in the hours and days that followed. The magnitude 8.6 2005 Nias–Simeulue earthquake , which originated off the coast of the Sumatran island of Nias , is not considered an aftershock, despite its proximity to the epicentre, and was most likely triggered by stress changes associated with the 2004 event. The earthquake produced its own aftershocks (some registering a magnitude of as high as 6.9 ) and presently ranks as the third-largest earthquake ever recorded on the moment magnitude or Richter magnitude scale. Other aftershocks of up to magnitude 7.2 continued to shake the region daily for three or four months. As well as continuing aftershocks, the energy released by the original earthquake continued to make its presence felt well after the event. A week after the earthquake, its reverberations could still be measured, providing valuable scientific data about the Earth's interior. The 2004 Indian Ocean earthquake came just three days after a magnitude 8.1 earthquake in the sub-antarctic Auckland Islands , an uninhabited region west of New Zealand, and Macquarie Island to Australia's north. This is unusual since earthquakes of magnitude eight or more occur only about once per year on average. The U.S. Geological Survey sees no evidence of a causal relationship between these events. The 2004 Indian Ocean earthquake is thought to have triggered activity in both Leuser Mountain and Mount Talang , volcanoes in Aceh along the same range of peaks, while the 2005 Nias–Simeulue earthquake sparked activity in Lake Toba , a massive caldera in Sumatra. The energy released on the Earth's surface ( M e , the energy magnitude, which is the seismic potential for damage ) by the 2004 Indian Ocean earthquake was estimated at 1.1 × 10 17 joules (110 PJ ; 26 Mt ) . This energy is equivalent to over 1,500 times that of the Hiroshima atomic bomb , but less than that of Tsar Bomba , the largest nuclear weapon ever detonated. The earthquake generated a seismic oscillation of the Earth's surface of up to 200–300 mm (8–12 in) , equivalent to the effect of the tidal forces caused by the Sun and Moon. The seismic waves of the earthquake were felt across the planet, as far away as the U.S. state of Oklahoma , where vertical movements of 3 mm (0.12 in) were recorded. By February 2005, the earthquake's effects were still detectable as a 20 μm (0.02 mm; 0.0008 in) complex harmonic oscillation of the Earth's surface, which gradually diminished and merged with the incessant free oscillation of the Earth more than four months after the earthquake. Because of its enormous energy release and shallow rupture depth, the earthquake generated remarkable seismic ground motions around the globe, particularly due to huge Rayleigh (surface) elastic waves that exceeded 10 mm (0.4 in) in vertical amplitude everywhere on Earth. The record section plot displays vertical displacements of the Earth's surface recorded by seismometers from the IRIS/USGS Global Seismographic Network plotted with respect to time (since the earthquake initiation) on the horizontal axis, and vertical displacements of the Earth on the vertical axis (note the 1 cm scale bar at the bottom for scale). The seismograms are arranged vertically by distance from the epicentre in degrees. The earliest, lower amplitude signal is that of the compressional (P) wave , which takes about 22 minutes to reach the other side of the planet (the antipode ; in this case near Ecuador). The largest amplitude signals are seismic surface waves that reach the antipode after about 100 minutes. The surface waves can be clearly seen to reinforce near the antipode (with the closest seismic stations in Ecuador), and to subsequently encircle the planet to return to the epicentral region after about 200 minutes. A major aftershock (magnitude 7.1) can be seen at the closest stations starting just after the 200-minute mark. The aftershock would be considered a major earthquake under ordinary circumstances but is dwarfed by the mainshock. The shift of mass and the massive release of energy slightly altered the Earth's rotation. Weeks after the earthquake, theoretical models suggested the earthquake shortened the length of a day by 2.68 microseconds , due to a decrease in the oblateness of the Earth. It also caused the Earth to minutely "wobble" on its axis by up to 25 mm (1 in) in the direction of 145° east longitude , or perhaps by up to 50 or 60 mm (2.0 or 2.4 in) . Because of tidal effects of the Moon, the length of a day increases at an average of 15 microseconds per year, so any rotational change due to the earthquake will be lost quickly. Similarly, the natural Chandler wobble of the Earth, which in some cases can be up to 15 m (50 ft) , eventually offset the minor wobble produced by the earthquake. There was 10 m (33 ft) movement laterally and 4–5 m (13–16 ft) vertically along the fault line. Early speculation was that some of the smaller islands south-west of Sumatra, which is on the Burma Plate (the southern regions are on the Sunda Plate ), might have moved south-west by up to 36 m (120 ft) , but more accurate data released more than a month after the earthquake found the movement to be about 0.2 m (8 in) . Since movement was vertical as well as lateral, some coastal areas may have been moved to below sea level. The Andaman and Nicobar Islands appear to have shifted south-west by around 1.25 m (4 ft 1 in) and to have sunk by 1 m (3 ft 3 in) . In February 2005, the Royal Navy vessel HMS Scott surveyed the seabed around the earthquake zone, which varies in depth between 1,000 and 5,000 m (550 and 2,730 fathoms; 3,300 and 16,400 ft) . The survey, conducted using a high-resolution, multi-beam sonar system, revealed that the earthquake had made a considerable impact on the topography of the seabed. 1,500-metre-high (5,000 ft) thrust ridges created by previous geologic activity along the fault had collapsed, generating landslides several kilometres wide. One such landslide consisted of a single block of rock some 100 m (330 ft) high and 2 km (1.2 mi) long. The momentum of the water displaced by tectonic uplift had also dragged massive slabs of rock, each weighing millions of tonnes, as far as 10 km (6 mi) across the seabed. An oceanic trench several kilometres wide was exposed in the earthquake zone. The TOPEX/Poseidon and Jason-1 satellites happened to pass over the tsunami as it was crossing the ocean. These satellites carry radars that measure precisely the height of the water surface; anomalies in the order of 500 mm (20 in) were measured. Measurements from these satellites may prove invaluable for the understanding of the earthquake and tsunami. Unlike data from tide gauges installed on shores, measurements obtained in the middle of the ocean can be used for computing the parameters of the source earthquake without having to compensate for the complex ways in which proximity to the coast changes the size and shape of a wave. Before the 2004 quake there were three arguments against a large earthquake occurring the Sumatra region. After the quake it was considered that earthquake hazard risk would need to be reassessed for regions previously thought to have low risk based on these criteria: The subducting plate at the location of the 2004 quake is older and more dense. Before the 2004 earthquake it was thought that only the subduction of young and buoyant crust could product giant earthquakes. Slow plate motion. Previously it was thought that the convergence rate had to be fast. Before the 2004 quake it was thought that giant earthquakes only occurred in regions without back-arc basins .Great earthquakes, such as the 2004 Indian Ocean earthquake, are associated with megathrust events in subduction zones. Their seismic moments can account for a significant fraction of the global seismic moment across century-scale periods. Of all the moment released by earthquakes in the 100 years from 1906 through 2005, roughly one eighth was due to the 2004 Indian Ocean earthquake. This quake, together with the Great Alaskan earthquake (1964) and the Great Chilean earthquake (1960), account for almost half of the total moment. Since 1900, the only earthquakes recorded with a greater magnitude were the 1960 Valdivia earthquake (magnitude 9.5) and the 1964 Alaska earthquake in Prince William Sound (magnitude 9.2). The only other recorded earthquakes of magnitude 9.0 or greater were off Kamchatka , Russia, on 5 November 1952 (magnitude 9.0) and Tōhoku, Japan (magnitude 9.1) in March 2011 . Each of these megathrust earthquakes also spawned tsunamis in the Pacific Ocean. In comparison to the 2004 Indian Ocean earthquake, the death toll from these earthquakes and tsunamis was significantly lower, primarily because of the lower population density along the coasts near affected areas. Comparisons with earlier earthquakes are difficult, as earthquake strength were not measured systematically until the 1930s. However, historical earthquake strength can sometimes be estimated by examining historical descriptions of the damage caused, and the geological records of the areas where they occurred. Some examples of significant historical megathrust earthquakes are the 1868 Arica earthquake in Peru and the 1700 Cascadia earthquake in western North America.The 2004 Indian Ocean earthquake was unusually large in geographical and geological extent. An estimated 1,600 km (1,000 mi) of fault surface slipped (or ruptured) about 15 m (50 ft) along the subduction zone where the Indian Plate slides under (or subducts) the overriding Burma Plate. The slip did not happen instantaneously but took place in two phases over several minutes: Seismographic and acoustic data indicate that the first phase involved a rupture about 400 km (250 mi) long and 100 km (60 mi) wide, 30 km (19 mi) beneath the sea bed—the largest rupture ever known to have been caused by an earthquake. The rupture proceeded at about 2.8 km/s (1.74 mi/s; 10,100 km/h; 6,260 mph) , beginning off the coast of Aceh and proceeding north-westerly over about 100 seconds. After a pause of about another 100 seconds, the rupture continued northwards towards the Andaman and Nicobar Islands . The northern rupture occurred more slowly than in the south, at about 2.1 km/s (1.3 mi/s; 7,600 km/h; 4,700 mph) , continuing north for another five minutes to a plate boundary where the fault type changes from subduction to strike-slip (the two plates slide past one another in opposite directions). The Indian Plate is part of the Indo-Australian Plate , which underlies the Indian Ocean and Bay of Bengal , and is moving north-east at an average of 60 mm/a (0.075 in/Ms) . The India Plate meets the Burma Plate (which is considered a portion of the great Eurasian Plate ) at the Sunda Trench . At this point, the India Plate subducts beneath the Burma Plate, which carries the Nicobar Islands, the Andaman Islands, and northern Sumatra. The India Plate sinks deeper and deeper beneath the Burma Plate until the increasing temperature and pressure drive volatiles out of the subducting plate. These volatiles rise into the overlying plate, causing partial melting and the formation of magma. The rising magma intrudes into the crust above and exits the Earth's crust through volcanoes in the form of a volcanic arc . The volcanic activity that results as the Indo-Australian Plate subducts the Eurasian Plate has created the Sunda Arc . As well as the sideways movement between the plates, the 2004 Indian Ocean earthquake resulted in a rise of the seafloor by several metres, displacing an estimated 30 km 3 (7.2 cu mi) of water and triggering devastating tsunami waves. The waves radiated outwards along the entire 1,600 km (1,000 mi) length of the rupture (acting as a line source ). This greatly increased the geographical area over which the waves were observed, reaching as far as Mexico, Chile, and the Arctic. The raising of the seafloor significantly reduced the capacity of the Indian Ocean, producing a permanent rise in the global sea level by an estimated 0.1 mm (0.004 in) . Numerous aftershocks were reported off the Andaman Islands , the Nicobar Islands and the region of the original epicentre in the hours and days that followed. The magnitude 8.6 2005 Nias–Simeulue earthquake , which originated off the coast of the Sumatran island of Nias , is not considered an aftershock, despite its proximity to the epicentre, and was most likely triggered by stress changes associated with the 2004 event. The earthquake produced its own aftershocks (some registering a magnitude of as high as 6.9 ) and presently ranks as the third-largest earthquake ever recorded on the moment magnitude or Richter magnitude scale. Other aftershocks of up to magnitude 7.2 continued to shake the region daily for three or four months. As well as continuing aftershocks, the energy released by the original earthquake continued to make its presence felt well after the event. A week after the earthquake, its reverberations could still be measured, providing valuable scientific data about the Earth's interior. The 2004 Indian Ocean earthquake came just three days after a magnitude 8.1 earthquake in the sub-antarctic Auckland Islands , an uninhabited region west of New Zealand, and Macquarie Island to Australia's north. This is unusual since earthquakes of magnitude eight or more occur only about once per year on average. The U.S. Geological Survey sees no evidence of a causal relationship between these events. The 2004 Indian Ocean earthquake is thought to have triggered activity in both Leuser Mountain and Mount Talang , volcanoes in Aceh along the same range of peaks, while the 2005 Nias–Simeulue earthquake sparked activity in Lake Toba , a massive caldera in Sumatra. The energy released on the Earth's surface ( M e , the energy magnitude, which is the seismic potential for damage ) by the 2004 Indian Ocean earthquake was estimated at 1.1 × 10 17 joules (110 PJ ; 26 Mt ) . This energy is equivalent to over 1,500 times that of the Hiroshima atomic bomb , but less than that of Tsar Bomba , the largest nuclear weapon ever detonated. The earthquake generated a seismic oscillation of the Earth's surface of up to 200–300 mm (8–12 in) , equivalent to the effect of the tidal forces caused by the Sun and Moon. The seismic waves of the earthquake were felt across the planet, as far away as the U.S. state of Oklahoma , where vertical movements of 3 mm (0.12 in) were recorded. By February 2005, the earthquake's effects were still detectable as a 20 μm (0.02 mm; 0.0008 in) complex harmonic oscillation of the Earth's surface, which gradually diminished and merged with the incessant free oscillation of the Earth more than four months after the earthquake. Because of its enormous energy release and shallow rupture depth, the earthquake generated remarkable seismic ground motions around the globe, particularly due to huge Rayleigh (surface) elastic waves that exceeded 10 mm (0.4 in) in vertical amplitude everywhere on Earth. The record section plot displays vertical displacements of the Earth's surface recorded by seismometers from the IRIS/USGS Global Seismographic Network plotted with respect to time (since the earthquake initiation) on the horizontal axis, and vertical displacements of the Earth on the vertical axis (note the 1 cm scale bar at the bottom for scale). The seismograms are arranged vertically by distance from the epicentre in degrees. The earliest, lower amplitude signal is that of the compressional (P) wave , which takes about 22 minutes to reach the other side of the planet (the antipode ; in this case near Ecuador). The largest amplitude signals are seismic surface waves that reach the antipode after about 100 minutes. The surface waves can be clearly seen to reinforce near the antipode (with the closest seismic stations in Ecuador), and to subsequently encircle the planet to return to the epicentral region after about 200 minutes. A major aftershock (magnitude 7.1) can be seen at the closest stations starting just after the 200-minute mark. The aftershock would be considered a major earthquake under ordinary circumstances but is dwarfed by the mainshock. The shift of mass and the massive release of energy slightly altered the Earth's rotation. Weeks after the earthquake, theoretical models suggested the earthquake shortened the length of a day by 2.68 microseconds , due to a decrease in the oblateness of the Earth. It also caused the Earth to minutely "wobble" on its axis by up to 25 mm (1 in) in the direction of 145° east longitude , or perhaps by up to 50 or 60 mm (2.0 or 2.4 in) . Because of tidal effects of the Moon, the length of a day increases at an average of 15 microseconds per year, so any rotational change due to the earthquake will be lost quickly. Similarly, the natural Chandler wobble of the Earth, which in some cases can be up to 15 m (50 ft) , eventually offset the minor wobble produced by the earthquake. There was 10 m (33 ft) movement laterally and 4–5 m (13–16 ft) vertically along the fault line. Early speculation was that some of the smaller islands south-west of Sumatra, which is on the Burma Plate (the southern regions are on the Sunda Plate ), might have moved south-west by up to 36 m (120 ft) , but more accurate data released more than a month after the earthquake found the movement to be about 0.2 m (8 in) . Since movement was vertical as well as lateral, some coastal areas may have been moved to below sea level. The Andaman and Nicobar Islands appear to have shifted south-west by around 1.25 m (4 ft 1 in) and to have sunk by 1 m (3 ft 3 in) . In February 2005, the Royal Navy vessel HMS Scott surveyed the seabed around the earthquake zone, which varies in depth between 1,000 and 5,000 m (550 and 2,730 fathoms; 3,300 and 16,400 ft) . The survey, conducted using a high-resolution, multi-beam sonar system, revealed that the earthquake had made a considerable impact on the topography of the seabed. 1,500-metre-high (5,000 ft) thrust ridges created by previous geologic activity along the fault had collapsed, generating landslides several kilometres wide. One such landslide consisted of a single block of rock some 100 m (330 ft) high and 2 km (1.2 mi) long. The momentum of the water displaced by tectonic uplift had also dragged massive slabs of rock, each weighing millions of tonnes, as far as 10 km (6 mi) across the seabed. An oceanic trench several kilometres wide was exposed in the earthquake zone. The TOPEX/Poseidon and Jason-1 satellites happened to pass over the tsunami as it was crossing the ocean. These satellites carry radars that measure precisely the height of the water surface; anomalies in the order of 500 mm (20 in) were measured. Measurements from these satellites may prove invaluable for the understanding of the earthquake and tsunami. Unlike data from tide gauges installed on shores, measurements obtained in the middle of the ocean can be used for computing the parameters of the source earthquake without having to compensate for the complex ways in which proximity to the coast changes the size and shape of a wave.Before the 2004 quake there were three arguments against a large earthquake occurring the Sumatra region. After the quake it was considered that earthquake hazard risk would need to be reassessed for regions previously thought to have low risk based on these criteria: The subducting plate at the location of the 2004 quake is older and more dense. Before the 2004 earthquake it was thought that only the subduction of young and buoyant crust could product giant earthquakes. Slow plate motion. Previously it was thought that the convergence rate had to be fast. Before the 2004 quake it was thought that giant earthquakes only occurred in regions without back-arc basins .The sudden vertical rise of the seabed by several metres during the earthquake displaced massive volumes of water, resulting in a tsunami that struck the coasts of the Indian Ocean. A tsunami that causes damage far away from its source is sometimes called a teletsunami and is much more likely to be produced by the vertical motion of the seabed than by horizontal motion. The tsunami, like all others, behaved differently in deep water than in shallow water. In deep ocean water, tsunami waves form only a low, broad hump, barely noticeable and harmless, which generally travels at high speed of 500 to 1,000 km/h (310 to 620 mph) ; in shallow water near coastlines, a tsunami slows down to only tens of kilometres per hour but, in doing so, forms large destructive waves. Scientists investigating the damage in Aceh found evidence that the wave reached a height of 24 m (80 ft) when coming ashore along large stretches of the coastline, rising to 30 m (100 ft) in some areas when travelling inland. Radar satellites recorded the heights of tsunami waves in deep water: maximum height was at 600 mm (2 ft) two hours after the earthquake, the first such observations ever made. According to Tad Murty , vice-president of the Tsunami Society, the total energy of the tsunami waves was equivalent to about 5 megatons of TNT (21 PJ ) , which is more than twice the total explosive energy used during all of World War II (including the two atomic bombs) but still a couple of orders of magnitude less than the energy released in the earthquake itself. In many places, the waves reached as far as 2 km (1.2 mi) inland. Because the 1,600 km (1,000 mi) fault affected by the earthquake was in a nearly north–south orientation, the greatest strength of the tsunami waves was in an east–west direction. Bangladesh , which lies at the northern end of the Bay of Bengal , had few casualties despite being a low-lying country relatively near the epicentre. It also benefited from the fact that the earthquake proceeded more slowly in the northern rupture zone, greatly reducing the energy of the water displacements in that region. Coasts that have a landmass between them and the tsunami's location of origin are usually safe; however, tsunami waves can sometimes diffract around such landmasses. Thus, the state of Kerala was hit by the tsunami despite being on the western coast of India, and the western coast of Sri Lanka suffered substantial impacts. Distance alone was no guarantee of safety, as Somalia was hit harder than Bangladesh despite being much farther away. Because of the distances involved, the tsunami took anywhere from fifteen minutes to seven hours to reach the coastlines. The northern regions of the Indonesian island of Sumatra were hit quickly, while Sri Lanka and the east coast of India were hit roughly 90 minutes to two hours later. Thailand was struck about two hours later despite being closer to the epicentre because the tsunami travelled more slowly in the shallow Andaman Sea off its western coast. The tsunami was noticed as far as Struisbaai in South Africa, about 8,500 km (5,300 mi) away, where a 1.5-metre-high (5 ft) tide surged on shore about 16 hours after the earthquake. It took a relatively long time to reach Struisbaai at the southernmost point of Africa, probably because of the broad continental shelf off South Africa and because the tsunami would have followed the South African coast from east to west. The tsunami also reached Antarctica, where tidal gauges at Japan's Showa Base recorded oscillations of up to a metre ( 3 ft 3 in ), with disturbances lasting a couple of days. Some of the tsunami's energy escaped into the Pacific Ocean, where it produced small but measurable tsunamis along the western coasts of North and South America, typically around 200 to 400 mm (7.9 to 15.7 in) . At Manzanillo , Mexico, a 2.6 m (8.5 ft) crest-to-trough tsunami was measured. As well, the tsunami was large enough to be detected in Vancouver , which puzzled many scientists, as the tsunamis measured in some parts of South America were larger than those measured in some parts of the Indian Ocean. It has been theorized that the tsunamis were focused and directed at long ranges by the mid-ocean ridges which run along the margins of the continental plates. Despite a delay of up to several hours between the earthquake and the impact of the tsunami, nearly all of the victims were taken by surprise. There were no tsunami warning systems in the Indian Ocean to detect tsunamis or to warn the general population living around the ocean. Tsunami detection is not easy because while a tsunami is in deep water, it has little height and a network of sensors is needed to detect it. Tsunamis are more frequent in the Pacific Ocean than in other oceans because of earthquakes in the " Ring of Fire ". Although the extreme western edge of the Ring of Fire extends into the Indian Ocean (the point where the earthquake struck), no warning system exists in that ocean. Tsunamis there are relatively rare despite earthquakes being relatively frequent in Indonesia. The last major tsunami was caused by the 1883 eruption of Krakatoa . Not every earthquake produces large tsunamis: on 28 March 2005, a magnitude 8.7 earthquake hit roughly the same area of the Indian Ocean but did not result in a major tsunami. The first warning sign of a possible tsunami is the earthquake itself. However, tsunamis can strike thousands of kilometres away where the earthquake is felt only weakly or not at all. Also, in the minutes preceding a tsunami strike, the sea sometimes recedes temporarily from the coast, which was observed on the eastern earthquake rupture zone such as the coastlines of Aceh, Phuket island, and Khao Lak area in Thailand, Penang island of Malaysia, and the Andaman and Nicobar islands . This rare sight reportedly induced people, especially children, to visit the coast to investigate and collect stranded fish on as much as 2.5 km (1.6 mi) of exposed beach, with fatal results. However, not all tsunamis cause this "disappearing sea" effect. In some cases, there are no warning signs at all: the sea will suddenly swell without retreating, surprising many people and giving them little time to flee. One of the few coastal areas to evacuate ahead of the tsunami was on the Indonesian island of Simeulue , close to the epicentre. Island folklore recounted an earthquake and tsunami in 1907 , and the islanders fled to inland hills after the initial shaking and before the tsunami struck. These tales and oral folklore from previous generations may have helped the survival of the inhabitants. On Maikhao Beach in north Phuket City , Thailand, a 10-year-old British tourist named Tilly Smith had studied tsunamis in geography at school and recognised the warning signs of the receding ocean and frothing bubbles. She and her parents warned others on the beach, which was evacuated safely. John Chroston , a biology teacher from Scotland, also recognised the signs at Kamala Bay north of Phuket, taking a busload of vacationers and locals to safety on higher ground. Anthropologists had initially expected the aboriginal population of the Andaman Islands to be badly affected by the tsunami and even feared the already depopulated Onge tribe could have been wiped out. Many of the aboriginal tribes evacuated and suffered fewer casualties, however. Oral traditions developed from previous earthquakes helped the aboriginal tribes escape the tsunami. For example, the folklore of the Onges talks of "huge shaking of ground followed by high wall of water". Almost all of the Onge people seemed to have survived the tsunami. The tsunami devastated the coastline of Aceh province, about 20 minutes after the earthquake. Banda Aceh , the closest major city, suffered severe casualties. The sea receded and exposed the seabed, prompting locals to collect stranded fish and explore the area. Local eyewitnesses described three large waves, with the first wave rising gently to the foundation of the buildings, followed minutes later by a sudden withdrawal of the sea near the port of Ulèë Lheue . This was succeeded by the appearance of two large black-coloured steep waves which then travelled inland into the capital city as a large turbulent bore. Eyewitnesses described the tsunami as a "black giant", "mountain" and a "wall of water". Video footage revealed torrents of black water, surging by windows of a two-story residential area situated about 3.2 km (2.0 mi) inland. Additionally, amateur footage recorded in the middle of the city captured an approaching black surge flowing down the city streets, full of debris, inundating them. The level of destruction was extreme on the northwestern areas of the city, immediately inland of the aquaculture ponds, and directly facing the Indian Ocean. The tsunami height was reduced from 12 m (39 ft) at Ulee Lheue to 6 m (20 ft) a further 8 km (5.0 mi) to the north-east. The inundation was observed to extend 3–4 km (1.9–2.5 mi) inland throughout the city. Within 2–3 km (1.2–1.9 mi) of the shoreline, houses, except for strongly-built reinforced concrete ones with brick walls, which seemed to have been partially damaged by the earthquake before the tsunami attack, were swept away or destroyed by the tsunami. The area toward the sea was wiped clean of nearly every structure, while closer to the river, dense construction in a commercial district showed the effects of severe flooding. The flow depth at the city was just at the level of the second floor, and there were large amounts of debris piled along the streets and in the ground-floor storefronts. In the seaside section of Ulee Lheue, the flow depths were over 9 m (30 ft) . Footage showed evidence of back-flowing of the Aceh River , carrying debris and people from destroyed villages at the coast and transporting them up to 40 km (25 mi) inland. A group of small islands: Weh, Breueh, Nasi, Teunom, Bunta, Lumpat, and Batee lie just north of the capital city. The tsunami reached a run-up of 10–20 m (33–66 ft) on the western shorelines of Breueh Island and Nasi Island. Coastal villages were destroyed by the waves. On the island of Pulau Weh , strong surges were experienced in the port of Sabang , yet there was little damage with reported runup values of 3–5 m (9.8–16.4 ft) , most likely due to the island being sheltered from the direct attack by the islands to the south-west. Lhoknga is a small coastal community about 13 km (8.1 mi) south-west of Banda Aceh, located on a flat coastal plain in between two rainforest -covered hills, overlooking a large bay and famous for its large swathe of white sandy beach and surfing activities. The locals reported 10 to 12 waves, with the second and third being the highest and most destructive. Interviews with the locals revealed that the sea temporarily receded and exposed coral reefs . In the distant horizon, gigantic black waves about 30 m (98 ft) high made explosion-like sounds as they broke and approached the shore. The first wave came rapidly landward from the south-west as a turbulent bore about 0.5–2.5 m (1.6–8.2 ft) high. The second and third waves were 15–30 m (49–98 ft) high at the coast and appeared like gigantic surfing waves but "taller than the coconut trees and was like a mountain". The second wave was the largest; it came from the west-southwest within five minutes of the first wave. The tsunami stranded cargo ships, barges and destroyed a cement mining facility near the Lampuuk coast, where it reached the fourth level of the building. Meulaboh , a remote coastal city, was among the hardest hit by the tsunami. The waves arrived after the sea receded about 500 m (1,600 ft) , followed by an advancing small tsunami. The second and third destructive waves arrived later, which exceeded the height of the coconut trees. The inundation distance is about 5 km (3.1 mi) . Other towns on Aceh's west coast hit by the disaster included Leupung , Lhokruet, Lamno, Patek, Calang , and Teunom. Affected or destroyed towns on the region's north and east coast were Pidie Regency, Samalanga, Panteraja, and Lhokseumawe. The high fatality rate in the area was mainly due to lack of preparation of the community towards a tsunami and limited knowledge and education among the population regarding the natural phenomenon. Helicopter surveys revealed entire settlements virtually destroyed, with destruction extending miles inland. Only a few mosques remained standing. The greatest run-up height of the tsunami was measured at a hill between Lhoknga and Leupung, on the western coast of the northern tip of Sumatra, near Banda Aceh, and reached 51 m (167 ft) . The tsunami heights in Sumatra: 15–30 m (49–98 ft) on the west coast of Aceh 6–12 m (20–39 ft) on the Banda Aceh coast 6 m (20 ft) on the Krueng Raya coast 5 m (16 ft) on the Sigli coast 3–6 m (9.8–19.7 ft) on the north coast of Weh Island directly facing the tsunami source 3 m (9.8 ft) on the opposite side of the coast of Weh Island facing the tsunami The island country of Sri Lanka, located about 1,700 km (1,100 mi) from Sumatra, was ravaged by the tsunami around 2 hours after the earthquake. The tsunami first struck the eastern coastline and subsequently refracted around the southern point of Sri Lanka (Dondra Head). The refracted tsunami waves then inundated the southwestern part of Sri Lanka after some of its energy was reflected from impact with the Maldives. In Sri Lanka, the civilian casualties were second only to those in Indonesia, with approximately 35,000 killed. The eastern shores of Sri Lanka were the hardest hit since it faced the epicentre of the earthquake, while the southwestern shores were hit later, but the death toll was just as severe. The southwestern shores are a hotspot for tourists and fishing. The degradation of the natural environment in Sri Lanka contributed to the high death tolls. Approximately 90,000 buildings and many wooden houses were destroyed. The tsunami arrived on the island as a small brown-orange-coloured flood. Moments later, the ocean floor was exposed as much as 1 km (0.62 mi) in places, which was followed by massive second and third waves. Amateur video recorded at the city of Galle showed a large deluge flooding the city, carrying debris and sweeping away people while in the coastal resort town of Beruwala , the tsunami appeared as a huge brown-orange-coloured bore which reached the first level of a hotel, causing destruction and taking people unaware. Other videos recorded showed that the tsunami appeared like a flood raging inland. The construction of seawalls and breakwaters reduced the power of waves at some locations. The largest run-up measured was at 12.5 m (41 ft) with inundation distance of 390–1,500 m (1,280–4,920 ft) in Yala . In Hambantota , run-ups measured 11 m (36 ft) with the greatest inundation distance of 2 km (1.2 mi) . Run-up measurements along the Sri Lankan coasts are at 2.4–4.11 m (7 ft 10 in – 13 ft 6 in) . Waves measured on the east coast ranged from 4.5–9 m (15–30 ft) at Pottuvill to Batticaloa at 2.6–5 m (8 ft 6 in – 16 ft 5 in) in the north-east around Trincomalee and 4–5 m (13–16 ft) in the west coast from Moratuwa to Ambalangoda. Sri Lanka tsunami height survey: 9 m (30 ft) at Koggala 6 m (20 ft) at Galle port 4.8 m (16 ft) around the Galle coast 8.7 m (29 ft) at Nonagama 4.9 m (16 ft) at Weligama 4 m (13 ft) at Dodundawa 4.7 m (15 ft) at Ambalangoda 4.7 m (15 ft) at Hikkaduwa Fishery Harbour 10 m (33 ft) at Kahawa 4.8 m (16 ft) at North Beach of Beruwala 6 m (20 ft) at Paiyagala A regular passenger train operating between Maradana and Matara was derailed and overturned by the tsunami and claimed at least 1,700 lives, the largest single rail disaster death toll in history. Estimates based on the state of the shoreline and a high-water mark on a nearby building place the tsunami 7.5–9 m (25–30 ft) above sea level and 2–3 m (6 ft 7 in – 9 ft 10 in) higher than the top of the train. The tsunami travelled eastward through the Andaman Sea and hit the south-western coasts of Thailand , about 2 hours after the earthquake. Located about 500 km (310 mi) from the epicentre, at the time, the region was popular with tourists because of Christmas. Many of these tourists were caught off-guard by the tsunami, as they had no prior warning. The tsunami hit during high tide . Major locations damaged included the western shores of Phuket island, the resort town of Khao Lak in Phang Nga Province, the coastal provinces of Krabi , Satun , Ranong and Trang and small offshore islands like Ko Racha Yai, the Phi Phi islands, the Surin Islands and the Similan archipelago . Approximately 8,000 people were killed. Thailand experienced the second largest tsunami run-up. The tsunami heights recorded: 6–10 m (20–33 ft) in Khao Lak 3–6 m (9.8–19.7 ft) along the west coast of Phuket island 3 m (9.8 ft) along the south coast of Phuket island 2 m (6 ft 7 in) along the east coast of Phuket island 4–6 m (13–20 ft) on the Phi Phi Islands 19.6 m (64 ft) at Ban Thung Dap 5 m (16 ft) at Ramson 6.8 m (22 ft) at Ban Thale Nok 5 m (16 ft) at Hat Praphat (Ranong Coastal Resources Research Station) 6.3 m (21 ft) at Thai Mueang District 6.8 m (22 ft) at Rai Dan The province of Phang Nga was the most affected area in Thailand . The quiet resort town of Khao Lak is located on a stretch of golden sandy beach, famed for its hotels overlooking the Andaman Sea and hilly rainforests . A video, taken by a local restaurant manager from a hill adjacent to the beach, showed that the tsunami's arrival was preceded by a sudden retreat of the sea exposing the seafloor. Many tourists and locals can be seen trying to gather fish. Moments later, the tsunami arrives as a wall of foaming water that slams into the coast, washing away numerous people who had no time to escape. Another amateur video, captured by a German family at beach level, showed the tsunami appearing as a white horizontal line in the distant horizon, gradually becoming bigger (bore-like), engulfing a jet skier and lifting two police boats. A maximum inundation of approximately 2 km (1.2 mi) was measured, the inundated depths were 4–7 m (13–23 ft) and there was evidence that the tsunami reached the third floor of a resort hotel. The tsunami in Khao Lak was bigger due to offshore coral reefs and shallow seafloor which caused the tsunami to pile-up. This was similar to eyewitness accounts of the tsunami at Banda Aceh . Khao Lak also experienced the largest tsunami run-up height outside of Sumatra . [ page needed ] . The highest-recorded tsunami run-up was measured 19.6 m (64 ft) at Ban Thung Dap, on the south-west tip of Ko Phra Thong Island and the second-highest at 15.8 m (52 ft) at Ban Nam Kim. Moreover, the largest death toll occurred at Khao Lak, with about 5,000 people killed. In addition, the tsunami inflicted damage to the popular resort town of Ao Nang in Krabi Province. Video footage showed that the tsunami appeared as multiple white surfs violently lifting up yachts, boats and crashing onto beaches. Footage captured at Koh Lanta showed a wall of water swamping the beach, while another video taken at another location showed a large surfing wave like tsunami approaching the shore, lifting up a yacht and flooding the beach. At Koh Sriboya, the tsunami advanced inland as a turbulent medium bore, while at Koh Phayam, Ranong Province , the tsunami appeared as a wall of water. At Phuket Province , the island province's western beaches were struck by the tsunami. At Patong Beach , a popular tourist destination, the tsunami first arrived as a small flood, which swept away cars and surprised people. About 10 minutes later, the sea receded for a while before the tsunami arrived again as a large wall of water looming over the skyline and flooding the coast. Another video from Kamala Beach showed the tsunami flooding the ground floor of a restaurant sweeping away an elderly couple. On Karon Beach , Kamala Beach and Kata Beach , the tsunami came in like a surging flood inland carrying people and cars. On some locations, a coastal road was built which was higher than the shore, protecting a hotel which was behind it. On the east coast of Phuket Island, the tsunami height was about 2 m. In one river mouth, many boats were damaged. The tsunami moved counter-clockwise around Phuket Island, as was the case at Okushiri Island in the 1993 Hokkaido earthquake . According to interviews, the second wave was the largest. The tsunami heights were 5–6 m (16–20 ft) and the inundated depth was about 2 m (6.6 ft) . The tsunami surprised many tourists at Koh Racha Yai, where it flooded the resorts. About 250 people perished directly in the tsunami. The Phi Phi Islands are a group of small islands that were affected by the tsunami. The north bay of Phi Phi Don Island opens to the north-west in the direction of the tsunami. The measured tsunami height on this beach was 5.8 m (19 ft) . According to eyewitness accounts, the tsunami came from the north and south. The ground level was about 2 m above sea level, where there were many cottages and hotels. The south bay opens to the south-east and faces in the opposite direction from the tsunami. Furthermore, Phi Phi Le Island shields the port of Phi Phi Don Island. The measured tsunami height was 4.6 m (15 ft) in the port. Amateur camcorder footage taken by Israeli tourists showed the tsunami advancing inland suddenly as a small flood, gradually becoming more powerful and engulfing the whole beach and resort, with the tsunami carrying a yacht out to sea. Moreover, the tsunami was detected by scuba divers around offshore islands like the Similan Islands and the Surin Islands . The divers reported being caught in a violent, swirling current suddenly while underwater. Local camcorder footage showed the tsunami surging inland and flooding camping equipment at the Similan Islands while the tsunami caught tourists unaware at the Surin Islands, and dragging them out towards the sea. The tsunami reached the states of Andhra Pradesh and Tamil Nadu along the southeastern coastline of the Indian mainland about 2 hours after the earthquake. At the same time, it arrived in the state of Kerala , on the southwestern coast. There were two to five tsunamis that coincided with the local high tide in some areas. The tsunami runup height measured in mainland India by Ministry of Home Affairs includes: 3.4 m (11 ft) at Kerala, inundation distance of 0.5–1.5 km (0.31–0.93 mi) with 250 km (160 mi) of coastline affected 4.5 m (15 ft) at the southern coastline of Tamil Nadu, inundation distance of 0.2–2 km (0.12–1.24 mi) with 100 km (62 mi) of coastline affected 5 m (16 ft) at the eastern coastline of Tamil Nadu facing tsunami source, inundation distance of 0.4–1.5 km (0.25–0.93 mi) with 800 km (500 mi) of coastline affected 4 m (13 ft) at Pondicherry, inundation distance of 0.2–2 km (0.12–1.24 mi) with 25 km (16 mi) of coastline affected 2.2 m (7.2 ft) at Andhra Pradesh, inundation distance of 0.2–1 km (0.12–0.62 mi) with 985 km (612 mi) of coastline affected Along the coast of Tamil Nadu , the 13 km (8.1 mi) Marina Beach in Chennai was battered by the tsunami which swept across the beach taking morning walkers unaware. Amateur video recorded taken at a resort beach showed the tsunami arriving as a large wall of water as it approached the coast and flooding it as it advanced inland. Besides that, a 10 m (33 ft) black muddy tsunami ravaged the city of Karaikal, where 492 people died. The city of Pondicherry, protected by seawalls was relatively unscathed. Local video recorded that before the arrival of the tsunami, people can be seen swarming the beach to check on stranded fish from the exposed beach. Furthermore, at the coastal town of Kanyakumari , the seabed was exposed briefly before a large wall of water can be seen on the horizon and subsequently flooding the town. Other footage showed the tsunami dramatically crashed into the Vivekananda Rock Memorial . The worst affected area in Tamil Nadu was Nagapattinam district , with 6,051 fatalities caused by a 5 m (16 ft) tsunami, followed by Cuddalore district , with many villages destroyed. Most of the people killed were members of the fishing community. Velankanni a sea shore town with a Catholic Basilica and a popular pilgrimage destination was also one of the worst hit by this tsunami that struck at around 9.30 am on that Sunday, when pilgrims who were mostly from Kerala among others were inside the church attending the Malayalam Mass . The rising sea water did not enter the shrine, but the receding waters swept away hundreds of pilgrims who were on the beach. The shrine's compound, nearby villages, hundreds of shops, homes and pilgrims were washed away into the sea. About 600 pilgrims died. Rescue teams extricated more than 400 bodies from the sand and rocks in the vicinity and large number of unidentified bodies were buried in mass graves. The state of Kerala experienced tsunami-related damage in three southern densely populated districts, Ernakulam , Alappuzha , and Kollam, due to diffraction of the waves around Sri Lanka. The southernmost district of Thiruvananthapuram , however, escaped damage, possibly due to the wide turn of the diffracted waves at the peninsular tip. Major damage occurred in two narrow strips of land bound on the west by the Arabian Sea and on the east by the Kerala backwaters . The waves receded before the first tsunami with the highest fatality reported from the densely populated Alappad panchayat (including the villages of Cheriya Azhikkal and Azhikkal) at Kollam district, caused by a 4 m (13 ft) tsunami. A video recorded by locals showed the tsunami flooding the beach and villages, causing despair amongst the villagers. Many villages in the state of Andhra Pradesh were destroyed. In the Krishna district, the tsunami created havoc in Manginapudi and on Machalipattanam Beach. The most affected was Prakasham District, recording 35 deaths, with maximum damage at Singraikonda. Given the enormous power of the tsunami, the fishing industry suffered the greatest. Moreover, the cost of damage in the transport sector was reported in the tens of thousands. The tsunami run-up was only 1.6 m (5.2 ft) in areas in the state of Tamil Nadu shielded by the island of Sri Lanka but was 4–5 m (13–16 ft) in coastal districts such as Nagapattinam in Tamil Nadu directly across from Sumatra . On the western coast, the runup elevations were 4.5 m (15 ft) at Kanyakumari District in Tamil Nadu and 3.4 m (11 ft) each at Kollam and Ernakulam districts in Kerala . The time between the waves ranged from about 15 minutes to 90 minutes. The tsunami varied in height from 2 m (6.6 ft) to 10 m (33 ft) based on survivors' accounts. The tsunami travelled 2.5 km (1.6 mi) at its maximum inland at Karaikal , Puducherry . The inundation distance varied between 1,006–500 m (3,301–1,640 ft) in most areas, except at river mouths, where it was more than 1 km (0.62 mi) . Areas with dense coconut groves or mangroves had much smaller inundation distances, and those with river mouths or backwaters saw larger inundation distances. [ citation needed ] Presence of seawalls at the Kerala and Tamil Nadu coasts reduced the impact of the waves. However, when the seawalls were made of loose stones, the stones were displaced and carried a few metres inland. Due to close proximity to the earthquake, the tsunami took just minutes to devastate the Andaman and Nicobar Islands . The Andaman Islands were moderately affected while the island of Little Andaman and the Nicobar Islands were severely affected by the tsunami. In South Andaman island, based on local eyewitnesses, there were three tsunami waves, with the third being the most destructive. Flooding occurred at the coast and low-lying areas inland, which were connected to open sea through creeks. Inundation was observed, along the east coast of South Andaman Island, restricted to Chidiyatapu, Burmanallah, Kodiaghat, Beadnabad, Corbyn's cove and Marina Park/Aberdeen Jetty areas. Along the west coast, the inundation was observed around Guptapara, Manjeri, Wandoor, Collinpur and Tirur regions. Several near-shore establishments and numerous infrastructures such as seawalls and a 20 MW diesel-generated power plant at Bamboo Flat were destroyed. At Port Blair , the water receded before the first wave, and the third wave was the tallest and caused the most damage. Results of the tsunami survey in South Andaman along Chiriyatapu, Corbyn's Cove and Wandoor beaches: [ citation needed ] 5 m (16 ft) in maximum tsunami height with a run-up of 4.24 m (13.9 ft) at Chiriyatapu Beach 5.5 m (18 ft) in maximum tsunami height and run-up at Corbyn's Cove Beach 6.6 m (22 ft) in maximum tsunami height and run-up of 4.63 m (15.2 ft) at Wandoor Beach Meanwhile, in the Little Andaman, tsunami waves impinged on the eastern shore about 25 to 30 minutes after the earthquake in a four-wave cycle of which the fourth tsunami was the most devastating with a wave height of about 10 m (33 ft) . The tsunami destroyed settlements at Hut Bay within a range of 1 km (0.62 mi) from the seashore. Run up level up to 3.8 m (12 ft) have been measured. In Malacca, located on the island of Car Nicobar , there were three tsunami waves. The sea was observed to rise suddenly before the onset of the first wave. The first wave came 5 minutes after the earthquake, preceded by a recession of the sea up to 600–700 m (2,000–2,300 ft) . [ citation needed ] . The second and third waves came in 10 minutes intervals after the first wave. The third wave was the strongest, with a maximum tsunami wave height of 11 m (36 ft) . Waves nearly three stories high devastated the Indian Air Force base, located just south of Malacca. The maximum tsunami wave height of 11 m (36 ft) . [ citation needed ] Inundation limit was found to be up to 1.25 km (0.78 mi) inland. The impact of the waves was so severe that four oil tankers were thrown almost 800 m (2,600 ft) from the seashore near Malacca to the Air force colony main gate. In Chuckchucha and Lapati, the tsunami arrived in a three-wave cycle with a maximum tsunami wave height of 12 m (39 ft) . In Campbell Bay of Great Nicobar Island, the tsunami waves hit the area three times with an inundation limit of 250–500 m (820–1,640 ft) . A rise in sea level was observed before the first wave came within 5 minutes of the earthquake. The second and third waves came in 10-minute intervals after the first. The second wave was the strongest. The tsunami waves wreaked havoc in the densely populated Jogindar Nagar area, situated 13 km (8.1 mi) south of Campbell Bay. [ citation needed ] According to local accounts, [ attribution needed ] tsunami waves attacked the area three times. The first wave came five minutes after the mainshock (0629 hrs.) with a marginal drop in sea level. The second wave came 10 minutes after the first one with a maximum height of 4.8 m (16 ft) to 8 m (26 ft) and caused the major destruction. The third wave came within 15 minutes after the second with lower wave height. The maximum inundation limit due to tsunami water was about 500 m (1,600 ft) . The worst affected island in the Andaman & Nicobar chain is Katchall Island, with 303 people confirmed dead and 4,354 missing out of a total population of 5,312. The significant shielding of Port Blair and Campbell Bay by steep mountainous outcrops contributed to the relatively low wave heights at these locations, whereas the open terrain along the eastern coast at Malacca and Hut Bay contributed to the great height of the tsunami waves. Reports of tsunami wave height: 1.5 m (4 ft 11 in) at Diglipur and Rangat at North Andaman Island 8 m (26 ft) high at Campbell Bay on Great Nicobar Island 10–12 m (33–39 ft) high at Malacca (in Car Nicobar Island) and at Hut Bay on Little Andaman Island 3 m (9.8 ft) high at Port Blair on South Andaman Island The tsunami severely affected the Maldives at a distance of 2,500 km (1,600 mi) from the epicentre. Similar to Sri Lanka, survivors reported three waves with the second wave being the most powerful. Being rich in coral reefs, the Maldives provides an opportunity for scientists to assess the impact of a tsunami on coral atolls. The significantly lower tsunami impact on the Maldives compared to Sri Lanka is mostly due to the topography and bathymetry of the atoll chain with offshore coral reefs, deep channels separating individual atolls and its arrival within low tide which decreased the power of the tsunami. After the tsunami, there was some concern that the country might be submerged entirely and become uninhabitable. However, this was proven untrue. The highest tsunami wave measured was 4 m (13 ft) at Vilufushi Island . The tsunami arrived approximately 2 hours after the earthquake. The greatest tsunami inundation occurred at North Male Atoll, Male island at 250 m (820 ft) along the streets. Local footage recorded showed the tsunami flooding the streets up to knee level in town, while another video taken at the beach showed the tsunami slowly flooding and gradually surging inland. The Maldives tsunami wave analysis: 1.3–2.4 m (4 ft 3 in – 7 ft 10 in) at North Male Atoll, Male Island 2 m (6 ft 7 in) at North Male Atoll, Huhule Island 1.7–2.8 m (5 ft 7 in – 9 ft 2 in) at South Male Atoll, Embudhu Finothu 2.5–3.3 m (8 ft 2 in – 10 ft 10 in) at Laamu Atoll, Fonadhoo Island 2.2–2.9 m (7 ft 3 in – 9 ft 6 in) at Laamu Atoll, Gan Island 2.3–3 m (7 ft 7 in – 9 ft 10 in) at North Male Atoll, Dhiffushi Island 2.2–2.4 m (7 ft 3 in – 7 ft 10 in) at North Male Atoll, Huraa Island more than 1.5 m (4 ft 11 in) at North Male Atoll, Kuda Huraa Island In Myanmar , the tsunami caused only moderate damage, which arrived between 2 and 5.5 hours after the earthquake. Although the country's western Andaman Sea coastline lies at the proximity of the rupture zone, there were smaller tsunamis than the neighbouring Thai coast, because the main tsunami source did not extend to the Andaman Islands. Another factor is that some coasts of Taninthayi Division were protected by the Myeik Archipelago . Based on scientific surveys from Ayeyarwady Delta through Taninthayi Division, it was revealed that tsunami heights along the Myanmar coast were between 0.4–2.9 m (1 ft 4 in – 9 ft 6 in) . Eyewitnesses compared the tsunami with the "rainy-season high tide"; although at most locations, the tsunami height was similar or smaller than the "rainy-season high tide" level. Tsunami survey heights: [ citation needed ] Interviews with local people indicate that they did not feel the earthquake in Taninthayi Division or Ayeyarwady Delta. The 71 casualties can be attributed to poor housing infrastructure and additionally, the fact that the coastal residents in the surveyed areas live on flat land along the coast, especially in the Ayeyarwady Delta, and that there is no higher ground to which to evacuate. The tsunami heights from the 2004 December earthquake were not more than 3 m (9.8 ft) along the Myanmar coast, the amplitudes were slightly large off the Ayeyarwady Delta, probably because the shallow delta caused a concentration in tsunami energy. The tsunami travelled 5,000 km (3,100 mi) west across the open ocean before striking the East African country of Somalia . Around 289 fatalities were reported in the Horn of Africa , drowned by four tsunami waves. The hardest-hit was a 650 km (400 mi) stretch of the Somalia coastline between Garacad ( Mudug region) and Xaafuun ( Bari region), which forms part of the Puntland province. Most of the victims were reported along the low-lying Xaafuun Peninsula . The Puntland coast in northern Somalia was by far the area hardest hit by the waves to the west of the Indian subcontinent. The waves arrived around noon local time. Consequently, tsunami runup heights vary from 5 m (16 ft) to 9 m (30 ft) with inundation distances varying from 44 m (144 ft) to 704 m (2,310 ft) . The maximum runup height of almost 9 m (30 ft) was recorded in Bandarbeyla. An even higher runup point was measured on a cliff near the town of Eyl, solely on an eyewitness account. The highest death toll was in Hafun , with 19 dead and 160 people presumed missing out of its 5,000 inhabitants. This was the highest number of casualties in a single African town and the largest tsunami death toll in a single town to the west of the Indian subcontinent . In Xaafuun, small drawbacks were observed before the third and most powerful tsunami wave flooded the town. The tsunami also reached Malaysia, mainly on the northern states such as Kedah , Perak and Penang and on offshore islands such as Langkawi island. Peninsular Malaysia was shielded by the full force of the tsunami due to the protection offered by the island of Sumatra, which lies just off the western coast. Bangladesh escaped major damage and deaths because the water displaced by the strike-slip fault was relatively little on the northern section of the rupture zone, which ruptured slowly. In Yemen , the tsunami killed two people with a maximum runup of 2 m (6.6 ft) . The tsunami was detected in the southern parts of east Africa, where rough seas were reported, specifically on the eastern and southern coasts that face the Indian Ocean. A few other African countries also recorded fatalities; one in Kenya, three in Seychelles , ten in Tanzania, and South Africa, where two were killed as a direct result of the tsunami—the furthest from the epicentre. Tidal surges also occurred along the Western Australian coast that lasted for several hours, resulting in boats losing their moorings and two people needing to be rescued. Despite a delay of up to several hours between the earthquake and the impact of the tsunami, nearly all of the victims were taken by surprise. There were no tsunami warning systems in the Indian Ocean to detect tsunamis or to warn the general population living around the ocean. Tsunami detection is not easy because while a tsunami is in deep water, it has little height and a network of sensors is needed to detect it. Tsunamis are more frequent in the Pacific Ocean than in other oceans because of earthquakes in the " Ring of Fire ". Although the extreme western edge of the Ring of Fire extends into the Indian Ocean (the point where the earthquake struck), no warning system exists in that ocean. Tsunamis there are relatively rare despite earthquakes being relatively frequent in Indonesia. The last major tsunami was caused by the 1883 eruption of Krakatoa . Not every earthquake produces large tsunamis: on 28 March 2005, a magnitude 8.7 earthquake hit roughly the same area of the Indian Ocean but did not result in a major tsunami. The first warning sign of a possible tsunami is the earthquake itself. However, tsunamis can strike thousands of kilometres away where the earthquake is felt only weakly or not at all. Also, in the minutes preceding a tsunami strike, the sea sometimes recedes temporarily from the coast, which was observed on the eastern earthquake rupture zone such as the coastlines of Aceh, Phuket island, and Khao Lak area in Thailand, Penang island of Malaysia, and the Andaman and Nicobar islands . This rare sight reportedly induced people, especially children, to visit the coast to investigate and collect stranded fish on as much as 2.5 km (1.6 mi) of exposed beach, with fatal results. However, not all tsunamis cause this "disappearing sea" effect. In some cases, there are no warning signs at all: the sea will suddenly swell without retreating, surprising many people and giving them little time to flee. One of the few coastal areas to evacuate ahead of the tsunami was on the Indonesian island of Simeulue , close to the epicentre. Island folklore recounted an earthquake and tsunami in 1907 , and the islanders fled to inland hills after the initial shaking and before the tsunami struck. These tales and oral folklore from previous generations may have helped the survival of the inhabitants. On Maikhao Beach in north Phuket City , Thailand, a 10-year-old British tourist named Tilly Smith had studied tsunamis in geography at school and recognised the warning signs of the receding ocean and frothing bubbles. She and her parents warned others on the beach, which was evacuated safely. John Chroston , a biology teacher from Scotland, also recognised the signs at Kamala Bay north of Phuket, taking a busload of vacationers and locals to safety on higher ground. Anthropologists had initially expected the aboriginal population of the Andaman Islands to be badly affected by the tsunami and even feared the already depopulated Onge tribe could have been wiped out. Many of the aboriginal tribes evacuated and suffered fewer casualties, however. Oral traditions developed from previous earthquakes helped the aboriginal tribes escape the tsunami. For example, the folklore of the Onges talks of "huge shaking of ground followed by high wall of water". Almost all of the Onge people seemed to have survived the tsunami. The tsunami devastated the coastline of Aceh province, about 20 minutes after the earthquake. Banda Aceh , the closest major city, suffered severe casualties. The sea receded and exposed the seabed, prompting locals to collect stranded fish and explore the area. Local eyewitnesses described three large waves, with the first wave rising gently to the foundation of the buildings, followed minutes later by a sudden withdrawal of the sea near the port of Ulèë Lheue . This was succeeded by the appearance of two large black-coloured steep waves which then travelled inland into the capital city as a large turbulent bore. Eyewitnesses described the tsunami as a "black giant", "mountain" and a "wall of water". Video footage revealed torrents of black water, surging by windows of a two-story residential area situated about 3.2 km (2.0 mi) inland. Additionally, amateur footage recorded in the middle of the city captured an approaching black surge flowing down the city streets, full of debris, inundating them. The level of destruction was extreme on the northwestern areas of the city, immediately inland of the aquaculture ponds, and directly facing the Indian Ocean. The tsunami height was reduced from 12 m (39 ft) at Ulee Lheue to 6 m (20 ft) a further 8 km (5.0 mi) to the north-east. The inundation was observed to extend 3–4 km (1.9–2.5 mi) inland throughout the city. Within 2–3 km (1.2–1.9 mi) of the shoreline, houses, except for strongly-built reinforced concrete ones with brick walls, which seemed to have been partially damaged by the earthquake before the tsunami attack, were swept away or destroyed by the tsunami. The area toward the sea was wiped clean of nearly every structure, while closer to the river, dense construction in a commercial district showed the effects of severe flooding. The flow depth at the city was just at the level of the second floor, and there were large amounts of debris piled along the streets and in the ground-floor storefronts. In the seaside section of Ulee Lheue, the flow depths were over 9 m (30 ft) . Footage showed evidence of back-flowing of the Aceh River , carrying debris and people from destroyed villages at the coast and transporting them up to 40 km (25 mi) inland. A group of small islands: Weh, Breueh, Nasi, Teunom, Bunta, Lumpat, and Batee lie just north of the capital city. The tsunami reached a run-up of 10–20 m (33–66 ft) on the western shorelines of Breueh Island and Nasi Island. Coastal villages were destroyed by the waves. On the island of Pulau Weh , strong surges were experienced in the port of Sabang , yet there was little damage with reported runup values of 3–5 m (9.8–16.4 ft) , most likely due to the island being sheltered from the direct attack by the islands to the south-west. Lhoknga is a small coastal community about 13 km (8.1 mi) south-west of Banda Aceh, located on a flat coastal plain in between two rainforest -covered hills, overlooking a large bay and famous for its large swathe of white sandy beach and surfing activities. The locals reported 10 to 12 waves, with the second and third being the highest and most destructive. Interviews with the locals revealed that the sea temporarily receded and exposed coral reefs . In the distant horizon, gigantic black waves about 30 m (98 ft) high made explosion-like sounds as they broke and approached the shore. The first wave came rapidly landward from the south-west as a turbulent bore about 0.5–2.5 m (1.6–8.2 ft) high. The second and third waves were 15–30 m (49–98 ft) high at the coast and appeared like gigantic surfing waves but "taller than the coconut trees and was like a mountain". The second wave was the largest; it came from the west-southwest within five minutes of the first wave. The tsunami stranded cargo ships, barges and destroyed a cement mining facility near the Lampuuk coast, where it reached the fourth level of the building. Meulaboh , a remote coastal city, was among the hardest hit by the tsunami. The waves arrived after the sea receded about 500 m (1,600 ft) , followed by an advancing small tsunami. The second and third destructive waves arrived later, which exceeded the height of the coconut trees. The inundation distance is about 5 km (3.1 mi) . Other towns on Aceh's west coast hit by the disaster included Leupung , Lhokruet, Lamno, Patek, Calang , and Teunom. Affected or destroyed towns on the region's north and east coast were Pidie Regency, Samalanga, Panteraja, and Lhokseumawe. The high fatality rate in the area was mainly due to lack of preparation of the community towards a tsunami and limited knowledge and education among the population regarding the natural phenomenon. Helicopter surveys revealed entire settlements virtually destroyed, with destruction extending miles inland. Only a few mosques remained standing. The greatest run-up height of the tsunami was measured at a hill between Lhoknga and Leupung, on the western coast of the northern tip of Sumatra, near Banda Aceh, and reached 51 m (167 ft) . The tsunami heights in Sumatra: 15–30 m (49–98 ft) on the west coast of Aceh 6–12 m (20–39 ft) on the Banda Aceh coast 6 m (20 ft) on the Krueng Raya coast 5 m (16 ft) on the Sigli coast 3–6 m (9.8–19.7 ft) on the north coast of Weh Island directly facing the tsunami source 3 m (9.8 ft) on the opposite side of the coast of Weh Island facing the tsunamiThe tsunami devastated the coastline of Aceh province, about 20 minutes after the earthquake. Banda Aceh , the closest major city, suffered severe casualties. The sea receded and exposed the seabed, prompting locals to collect stranded fish and explore the area. Local eyewitnesses described three large waves, with the first wave rising gently to the foundation of the buildings, followed minutes later by a sudden withdrawal of the sea near the port of Ulèë Lheue . This was succeeded by the appearance of two large black-coloured steep waves which then travelled inland into the capital city as a large turbulent bore. Eyewitnesses described the tsunami as a "black giant", "mountain" and a "wall of water". Video footage revealed torrents of black water, surging by windows of a two-story residential area situated about 3.2 km (2.0 mi) inland. Additionally, amateur footage recorded in the middle of the city captured an approaching black surge flowing down the city streets, full of debris, inundating them. The level of destruction was extreme on the northwestern areas of the city, immediately inland of the aquaculture ponds, and directly facing the Indian Ocean. The tsunami height was reduced from 12 m (39 ft) at Ulee Lheue to 6 m (20 ft) a further 8 km (5.0 mi) to the north-east. The inundation was observed to extend 3–4 km (1.9–2.5 mi) inland throughout the city. Within 2–3 km (1.2–1.9 mi) of the shoreline, houses, except for strongly-built reinforced concrete ones with brick walls, which seemed to have been partially damaged by the earthquake before the tsunami attack, were swept away or destroyed by the tsunami. The area toward the sea was wiped clean of nearly every structure, while closer to the river, dense construction in a commercial district showed the effects of severe flooding. The flow depth at the city was just at the level of the second floor, and there were large amounts of debris piled along the streets and in the ground-floor storefronts. In the seaside section of Ulee Lheue, the flow depths were over 9 m (30 ft) . Footage showed evidence of back-flowing of the Aceh River , carrying debris and people from destroyed villages at the coast and transporting them up to 40 km (25 mi) inland. A group of small islands: Weh, Breueh, Nasi, Teunom, Bunta, Lumpat, and Batee lie just north of the capital city. The tsunami reached a run-up of 10–20 m (33–66 ft) on the western shorelines of Breueh Island and Nasi Island. Coastal villages were destroyed by the waves. On the island of Pulau Weh , strong surges were experienced in the port of Sabang , yet there was little damage with reported runup values of 3–5 m (9.8–16.4 ft) , most likely due to the island being sheltered from the direct attack by the islands to the south-west. Lhoknga is a small coastal community about 13 km (8.1 mi) south-west of Banda Aceh, located on a flat coastal plain in between two rainforest -covered hills, overlooking a large bay and famous for its large swathe of white sandy beach and surfing activities. The locals reported 10 to 12 waves, with the second and third being the highest and most destructive. Interviews with the locals revealed that the sea temporarily receded and exposed coral reefs . In the distant horizon, gigantic black waves about 30 m (98 ft) high made explosion-like sounds as they broke and approached the shore. The first wave came rapidly landward from the south-west as a turbulent bore about 0.5–2.5 m (1.6–8.2 ft) high. The second and third waves were 15–30 m (49–98 ft) high at the coast and appeared like gigantic surfing waves but "taller than the coconut trees and was like a mountain". The second wave was the largest; it came from the west-southwest within five minutes of the first wave. The tsunami stranded cargo ships, barges and destroyed a cement mining facility near the Lampuuk coast, where it reached the fourth level of the building. Meulaboh , a remote coastal city, was among the hardest hit by the tsunami. The waves arrived after the sea receded about 500 m (1,600 ft) , followed by an advancing small tsunami. The second and third destructive waves arrived later, which exceeded the height of the coconut trees. The inundation distance is about 5 km (3.1 mi) . Other towns on Aceh's west coast hit by the disaster included Leupung , Lhokruet, Lamno, Patek, Calang , and Teunom. Affected or destroyed towns on the region's north and east coast were Pidie Regency, Samalanga, Panteraja, and Lhokseumawe. The high fatality rate in the area was mainly due to lack of preparation of the community towards a tsunami and limited knowledge and education among the population regarding the natural phenomenon. Helicopter surveys revealed entire settlements virtually destroyed, with destruction extending miles inland. Only a few mosques remained standing. The greatest run-up height of the tsunami was measured at a hill between Lhoknga and Leupung, on the western coast of the northern tip of Sumatra, near Banda Aceh, and reached 51 m (167 ft) . The tsunami heights in Sumatra: 15–30 m (49–98 ft) on the west coast of Aceh 6–12 m (20–39 ft) on the Banda Aceh coast 6 m (20 ft) on the Krueng Raya coast 5 m (16 ft) on the Sigli coast 3–6 m (9.8–19.7 ft) on the north coast of Weh Island directly facing the tsunami source 3 m (9.8 ft) on the opposite side of the coast of Weh Island facing the tsunamiThe island country of Sri Lanka, located about 1,700 km (1,100 mi) from Sumatra, was ravaged by the tsunami around 2 hours after the earthquake. The tsunami first struck the eastern coastline and subsequently refracted around the southern point of Sri Lanka (Dondra Head). The refracted tsunami waves then inundated the southwestern part of Sri Lanka after some of its energy was reflected from impact with the Maldives. In Sri Lanka, the civilian casualties were second only to those in Indonesia, with approximately 35,000 killed. The eastern shores of Sri Lanka were the hardest hit since it faced the epicentre of the earthquake, while the southwestern shores were hit later, but the death toll was just as severe. The southwestern shores are a hotspot for tourists and fishing. The degradation of the natural environment in Sri Lanka contributed to the high death tolls. Approximately 90,000 buildings and many wooden houses were destroyed. The tsunami arrived on the island as a small brown-orange-coloured flood. Moments later, the ocean floor was exposed as much as 1 km (0.62 mi) in places, which was followed by massive second and third waves. Amateur video recorded at the city of Galle showed a large deluge flooding the city, carrying debris and sweeping away people while in the coastal resort town of Beruwala , the tsunami appeared as a huge brown-orange-coloured bore which reached the first level of a hotel, causing destruction and taking people unaware. Other videos recorded showed that the tsunami appeared like a flood raging inland. The construction of seawalls and breakwaters reduced the power of waves at some locations. The largest run-up measured was at 12.5 m (41 ft) with inundation distance of 390–1,500 m (1,280–4,920 ft) in Yala . In Hambantota , run-ups measured 11 m (36 ft) with the greatest inundation distance of 2 km (1.2 mi) . Run-up measurements along the Sri Lankan coasts are at 2.4–4.11 m (7 ft 10 in – 13 ft 6 in) . Waves measured on the east coast ranged from 4.5–9 m (15–30 ft) at Pottuvill to Batticaloa at 2.6–5 m (8 ft 6 in – 16 ft 5 in) in the north-east around Trincomalee and 4–5 m (13–16 ft) in the west coast from Moratuwa to Ambalangoda. Sri Lanka tsunami height survey: 9 m (30 ft) at Koggala 6 m (20 ft) at Galle port 4.8 m (16 ft) around the Galle coast 8.7 m (29 ft) at Nonagama 4.9 m (16 ft) at Weligama 4 m (13 ft) at Dodundawa 4.7 m (15 ft) at Ambalangoda 4.7 m (15 ft) at Hikkaduwa Fishery Harbour 10 m (33 ft) at Kahawa 4.8 m (16 ft) at North Beach of Beruwala 6 m (20 ft) at Paiyagala A regular passenger train operating between Maradana and Matara was derailed and overturned by the tsunami and claimed at least 1,700 lives, the largest single rail disaster death toll in history. Estimates based on the state of the shoreline and a high-water mark on a nearby building place the tsunami 7.5–9 m (25–30 ft) above sea level and 2–3 m (6 ft 7 in – 9 ft 10 in) higher than the top of the train.The tsunami travelled eastward through the Andaman Sea and hit the south-western coasts of Thailand , about 2 hours after the earthquake. Located about 500 km (310 mi) from the epicentre, at the time, the region was popular with tourists because of Christmas. Many of these tourists were caught off-guard by the tsunami, as they had no prior warning. The tsunami hit during high tide . Major locations damaged included the western shores of Phuket island, the resort town of Khao Lak in Phang Nga Province, the coastal provinces of Krabi , Satun , Ranong and Trang and small offshore islands like Ko Racha Yai, the Phi Phi islands, the Surin Islands and the Similan archipelago . Approximately 8,000 people were killed. Thailand experienced the second largest tsunami run-up. The tsunami heights recorded: 6–10 m (20–33 ft) in Khao Lak 3–6 m (9.8–19.7 ft) along the west coast of Phuket island 3 m (9.8 ft) along the south coast of Phuket island 2 m (6 ft 7 in) along the east coast of Phuket island 4–6 m (13–20 ft) on the Phi Phi Islands 19.6 m (64 ft) at Ban Thung Dap 5 m (16 ft) at Ramson 6.8 m (22 ft) at Ban Thale Nok 5 m (16 ft) at Hat Praphat (Ranong Coastal Resources Research Station) 6.3 m (21 ft) at Thai Mueang District 6.8 m (22 ft) at Rai Dan The province of Phang Nga was the most affected area in Thailand . The quiet resort town of Khao Lak is located on a stretch of golden sandy beach, famed for its hotels overlooking the Andaman Sea and hilly rainforests . A video, taken by a local restaurant manager from a hill adjacent to the beach, showed that the tsunami's arrival was preceded by a sudden retreat of the sea exposing the seafloor. Many tourists and locals can be seen trying to gather fish. Moments later, the tsunami arrives as a wall of foaming water that slams into the coast, washing away numerous people who had no time to escape. Another amateur video, captured by a German family at beach level, showed the tsunami appearing as a white horizontal line in the distant horizon, gradually becoming bigger (bore-like), engulfing a jet skier and lifting two police boats. A maximum inundation of approximately 2 km (1.2 mi) was measured, the inundated depths were 4–7 m (13–23 ft) and there was evidence that the tsunami reached the third floor of a resort hotel. The tsunami in Khao Lak was bigger due to offshore coral reefs and shallow seafloor which caused the tsunami to pile-up. This was similar to eyewitness accounts of the tsunami at Banda Aceh . Khao Lak also experienced the largest tsunami run-up height outside of Sumatra . [ page needed ] . The highest-recorded tsunami run-up was measured 19.6 m (64 ft) at Ban Thung Dap, on the south-west tip of Ko Phra Thong Island and the second-highest at 15.8 m (52 ft) at Ban Nam Kim. Moreover, the largest death toll occurred at Khao Lak, with about 5,000 people killed. In addition, the tsunami inflicted damage to the popular resort town of Ao Nang in Krabi Province. Video footage showed that the tsunami appeared as multiple white surfs violently lifting up yachts, boats and crashing onto beaches. Footage captured at Koh Lanta showed a wall of water swamping the beach, while another video taken at another location showed a large surfing wave like tsunami approaching the shore, lifting up a yacht and flooding the beach. At Koh Sriboya, the tsunami advanced inland as a turbulent medium bore, while at Koh Phayam, Ranong Province , the tsunami appeared as a wall of water. At Phuket Province , the island province's western beaches were struck by the tsunami. At Patong Beach , a popular tourist destination, the tsunami first arrived as a small flood, which swept away cars and surprised people. About 10 minutes later, the sea receded for a while before the tsunami arrived again as a large wall of water looming over the skyline and flooding the coast. Another video from Kamala Beach showed the tsunami flooding the ground floor of a restaurant sweeping away an elderly couple. On Karon Beach , Kamala Beach and Kata Beach , the tsunami came in like a surging flood inland carrying people and cars. On some locations, a coastal road was built which was higher than the shore, protecting a hotel which was behind it. On the east coast of Phuket Island, the tsunami height was about 2 m. In one river mouth, many boats were damaged. The tsunami moved counter-clockwise around Phuket Island, as was the case at Okushiri Island in the 1993 Hokkaido earthquake . According to interviews, the second wave was the largest. The tsunami heights were 5–6 m (16–20 ft) and the inundated depth was about 2 m (6.6 ft) . The tsunami surprised many tourists at Koh Racha Yai, where it flooded the resorts. About 250 people perished directly in the tsunami. The Phi Phi Islands are a group of small islands that were affected by the tsunami. The north bay of Phi Phi Don Island opens to the north-west in the direction of the tsunami. The measured tsunami height on this beach was 5.8 m (19 ft) . According to eyewitness accounts, the tsunami came from the north and south. The ground level was about 2 m above sea level, where there were many cottages and hotels. The south bay opens to the south-east and faces in the opposite direction from the tsunami. Furthermore, Phi Phi Le Island shields the port of Phi Phi Don Island. The measured tsunami height was 4.6 m (15 ft) in the port. Amateur camcorder footage taken by Israeli tourists showed the tsunami advancing inland suddenly as a small flood, gradually becoming more powerful and engulfing the whole beach and resort, with the tsunami carrying a yacht out to sea. Moreover, the tsunami was detected by scuba divers around offshore islands like the Similan Islands and the Surin Islands . The divers reported being caught in a violent, swirling current suddenly while underwater. Local camcorder footage showed the tsunami surging inland and flooding camping equipment at the Similan Islands while the tsunami caught tourists unaware at the Surin Islands, and dragging them out towards the sea.The tsunami reached the states of Andhra Pradesh and Tamil Nadu along the southeastern coastline of the Indian mainland about 2 hours after the earthquake. At the same time, it arrived in the state of Kerala , on the southwestern coast. There were two to five tsunamis that coincided with the local high tide in some areas. The tsunami runup height measured in mainland India by Ministry of Home Affairs includes: 3.4 m (11 ft) at Kerala, inundation distance of 0.5–1.5 km (0.31–0.93 mi) with 250 km (160 mi) of coastline affected 4.5 m (15 ft) at the southern coastline of Tamil Nadu, inundation distance of 0.2–2 km (0.12–1.24 mi) with 100 km (62 mi) of coastline affected 5 m (16 ft) at the eastern coastline of Tamil Nadu facing tsunami source, inundation distance of 0.4–1.5 km (0.25–0.93 mi) with 800 km (500 mi) of coastline affected 4 m (13 ft) at Pondicherry, inundation distance of 0.2–2 km (0.12–1.24 mi) with 25 km (16 mi) of coastline affected 2.2 m (7.2 ft) at Andhra Pradesh, inundation distance of 0.2–1 km (0.12–0.62 mi) with 985 km (612 mi) of coastline affected Along the coast of Tamil Nadu , the 13 km (8.1 mi) Marina Beach in Chennai was battered by the tsunami which swept across the beach taking morning walkers unaware. Amateur video recorded taken at a resort beach showed the tsunami arriving as a large wall of water as it approached the coast and flooding it as it advanced inland. Besides that, a 10 m (33 ft) black muddy tsunami ravaged the city of Karaikal, where 492 people died. The city of Pondicherry, protected by seawalls was relatively unscathed. Local video recorded that before the arrival of the tsunami, people can be seen swarming the beach to check on stranded fish from the exposed beach. Furthermore, at the coastal town of Kanyakumari , the seabed was exposed briefly before a large wall of water can be seen on the horizon and subsequently flooding the town. Other footage showed the tsunami dramatically crashed into the Vivekananda Rock Memorial . The worst affected area in Tamil Nadu was Nagapattinam district , with 6,051 fatalities caused by a 5 m (16 ft) tsunami, followed by Cuddalore district , with many villages destroyed. Most of the people killed were members of the fishing community. Velankanni a sea shore town with a Catholic Basilica and a popular pilgrimage destination was also one of the worst hit by this tsunami that struck at around 9.30 am on that Sunday, when pilgrims who were mostly from Kerala among others were inside the church attending the Malayalam Mass . The rising sea water did not enter the shrine, but the receding waters swept away hundreds of pilgrims who were on the beach. The shrine's compound, nearby villages, hundreds of shops, homes and pilgrims were washed away into the sea. About 600 pilgrims died. Rescue teams extricated more than 400 bodies from the sand and rocks in the vicinity and large number of unidentified bodies were buried in mass graves. The state of Kerala experienced tsunami-related damage in three southern densely populated districts, Ernakulam , Alappuzha , and Kollam, due to diffraction of the waves around Sri Lanka. The southernmost district of Thiruvananthapuram , however, escaped damage, possibly due to the wide turn of the diffracted waves at the peninsular tip. Major damage occurred in two narrow strips of land bound on the west by the Arabian Sea and on the east by the Kerala backwaters . The waves receded before the first tsunami with the highest fatality reported from the densely populated Alappad panchayat (including the villages of Cheriya Azhikkal and Azhikkal) at Kollam district, caused by a 4 m (13 ft) tsunami. A video recorded by locals showed the tsunami flooding the beach and villages, causing despair amongst the villagers. Many villages in the state of Andhra Pradesh were destroyed. In the Krishna district, the tsunami created havoc in Manginapudi and on Machalipattanam Beach. The most affected was Prakasham District, recording 35 deaths, with maximum damage at Singraikonda. Given the enormous power of the tsunami, the fishing industry suffered the greatest. Moreover, the cost of damage in the transport sector was reported in the tens of thousands. The tsunami run-up was only 1.6 m (5.2 ft) in areas in the state of Tamil Nadu shielded by the island of Sri Lanka but was 4–5 m (13–16 ft) in coastal districts such as Nagapattinam in Tamil Nadu directly across from Sumatra . On the western coast, the runup elevations were 4.5 m (15 ft) at Kanyakumari District in Tamil Nadu and 3.4 m (11 ft) each at Kollam and Ernakulam districts in Kerala . The time between the waves ranged from about 15 minutes to 90 minutes. The tsunami varied in height from 2 m (6.6 ft) to 10 m (33 ft) based on survivors' accounts. The tsunami travelled 2.5 km (1.6 mi) at its maximum inland at Karaikal , Puducherry . The inundation distance varied between 1,006–500 m (3,301–1,640 ft) in most areas, except at river mouths, where it was more than 1 km (0.62 mi) . Areas with dense coconut groves or mangroves had much smaller inundation distances, and those with river mouths or backwaters saw larger inundation distances. [ citation needed ] Presence of seawalls at the Kerala and Tamil Nadu coasts reduced the impact of the waves. However, when the seawalls were made of loose stones, the stones were displaced and carried a few metres inland. Due to close proximity to the earthquake, the tsunami took just minutes to devastate the Andaman and Nicobar Islands . The Andaman Islands were moderately affected while the island of Little Andaman and the Nicobar Islands were severely affected by the tsunami. In South Andaman island, based on local eyewitnesses, there were three tsunami waves, with the third being the most destructive. Flooding occurred at the coast and low-lying areas inland, which were connected to open sea through creeks. Inundation was observed, along the east coast of South Andaman Island, restricted to Chidiyatapu, Burmanallah, Kodiaghat, Beadnabad, Corbyn's cove and Marina Park/Aberdeen Jetty areas. Along the west coast, the inundation was observed around Guptapara, Manjeri, Wandoor, Collinpur and Tirur regions. Several near-shore establishments and numerous infrastructures such as seawalls and a 20 MW diesel-generated power plant at Bamboo Flat were destroyed. At Port Blair , the water receded before the first wave, and the third wave was the tallest and caused the most damage. Results of the tsunami survey in South Andaman along Chiriyatapu, Corbyn's Cove and Wandoor beaches: [ citation needed ] 5 m (16 ft) in maximum tsunami height with a run-up of 4.24 m (13.9 ft) at Chiriyatapu Beach 5.5 m (18 ft) in maximum tsunami height and run-up at Corbyn's Cove Beach 6.6 m (22 ft) in maximum tsunami height and run-up of 4.63 m (15.2 ft) at Wandoor Beach Meanwhile, in the Little Andaman, tsunami waves impinged on the eastern shore about 25 to 30 minutes after the earthquake in a four-wave cycle of which the fourth tsunami was the most devastating with a wave height of about 10 m (33 ft) . The tsunami destroyed settlements at Hut Bay within a range of 1 km (0.62 mi) from the seashore. Run up level up to 3.8 m (12 ft) have been measured. In Malacca, located on the island of Car Nicobar , there were three tsunami waves. The sea was observed to rise suddenly before the onset of the first wave. The first wave came 5 minutes after the earthquake, preceded by a recession of the sea up to 600–700 m (2,000–2,300 ft) . [ citation needed ] . The second and third waves came in 10 minutes intervals after the first wave. The third wave was the strongest, with a maximum tsunami wave height of 11 m (36 ft) . Waves nearly three stories high devastated the Indian Air Force base, located just south of Malacca. The maximum tsunami wave height of 11 m (36 ft) . [ citation needed ] Inundation limit was found to be up to 1.25 km (0.78 mi) inland. The impact of the waves was so severe that four oil tankers were thrown almost 800 m (2,600 ft) from the seashore near Malacca to the Air force colony main gate. In Chuckchucha and Lapati, the tsunami arrived in a three-wave cycle with a maximum tsunami wave height of 12 m (39 ft) . In Campbell Bay of Great Nicobar Island, the tsunami waves hit the area three times with an inundation limit of 250–500 m (820–1,640 ft) . A rise in sea level was observed before the first wave came within 5 minutes of the earthquake. The second and third waves came in 10-minute intervals after the first. The second wave was the strongest. The tsunami waves wreaked havoc in the densely populated Jogindar Nagar area, situated 13 km (8.1 mi) south of Campbell Bay. [ citation needed ] According to local accounts, [ attribution needed ] tsunami waves attacked the area three times. The first wave came five minutes after the mainshock (0629 hrs.) with a marginal drop in sea level. The second wave came 10 minutes after the first one with a maximum height of 4.8 m (16 ft) to 8 m (26 ft) and caused the major destruction. The third wave came within 15 minutes after the second with lower wave height. The maximum inundation limit due to tsunami water was about 500 m (1,600 ft) . The worst affected island in the Andaman & Nicobar chain is Katchall Island, with 303 people confirmed dead and 4,354 missing out of a total population of 5,312. The significant shielding of Port Blair and Campbell Bay by steep mountainous outcrops contributed to the relatively low wave heights at these locations, whereas the open terrain along the eastern coast at Malacca and Hut Bay contributed to the great height of the tsunami waves. Reports of tsunami wave height: 1.5 m (4 ft 11 in) at Diglipur and Rangat at North Andaman Island 8 m (26 ft) high at Campbell Bay on Great Nicobar Island 10–12 m (33–39 ft) high at Malacca (in Car Nicobar Island) and at Hut Bay on Little Andaman Island 3 m (9.8 ft) high at Port Blair on South Andaman IslandDue to close proximity to the earthquake, the tsunami took just minutes to devastate the Andaman and Nicobar Islands . The Andaman Islands were moderately affected while the island of Little Andaman and the Nicobar Islands were severely affected by the tsunami. In South Andaman island, based on local eyewitnesses, there were three tsunami waves, with the third being the most destructive. Flooding occurred at the coast and low-lying areas inland, which were connected to open sea through creeks. Inundation was observed, along the east coast of South Andaman Island, restricted to Chidiyatapu, Burmanallah, Kodiaghat, Beadnabad, Corbyn's cove and Marina Park/Aberdeen Jetty areas. Along the west coast, the inundation was observed around Guptapara, Manjeri, Wandoor, Collinpur and Tirur regions. Several near-shore establishments and numerous infrastructures such as seawalls and a 20 MW diesel-generated power plant at Bamboo Flat were destroyed. At Port Blair , the water receded before the first wave, and the third wave was the tallest and caused the most damage. Results of the tsunami survey in South Andaman along Chiriyatapu, Corbyn's Cove and Wandoor beaches: [ citation needed ] 5 m (16 ft) in maximum tsunami height with a run-up of 4.24 m (13.9 ft) at Chiriyatapu Beach 5.5 m (18 ft) in maximum tsunami height and run-up at Corbyn's Cove Beach 6.6 m (22 ft) in maximum tsunami height and run-up of 4.63 m (15.2 ft) at Wandoor Beach Meanwhile, in the Little Andaman, tsunami waves impinged on the eastern shore about 25 to 30 minutes after the earthquake in a four-wave cycle of which the fourth tsunami was the most devastating with a wave height of about 10 m (33 ft) . The tsunami destroyed settlements at Hut Bay within a range of 1 km (0.62 mi) from the seashore. Run up level up to 3.8 m (12 ft) have been measured. In Malacca, located on the island of Car Nicobar , there were three tsunami waves. The sea was observed to rise suddenly before the onset of the first wave. The first wave came 5 minutes after the earthquake, preceded by a recession of the sea up to 600–700 m (2,000–2,300 ft) . [ citation needed ] . The second and third waves came in 10 minutes intervals after the first wave. The third wave was the strongest, with a maximum tsunami wave height of 11 m (36 ft) . Waves nearly three stories high devastated the Indian Air Force base, located just south of Malacca. The maximum tsunami wave height of 11 m (36 ft) . [ citation needed ] Inundation limit was found to be up to 1.25 km (0.78 mi) inland. The impact of the waves was so severe that four oil tankers were thrown almost 800 m (2,600 ft) from the seashore near Malacca to the Air force colony main gate. In Chuckchucha and Lapati, the tsunami arrived in a three-wave cycle with a maximum tsunami wave height of 12 m (39 ft) . In Campbell Bay of Great Nicobar Island, the tsunami waves hit the area three times with an inundation limit of 250–500 m (820–1,640 ft) . A rise in sea level was observed before the first wave came within 5 minutes of the earthquake. The second and third waves came in 10-minute intervals after the first. The second wave was the strongest. The tsunami waves wreaked havoc in the densely populated Jogindar Nagar area, situated 13 km (8.1 mi) south of Campbell Bay. [ citation needed ] According to local accounts, [ attribution needed ] tsunami waves attacked the area three times. The first wave came five minutes after the mainshock (0629 hrs.) with a marginal drop in sea level. The second wave came 10 minutes after the first one with a maximum height of 4.8 m (16 ft) to 8 m (26 ft) and caused the major destruction. The third wave came within 15 minutes after the second with lower wave height. The maximum inundation limit due to tsunami water was about 500 m (1,600 ft) . The worst affected island in the Andaman & Nicobar chain is Katchall Island, with 303 people confirmed dead and 4,354 missing out of a total population of 5,312. The significant shielding of Port Blair and Campbell Bay by steep mountainous outcrops contributed to the relatively low wave heights at these locations, whereas the open terrain along the eastern coast at Malacca and Hut Bay contributed to the great height of the tsunami waves. Reports of tsunami wave height: 1.5 m (4 ft 11 in) at Diglipur and Rangat at North Andaman Island 8 m (26 ft) high at Campbell Bay on Great Nicobar Island 10–12 m (33–39 ft) high at Malacca (in Car Nicobar Island) and at Hut Bay on Little Andaman Island 3 m (9.8 ft) high at Port Blair on South Andaman IslandThe tsunami severely affected the Maldives at a distance of 2,500 km (1,600 mi) from the epicentre. Similar to Sri Lanka, survivors reported three waves with the second wave being the most powerful. Being rich in coral reefs, the Maldives provides an opportunity for scientists to assess the impact of a tsunami on coral atolls. The significantly lower tsunami impact on the Maldives compared to Sri Lanka is mostly due to the topography and bathymetry of the atoll chain with offshore coral reefs, deep channels separating individual atolls and its arrival within low tide which decreased the power of the tsunami. After the tsunami, there was some concern that the country might be submerged entirely and become uninhabitable. However, this was proven untrue. The highest tsunami wave measured was 4 m (13 ft) at Vilufushi Island . The tsunami arrived approximately 2 hours after the earthquake. The greatest tsunami inundation occurred at North Male Atoll, Male island at 250 m (820 ft) along the streets. Local footage recorded showed the tsunami flooding the streets up to knee level in town, while another video taken at the beach showed the tsunami slowly flooding and gradually surging inland. The Maldives tsunami wave analysis: 1.3–2.4 m (4 ft 3 in – 7 ft 10 in) at North Male Atoll, Male Island 2 m (6 ft 7 in) at North Male Atoll, Huhule Island 1.7–2.8 m (5 ft 7 in – 9 ft 2 in) at South Male Atoll, Embudhu Finothu 2.5–3.3 m (8 ft 2 in – 10 ft 10 in) at Laamu Atoll, Fonadhoo Island 2.2–2.9 m (7 ft 3 in – 9 ft 6 in) at Laamu Atoll, Gan Island 2.3–3 m (7 ft 7 in – 9 ft 10 in) at North Male Atoll, Dhiffushi Island 2.2–2.4 m (7 ft 3 in – 7 ft 10 in) at North Male Atoll, Huraa Island more than 1.5 m (4 ft 11 in) at North Male Atoll, Kuda Huraa IslandIn Myanmar , the tsunami caused only moderate damage, which arrived between 2 and 5.5 hours after the earthquake. Although the country's western Andaman Sea coastline lies at the proximity of the rupture zone, there were smaller tsunamis than the neighbouring Thai coast, because the main tsunami source did not extend to the Andaman Islands. Another factor is that some coasts of Taninthayi Division were protected by the Myeik Archipelago . Based on scientific surveys from Ayeyarwady Delta through Taninthayi Division, it was revealed that tsunami heights along the Myanmar coast were between 0.4–2.9 m (1 ft 4 in – 9 ft 6 in) . Eyewitnesses compared the tsunami with the "rainy-season high tide"; although at most locations, the tsunami height was similar or smaller than the "rainy-season high tide" level. Tsunami survey heights: [ citation needed ] Interviews with local people indicate that they did not feel the earthquake in Taninthayi Division or Ayeyarwady Delta. The 71 casualties can be attributed to poor housing infrastructure and additionally, the fact that the coastal residents in the surveyed areas live on flat land along the coast, especially in the Ayeyarwady Delta, and that there is no higher ground to which to evacuate. The tsunami heights from the 2004 December earthquake were not more than 3 m (9.8 ft) along the Myanmar coast, the amplitudes were slightly large off the Ayeyarwady Delta, probably because the shallow delta caused a concentration in tsunami energy. The tsunami travelled 5,000 km (3,100 mi) west across the open ocean before striking the East African country of Somalia . Around 289 fatalities were reported in the Horn of Africa , drowned by four tsunami waves. The hardest-hit was a 650 km (400 mi) stretch of the Somalia coastline between Garacad ( Mudug region) and Xaafuun ( Bari region), which forms part of the Puntland province. Most of the victims were reported along the low-lying Xaafuun Peninsula . The Puntland coast in northern Somalia was by far the area hardest hit by the waves to the west of the Indian subcontinent. The waves arrived around noon local time. Consequently, tsunami runup heights vary from 5 m (16 ft) to 9 m (30 ft) with inundation distances varying from 44 m (144 ft) to 704 m (2,310 ft) . The maximum runup height of almost 9 m (30 ft) was recorded in Bandarbeyla. An even higher runup point was measured on a cliff near the town of Eyl, solely on an eyewitness account. The highest death toll was in Hafun , with 19 dead and 160 people presumed missing out of its 5,000 inhabitants. This was the highest number of casualties in a single African town and the largest tsunami death toll in a single town to the west of the Indian subcontinent . In Xaafuun, small drawbacks were observed before the third and most powerful tsunami wave flooded the town. The tsunami also reached Malaysia, mainly on the northern states such as Kedah , Perak and Penang and on offshore islands such as Langkawi island. Peninsular Malaysia was shielded by the full force of the tsunami due to the protection offered by the island of Sumatra, which lies just off the western coast. Bangladesh escaped major damage and deaths because the water displaced by the strike-slip fault was relatively little on the northern section of the rupture zone, which ruptured slowly. In Yemen , the tsunami killed two people with a maximum runup of 2 m (6.6 ft) . The tsunami was detected in the southern parts of east Africa, where rough seas were reported, specifically on the eastern and southern coasts that face the Indian Ocean. A few other African countries also recorded fatalities; one in Kenya, three in Seychelles , ten in Tanzania, and South Africa, where two were killed as a direct result of the tsunami—the furthest from the epicentre. Tidal surges also occurred along the Western Australian coast that lasted for several hours, resulting in boats losing their moorings and two people needing to be rescued. According to the U.S. Geological Survey , a total of 227,898 people died. Measured in lives lost, this is one of the ten worst earthquakes in recorded history , as well as the single worst tsunami in history. Indonesia was the worst affected area, with most death toll estimates at around 170,000. An initial report by Siti Fadilah Supari , the Indonesian Minister of Health at the time, estimated the death total to be as high as 220,000 in Indonesia alone, giving a total of 280,000 fatalities. However, the estimated number of dead and missing in Indonesia were later reduced by over 50,000. In their report, the Tsunami Evaluation Coalition stated, "It should be remembered that all such data are subject to error, as data on missing persons especially are not always as good as one might wish". A much higher number of deaths has been suggested for Myanmar based on reports from Thailand. The tsunami caused severe damage and deaths as far as the east coast of Africa, with the furthest recorded fatality directly attributed to the tsunami at Rooi-Els , close to Cape Town , 8,000 km (5,000 mi) from the epicentre. Relief agencies reported that one third of the dead appeared to be children. This was a result of the high proportion of children in the populations of many of the affected regions and because children were the least able to resist being overcome by the surging waters. Oxfam went on to report that as many as four times more women than men were killed in some regions because they were waiting on the beach for the fishers to return and looking after their children in the houses. States of emergency were declared in Sri Lanka, Indonesia, and the Maldives. The United Nations estimated at the outset that the relief operation would be the costliest in human history. [ citation needed ] Then- UN Secretary-General Kofi Annan stated that reconstruction would probably take between five and ten years. Governments and non-governmental organizations feared that the final death toll might double as a result of diseases, prompting a massive humanitarian response . [ citation needed ] In addition to a large number of local residents, up to 9,000 foreign tourists (mostly Europeans) enjoying the peak holiday travel season were among the dead or missing, especially people from the Nordic countries . Sweden was the European country most severely affected both in absolute numbers, and by a wide margin when considered in relation to the country's population, with a death toll of 543. Germany was close behind with 539 identified victims. Beyond the heavy toll on human lives, the Indian Ocean earthquake caused an enormous environmental impact that affected the region for many years. Severe damage was inflicted on ecosystems such as mangroves, coral reefs, forests, coastal wetlands, vegetation, sand dunes and rock formations, animal and plant biodiversity and groundwater . Also, the spread of solid and liquid waste and industrial chemicals, water pollution and the destruction of sewage collectors and treatment plants threatened the environment even further, in untold ways. The environmental impact took a long time and significant resources to assess. The main effect was caused by poisoning of the freshwater supplies and of the soil by saltwater infiltration and a deposit of a salt layer over arable land. In the Maldives, 16 to 17 coral reef atolls that were overcome by sea waves are without fresh water and could be rendered uninhabitable for decades. Uncountable wells that served communities were invaded by sea, sand, and earth; and aquifers were invaded through porous rock. On the island's east coast, the tsunami contaminated wells on which many villagers relied for drinking water. The Colombo-based International Water Management Institute monitored the effects of saltwater and concluded that the wells recovered to pre-tsunami drinking water quality one-and-a-half years after the event. The IWMI developed protocols for cleaning wells contaminated by saltwater; these were subsequently officially endorsed by the World Health Organization as part of its series of Emergency Guidelines. Salted-over soil becomes sterile, and it is difficult and costly to restore for agriculture. It also causes the death of plants and important soil micro-organisms. Thousands of rice, mango, and banana plantations in Sri Lanka were destroyed almost entirely and will take years to recover. In addition to other forms of aid, the Australian government sent ecological experts to help develop strategies for reef-monitoring and rehabilitation of marine environments and coral reefs in the Maldives, Seychelles and other areas. Scientists had developed significant ecological expertise from work with the Great Barrier Reef , in Australia's northeastern waters. In response to the unprecedented situation, the United Nations Environment Programme (UNEP) worked with governments in the region to determine the severity of the ecological impact and how to address it. UNEP established an emergency fund, set up a Task Force to respond to requests for assistance from countries affected by the tsunami, and was able to mobilize and distribute approximately US$9.3 million for environmental recovery and disaster risk reduction between 2004 and 2007. Funding came from other international agencies and from countries including Finland, Norway, Spain, Sweden and the United Kingdom. Evidence suggested that the presence of mangroves in coastal areas had provided some protection, when compared to areas that had been cleared for aquaculture or development. As a result, mangrove restoration become a focus of a number of projects, with varied success. Such approaches to ecosystem-based disaster risk reduction appear to be most successful when local communities are closely involved as stakeholders throughout the process, and when careful attention is paid to the physical conditions of chosen sites to ensure that mangroves can thrive there. The level of damage to the economy resulting from the tsunami depends on the scale examined. While the overall impact on the national economies was minor, local economies were devastated. The two main occupations affected by the tsunami were fishing and tourism. Some economists believe that damage to the affected national economies will be minor because losses in the tourism and fishing industries are a relatively small percentage of the GDP. However, others caution that damage to infrastructure is an overriding factor. In some areas drinking water supplies and farm fields may have been contaminated for years by saltwater from the ocean. The impact on coastal fishing communities and the people living there, some of the poorest in the region, has been devastating with high losses of income earners as well as boats and fishing gear. In Sri Lanka, artisanal fishery, in which the use of fish baskets, fishing traps, and spears are commonly used, is an important source of fish for local markets; industrial fishery is the major economic activity, providing direct employment to about 250,000 people. In recent years the fishery industry has emerged as a dynamic export-oriented sector, generating substantial foreign exchange earnings. Preliminary estimates indicated that 66% of the fishing fleet and industrial infrastructure in coastal regions were destroyed by the wave surges. While the tsunami destroyed many of the boats vital to Sri Lanka's fishing industry, it also created a demand for fibreglass-reinforced plastic catamarans in the boatyards of Tamil Nadu . Given that over 51,000 vessels were lost to the tsunami, the industry boomed. However, the huge demand has led to lower quality in the process, and some important materials were sacrificed to cut prices for those who were impoverished by the tsunami. Even though only coastal regions were directly affected by the waters of the tsunami, the indirect effects have spread to inland provinces as well. Since the media coverage of the event was so extensive, many tourists cancelled vacations and trips to that part of the world, even though their travel destinations may not have been affected. This ripple effect could especially be felt in the inland provinces of Thailand, such as Krabi, which acted as a starting point for many other tourist destinations in Thailand. Countries in the region appealed to tourists to return, pointing out that most tourist infrastructure is undamaged. However, tourists were reluctant to do so for psychological reasons. Even beach resorts in parts of Thailand which were untouched by the tsunami were hit by cancellations. Both the earthquake and the tsunami may have affected shipping in the Malacca Straits , which separate Malaysia and the Indonesian island of Sumatra, by changing the depth of the seabed and by disturbing navigational buoys and old shipwrecks. In one area of the Strait, water depths were previously up to 1,200 m (4,000 ft) , and are now only 30 m (100 ft) in some areas, making shipping impossible and dangerous. These problems also made the delivery of relief aid more challenging. Compiling new navigational charts may take months or years. Officials also hoped that piracy in the region would drop off, since the tsunami had killed pirates and destroyed their boats. Due to multiple factors, there was a 71.6% drop in the number of piracy incidents between 2004 and 2005, from 60 to 17 incidents. Levels remained relatively low for some years. However, between 2013 and 2014, piracy incidents rose dramatically by 73.2% to exceed pre-tsunami levels. The last major tsunami in the Indian Ocean was about A.D. 1400. In 2008, a team of scientists working on Phra Thong, a barrier island along the hard-hit west coast of Thailand, reported evidence of at least three previous major tsunamis in the preceding 2,800 years, the most recent from about 700 years ago. A second team found similar evidence of previous tsunamis in Aceh, a province at the northern tip of Sumatra ; radiocarbon dating of bark fragments in the soil below the second sand layer led the scientists to estimate that the most recent predecessor to the 2004 tsunami probably occurred between A.D. 1300 and 1450. The 2004 earthquake and tsunami combined is the world's deadliest natural disaster since the 1976 Tangshan earthquake . The earthquake was the third-most-powerful earthquake recorded since 1900. The deadliest-known earthquake in history occurred in 1556 in Shaanxi, China , with an estimated death toll of 830,000, though figures from this period may not be as reliable. Before 2004, the tsunami created in both Indian and Pacific Ocean waters by the 1883 eruption of Krakatoa , thought to have resulted in anywhere from 36,000 to 120,000 deaths, had probably been the deadliest in the region. In 1782, about 40,000 people are thought to have been killed by a tsunami (or a cyclone) in the South China Sea . The deadliest tsunami before 2004 was Italy's 1908 Messina earthquake on the Mediterranean Sea where the earthquake and tsunami killed about 123,000. Many health professionals and aid workers have reported widespread psychological trauma associated with the tsunami. Even 14 years afterwards, researchers find HPA axis dysregulation and "burnout" in survivors. Traditional beliefs in many of the affected regions state that a relative of the family must bury the body of the dead, and in many cases, no body remained to be buried. Women in Aceh required a special approach from foreign aid agencies, and continue to have unique needs. [ citation needed ] The hardest-hit area, Aceh , is a religiously conservative Islamic society and has had no tourism nor any Western presence in recent years due to the insurgency between the Indonesian military and Free Aceh Movement (GAM). Some believe that the tsunami was divine punishment for lay Muslims shirking their daily prayers or following a materialistic lifestyle. Others have said that Allah was angry that Muslims were killing each other in an ongoing conflict. Saudi cleric Muhammad Al-Munajjid attributed it to divine retribution against non-Muslim vacationers "who used to sprawl all over the beaches and in pubs overflowing with wine" during Christmas break. The widespread devastation caused by the tsunami led GAM to declare a cease-fire on 28 December 2004 followed by the Indonesian government, and the two groups resumed long-stalled peace talks, which resulted in a peace agreement signed 15 August 2005. The agreement explicitly cites the tsunami as a justification. In a poll conducted in 27 countries, 15% of respondents named the tsunami the most significant event of the year. Only the Iraq War was named by as many respondents. The extensive international media coverage of the tsunami, and the role of mass media and journalists in reconstruction, were discussed by editors of newspapers and broadcast media in tsunami-affected areas, in special video-conferences set up by the Asia Pacific Journalism Centre. The tsunami left both the people and government of India in a state of heightened alert. On 30 December 2004, four days after the tsunami, Terra Research notified the India government that its sensors indicated there was a possibility of 7.9 to 8.1 magnitude tectonic shift in the next 12 hours between Sumatra and New Zealand. In response, the Indian Minister of Home Affairs announced that a fresh onslaught of deadly tsunami was likely along the southern Indian coast and the Andaman and Nicobar Islands , even as there was no sign of turbulence in the region. The announcement generated panic in the Indian Ocean region and caused thousands to flee their homes, which resulted in jammed roads. The announcement was a false alarm, and the Home Affairs minister withdrew their announcement. On further investigation, the India government learned that the consulting company Terra Research was run from the home of a self-described earthquake forecaster who had no telephone listing and maintained a website where he sold copies of his detection system. The tsunami had a severe humanitarian and political impact in Sweden. The hardest-hit country outside Asia, Sweden, lost 543 tourists, mainly in Thailand. The Persson Cabinet was heavily criticized for its inaction. Smith Dharmasaroja , a meteorologist who had predicted that an earthquake and tsunami "is going to occur for sure" way back in 1994, was assigned the development of the Thai tsunami warning system. The Indian Ocean Tsunami Warning System was formed in early 2005 to provide an early warning of tsunamis for inhabitants around the Indian Ocean coasts. The changes in the distribution of masses inside the Earth due to the earthquake had several consequences. It displaced the North Pole by 25 mm (0.98 in) . It also slightly changed the shape of the Earth, specifically by decreasing Earth's oblateness by about one part in 10 billion, consequentially increasing Earth's rotation a little and thus shortening the length of the day by 2.68 microseconds. According to the U.S. Geological Survey , a total of 227,898 people died. Measured in lives lost, this is one of the ten worst earthquakes in recorded history , as well as the single worst tsunami in history. Indonesia was the worst affected area, with most death toll estimates at around 170,000. An initial report by Siti Fadilah Supari , the Indonesian Minister of Health at the time, estimated the death total to be as high as 220,000 in Indonesia alone, giving a total of 280,000 fatalities. However, the estimated number of dead and missing in Indonesia were later reduced by over 50,000. In their report, the Tsunami Evaluation Coalition stated, "It should be remembered that all such data are subject to error, as data on missing persons especially are not always as good as one might wish". A much higher number of deaths has been suggested for Myanmar based on reports from Thailand. The tsunami caused severe damage and deaths as far as the east coast of Africa, with the furthest recorded fatality directly attributed to the tsunami at Rooi-Els , close to Cape Town , 8,000 km (5,000 mi) from the epicentre. Relief agencies reported that one third of the dead appeared to be children. This was a result of the high proportion of children in the populations of many of the affected regions and because children were the least able to resist being overcome by the surging waters. Oxfam went on to report that as many as four times more women than men were killed in some regions because they were waiting on the beach for the fishers to return and looking after their children in the houses. States of emergency were declared in Sri Lanka, Indonesia, and the Maldives. The United Nations estimated at the outset that the relief operation would be the costliest in human history. [ citation needed ] Then- UN Secretary-General Kofi Annan stated that reconstruction would probably take between five and ten years. Governments and non-governmental organizations feared that the final death toll might double as a result of diseases, prompting a massive humanitarian response . [ citation needed ] In addition to a large number of local residents, up to 9,000 foreign tourists (mostly Europeans) enjoying the peak holiday travel season were among the dead or missing, especially people from the Nordic countries . Sweden was the European country most severely affected both in absolute numbers, and by a wide margin when considered in relation to the country's population, with a death toll of 543. Germany was close behind with 539 identified victims.Beyond the heavy toll on human lives, the Indian Ocean earthquake caused an enormous environmental impact that affected the region for many years. Severe damage was inflicted on ecosystems such as mangroves, coral reefs, forests, coastal wetlands, vegetation, sand dunes and rock formations, animal and plant biodiversity and groundwater . Also, the spread of solid and liquid waste and industrial chemicals, water pollution and the destruction of sewage collectors and treatment plants threatened the environment even further, in untold ways. The environmental impact took a long time and significant resources to assess. The main effect was caused by poisoning of the freshwater supplies and of the soil by saltwater infiltration and a deposit of a salt layer over arable land. In the Maldives, 16 to 17 coral reef atolls that were overcome by sea waves are without fresh water and could be rendered uninhabitable for decades. Uncountable wells that served communities were invaded by sea, sand, and earth; and aquifers were invaded through porous rock. On the island's east coast, the tsunami contaminated wells on which many villagers relied for drinking water. The Colombo-based International Water Management Institute monitored the effects of saltwater and concluded that the wells recovered to pre-tsunami drinking water quality one-and-a-half years after the event. The IWMI developed protocols for cleaning wells contaminated by saltwater; these were subsequently officially endorsed by the World Health Organization as part of its series of Emergency Guidelines. Salted-over soil becomes sterile, and it is difficult and costly to restore for agriculture. It also causes the death of plants and important soil micro-organisms. Thousands of rice, mango, and banana plantations in Sri Lanka were destroyed almost entirely and will take years to recover. In addition to other forms of aid, the Australian government sent ecological experts to help develop strategies for reef-monitoring and rehabilitation of marine environments and coral reefs in the Maldives, Seychelles and other areas. Scientists had developed significant ecological expertise from work with the Great Barrier Reef , in Australia's northeastern waters. In response to the unprecedented situation, the United Nations Environment Programme (UNEP) worked with governments in the region to determine the severity of the ecological impact and how to address it. UNEP established an emergency fund, set up a Task Force to respond to requests for assistance from countries affected by the tsunami, and was able to mobilize and distribute approximately US$9.3 million for environmental recovery and disaster risk reduction between 2004 and 2007. Funding came from other international agencies and from countries including Finland, Norway, Spain, Sweden and the United Kingdom. Evidence suggested that the presence of mangroves in coastal areas had provided some protection, when compared to areas that had been cleared for aquaculture or development. As a result, mangrove restoration become a focus of a number of projects, with varied success. Such approaches to ecosystem-based disaster risk reduction appear to be most successful when local communities are closely involved as stakeholders throughout the process, and when careful attention is paid to the physical conditions of chosen sites to ensure that mangroves can thrive there. The level of damage to the economy resulting from the tsunami depends on the scale examined. While the overall impact on the national economies was minor, local economies were devastated. The two main occupations affected by the tsunami were fishing and tourism. Some economists believe that damage to the affected national economies will be minor because losses in the tourism and fishing industries are a relatively small percentage of the GDP. However, others caution that damage to infrastructure is an overriding factor. In some areas drinking water supplies and farm fields may have been contaminated for years by saltwater from the ocean. The impact on coastal fishing communities and the people living there, some of the poorest in the region, has been devastating with high losses of income earners as well as boats and fishing gear. In Sri Lanka, artisanal fishery, in which the use of fish baskets, fishing traps, and spears are commonly used, is an important source of fish for local markets; industrial fishery is the major economic activity, providing direct employment to about 250,000 people. In recent years the fishery industry has emerged as a dynamic export-oriented sector, generating substantial foreign exchange earnings. Preliminary estimates indicated that 66% of the fishing fleet and industrial infrastructure in coastal regions were destroyed by the wave surges. While the tsunami destroyed many of the boats vital to Sri Lanka's fishing industry, it also created a demand for fibreglass-reinforced plastic catamarans in the boatyards of Tamil Nadu . Given that over 51,000 vessels were lost to the tsunami, the industry boomed. However, the huge demand has led to lower quality in the process, and some important materials were sacrificed to cut prices for those who were impoverished by the tsunami. Even though only coastal regions were directly affected by the waters of the tsunami, the indirect effects have spread to inland provinces as well. Since the media coverage of the event was so extensive, many tourists cancelled vacations and trips to that part of the world, even though their travel destinations may not have been affected. This ripple effect could especially be felt in the inland provinces of Thailand, such as Krabi, which acted as a starting point for many other tourist destinations in Thailand. Countries in the region appealed to tourists to return, pointing out that most tourist infrastructure is undamaged. However, tourists were reluctant to do so for psychological reasons. Even beach resorts in parts of Thailand which were untouched by the tsunami were hit by cancellations. Both the earthquake and the tsunami may have affected shipping in the Malacca Straits , which separate Malaysia and the Indonesian island of Sumatra, by changing the depth of the seabed and by disturbing navigational buoys and old shipwrecks. In one area of the Strait, water depths were previously up to 1,200 m (4,000 ft) , and are now only 30 m (100 ft) in some areas, making shipping impossible and dangerous. These problems also made the delivery of relief aid more challenging. Compiling new navigational charts may take months or years. Officials also hoped that piracy in the region would drop off, since the tsunami had killed pirates and destroyed their boats. Due to multiple factors, there was a 71.6% drop in the number of piracy incidents between 2004 and 2005, from 60 to 17 incidents. Levels remained relatively low for some years. However, between 2013 and 2014, piracy incidents rose dramatically by 73.2% to exceed pre-tsunami levels. The last major tsunami in the Indian Ocean was about A.D. 1400. In 2008, a team of scientists working on Phra Thong, a barrier island along the hard-hit west coast of Thailand, reported evidence of at least three previous major tsunamis in the preceding 2,800 years, the most recent from about 700 years ago. A second team found similar evidence of previous tsunamis in Aceh, a province at the northern tip of Sumatra ; radiocarbon dating of bark fragments in the soil below the second sand layer led the scientists to estimate that the most recent predecessor to the 2004 tsunami probably occurred between A.D. 1300 and 1450. The 2004 earthquake and tsunami combined is the world's deadliest natural disaster since the 1976 Tangshan earthquake . The earthquake was the third-most-powerful earthquake recorded since 1900. The deadliest-known earthquake in history occurred in 1556 in Shaanxi, China , with an estimated death toll of 830,000, though figures from this period may not be as reliable. Before 2004, the tsunami created in both Indian and Pacific Ocean waters by the 1883 eruption of Krakatoa , thought to have resulted in anywhere from 36,000 to 120,000 deaths, had probably been the deadliest in the region. In 1782, about 40,000 people are thought to have been killed by a tsunami (or a cyclone) in the South China Sea . The deadliest tsunami before 2004 was Italy's 1908 Messina earthquake on the Mediterranean Sea where the earthquake and tsunami killed about 123,000. Many health professionals and aid workers have reported widespread psychological trauma associated with the tsunami. Even 14 years afterwards, researchers find HPA axis dysregulation and "burnout" in survivors. Traditional beliefs in many of the affected regions state that a relative of the family must bury the body of the dead, and in many cases, no body remained to be buried. Women in Aceh required a special approach from foreign aid agencies, and continue to have unique needs. [ citation needed ] The hardest-hit area, Aceh , is a religiously conservative Islamic society and has had no tourism nor any Western presence in recent years due to the insurgency between the Indonesian military and Free Aceh Movement (GAM). Some believe that the tsunami was divine punishment for lay Muslims shirking their daily prayers or following a materialistic lifestyle. Others have said that Allah was angry that Muslims were killing each other in an ongoing conflict. Saudi cleric Muhammad Al-Munajjid attributed it to divine retribution against non-Muslim vacationers "who used to sprawl all over the beaches and in pubs overflowing with wine" during Christmas break. The widespread devastation caused by the tsunami led GAM to declare a cease-fire on 28 December 2004 followed by the Indonesian government, and the two groups resumed long-stalled peace talks, which resulted in a peace agreement signed 15 August 2005. The agreement explicitly cites the tsunami as a justification. In a poll conducted in 27 countries, 15% of respondents named the tsunami the most significant event of the year. Only the Iraq War was named by as many respondents. The extensive international media coverage of the tsunami, and the role of mass media and journalists in reconstruction, were discussed by editors of newspapers and broadcast media in tsunami-affected areas, in special video-conferences set up by the Asia Pacific Journalism Centre. The tsunami left both the people and government of India in a state of heightened alert. On 30 December 2004, four days after the tsunami, Terra Research notified the India government that its sensors indicated there was a possibility of 7.9 to 8.1 magnitude tectonic shift in the next 12 hours between Sumatra and New Zealand. In response, the Indian Minister of Home Affairs announced that a fresh onslaught of deadly tsunami was likely along the southern Indian coast and the Andaman and Nicobar Islands , even as there was no sign of turbulence in the region. The announcement generated panic in the Indian Ocean region and caused thousands to flee their homes, which resulted in jammed roads. The announcement was a false alarm, and the Home Affairs minister withdrew their announcement. On further investigation, the India government learned that the consulting company Terra Research was run from the home of a self-described earthquake forecaster who had no telephone listing and maintained a website where he sold copies of his detection system. The tsunami had a severe humanitarian and political impact in Sweden. The hardest-hit country outside Asia, Sweden, lost 543 tourists, mainly in Thailand. The Persson Cabinet was heavily criticized for its inaction. Smith Dharmasaroja , a meteorologist who had predicted that an earthquake and tsunami "is going to occur for sure" way back in 1994, was assigned the development of the Thai tsunami warning system. The Indian Ocean Tsunami Warning System was formed in early 2005 to provide an early warning of tsunamis for inhabitants around the Indian Ocean coasts. The changes in the distribution of masses inside the Earth due to the earthquake had several consequences. It displaced the North Pole by 25 mm (0.98 in) . It also slightly changed the shape of the Earth, specifically by decreasing Earth's oblateness by about one part in 10 billion, consequentially increasing Earth's rotation a little and thus shortening the length of the day by 2.68 microseconds. A great deal of humanitarian aid was needed because of widespread damage to the infrastructure, shortages of food and water, and economic damage. Epidemics were of particular concern due to the high population density and tropical climate of the affected areas. The main concern of humanitarian and government agencies was to provide sanitation facilities and fresh drinking water to contain the spread of diseases such as cholera , diphtheria , dysentery , typhoid and hepatitis A and hepatitis B . There was also a great concern that the death toll could increase as disease and hunger spread. However, because of the initial quick response, this was minimized. In the days following the tsunami, significant effort was spent in burying bodies hurriedly due to fear of disease spreading. However, the public health risks may have been exaggerated, and therefore this may not have been the best way to allocate resources. The World Food Programme provided food aid to more than 1.3 million people affected by the tsunami. Nations all over the world provided over US$14 billion in aid for damaged regions, with the governments of Australia pledging US$819.9 million (including a US$760.6 million aid package for Indonesia), Germany offering US$660 million, Japan offering US$500 million, Canada offering US$343 million, Norway and the Netherlands offering both US$183 million, the United States offering US$35 million initially (increased to US$350 million), and the World Bank offering US$250 million. Also, Italy offered US$95 million, increased later to US$113 million of which US$42 million was donated by the population using the SMS system. Australia, India, Japan and the United States formed an ad-hoc corroborative group, and it was the origin of Quadrilateral Security Dialogue . According to USAID , the US has pledged additional funds in long-term U.S. support to help the tsunami victims rebuild their lives. On 9 February 2005, President Bush asked Congress to increase the U.S. commitment to a total of US$950 million. Officials estimated that billions of dollars would be needed. Bush also asked his father, former President George H. W. Bush, and former President Bill Clinton to lead a U.S. effort to provide private aid to the tsunami victims. In mid-March, the Asian Development Bank reported that over US$4 billion in aid promised by governments was behind schedule. Sri Lanka reported that it had received no foreign government aid, while foreign individuals had been generous. Many charities were given considerable donations from the public. For example, in the United Kingdom, the public donated roughly £330 million sterling (nearly US$600 million). This considerably outweighed the allocation by the government to disaster relief and reconstruction of £75 million and came to an average of about £5.50 (US$10) donated by every citizen. In August 2006, fifteen local aid staff working on post-tsunami rebuilding were found executed in north-east Sri Lanka after heavy fighting between government troops and the Tamil Tiger rebels, the main umbrella body for aid agencies in the country said. The 2004 disaster prompted the creation of the Indian Ocean Tsunami Warning System .

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Mayinga_N'Seka/html

Mayinga N'Seka

Mayinga N'Seka (1954 – October 19, 1976 in Kinshasa ) was a nurse in Zaïre , now Democratic Republic of the Congo . She died from Ebola virus disease during the 1976 epidemic in Zaïre . She has been incorrectly identified as the index case by several sources, but a World Health Organization commission report on the outbreak lists a man from Yambuku , Mabalo Lokela, as the index case. Lokela, a 44-year-old who had been buying meat in Sudan , died on September 8, 1976, over a month before N'Seka. N'Seka worked as a nurse at Mbalad Hospital in Kinshasa and contracted Ebola after caring for a Roman Catholic nun who had flown in for treatment from the Yambuku Mission Hospital, where the outbreak began. Mayinga died at Ngaleima Hospital on October 19, 1976. There were 318 cases in that outbreak, which had an 88% mortality rate. In his book about the 1976 outbreak, Ebola , William Close writes that N'Seka had treated a nun, Sister Fermina, who worked at the Catholic mission in Yambuku, the center of the outbreak. Another nun and a priest had also been brought to the capital for treatment. Officials hurried to find N'Seka's contacts in the city , including staff of the United States Embassy (where she had been finalizing a student visa). Fermina died at the hospital in Kinshasa while trying to return to Belgium so a diagnosis on the disease could be performed. The highly infectious and deadly nature of the disease was still unknown when N'Seka treated Fermina, and no special precautions were taken to prevent contact with the nun's blood or fluids . The 22-year-old N'Seka was preparing to travel to America to study advanced nursing on a scholarship at the time of her death. [ citation needed ]The variant of the Ebola virus that infected N'Seka was originally named " Zaïre virus strain Mayinga " (now Ebola virus variant Mayinga; EBOV/May), and is the prototype virus for the species Zaire ebolavirus , which is itself the type species for the genus Ebolavirus . N'Seka's blood has also been used all over the world in procuring various strain frequencies and structures about Ebola virus. No agreement was made with the government to distribute it.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Texas_Health_Presbyterian_Hospital_Dallas/html

Texas Health Presbyterian Hospital Dallas

Texas Health Presbyterian Hospital Dallas ( Texas Health Dallas , Presbyterian , or Presby ) is a teaching hospital and tertiary care facility in the United States , located in the Vickery Meadow area of Dallas , Texas . It is the flagship institution of 29 hospitals in Texas Health Resources , the largest healthcare system in North Texas and one of the largest in the United States . The hospital, which opened in 1966, has 875 beds and around 1,200 physicians. The hospital is the largest business within Vickery Meadow. In 2008, the hospital implemented a program in which critical care physician specialists are available to patients in the medical and surgical intensive care units 24 hours a day, eliminating ventilator -associated pneumonia , central line infections and pressure ulcers . The hospital has maintained an active internal medicine residency training program since 1977, and hosts rotating medical students from University of Texas Southwestern Medical Center .In 2014, the hospital was thrust into the national spotlight as the site of the first Ebola case diagnosed in the United States (see Ebola incident ). One patient, Thomas Eric Duncan , who allegedly told healthcare workers there that he had recently traveled from Liberia, was not initially diagnosed with Ebola, but sent home. When he continued to become sicker he returned to the hospital, where his Ebola was correctly diagnosed, but he died of the disease. Two nurses who had treated this patient, Nina Pham and Amber Joy Vinson, subsequently contracted Ebola. Ms. Vinson had flown from Dallas to Ohio and back before she was diagnosed with Ebola, potentially exposing a number of other people to the disease in the meantime. [ citation needed ]Exteriors of the 1966 hospital building were used extensively in the original nighttime drama Dallas . The building represented the fictional Dallas Memorial Hospital during on location filming and in establishing shots during Seasons 2, 3 & 4 of the series which included record high rated episodes related to Who shot J.R.? storyline.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Dead_Internet_theory/html

Dead Internet theory

The dead Internet theory is an online conspiracy theory that asserts that the Internet now consists mainly of bot activity and automatically generated content manipulated by algorithmic curation , minimising organic human activity to manipulate the population. Proponents of the theory believe these bots were created intentionally to help manipulate algorithms and boost search results in order to manipulate consumers. Some proponents of the theory accuse government agencies of using bots to manipulate public perception. The date given for this "death" was generally around 2016 or 2017. The dead Internet theory has gained traction because many of the observed phenomena are quantifiable, such as increased bot traffic, but the literature does not support the full theory. Caroline Busta, founder of the media platform New Models , was quoted in an article in The Atlantic calling much of the dead Internet theory a "paranoid fantasy", even if there are legitimate criticisms involving bot traffic and the integrity of the internet, but she said she does agree with the "overarching idea". In an article in The New Atlantis , Robert Mariani called the theory a mix between a genuine conspiracy theory and a creepypasta . The dead Internet theory's exact origin is difficult to pinpoint, but it most likely emerged from 4chan or Wizardchan as a theoretical concept in the late 2010s or early 2020s. In 2021, a thread titled "Dead Internet Theory: Most Of The Internet Is Fake" was published on the forum Agora Road's Macintosh Cafe, marking the term's spread beyond these initial imageboards. But discussion and debate of the theory have been prevalent in online forums, technology conferences, and academic circles, possibly since earlier. It was inspired by concerns about the Internet's increasing complexity, dependence on fragile infrastructure, potential cyberattack vulnerabilities, and, most importantly, the exponential increase in artificial intelligence capabilities and use. The theory gained traction in discussions among technology enthusiasts, researchers, and futurists who sought to explore the risks associated with our reliance on the Internet. The conspiracy theory has entered public culture through widespread coverage and has been discussed on various high-profile YouTube channels. It gained more mainstream attention with an article in The Atlantic titled "Maybe You Missed It, but the Internet 'Died' Five Years Ago". This article has been widely cited by other articles on the topic. The dead Internet theory has two main components: that bots have displaced human activity on the Internet and that actors are employing these bots to manipulate the human population. The first part of this theory, that bots create much of the content on the internet and perhaps contribute more than organic human content, has been a concern for a while, with the original post by "IlluminatiPirate" citing the article "How Much of the Internet Is Fake? Turns Out, a Lot of It, Actually" in New York magazine. The second half of the dead Internet theory builds on this observable phenomenon by proposing that the U.S. government, corporations, or other actors are intentionally employing these bots to manipulate the human population for a variety of reasons. In the original post, the idea that bots have displaced human content is described as the "setup", with the "thesis" of the theory itself focusing on the United States government being responsible for this, stating: "The U.S. government is engaging in an artificial intelligence powered gaslighting of the entire world population." Generative pre-trained transformers (GPTs) are a class of large language models (LLMs) that employ artificial neural networks to produce human-like content. The first of these was developed by OpenAI . These models have created significant controversy. For example, Timothy Shoup of the Copenhagen Institute for Futures Studies has said, "in the scenario where GPT-3 'gets loose', the internet would be completely unrecognizable". He predicted that in such a scenario, 99% to 99.9% of content online might be AI-generated by 2025 to 2030. These predictions have been used as evidence for the dead internet theory. In 2024, Google reported that its search results were being inundated with websites that "feel like they were created for search engines instead of people." In correspondence with Gizmodo , a Google spokesperson acknowledged the role of generative AI in the rapid proliferation of such content and that it could displace more valuable human-made alternatives. ChatGPT is an AI chatbot whose 2022 release to the general public led journalists to call the dead internet theory potentially more realistic than before. Before ChatGPT's release, the dead internet theory mostly emphasized government organizations, corporations, and tech-literate individuals. ChatGPT puts the power of AI in the hands of average internet users. This technology caused concern that the Internet would become filled with content created through the use of AI that would drown out organic human content. In 2016, the security firm Imperva released a report on bot traffic and found that bots were responsible for 52% of web traffic, the first time they had surpassed human traffic. This report has been used as evidence in reports on the dead Internet theory. In the past, the social media site Reddit allowed free access to its API and data, which allowed users to employ third-party moderation apps and train AI in human interaction. Controversially, Reddit moved to charge for access to its user dataset. Companies training AI will likely continue to use this data for training future AI. As LLMs such as ChatGPT become available to the general public, they are increasingly being employed on Reddit by users and bot accounts. Professor Toby Walsh of the University of New South Wales said in an interview with Business Insider that training the next generation of AI on content created by previous generations could cause the content to suffer. University of South Florida professor John Licato compared this situation of AI-generated web content flooding Reddit to the dead Internet theory. Several Twitter accounts started posting tweets starting with the phrase "I hate texting" followed by an alternative activity, such as "i hate texting i just want to hold ur hand", or "i hate texting just come live with me". These posts received tens of thousands of likes, and many suspected them to be bot accounts. Proponents of the dead internet theory have used these accounts as an example. The proportion of user accounts run by bots became a major issue during Elon Musk 's acquisition of Twitter. During this process, Musk disputed Twitter's claim that fewer than 5% of their monetizable daily active users (mDAU) were bots. During this dispute, Musk commissioned the company Cybra to estimate what percentage of Twitter accounts were bots, with one study estimating 13.7% and the second estimating 11%. These bot accounts are thought to be responsible for a disproportionate amount of the content generated. This incident has been pointed to by believers in the dead internet theory as evidence. There is a market online for fake YouTube views to boost a video's credibility and reach broader audiences. At one point, fake views were so prevalent that some engineers were concerned YouTube's algorithm for detecting them would begin to treat the fake views as default and start misclassifying real ones. YouTube engineers coined the term "the Inversion" to describe this phenomenon. YouTube bots and the fear of "the Inversion" were cited as support for the dead internet theory in a thread on the internet forum Agora Road's Macintosh Cafe. Generative pre-trained transformers (GPTs) are a class of large language models (LLMs) that employ artificial neural networks to produce human-like content. The first of these was developed by OpenAI . These models have created significant controversy. For example, Timothy Shoup of the Copenhagen Institute for Futures Studies has said, "in the scenario where GPT-3 'gets loose', the internet would be completely unrecognizable". He predicted that in such a scenario, 99% to 99.9% of content online might be AI-generated by 2025 to 2030. These predictions have been used as evidence for the dead internet theory. In 2024, Google reported that its search results were being inundated with websites that "feel like they were created for search engines instead of people." In correspondence with Gizmodo , a Google spokesperson acknowledged the role of generative AI in the rapid proliferation of such content and that it could displace more valuable human-made alternatives. ChatGPT is an AI chatbot whose 2022 release to the general public led journalists to call the dead internet theory potentially more realistic than before. Before ChatGPT's release, the dead internet theory mostly emphasized government organizations, corporations, and tech-literate individuals. ChatGPT puts the power of AI in the hands of average internet users. This technology caused concern that the Internet would become filled with content created through the use of AI that would drown out organic human content. ChatGPT is an AI chatbot whose 2022 release to the general public led journalists to call the dead internet theory potentially more realistic than before. Before ChatGPT's release, the dead internet theory mostly emphasized government organizations, corporations, and tech-literate individuals. ChatGPT puts the power of AI in the hands of average internet users. This technology caused concern that the Internet would become filled with content created through the use of AI that would drown out organic human content. In 2016, the security firm Imperva released a report on bot traffic and found that bots were responsible for 52% of web traffic, the first time they had surpassed human traffic. This report has been used as evidence in reports on the dead Internet theory. In the past, the social media site Reddit allowed free access to its API and data, which allowed users to employ third-party moderation apps and train AI in human interaction. Controversially, Reddit moved to charge for access to its user dataset. Companies training AI will likely continue to use this data for training future AI. As LLMs such as ChatGPT become available to the general public, they are increasingly being employed on Reddit by users and bot accounts. Professor Toby Walsh of the University of New South Wales said in an interview with Business Insider that training the next generation of AI on content created by previous generations could cause the content to suffer. University of South Florida professor John Licato compared this situation of AI-generated web content flooding Reddit to the dead Internet theory. Several Twitter accounts started posting tweets starting with the phrase "I hate texting" followed by an alternative activity, such as "i hate texting i just want to hold ur hand", or "i hate texting just come live with me". These posts received tens of thousands of likes, and many suspected them to be bot accounts. Proponents of the dead internet theory have used these accounts as an example. The proportion of user accounts run by bots became a major issue during Elon Musk 's acquisition of Twitter. During this process, Musk disputed Twitter's claim that fewer than 5% of their monetizable daily active users (mDAU) were bots. During this dispute, Musk commissioned the company Cybra to estimate what percentage of Twitter accounts were bots, with one study estimating 13.7% and the second estimating 11%. These bot accounts are thought to be responsible for a disproportionate amount of the content generated. This incident has been pointed to by believers in the dead internet theory as evidence. Several Twitter accounts started posting tweets starting with the phrase "I hate texting" followed by an alternative activity, such as "i hate texting i just want to hold ur hand", or "i hate texting just come live with me". These posts received tens of thousands of likes, and many suspected them to be bot accounts. Proponents of the dead internet theory have used these accounts as an example. The proportion of user accounts run by bots became a major issue during Elon Musk 's acquisition of Twitter. During this process, Musk disputed Twitter's claim that fewer than 5% of their monetizable daily active users (mDAU) were bots. During this dispute, Musk commissioned the company Cybra to estimate what percentage of Twitter accounts were bots, with one study estimating 13.7% and the second estimating 11%. These bot accounts are thought to be responsible for a disproportionate amount of the content generated. This incident has been pointed to by believers in the dead internet theory as evidence. There is a market online for fake YouTube views to boost a video's credibility and reach broader audiences. At one point, fake views were so prevalent that some engineers were concerned YouTube's algorithm for detecting them would begin to treat the fake views as default and start misclassifying real ones. YouTube engineers coined the term "the Inversion" to describe this phenomenon. YouTube bots and the fear of "the Inversion" were cited as support for the dead internet theory in a thread on the internet forum Agora Road's Macintosh Cafe. The dead internet theory has been discussed among users of the social media platform X (formerly Twitter) . Users have noted that bot activity has affected their experience. Numerous YouTube channels and online communities, including the Linus Tech Tips forums, have covered the dead Internet theory, which has helped to advance the idea into mainstream discourse. The dead internet theory has been discussed among users of the social media platform X (formerly Twitter) . Users have noted that bot activity has affected their experience. Numerous YouTube channels and online communities, including the Linus Tech Tips forums, have covered the dead Internet theory, which has helped to advance the idea into mainstream discourse.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Bat/html

Bat

(traditional): (present): Bats are flying mammals of the order Chiroptera ( / k aɪ ˈ r ɒ p t ə r ə / ). [lower-alpha 1] With their forelimbs adapted as wings , they are the only mammals capable of true and sustained flight . Bats are more agile in flight than most birds, flying with their very long spread-out digits covered with a thin membrane or patagium . The smallest bat, and arguably the smallest extant mammal , is Kitti's hog-nosed bat , which is 29–34 millimetres ( 1 + 1 ⁄ 8 – 1 + 3 ⁄ 8 inches) in length, 150 mm (6 in) across the wings and 2–2.6 g ( 1 ⁄ 16 – 3 ⁄ 32 oz) in mass. The largest bats are the flying foxes , with the giant golden-crowned flying fox ( Acerodon jubatus ) reaching a weight of 1.6 kg ( 3 + 1 ⁄ 2 lb) and having a wingspan of 1.7 m (5 ft 7 in) . The second largest order of mammals after rodents , bats comprise about 20% of all classified mammal species worldwide, with over 1,400 species. These were traditionally divided into two suborders: the largely fruit-eating megabats , and the echolocating microbats . But more recent evidence has supported dividing the order into Yinpterochiroptera and Yangochiroptera , with megabats as members of the former along with several species of microbats. Many bats are insectivores , and most of the rest are frugivores (fruit-eaters) or nectarivores (nectar-eaters). A few species feed on animals other than insects; for example, the vampire bats feed on blood . Most bats are nocturnal , and many roost in caves or other refuges; it is uncertain whether bats have these behaviours to escape predators . Bats are present throughout the world, with the exception of extremely cold regions. They are important in their ecosystems for pollinating flowers and dispersing seeds; many tropical plants depend entirely on bats for these services. Bats provide humans with some direct benefits, at the cost of some disadvantages. Bat dung has been mined as guano from caves and used as fertiliser. Bats consume insect pests, reducing the need for pesticides and other insect management measures. They are sometimes numerous enough and close enough to human settlements to serve as tourist attractions, and they are used as food across Asia and the Pacific Rim . However, fruit bats are frequently considered pests by fruit growers. Due to their physiology, bats are one type of animal that acts as a natural reservoir of many pathogens , such as rabies ; and since they are highly mobile, social, and long-lived, they can readily spread disease among themselves. If humans interact with bats, these traits become potentially dangerous to humans. Some bats are also predators of mosquitoes , suppressing the transmission of mosquito-borne diseases . Depending on the culture, bats may be symbolically associated with positive traits, such as protection from certain diseases or risks, rebirth, or long life, but in the West, bats are popularly associated with darkness, malevolence, witchcraft, vampires , and death.An older English name for bats is flittermouse , which matches their name in other Germanic languages (for example German Fledermaus and Swedish fladdermus ), related to the fluttering of wings. Middle English had bakke , most likely cognate with Old Swedish natbakka ("night-bat"), which may have undergone a shift from -k- to -t- (to Modern English bat ) influenced by Latin blatta , "moth, nocturnal insect". The word "bat" was probably first used in the early 1570s. The name "Chiroptera" derives from Ancient Greek : χείρ – cheir , "hand" and πτερόν – pteron , "wing". The delicate skeletons of bats do not fossilise well; it is estimated that only 12% of bat genera that lived have been found in the fossil record. Most of the oldest known bat fossils were already very similar to modern microbats, such as Archaeopteropus (32 million years ago). The oldest known bat fossils include Archaeonycteris praecursor and Altaynycteris aurora (55-56 million years ago), both known only from isolated teeth. The oldest complete bat skeleton is Icaronycteris gunnelli (52 million years ago), known from two skeletons discovered in Wyoming. The extinct bats Palaeochiropteryx tupaiodon and Hassianycteris kumari , both of which lived 48 million years ago, are the first fossil mammals whose colouration has been discovered: both were reddish-brown. Bats were formerly grouped in the superorder Archonta , along with the treeshrews (Scandentia), colugos (Dermoptera), and primates . Modern genetic evidence now places bats in the superorder Laurasiatheria , with its sister taxon as Ferungulata , which includes carnivorans , pangolins , odd-toed ungulates , even-toed ungulates , and cetaceans . One study places Chiroptera as a sister taxon to odd-toed ungulates (Perissodactyla). Euarchontoglires (primates, treeshrews, rodents, rabbits) Eulipotyphla (hedgehogs, shrews, moles, solenodons) Chiroptera (bats) Pholidota (pangolins) Carnivora (cats, hyenas, dogs, bears, seals, weasels) Perissodactyla (horses, tapirs, rhinos) Cetartiodactyla (camels, ruminants, whales) The flying primate hypothesis proposed that when adaptations to flight are removed, megabats are allied to primates by anatomical features not shared with microbats and thus flight evolved twice in mammals. Genetic studies have strongly supported the monophyly of bats and the single origin of mammal flight. An independent molecular analysis trying to establish the dates when bat ectoparasites ( bedbugs ) evolved came to the conclusion that bedbugs similar to those known today (all major extant lineages, all of which feed primarily on bats) had already diversified and become established over 100 mya (i.e., long before the oldest records for bats, 52 mya), suggesting that they initially all evolved on non-bat hosts and "bats were colonized several times independently, unless the evolutionary origin of bats has been grossly underestimated." Fleas , as a group, are quite old (most flea families formed around the end of the Cretaceous ), but no analyses have provided estimates for the age of the flea lineages associated with bats. The oldest known members of a different lineage of bat ectoparasites ( bat flies ), however, are from roughly 20 mya, well after the origin of bats. The bat-ectoparasitic earwig family Arixeniidae has no fossil record, but is not believed to originate more than 23 mya. Pteropodidae (megabats) Megadermatidae (false vampire bats) Craseonycteridae (Kitti's hog-nosed bat) Rhinopomatidae (mouse-tailed bats) Hipposideridae (Old World leaf-nosed bats) Rhinolophidae (horseshoe bats) Miniopteridae (long winged bat) Noctilionidae (fisherman bats) Mormoopidae ( Pteronotus ) Mystacinidae (New Zealand short-tailed bats) Thyropteridae (disc-winged bats) Furipteridae Mormoopidae ( Mormoops ) Phyllostomidae (New World leaf-nosed bats) Molossidae (free-tailed bats) Emballonuridae (sac-winged bats) Myzopodidae (sucker-footed bats) Emballonuridae ( Taphozous ) Natalidae (funnel-eared bats) Vespertilionidae (vesper bats) Genetic evidence indicates that megabats originated during the early Eocene , and belong within the four major lines of microbats. Two new suborders have been proposed; Yinpterochiroptera includes the Pteropodidae , or megabat family, as well as the families Rhinolophidae , Hipposideridae , Craseonycteridae , Megadermatidae , and Rhinopomatidae . Yangochiroptera includes the other families of bats (all of which use laryngeal echolocation), a conclusion supported by a 2005 DNA study. A 2013 phylogenomic study supported the two new proposed suborders. Yangochiroptera (as above) Pteropodidae (megabats) Megadermatidae (false vampire bats) horseshoe bats and allies The 2003 discovery of an early fossil bat from the 52-million-year-old Green River Formation , Onychonycteris finneyi , indicates that flight evolved before echolocative abilities. Onychonycteris had claws on all five of its fingers, whereas modern bats have at most two claws on two digits of each hand. It also had longer hind legs and shorter forearms, similar to climbing mammals that hang under branches, such as sloths and gibbons . This palm-sized bat had short, broad wings, suggesting that it could not fly as fast or as far as later bat species. Instead of flapping its wings continuously while flying, Onychonycteris probably alternated between flaps and glides in the air. This suggests that this bat did not fly as much as modern bats, but flew from tree to tree and spent most of its time climbing or hanging on branches. The distinctive features of the Onychonycteris fossil also support the hypothesis that mammalian flight most likely evolved in arboreal locomotors, rather than terrestrial runners. This model of flight development, commonly known as the "trees-down" theory, holds that bats first flew by taking advantage of height and gravity to drop down on to prey, rather than running fast enough for a ground-level take off. The molecular phylogeny was controversial, as it pointed to microbats not having a unique common ancestry , which implied that some seemingly unlikely transformations occurred. The first is that laryngeal echolocation evolved twice in bats, once in Yangochiroptera and once in the rhinolophoids. The second is that laryngeal echolocation had a single origin in Chiroptera, was subsequently lost in the family Pteropodidae (all megabats), and later evolved as a system of tongue-clicking in the genus Rousettus . Analyses of the sequence of the vocalization gene FoxP2 were inconclusive on whether laryngeal echolocation was lost in the pteropodids or gained in the echolocating lineages. Echolocation probably first derived in bats from communicative calls. The Eocene bats Icaronycteris (52 million years ago) and Palaeochiropteryx had cranial adaptations suggesting an ability to detect ultrasound . This may have been used at first mainly to forage on the ground for insects and map out their surroundings in their gliding phase, or for communicative purposes. After the adaptation of flight was established, it may have been refined to target flying prey by echolocation. Analyses of the hearing gene Prestin seem to favour the idea that echolocation developed independently at least twice, rather than being lost secondarily in the pteropodids, but ontogenic analysis of the cochlea supports that laryngeal echolocation evolved only once. Bats are placental mammals . After rodents , they are the largest order , making up about 20% of mammal species. In 1758, Carl Linnaeus classified the seven bat species he knew of in the genus Vespertilio in the order Primates . Around twenty years later, the German naturalist Johann Friedrich Blumenbach gave them their own order, Chiroptera. Since then, the number of described species has risen to over 1,400, traditionally classified as two suborders: Megachiroptera (megabats), and Microchiroptera (microbats/echolocating bats). Not all megabats are larger than microbats. Several characteristics distinguish the two groups. Microbats use echolocation for navigation and finding prey, but megabats apart from those in the genus Rousettus do not. Accordingly, megabats have a well-developed eyesight. Megabats have a claw on the second finger of the forelimb. The external ears of microbats do not close to form a ring; the edges are separated from each other at the base of the ear. Megabats eat fruit , nectar , or pollen, while most microbats eat insects ; others feed on fruit, nectar, pollen, fish , frogs, small mammals, or blood . Below is a table chart following the bat classification of families recognized by various authors of the ninth volume of Handbook of the Mammals of the World published in 2019: The delicate skeletons of bats do not fossilise well; it is estimated that only 12% of bat genera that lived have been found in the fossil record. Most of the oldest known bat fossils were already very similar to modern microbats, such as Archaeopteropus (32 million years ago). The oldest known bat fossils include Archaeonycteris praecursor and Altaynycteris aurora (55-56 million years ago), both known only from isolated teeth. The oldest complete bat skeleton is Icaronycteris gunnelli (52 million years ago), known from two skeletons discovered in Wyoming. The extinct bats Palaeochiropteryx tupaiodon and Hassianycteris kumari , both of which lived 48 million years ago, are the first fossil mammals whose colouration has been discovered: both were reddish-brown. Bats were formerly grouped in the superorder Archonta , along with the treeshrews (Scandentia), colugos (Dermoptera), and primates . Modern genetic evidence now places bats in the superorder Laurasiatheria , with its sister taxon as Ferungulata , which includes carnivorans , pangolins , odd-toed ungulates , even-toed ungulates , and cetaceans . One study places Chiroptera as a sister taxon to odd-toed ungulates (Perissodactyla). Euarchontoglires (primates, treeshrews, rodents, rabbits) Eulipotyphla (hedgehogs, shrews, moles, solenodons) Chiroptera (bats) Pholidota (pangolins) Carnivora (cats, hyenas, dogs, bears, seals, weasels) Perissodactyla (horses, tapirs, rhinos) Cetartiodactyla (camels, ruminants, whales) The flying primate hypothesis proposed that when adaptations to flight are removed, megabats are allied to primates by anatomical features not shared with microbats and thus flight evolved twice in mammals. Genetic studies have strongly supported the monophyly of bats and the single origin of mammal flight. An independent molecular analysis trying to establish the dates when bat ectoparasites ( bedbugs ) evolved came to the conclusion that bedbugs similar to those known today (all major extant lineages, all of which feed primarily on bats) had already diversified and become established over 100 mya (i.e., long before the oldest records for bats, 52 mya), suggesting that they initially all evolved on non-bat hosts and "bats were colonized several times independently, unless the evolutionary origin of bats has been grossly underestimated." Fleas , as a group, are quite old (most flea families formed around the end of the Cretaceous ), but no analyses have provided estimates for the age of the flea lineages associated with bats. The oldest known members of a different lineage of bat ectoparasites ( bat flies ), however, are from roughly 20 mya, well after the origin of bats. The bat-ectoparasitic earwig family Arixeniidae has no fossil record, but is not believed to originate more than 23 mya. An independent molecular analysis trying to establish the dates when bat ectoparasites ( bedbugs ) evolved came to the conclusion that bedbugs similar to those known today (all major extant lineages, all of which feed primarily on bats) had already diversified and become established over 100 mya (i.e., long before the oldest records for bats, 52 mya), suggesting that they initially all evolved on non-bat hosts and "bats were colonized several times independently, unless the evolutionary origin of bats has been grossly underestimated." Fleas , as a group, are quite old (most flea families formed around the end of the Cretaceous ), but no analyses have provided estimates for the age of the flea lineages associated with bats. The oldest known members of a different lineage of bat ectoparasites ( bat flies ), however, are from roughly 20 mya, well after the origin of bats. The bat-ectoparasitic earwig family Arixeniidae has no fossil record, but is not believed to originate more than 23 mya. Pteropodidae (megabats) Megadermatidae (false vampire bats) Craseonycteridae (Kitti's hog-nosed bat) Rhinopomatidae (mouse-tailed bats) Hipposideridae (Old World leaf-nosed bats) Rhinolophidae (horseshoe bats) Miniopteridae (long winged bat) Noctilionidae (fisherman bats) Mormoopidae ( Pteronotus ) Mystacinidae (New Zealand short-tailed bats) Thyropteridae (disc-winged bats) Furipteridae Mormoopidae ( Mormoops ) Phyllostomidae (New World leaf-nosed bats) Molossidae (free-tailed bats) Emballonuridae (sac-winged bats) Myzopodidae (sucker-footed bats) Emballonuridae ( Taphozous ) Natalidae (funnel-eared bats) Vespertilionidae (vesper bats) Genetic evidence indicates that megabats originated during the early Eocene , and belong within the four major lines of microbats. Two new suborders have been proposed; Yinpterochiroptera includes the Pteropodidae , or megabat family, as well as the families Rhinolophidae , Hipposideridae , Craseonycteridae , Megadermatidae , and Rhinopomatidae . Yangochiroptera includes the other families of bats (all of which use laryngeal echolocation), a conclusion supported by a 2005 DNA study. A 2013 phylogenomic study supported the two new proposed suborders. Yangochiroptera (as above) Pteropodidae (megabats) Megadermatidae (false vampire bats) horseshoe bats and allies The 2003 discovery of an early fossil bat from the 52-million-year-old Green River Formation , Onychonycteris finneyi , indicates that flight evolved before echolocative abilities. Onychonycteris had claws on all five of its fingers, whereas modern bats have at most two claws on two digits of each hand. It also had longer hind legs and shorter forearms, similar to climbing mammals that hang under branches, such as sloths and gibbons . This palm-sized bat had short, broad wings, suggesting that it could not fly as fast or as far as later bat species. Instead of flapping its wings continuously while flying, Onychonycteris probably alternated between flaps and glides in the air. This suggests that this bat did not fly as much as modern bats, but flew from tree to tree and spent most of its time climbing or hanging on branches. The distinctive features of the Onychonycteris fossil also support the hypothesis that mammalian flight most likely evolved in arboreal locomotors, rather than terrestrial runners. This model of flight development, commonly known as the "trees-down" theory, holds that bats first flew by taking advantage of height and gravity to drop down on to prey, rather than running fast enough for a ground-level take off. The molecular phylogeny was controversial, as it pointed to microbats not having a unique common ancestry , which implied that some seemingly unlikely transformations occurred. The first is that laryngeal echolocation evolved twice in bats, once in Yangochiroptera and once in the rhinolophoids. The second is that laryngeal echolocation had a single origin in Chiroptera, was subsequently lost in the family Pteropodidae (all megabats), and later evolved as a system of tongue-clicking in the genus Rousettus . Analyses of the sequence of the vocalization gene FoxP2 were inconclusive on whether laryngeal echolocation was lost in the pteropodids or gained in the echolocating lineages. Echolocation probably first derived in bats from communicative calls. The Eocene bats Icaronycteris (52 million years ago) and Palaeochiropteryx had cranial adaptations suggesting an ability to detect ultrasound . This may have been used at first mainly to forage on the ground for insects and map out their surroundings in their gliding phase, or for communicative purposes. After the adaptation of flight was established, it may have been refined to target flying prey by echolocation. Analyses of the hearing gene Prestin seem to favour the idea that echolocation developed independently at least twice, rather than being lost secondarily in the pteropodids, but ontogenic analysis of the cochlea supports that laryngeal echolocation evolved only once. Bats are placental mammals . After rodents , they are the largest order , making up about 20% of mammal species. In 1758, Carl Linnaeus classified the seven bat species he knew of in the genus Vespertilio in the order Primates . Around twenty years later, the German naturalist Johann Friedrich Blumenbach gave them their own order, Chiroptera. Since then, the number of described species has risen to over 1,400, traditionally classified as two suborders: Megachiroptera (megabats), and Microchiroptera (microbats/echolocating bats). Not all megabats are larger than microbats. Several characteristics distinguish the two groups. Microbats use echolocation for navigation and finding prey, but megabats apart from those in the genus Rousettus do not. Accordingly, megabats have a well-developed eyesight. Megabats have a claw on the second finger of the forelimb. The external ears of microbats do not close to form a ring; the edges are separated from each other at the base of the ear. Megabats eat fruit , nectar , or pollen, while most microbats eat insects ; others feed on fruit, nectar, pollen, fish , frogs, small mammals, or blood . Below is a table chart following the bat classification of families recognized by various authors of the ninth volume of Handbook of the Mammals of the World published in 2019: The head and teeth shape of bats can vary by species. In general, megabats have longer snouts, larger eye sockets and smaller ears, giving them a more dog-like appearance, which is the source of their nickname of "flying foxes". Among microbats, longer snouts are associated with nectar-feeding. while vampire bats have reduced snouts to accommodate large incisors and canines. Small insect-eating bats can have as many as 38 teeth, while vampire bats have only 20. Bats that feed on hard-shelled insects have fewer but larger teeth with longer canines and more robust lower jaws than species that prey on softer bodied insects. In nectar-feeding bats, the canines are long while the cheek-teeth are reduced. In fruit-eating bats, the cusps of the cheek teeth are adapted for crushing. The upper incisors of vampire bats lack enamel , which keeps them razor-sharp. The bite force of small bats is generated through mechanical advantage , allowing them to bite through the hardened armour of insects or the skin of fruit. Bats are the only mammals capable of sustained flight, as opposed to gliding , as in the flying squirrel . The fastest bat, the Mexican free-tailed bat ( Tadarida brasiliensis ), can achieve a ground speed of 160 km/h (100 mph) . The finger bones of bats are much more flexible than those of other mammals, owing to their flattened cross-section and to low levels of calcium near their tips. The elongation of bat digits, a key feature required for wing development, is due to the upregulation of bone morphogenetic proteins (Bmps). During embryonic development , the gene controlling Bmp signalling, Bmp2 , is subjected to increased expression in bat forelimbs – resulting in the extension of the manual digits. This crucial genetic alteration helps create the specialized limbs required for powered flight. The relative proportion of extant bat forelimb digits compared with those of Eocene fossil bats have no significant differences, suggesting that bat wing morphology has been conserved for over fifty million years. During flight, the bones undergo bending and shearing stress ; the bending stresses felt are smaller than in terrestrial mammals, but the shearing stress is larger. The wing bones of bats have a slightly lower breaking stress point than those of birds. As in other mammals, and unlike in birds, the radius is the main component of the forearm. Bats have five elongated digits, which all radiate around the wrist. The thumb points forward and supports the leading edge of the wing, and the other digits support the tension held in the wing membrane. The second and third digits go along the wing tip, allowing the wing to be pulled forward against aerodynamic drag , without having to be thick as in pterosaur wings. The fourth and fifth digits go from the wrist to the trailing edge , and repel the bending force caused by air pushing up against the stiff membrane. Due to their flexible joints, bats are more maneuverable and more dexterous than gliding mammals. The wings of bats are much thinner and consist of more bones than the wings of birds, allowing bats to maneuver more accurately than the latter, and fly with more lift and less drag. By folding the wings in toward their bodies on the upstroke, they save 35 percent energy during flight. The membranes are delicate, tearing easily, but can regrow, and small tears heal quickly. The surface of the wings is equipped with touch-sensitive receptors on small bumps called Merkel cells , also found on human fingertips. These sensitive areas are different in bats, as each bump has a tiny hair in the center, making it even more sensitive and allowing the bat to detect and adapt to changing airflow; the primary use is to judge the most efficient speed at which to fly, and possibly also to avoid stalls . Insectivorous bats may also use tactile hairs to help perform complex maneuvers to capture prey in flight. The patagium is the wing membrane; it is stretched between the arm and finger bones, and down the side of the body to the hind limbs and tail. This skin membrane consists of connective tissue , elastic fibres , nerves , muscles , and blood vessels . The muscles keep the membrane taut during flight. The extent to which the tail of a bat is attached to a patagium can vary by species, with some having completely free tails or even no tails. The skin on the body of the bat, which has one layer of epidermis and dermis , as well as hair follicles , sweat glands and a fatty subcutaneous layer, is very different from the skin of the wing membrane. Depending on the bat species the presence of hair follicles and sweat glands will vary in the patagium . This patagium is an extremely thin double layer of epidermis; these layers are separated by a connective tissue center, rich with collagen and elastic fibers . In some bat species sweats glands will be present in between this connective tissue . Furthermore, if hair follicles are present this supports the bat in order to adjust sudden flight maneuvers. For bat embryos, apoptosis (programmed cell death) affects only the hindlimbs, while the forelimbs retain webbing between the digits that forms into the wing membranes. Unlike birds, whose stiff wings deliver bending and torsional stress to the shoulders, bats have a flexible wing membrane that can resist only tension. To achieve flight, a bat exerts force inwards at the points where the membrane meets the skeleton, so that an opposing force balances it on the wing edges perpendicular to the wing surface. This adaptation does not permit bats to reduce their wingspans, unlike birds, which can partly fold their wings in flight, radically reducing the wing span and area for the upstroke and for gliding. Hence bats cannot travel over long distances as birds can. Nectar- and pollen-eating bats can hover, in a similar way to hummingbirds . The sharp leading edges of the wings can create vortices , which provide lift . The vortex may be stabilized by the animal changing its wing curvatures. When not flying, bats hang upside down from their feet, a posture known as roosting. The femurs are attached at the hips in a way that allows them to bend outward and upward in flight. The ankle joint can flex to allow the trailing edge of the wings to bend downwards. This does not permit many movements other than hanging or clambering up trees. Most megabats roost with the head tucked towards the belly, whereas most microbats roost with the neck curled towards the back. This difference is reflected in the structure of the cervical or neck vertebrae in the two groups, which are clearly distinct. Tendons allow bats to lock their feet closed when hanging from a roost. Muscular power is needed to let go, but not to grasp a perch or when holding on. When on the ground, most bats can only crawl awkwardly. A few species such as the New Zealand lesser short-tailed bat and the common vampire bat are agile on the ground. Both species make lateral gaits (the limbs move one after the other) when moving slowly but vampire bats move with a bounding gait (all limbs move in unison) at greater speeds, the folded up wings being used to propel them forward. Vampire bat likely evolved these gaits to follow their hosts while short-tailed bats developed in the absence of terrestrial mammal competitors. Enhanced terrestrial locomotion does not appear to have reduced their ability to fly. Bats have an efficient circulatory system . They seem to make use of particularly strong venomotion, a rhythmic contraction of venous wall muscles. In most mammals, the walls of the veins provide mainly passive resistance, maintaining their shape as deoxygenated blood flows through them, but in bats they appear to actively support blood flow back to the heart with this pumping action. Since their bodies are relatively small and lightweight, bats are not at risk of blood flow rushing to their heads when roosting. Bats possess a highly adapted respiratory system to cope with the demands of powered flight, an energetically taxing activity that requires a large continuous throughput of oxygen. In bats, the relative alveolar surface area and pulmonary capillary blood volume are larger than in most other small quadrupedal mammals. During flight the respiratory cycle has a one-to-one relationship with the wing-beat cycle. Because of the restraints of the mammalian lungs, bats cannot maintain high-altitude flight. It takes a lot of energy and an efficient circulatory system to work the flight muscles of bats. Energy supply to the muscles engaged in flight requires about double the amount compared to the muscles that do not use flight as a means of mammalian locomotion. In parallel to energy consumption, blood oxygen levels of flying animals are twice as much as those of their terrestrially locomoting mammals. As the blood supply controls the amount of oxygen supplied throughout the body, the circulatory system must respond accordingly. Therefore, compared to a terrestrial mammal of the same relative size, the bat's heart can be up to three times larger, and pump more blood. Cardiac output is directly derived from heart rate and stroke volume of the blood; an active microbat can reach a heart rate of 1000 beats per minute . With its extremely thin membranous tissue, a bat's wing can significantly contribute to the organism's total gas exchange efficiency. Because of the high energy demand of flight, the bat's body meets those demands by exchanging gas through the patagium of the wing. When the bat has its wings spread it allows for an increase in surface area to volume ratio. The surface area of the wings is about 85% of the total body surface area, suggesting the possibility of a useful degree of gas exchange. The subcutaneous vessels in the membrane lie very close to the surface and allow for the diffusion of oxygen and carbon dioxide. The digestive system of bats has varying adaptations depending on the species of bat and its diet. As in other flying animals, food is processed quickly and effectively to keep up with the energy demand. Insectivorous bats may have certain digestive enzymes to better process insects, such as chitinase to break down chitin , which is a large component of insects. Vampire bats, probably due to their diet of blood, are the only vertebrates that do not have the enzyme maltase , which breaks down malt sugar , in their intestinal tract. Nectivorous and frugivorous bats have more maltase and sucrase enzymes than insectivorous, to cope with the higher sugar contents of their diet. The adaptations of the kidneys of bats vary with their diets. Carnivorous and vampire bats consume large amounts of protein and can output concentrated urine ; their kidneys have a thin cortex and long renal papillae . Frugivorous bats lack that ability and have kidneys adapted for electrolyte -retention due to their low-electrolyte diet; their kidneys accordingly have a thick cortex and very short conical papillae. Bats have higher metabolic rates associated with flying, which lead to an increased respiratory water loss. Their large wings are composed of the highly vascularized membranes, increasing the surface area, and leading to cutaneous evaporative water loss. Water helps maintain their ionic balance in their blood, thermoregulation system, and removal of wastes and toxins from the body via urine. They are also susceptible to blood urea poisoning if they do not receive enough fluid. The structure of the uterine system in female bats can vary by species, with some having two uterine horns while others have a single mainline chamber. Microbats and a few megabats emit ultrasonic sounds to produce echoes. Sound intensity of these echos are dependent on subglottic pressure. The bats' cricothyroid muscle controls the orientation pulse frequency, which is an important function. This muscle is located inside the larynx and it is the only tensor muscle capable of aiding phonation. By comparing the outgoing pulse with the returning echoes, bats can gather information on their surroundings. This allows them to detect prey in darkness. Some bat calls can reach 140 decibels . Microbats use their larynx to emit echolocation signals through the mouth or the nose. Microbat calls range in frequency from 14,000 to well over 100,000 Hz, extending well beyond the range of human hearing (between 20 and 20,000 Hz). Various groups of bats have evolved fleshy extensions around and above the nostrils, known as nose-leaves , which play a role in sound transmission. In low-duty cycle echolocation, bats can separate their calls and returning echoes by time. They have to time their short calls to finish before echoes return. The delay of the returning echoes allows the bat to estimate the range to their prey. In high-duty cycle echolocation, bats emit a continuous call and separate pulse and echo in frequency using the Doppler effect of their motion in flight. The shift of the returning echoes yields information relating to the motion and location of the bat's prey. These bats must deal with changes in the Doppler shift due to changes in their flight speed. They have adapted to change their pulse emission frequency in relation to their flight speed so echoes still return in the optimal hearing range. In addition to echolocating prey, bat ears are sensitive to sounds made by their prey, such as the fluttering of moth wings. The complex geometry of ridges on the inner surface of bat ears helps to sharply focus echolocation signals, and to passively listen for any other sound produced by the prey. These ridges can be regarded as the acoustic equivalent of a Fresnel lens , and exist in a large variety of unrelated animals, such as the aye-aye , lesser galago , bat-eared fox , mouse lemur , and others. Bats can estimate the elevation of their target using the interference patterns from the echoes reflecting from the tragus , a flap of skin in the external ear. By repeated scanning, bats can mentally construct an accurate image of the environment in which they are moving and of their prey. Some species of moth have exploited this, such as the tiger moths , which produces aposematic ultrasound signals to warn bats that they are chemically protected and therefore distasteful. Moth species including the tiger moth can produce signals to jam bat echolocation . Many moth species have a hearing organ called a tympanum , which responds to an incoming bat signal by causing the moth's flight muscles to twitch erratically, sending the moth into random evasive manoeuvres. The eyes of most microbat species are small and poorly developed, leading to poor visual acuity , but no species is blind. Most microbats have mesopic vision , meaning that they can detect light only in low levels, whereas other mammals have photopic vision , which allows colour vision. Microbats may use their vision for orientation and while travelling between their roosting grounds and feeding grounds, as echolocation is effective only over short distances. Some species can detect ultraviolet (UV). As the bodies of some microbats have distinct coloration, they may be able to discriminate colours. Megabat species often have eyesight as good as, if not better than, human vision. Their eyesight is adapted to both night and daylight vision, including some colour vision. Microbats make use of magnetoreception , in that they have a high sensitivity to the Earth's magnetic field , as birds do. Microbats use a polarity-based compass, meaning that they differentiate north from south, unlike birds, which use the strength of the magnetic field to differentiate latitudes , which may be used in long-distance travel. The mechanism is unknown but may involve magnetite particles. Most bats are homeothermic (having a stable body temperature), the exception being the vesper bats (Vespertilionidae), the horseshoe bats (Rhinolophidae), the free-tailed bats (Molossidae), and the bent-winged bats (Miniopteridae), which extensively use heterothermy (where body temperature can vary). Compared to other mammals, bats have a high thermal conductivity . The wings are filled with blood vessels, and lose body heat when extended. At rest, they may wrap their wings around themselves to trap a layer of warm air. Smaller bats generally have a higher metabolic rate than larger bats, and so need to consume more food in order to maintain homeothermy. Bats may avoid flying during the day to prevent overheating in the sun, since their dark wing-membranes absorb solar radiation. Bats may not be able to dissipate heat if the ambient temperature is too high; they use saliva to cool themselves in extreme conditions. Among megabats, the flying fox Pteropus hypomelanus uses saliva and wing-fanning to cool itself while roosting during the hottest part of the day. Among microbats, the Yuma myotis ( Myotis yumanensis ), the Mexican free-tailed bat, and the pallid bat ( Antrozous pallidus ) cope with temperatures up to 45 °C (113 °F) by panting, salivating, and licking their fur to promote evaporative cooling; this is sufficient to dissipate twice their metabolic heat production. Bats also possess a system of sphincter valves on the arterial side of the vascular network that runs along the edge of their wings. When fully open, these allow oxygenated blood to flow through the capillary network across the wing membrane; when contracted, they shunt flow directly to the veins, bypassing the wing capillaries. This allows bats to control how much heat is exchanged through the flight membrane, allowing them to release heat during flight. Many other mammals use the capillary network in oversized ears for the same purpose. Torpor , a state of decreased activity where the body temperature and metabolism decreases, is especially useful for bats, as they use a large amount of energy while active, depend upon an unreliable food source, and have a limited ability to store fat. They generally drop their body temperature in this state to 6–30 °C (43–86 °F) , and may reduce their energy expenditure by 50 to 99%. Tropical bats may use it to avoid predation, by reducing the amount of time spent on foraging and thus reducing the chance of being caught by a predator. Megabats were generally believed to be homeothermic, but three species of small megabats, with a mass of about 50 grams ( 1 + 3 ⁄ 4 ounces) , have been known to use torpor: the common blossom bat ( Syconycteris australis ), the long-tongued nectar bat ( Macroglossus minimus ), and the eastern tube-nosed bat ( Nyctimene robinsoni ). Torpid states last longer in the summer for megabats than in the winter. During hibernation , bats enter a torpid state and decrease their body temperature for 99.6% of their hibernation period; even during periods of arousal, when they return their body temperature to normal, they sometimes enter a shallow torpid state, known as "heterothermic arousal". Some bats become dormant during higher temperatures to keep cool in the summer months. Heterothermic bats during long migrations may fly at night and go into a torpid state roosting in the daytime. Unlike migratory birds, which fly during the day and feed during the night, nocturnal bats have a conflict between travelling and eating. The energy saved reduces their need to feed, and also decreases the duration of migration, which may prevent them from spending too much time in unfamiliar places, and decrease predation. In some species, pregnant individuals may not use torpor. The smallest bat is Kitti's hog-nosed bat ( Craseonycteris thonglongyai ), which is 29–34 mm ( 1 + 1 ⁄ 8 – 1 + 3 ⁄ 8 in) long with a 150-millimetre (6 in) wingspan and weighs 2–2.6 g ( 1 ⁄ 16 – 3 ⁄ 32 oz) . It is also arguably the smallest extant species of mammal, next to the Etruscan shrew . The largest bats are a few species of Pteropus megabats and the giant golden-crowned flying fox , ( Acerodon jubatus ), which can weigh 1.6 kg ( 3 + 1 ⁄ 2 lb) with a wingspan of 1.7 m (5 ft 7 in) . Larger bats tend to use lower frequencies and smaller bats higher for echolocation; high-frequency echolocation is better at detecting smaller prey. Small prey may be absent in the diets of large bats as they are unable to detect them. The adaptations of a particular bat species can directly influence what kinds of prey are available to it. The head and teeth shape of bats can vary by species. In general, megabats have longer snouts, larger eye sockets and smaller ears, giving them a more dog-like appearance, which is the source of their nickname of "flying foxes". Among microbats, longer snouts are associated with nectar-feeding. while vampire bats have reduced snouts to accommodate large incisors and canines. Small insect-eating bats can have as many as 38 teeth, while vampire bats have only 20. Bats that feed on hard-shelled insects have fewer but larger teeth with longer canines and more robust lower jaws than species that prey on softer bodied insects. In nectar-feeding bats, the canines are long while the cheek-teeth are reduced. In fruit-eating bats, the cusps of the cheek teeth are adapted for crushing. The upper incisors of vampire bats lack enamel , which keeps them razor-sharp. The bite force of small bats is generated through mechanical advantage , allowing them to bite through the hardened armour of insects or the skin of fruit. Bats are the only mammals capable of sustained flight, as opposed to gliding , as in the flying squirrel . The fastest bat, the Mexican free-tailed bat ( Tadarida brasiliensis ), can achieve a ground speed of 160 km/h (100 mph) . The finger bones of bats are much more flexible than those of other mammals, owing to their flattened cross-section and to low levels of calcium near their tips. The elongation of bat digits, a key feature required for wing development, is due to the upregulation of bone morphogenetic proteins (Bmps). During embryonic development , the gene controlling Bmp signalling, Bmp2 , is subjected to increased expression in bat forelimbs – resulting in the extension of the manual digits. This crucial genetic alteration helps create the specialized limbs required for powered flight. The relative proportion of extant bat forelimb digits compared with those of Eocene fossil bats have no significant differences, suggesting that bat wing morphology has been conserved for over fifty million years. During flight, the bones undergo bending and shearing stress ; the bending stresses felt are smaller than in terrestrial mammals, but the shearing stress is larger. The wing bones of bats have a slightly lower breaking stress point than those of birds. As in other mammals, and unlike in birds, the radius is the main component of the forearm. Bats have five elongated digits, which all radiate around the wrist. The thumb points forward and supports the leading edge of the wing, and the other digits support the tension held in the wing membrane. The second and third digits go along the wing tip, allowing the wing to be pulled forward against aerodynamic drag , without having to be thick as in pterosaur wings. The fourth and fifth digits go from the wrist to the trailing edge , and repel the bending force caused by air pushing up against the stiff membrane. Due to their flexible joints, bats are more maneuverable and more dexterous than gliding mammals. The wings of bats are much thinner and consist of more bones than the wings of birds, allowing bats to maneuver more accurately than the latter, and fly with more lift and less drag. By folding the wings in toward their bodies on the upstroke, they save 35 percent energy during flight. The membranes are delicate, tearing easily, but can regrow, and small tears heal quickly. The surface of the wings is equipped with touch-sensitive receptors on small bumps called Merkel cells , also found on human fingertips. These sensitive areas are different in bats, as each bump has a tiny hair in the center, making it even more sensitive and allowing the bat to detect and adapt to changing airflow; the primary use is to judge the most efficient speed at which to fly, and possibly also to avoid stalls . Insectivorous bats may also use tactile hairs to help perform complex maneuvers to capture prey in flight. The patagium is the wing membrane; it is stretched between the arm and finger bones, and down the side of the body to the hind limbs and tail. This skin membrane consists of connective tissue , elastic fibres , nerves , muscles , and blood vessels . The muscles keep the membrane taut during flight. The extent to which the tail of a bat is attached to a patagium can vary by species, with some having completely free tails or even no tails. The skin on the body of the bat, which has one layer of epidermis and dermis , as well as hair follicles , sweat glands and a fatty subcutaneous layer, is very different from the skin of the wing membrane. Depending on the bat species the presence of hair follicles and sweat glands will vary in the patagium . This patagium is an extremely thin double layer of epidermis; these layers are separated by a connective tissue center, rich with collagen and elastic fibers . In some bat species sweats glands will be present in between this connective tissue . Furthermore, if hair follicles are present this supports the bat in order to adjust sudden flight maneuvers. For bat embryos, apoptosis (programmed cell death) affects only the hindlimbs, while the forelimbs retain webbing between the digits that forms into the wing membranes. Unlike birds, whose stiff wings deliver bending and torsional stress to the shoulders, bats have a flexible wing membrane that can resist only tension. To achieve flight, a bat exerts force inwards at the points where the membrane meets the skeleton, so that an opposing force balances it on the wing edges perpendicular to the wing surface. This adaptation does not permit bats to reduce their wingspans, unlike birds, which can partly fold their wings in flight, radically reducing the wing span and area for the upstroke and for gliding. Hence bats cannot travel over long distances as birds can. Nectar- and pollen-eating bats can hover, in a similar way to hummingbirds . The sharp leading edges of the wings can create vortices , which provide lift . The vortex may be stabilized by the animal changing its wing curvatures. When not flying, bats hang upside down from their feet, a posture known as roosting. The femurs are attached at the hips in a way that allows them to bend outward and upward in flight. The ankle joint can flex to allow the trailing edge of the wings to bend downwards. This does not permit many movements other than hanging or clambering up trees. Most megabats roost with the head tucked towards the belly, whereas most microbats roost with the neck curled towards the back. This difference is reflected in the structure of the cervical or neck vertebrae in the two groups, which are clearly distinct. Tendons allow bats to lock their feet closed when hanging from a roost. Muscular power is needed to let go, but not to grasp a perch or when holding on. When on the ground, most bats can only crawl awkwardly. A few species such as the New Zealand lesser short-tailed bat and the common vampire bat are agile on the ground. Both species make lateral gaits (the limbs move one after the other) when moving slowly but vampire bats move with a bounding gait (all limbs move in unison) at greater speeds, the folded up wings being used to propel them forward. Vampire bat likely evolved these gaits to follow their hosts while short-tailed bats developed in the absence of terrestrial mammal competitors. Enhanced terrestrial locomotion does not appear to have reduced their ability to fly. Bats have an efficient circulatory system . They seem to make use of particularly strong venomotion, a rhythmic contraction of venous wall muscles. In most mammals, the walls of the veins provide mainly passive resistance, maintaining their shape as deoxygenated blood flows through them, but in bats they appear to actively support blood flow back to the heart with this pumping action. Since their bodies are relatively small and lightweight, bats are not at risk of blood flow rushing to their heads when roosting. Bats possess a highly adapted respiratory system to cope with the demands of powered flight, an energetically taxing activity that requires a large continuous throughput of oxygen. In bats, the relative alveolar surface area and pulmonary capillary blood volume are larger than in most other small quadrupedal mammals. During flight the respiratory cycle has a one-to-one relationship with the wing-beat cycle. Because of the restraints of the mammalian lungs, bats cannot maintain high-altitude flight. It takes a lot of energy and an efficient circulatory system to work the flight muscles of bats. Energy supply to the muscles engaged in flight requires about double the amount compared to the muscles that do not use flight as a means of mammalian locomotion. In parallel to energy consumption, blood oxygen levels of flying animals are twice as much as those of their terrestrially locomoting mammals. As the blood supply controls the amount of oxygen supplied throughout the body, the circulatory system must respond accordingly. Therefore, compared to a terrestrial mammal of the same relative size, the bat's heart can be up to three times larger, and pump more blood. Cardiac output is directly derived from heart rate and stroke volume of the blood; an active microbat can reach a heart rate of 1000 beats per minute . With its extremely thin membranous tissue, a bat's wing can significantly contribute to the organism's total gas exchange efficiency. Because of the high energy demand of flight, the bat's body meets those demands by exchanging gas through the patagium of the wing. When the bat has its wings spread it allows for an increase in surface area to volume ratio. The surface area of the wings is about 85% of the total body surface area, suggesting the possibility of a useful degree of gas exchange. The subcutaneous vessels in the membrane lie very close to the surface and allow for the diffusion of oxygen and carbon dioxide. The digestive system of bats has varying adaptations depending on the species of bat and its diet. As in other flying animals, food is processed quickly and effectively to keep up with the energy demand. Insectivorous bats may have certain digestive enzymes to better process insects, such as chitinase to break down chitin , which is a large component of insects. Vampire bats, probably due to their diet of blood, are the only vertebrates that do not have the enzyme maltase , which breaks down malt sugar , in their intestinal tract. Nectivorous and frugivorous bats have more maltase and sucrase enzymes than insectivorous, to cope with the higher sugar contents of their diet. The adaptations of the kidneys of bats vary with their diets. Carnivorous and vampire bats consume large amounts of protein and can output concentrated urine ; their kidneys have a thin cortex and long renal papillae . Frugivorous bats lack that ability and have kidneys adapted for electrolyte -retention due to their low-electrolyte diet; their kidneys accordingly have a thick cortex and very short conical papillae. Bats have higher metabolic rates associated with flying, which lead to an increased respiratory water loss. Their large wings are composed of the highly vascularized membranes, increasing the surface area, and leading to cutaneous evaporative water loss. Water helps maintain their ionic balance in their blood, thermoregulation system, and removal of wastes and toxins from the body via urine. They are also susceptible to blood urea poisoning if they do not receive enough fluid. The structure of the uterine system in female bats can vary by species, with some having two uterine horns while others have a single mainline chamber. Microbats and a few megabats emit ultrasonic sounds to produce echoes. Sound intensity of these echos are dependent on subglottic pressure. The bats' cricothyroid muscle controls the orientation pulse frequency, which is an important function. This muscle is located inside the larynx and it is the only tensor muscle capable of aiding phonation. By comparing the outgoing pulse with the returning echoes, bats can gather information on their surroundings. This allows them to detect prey in darkness. Some bat calls can reach 140 decibels . Microbats use their larynx to emit echolocation signals through the mouth or the nose. Microbat calls range in frequency from 14,000 to well over 100,000 Hz, extending well beyond the range of human hearing (between 20 and 20,000 Hz). Various groups of bats have evolved fleshy extensions around and above the nostrils, known as nose-leaves , which play a role in sound transmission. In low-duty cycle echolocation, bats can separate their calls and returning echoes by time. They have to time their short calls to finish before echoes return. The delay of the returning echoes allows the bat to estimate the range to their prey. In high-duty cycle echolocation, bats emit a continuous call and separate pulse and echo in frequency using the Doppler effect of their motion in flight. The shift of the returning echoes yields information relating to the motion and location of the bat's prey. These bats must deal with changes in the Doppler shift due to changes in their flight speed. They have adapted to change their pulse emission frequency in relation to their flight speed so echoes still return in the optimal hearing range. In addition to echolocating prey, bat ears are sensitive to sounds made by their prey, such as the fluttering of moth wings. The complex geometry of ridges on the inner surface of bat ears helps to sharply focus echolocation signals, and to passively listen for any other sound produced by the prey. These ridges can be regarded as the acoustic equivalent of a Fresnel lens , and exist in a large variety of unrelated animals, such as the aye-aye , lesser galago , bat-eared fox , mouse lemur , and others. Bats can estimate the elevation of their target using the interference patterns from the echoes reflecting from the tragus , a flap of skin in the external ear. By repeated scanning, bats can mentally construct an accurate image of the environment in which they are moving and of their prey. Some species of moth have exploited this, such as the tiger moths , which produces aposematic ultrasound signals to warn bats that they are chemically protected and therefore distasteful. Moth species including the tiger moth can produce signals to jam bat echolocation . Many moth species have a hearing organ called a tympanum , which responds to an incoming bat signal by causing the moth's flight muscles to twitch erratically, sending the moth into random evasive manoeuvres. The eyes of most microbat species are small and poorly developed, leading to poor visual acuity , but no species is blind. Most microbats have mesopic vision , meaning that they can detect light only in low levels, whereas other mammals have photopic vision , which allows colour vision. Microbats may use their vision for orientation and while travelling between their roosting grounds and feeding grounds, as echolocation is effective only over short distances. Some species can detect ultraviolet (UV). As the bodies of some microbats have distinct coloration, they may be able to discriminate colours. Megabat species often have eyesight as good as, if not better than, human vision. Their eyesight is adapted to both night and daylight vision, including some colour vision. Microbats make use of magnetoreception , in that they have a high sensitivity to the Earth's magnetic field , as birds do. Microbats use a polarity-based compass, meaning that they differentiate north from south, unlike birds, which use the strength of the magnetic field to differentiate latitudes , which may be used in long-distance travel. The mechanism is unknown but may involve magnetite particles. Microbats and a few megabats emit ultrasonic sounds to produce echoes. Sound intensity of these echos are dependent on subglottic pressure. The bats' cricothyroid muscle controls the orientation pulse frequency, which is an important function. This muscle is located inside the larynx and it is the only tensor muscle capable of aiding phonation. By comparing the outgoing pulse with the returning echoes, bats can gather information on their surroundings. This allows them to detect prey in darkness. Some bat calls can reach 140 decibels . Microbats use their larynx to emit echolocation signals through the mouth or the nose. Microbat calls range in frequency from 14,000 to well over 100,000 Hz, extending well beyond the range of human hearing (between 20 and 20,000 Hz). Various groups of bats have evolved fleshy extensions around and above the nostrils, known as nose-leaves , which play a role in sound transmission. In low-duty cycle echolocation, bats can separate their calls and returning echoes by time. They have to time their short calls to finish before echoes return. The delay of the returning echoes allows the bat to estimate the range to their prey. In high-duty cycle echolocation, bats emit a continuous call and separate pulse and echo in frequency using the Doppler effect of their motion in flight. The shift of the returning echoes yields information relating to the motion and location of the bat's prey. These bats must deal with changes in the Doppler shift due to changes in their flight speed. They have adapted to change their pulse emission frequency in relation to their flight speed so echoes still return in the optimal hearing range. In addition to echolocating prey, bat ears are sensitive to sounds made by their prey, such as the fluttering of moth wings. The complex geometry of ridges on the inner surface of bat ears helps to sharply focus echolocation signals, and to passively listen for any other sound produced by the prey. These ridges can be regarded as the acoustic equivalent of a Fresnel lens , and exist in a large variety of unrelated animals, such as the aye-aye , lesser galago , bat-eared fox , mouse lemur , and others. Bats can estimate the elevation of their target using the interference patterns from the echoes reflecting from the tragus , a flap of skin in the external ear. By repeated scanning, bats can mentally construct an accurate image of the environment in which they are moving and of their prey. Some species of moth have exploited this, such as the tiger moths , which produces aposematic ultrasound signals to warn bats that they are chemically protected and therefore distasteful. Moth species including the tiger moth can produce signals to jam bat echolocation . Many moth species have a hearing organ called a tympanum , which responds to an incoming bat signal by causing the moth's flight muscles to twitch erratically, sending the moth into random evasive manoeuvres. The eyes of most microbat species are small and poorly developed, leading to poor visual acuity , but no species is blind. Most microbats have mesopic vision , meaning that they can detect light only in low levels, whereas other mammals have photopic vision , which allows colour vision. Microbats may use their vision for orientation and while travelling between their roosting grounds and feeding grounds, as echolocation is effective only over short distances. Some species can detect ultraviolet (UV). As the bodies of some microbats have distinct coloration, they may be able to discriminate colours. Megabat species often have eyesight as good as, if not better than, human vision. Their eyesight is adapted to both night and daylight vision, including some colour vision. Microbats make use of magnetoreception , in that they have a high sensitivity to the Earth's magnetic field , as birds do. Microbats use a polarity-based compass, meaning that they differentiate north from south, unlike birds, which use the strength of the magnetic field to differentiate latitudes , which may be used in long-distance travel. The mechanism is unknown but may involve magnetite particles. Most bats are homeothermic (having a stable body temperature), the exception being the vesper bats (Vespertilionidae), the horseshoe bats (Rhinolophidae), the free-tailed bats (Molossidae), and the bent-winged bats (Miniopteridae), which extensively use heterothermy (where body temperature can vary). Compared to other mammals, bats have a high thermal conductivity . The wings are filled with blood vessels, and lose body heat when extended. At rest, they may wrap their wings around themselves to trap a layer of warm air. Smaller bats generally have a higher metabolic rate than larger bats, and so need to consume more food in order to maintain homeothermy. Bats may avoid flying during the day to prevent overheating in the sun, since their dark wing-membranes absorb solar radiation. Bats may not be able to dissipate heat if the ambient temperature is too high; they use saliva to cool themselves in extreme conditions. Among megabats, the flying fox Pteropus hypomelanus uses saliva and wing-fanning to cool itself while roosting during the hottest part of the day. Among microbats, the Yuma myotis ( Myotis yumanensis ), the Mexican free-tailed bat, and the pallid bat ( Antrozous pallidus ) cope with temperatures up to 45 °C (113 °F) by panting, salivating, and licking their fur to promote evaporative cooling; this is sufficient to dissipate twice their metabolic heat production. Bats also possess a system of sphincter valves on the arterial side of the vascular network that runs along the edge of their wings. When fully open, these allow oxygenated blood to flow through the capillary network across the wing membrane; when contracted, they shunt flow directly to the veins, bypassing the wing capillaries. This allows bats to control how much heat is exchanged through the flight membrane, allowing them to release heat during flight. Many other mammals use the capillary network in oversized ears for the same purpose. Torpor , a state of decreased activity where the body temperature and metabolism decreases, is especially useful for bats, as they use a large amount of energy while active, depend upon an unreliable food source, and have a limited ability to store fat. They generally drop their body temperature in this state to 6–30 °C (43–86 °F) , and may reduce their energy expenditure by 50 to 99%. Tropical bats may use it to avoid predation, by reducing the amount of time spent on foraging and thus reducing the chance of being caught by a predator. Megabats were generally believed to be homeothermic, but three species of small megabats, with a mass of about 50 grams ( 1 + 3 ⁄ 4 ounces) , have been known to use torpor: the common blossom bat ( Syconycteris australis ), the long-tongued nectar bat ( Macroglossus minimus ), and the eastern tube-nosed bat ( Nyctimene robinsoni ). Torpid states last longer in the summer for megabats than in the winter. During hibernation , bats enter a torpid state and decrease their body temperature for 99.6% of their hibernation period; even during periods of arousal, when they return their body temperature to normal, they sometimes enter a shallow torpid state, known as "heterothermic arousal". Some bats become dormant during higher temperatures to keep cool in the summer months. Heterothermic bats during long migrations may fly at night and go into a torpid state roosting in the daytime. Unlike migratory birds, which fly during the day and feed during the night, nocturnal bats have a conflict between travelling and eating. The energy saved reduces their need to feed, and also decreases the duration of migration, which may prevent them from spending too much time in unfamiliar places, and decrease predation. In some species, pregnant individuals may not use torpor. Torpor , a state of decreased activity where the body temperature and metabolism decreases, is especially useful for bats, as they use a large amount of energy while active, depend upon an unreliable food source, and have a limited ability to store fat. They generally drop their body temperature in this state to 6–30 °C (43–86 °F) , and may reduce their energy expenditure by 50 to 99%. Tropical bats may use it to avoid predation, by reducing the amount of time spent on foraging and thus reducing the chance of being caught by a predator. Megabats were generally believed to be homeothermic, but three species of small megabats, with a mass of about 50 grams ( 1 + 3 ⁄ 4 ounces) , have been known to use torpor: the common blossom bat ( Syconycteris australis ), the long-tongued nectar bat ( Macroglossus minimus ), and the eastern tube-nosed bat ( Nyctimene robinsoni ). Torpid states last longer in the summer for megabats than in the winter. During hibernation , bats enter a torpid state and decrease their body temperature for 99.6% of their hibernation period; even during periods of arousal, when they return their body temperature to normal, they sometimes enter a shallow torpid state, known as "heterothermic arousal". Some bats become dormant during higher temperatures to keep cool in the summer months. Heterothermic bats during long migrations may fly at night and go into a torpid state roosting in the daytime. Unlike migratory birds, which fly during the day and feed during the night, nocturnal bats have a conflict between travelling and eating. The energy saved reduces their need to feed, and also decreases the duration of migration, which may prevent them from spending too much time in unfamiliar places, and decrease predation. In some species, pregnant individuals may not use torpor. The smallest bat is Kitti's hog-nosed bat ( Craseonycteris thonglongyai ), which is 29–34 mm ( 1 + 1 ⁄ 8 – 1 + 3 ⁄ 8 in) long with a 150-millimetre (6 in) wingspan and weighs 2–2.6 g ( 1 ⁄ 16 – 3 ⁄ 32 oz) . It is also arguably the smallest extant species of mammal, next to the Etruscan shrew . The largest bats are a few species of Pteropus megabats and the giant golden-crowned flying fox , ( Acerodon jubatus ), which can weigh 1.6 kg ( 3 + 1 ⁄ 2 lb) with a wingspan of 1.7 m (5 ft 7 in) . Larger bats tend to use lower frequencies and smaller bats higher for echolocation; high-frequency echolocation is better at detecting smaller prey. Small prey may be absent in the diets of large bats as they are unable to detect them. The adaptations of a particular bat species can directly influence what kinds of prey are available to it. Flight has enabled bats to become one of the most widely distributed groups of mammals. Apart from the Arctic, the Antarctic and a few isolated oceanic islands, bats exist in almost every habitat on Earth. Tropical areas tend to have more species than temperate ones. Different species select different habitats during different seasons, ranging from seasides to mountains and deserts, but they require suitable roosts. Bat roosts can be found in hollows, crevices, foliage, and even human-made structures, and include "tents" the bats construct with leaves. Megabats generally roost in trees. Most microbats are nocturnal and megabats are typically diurnal or crepuscular . Microbats are known to exhibit diurnal behaviour in temperate regions during summer when there is insufficient night time to forage, and in areas where there are few avian predators during the day. In temperate areas, some microbats migrate hundreds of kilometres to winter hibernation dens; others pass into torpor in cold weather, rousing and feeding when warm weather allows insects to be active. Others retreat to caves for winter and hibernate for as much as six months. Microbats rarely fly in rain; it interferes with their echolocation, and they are unable to hunt. Different bat species have different diets, including insects, nectar, pollen, fruit and even vertebrates. Megabats are mostly fruit, nectar and pollen eaters. Due to their small size, high-metabolism and rapid burning of energy through flight, bats must consume large amounts of food for their size. Insectivorous bats may eat over 120 percent of their body weight per day, while frugivorous bats may eat over twice their weight. They can travel significant distances each night, exceptionally as much as 38.5 km (24 mi) in the spotted bat ( Euderma maculatum ), in search of food. Bats use a variety of hunting strategies. Bats get most of their water from the food they eat; many species also drink from water sources like lakes and streams, flying over the surface and dipping their tongues into the water. The Chiroptera as a whole are in the process of losing the ability to synthesise vitamin C . In a test of 34 bat species from six major families, including major insect- and fruit-eating bat families, all were found to have lost the ability to synthesise it, and this loss may derive from a common bat ancestor, as a single mutation. [lower-alpha 2] At least two species of bat, the frugivorous bat ( Rousettus leschenaultii ) and the insectivorous bat ( Hipposideros armiger ), have retained their ability to produce vitamin C. Most microbats, especially in temperate areas, prey on insects. The diet of an insectivorous bat may span many species, including flies , mosquitos , beetles , moths, grasshoppers , crickets , termites , bees , wasps , mayflies and caddisflies . Large numbers of Mexican free-tailed bats ( Tadarida brasiliensis ) fly hundreds of metres above the ground in central Texas to feed on migrating moths. Species that hunt insects in flight, like the little brown bat ( Myotis lucifugus ), may catch an insect in mid-air with the mouth, and eat it in the air or use their tail membranes or wings to scoop up the insect and carry it to the mouth. The bat may also take the insect back to its roost and eat it there. Slower moving bat species, such as the brown long-eared bat ( Plecotus auritus ) and many horseshoe bat species, may take or glean insects from vegetation or hunt them from perches. Insectivorous bats living at high latitudes have to consume prey with higher energetic value than tropical bats. Fruit eating, or frugivory, is found in both major suborders. Bats prefer ripe fruit, pulling it off the trees with their teeth. They fly back to their roosts to eat the fruit, sucking out the juice and spitting the seeds and pulp out onto the ground. This helps disperse the seeds of these fruit trees, which may take root and grow where the bats have left them, and many species of plants depend on bats for seed dispersal . The Jamaican fruit bat ( Artibeus jamaicensis ) has been recorded carrying fruits weighing 3–14 g ( 1 ⁄ 8 – 1 ⁄ 2 oz) or even as much as 50 g ( 1 + 3 ⁄ 4 oz) . Nectar-eating bats have acquired specialised adaptations. These bats possess long muzzles and long, extensible tongues covered in fine bristles that aid them in feeding on particular flowers and plants. The tube-lipped nectar bat ( Anoura fistulata ) has the longest tongue of any mammal relative to its body size. This is beneficial to them in terms of pollination and feeding. Their long, narrow tongues can reach deep into the long cup shape of some flowers. When the tongue retracts, it coils up inside the rib cage. Because of these features, nectar-feeding bats cannot easily turn to other food sources in times of scarcity, making them more prone to extinction than other types of bat. Nectar feeding also aids a variety of plants, since these bats serve as pollinators , as pollen gets attached to their fur while they are feeding. Around 500 species of flowering plant rely on bat pollination and thus tend to open their flowers at night. Many rainforest plants depend on bat pollination. Some bats prey on other vertebrates, such as fish, frogs, lizards, birds and mammals. The fringe-lipped bat ( Trachops cirrhosus, ) for example, is skilled at catching frogs. These bats locate large groups of frogs by tracking their mating calls, then plucking them from the surface of the water with their sharp canine teeth. The greater noctule bat can catch birds in flight. Some species, like the greater bulldog bat ( Noctilio leporinus ) hunt fish. They use echolocation to detect small ripples on the water's surface, swoop down and use specially enlarged claws on their hind feet to grab the fish, then take their prey to a feeding roost and consume it. At least two species of bat are known to feed on other bats: the spectral bat ( Vampyrum spectrum ), and the ghost bat ( Macroderma gigas ). A few species, specifically the common, white-winged , and hairy-legged vampire bats, feed only on animal blood ( hematophagy ). The common vampire bat typically feeds on large mammals such as cattle ; the hairy-legged and white-winged vampires feed on birds. Vampire bats target sleeping prey and can detect deep breathing. Heat sensors in the nose help them to detect blood vessels near the surface of the skin. They pierce the animal's skin with their teeth, biting away a small flap, and lap up the blood with their tongues, which have lateral grooves adapted to this purpose. The blood is kept from clotting by an anticoagulant in the saliva. Bats are subject to predation from birds of prey , such as owls , hawks , and falcons , and at roosts from terrestrial predators able to climb, such as cats. Low-flying bats are vulnerable to crocodiles . Twenty species of tropical New World snakes are known to capture bats, often waiting at the entrances of refuges, such as caves, for bats to fly past. J. Rydell and J. R. Speakman argue that bats evolved nocturnality during the early and middle Eocene period to avoid predators. The evidence is thought by some zoologists to be equivocal so far. As are most mammals, bats are hosts to a number of internal and external parasites. Among ectoparasites , bats carry fleas and mites , as well as specific parasites such as bat bugs and bat flies ( Nycteribiidae and Streblidae ). Bats are among the few non-aquatic mammalian orders that do not host lice , possibly due to competition from more specialised parasites that occupy the same niche. White nose syndrome is a condition associated with the deaths of millions of bats in the Eastern United States and Canada. The disease is named after a white fungus , Pseudogymnoascus destructans , found growing on the muzzles, ears, and wings of affected bats. The fungus is mostly spread from bat to bat, and causes the disease. The fungus was first discovered in central New York State in 2006 and spread quickly to the entire Eastern US north of Florida; mortality rates of 90–100% have been observed in most affected caves. New England and the mid-Atlantic states have, since 2006, witnessed entire species completely extirpated and others with numbers that have gone from the hundreds of thousands, even millions, to a few hundred or less. Nova Scotia, Quebec, Ontario, and New Brunswick have witnessed identical die offs, with the Canadian government making preparations to protect all remaining bat populations in its territory. Scientific evidence suggests that longer winters where the fungus has a longer period to infect bats result in greater mortality. In 2014, the infection crossed the Mississippi River, and in 2017, it was found on bats in Texas. Bats are natural reservoirs for a large number of zoonotic pathogens , including rabies , endemic in many bat populations, histoplasmosis both directly and in guano, Nipah and Hendra viruses , and possibly the ebola virus , whose natural reservoir is yet unknown. Their high mobility, broad distribution, long life spans, substantial sympatry (range overlap) of species, and social behaviour make bats favourable hosts and vectors of disease. Reviews have found different answers as to whether bats have more zoonotic viruses than other mammal groups. One 2015 review found that bats, rodents, and primates all harbored significantly more zoonotic viruses (which can be transmitted to humans) than other mammal groups, though the differences among the aforementioned three groups were not significant (bats have no more zoonotic viruses than rodents and primates). Another 2020 review of mammals and birds found that the identity of the taxonomic groups did not have any impact on the probability of harboring zoonotic viruses. Instead, more diverse groups had greater viral diversity. They seem to be highly resistant to many of the pathogens they carry, suggesting a degree of adaptation to their immune systems. Their interactions with livestock and pets, including predation by vampire bats, accidental encounters, and the scavenging of bat carcasses, compound the risk of zoonotic transmission. Bats are implicated in the emergence of severe acute respiratory syndrome (SARS) in China, since they serve as natural hosts for coronaviruses , several from a single cave in Yunnan , one of which developed into the SARS virus. However, they neither cause nor spread COVID-19 . Different bat species have different diets, including insects, nectar, pollen, fruit and even vertebrates. Megabats are mostly fruit, nectar and pollen eaters. Due to their small size, high-metabolism and rapid burning of energy through flight, bats must consume large amounts of food for their size. Insectivorous bats may eat over 120 percent of their body weight per day, while frugivorous bats may eat over twice their weight. They can travel significant distances each night, exceptionally as much as 38.5 km (24 mi) in the spotted bat ( Euderma maculatum ), in search of food. Bats use a variety of hunting strategies. Bats get most of their water from the food they eat; many species also drink from water sources like lakes and streams, flying over the surface and dipping their tongues into the water. The Chiroptera as a whole are in the process of losing the ability to synthesise vitamin C . In a test of 34 bat species from six major families, including major insect- and fruit-eating bat families, all were found to have lost the ability to synthesise it, and this loss may derive from a common bat ancestor, as a single mutation. [lower-alpha 2] At least two species of bat, the frugivorous bat ( Rousettus leschenaultii ) and the insectivorous bat ( Hipposideros armiger ), have retained their ability to produce vitamin C. Most microbats, especially in temperate areas, prey on insects. The diet of an insectivorous bat may span many species, including flies , mosquitos , beetles , moths, grasshoppers , crickets , termites , bees , wasps , mayflies and caddisflies . Large numbers of Mexican free-tailed bats ( Tadarida brasiliensis ) fly hundreds of metres above the ground in central Texas to feed on migrating moths. Species that hunt insects in flight, like the little brown bat ( Myotis lucifugus ), may catch an insect in mid-air with the mouth, and eat it in the air or use their tail membranes or wings to scoop up the insect and carry it to the mouth. The bat may also take the insect back to its roost and eat it there. Slower moving bat species, such as the brown long-eared bat ( Plecotus auritus ) and many horseshoe bat species, may take or glean insects from vegetation or hunt them from perches. Insectivorous bats living at high latitudes have to consume prey with higher energetic value than tropical bats. Fruit eating, or frugivory, is found in both major suborders. Bats prefer ripe fruit, pulling it off the trees with their teeth. They fly back to their roosts to eat the fruit, sucking out the juice and spitting the seeds and pulp out onto the ground. This helps disperse the seeds of these fruit trees, which may take root and grow where the bats have left them, and many species of plants depend on bats for seed dispersal . The Jamaican fruit bat ( Artibeus jamaicensis ) has been recorded carrying fruits weighing 3–14 g ( 1 ⁄ 8 – 1 ⁄ 2 oz) or even as much as 50 g ( 1 + 3 ⁄ 4 oz) . Nectar-eating bats have acquired specialised adaptations. These bats possess long muzzles and long, extensible tongues covered in fine bristles that aid them in feeding on particular flowers and plants. The tube-lipped nectar bat ( Anoura fistulata ) has the longest tongue of any mammal relative to its body size. This is beneficial to them in terms of pollination and feeding. Their long, narrow tongues can reach deep into the long cup shape of some flowers. When the tongue retracts, it coils up inside the rib cage. Because of these features, nectar-feeding bats cannot easily turn to other food sources in times of scarcity, making them more prone to extinction than other types of bat. Nectar feeding also aids a variety of plants, since these bats serve as pollinators , as pollen gets attached to their fur while they are feeding. Around 500 species of flowering plant rely on bat pollination and thus tend to open their flowers at night. Many rainforest plants depend on bat pollination. Some bats prey on other vertebrates, such as fish, frogs, lizards, birds and mammals. The fringe-lipped bat ( Trachops cirrhosus, ) for example, is skilled at catching frogs. These bats locate large groups of frogs by tracking their mating calls, then plucking them from the surface of the water with their sharp canine teeth. The greater noctule bat can catch birds in flight. Some species, like the greater bulldog bat ( Noctilio leporinus ) hunt fish. They use echolocation to detect small ripples on the water's surface, swoop down and use specially enlarged claws on their hind feet to grab the fish, then take their prey to a feeding roost and consume it. At least two species of bat are known to feed on other bats: the spectral bat ( Vampyrum spectrum ), and the ghost bat ( Macroderma gigas ). A few species, specifically the common, white-winged , and hairy-legged vampire bats, feed only on animal blood ( hematophagy ). The common vampire bat typically feeds on large mammals such as cattle ; the hairy-legged and white-winged vampires feed on birds. Vampire bats target sleeping prey and can detect deep breathing. Heat sensors in the nose help them to detect blood vessels near the surface of the skin. They pierce the animal's skin with their teeth, biting away a small flap, and lap up the blood with their tongues, which have lateral grooves adapted to this purpose. The blood is kept from clotting by an anticoagulant in the saliva. Most microbats, especially in temperate areas, prey on insects. The diet of an insectivorous bat may span many species, including flies , mosquitos , beetles , moths, grasshoppers , crickets , termites , bees , wasps , mayflies and caddisflies . Large numbers of Mexican free-tailed bats ( Tadarida brasiliensis ) fly hundreds of metres above the ground in central Texas to feed on migrating moths. Species that hunt insects in flight, like the little brown bat ( Myotis lucifugus ), may catch an insect in mid-air with the mouth, and eat it in the air or use their tail membranes or wings to scoop up the insect and carry it to the mouth. The bat may also take the insect back to its roost and eat it there. Slower moving bat species, such as the brown long-eared bat ( Plecotus auritus ) and many horseshoe bat species, may take or glean insects from vegetation or hunt them from perches. Insectivorous bats living at high latitudes have to consume prey with higher energetic value than tropical bats. Fruit eating, or frugivory, is found in both major suborders. Bats prefer ripe fruit, pulling it off the trees with their teeth. They fly back to their roosts to eat the fruit, sucking out the juice and spitting the seeds and pulp out onto the ground. This helps disperse the seeds of these fruit trees, which may take root and grow where the bats have left them, and many species of plants depend on bats for seed dispersal . The Jamaican fruit bat ( Artibeus jamaicensis ) has been recorded carrying fruits weighing 3–14 g ( 1 ⁄ 8 – 1 ⁄ 2 oz) or even as much as 50 g ( 1 + 3 ⁄ 4 oz) . Nectar-eating bats have acquired specialised adaptations. These bats possess long muzzles and long, extensible tongues covered in fine bristles that aid them in feeding on particular flowers and plants. The tube-lipped nectar bat ( Anoura fistulata ) has the longest tongue of any mammal relative to its body size. This is beneficial to them in terms of pollination and feeding. Their long, narrow tongues can reach deep into the long cup shape of some flowers. When the tongue retracts, it coils up inside the rib cage. Because of these features, nectar-feeding bats cannot easily turn to other food sources in times of scarcity, making them more prone to extinction than other types of bat. Nectar feeding also aids a variety of plants, since these bats serve as pollinators , as pollen gets attached to their fur while they are feeding. Around 500 species of flowering plant rely on bat pollination and thus tend to open their flowers at night. Many rainforest plants depend on bat pollination. Some bats prey on other vertebrates, such as fish, frogs, lizards, birds and mammals. The fringe-lipped bat ( Trachops cirrhosus, ) for example, is skilled at catching frogs. These bats locate large groups of frogs by tracking their mating calls, then plucking them from the surface of the water with their sharp canine teeth. The greater noctule bat can catch birds in flight. Some species, like the greater bulldog bat ( Noctilio leporinus ) hunt fish. They use echolocation to detect small ripples on the water's surface, swoop down and use specially enlarged claws on their hind feet to grab the fish, then take their prey to a feeding roost and consume it. At least two species of bat are known to feed on other bats: the spectral bat ( Vampyrum spectrum ), and the ghost bat ( Macroderma gigas ). A few species, specifically the common, white-winged , and hairy-legged vampire bats, feed only on animal blood ( hematophagy ). The common vampire bat typically feeds on large mammals such as cattle ; the hairy-legged and white-winged vampires feed on birds. Vampire bats target sleeping prey and can detect deep breathing. Heat sensors in the nose help them to detect blood vessels near the surface of the skin. They pierce the animal's skin with their teeth, biting away a small flap, and lap up the blood with their tongues, which have lateral grooves adapted to this purpose. The blood is kept from clotting by an anticoagulant in the saliva. Bats are subject to predation from birds of prey , such as owls , hawks , and falcons , and at roosts from terrestrial predators able to climb, such as cats. Low-flying bats are vulnerable to crocodiles . Twenty species of tropical New World snakes are known to capture bats, often waiting at the entrances of refuges, such as caves, for bats to fly past. J. Rydell and J. R. Speakman argue that bats evolved nocturnality during the early and middle Eocene period to avoid predators. The evidence is thought by some zoologists to be equivocal so far. As are most mammals, bats are hosts to a number of internal and external parasites. Among ectoparasites , bats carry fleas and mites , as well as specific parasites such as bat bugs and bat flies ( Nycteribiidae and Streblidae ). Bats are among the few non-aquatic mammalian orders that do not host lice , possibly due to competition from more specialised parasites that occupy the same niche. White nose syndrome is a condition associated with the deaths of millions of bats in the Eastern United States and Canada. The disease is named after a white fungus , Pseudogymnoascus destructans , found growing on the muzzles, ears, and wings of affected bats. The fungus is mostly spread from bat to bat, and causes the disease. The fungus was first discovered in central New York State in 2006 and spread quickly to the entire Eastern US north of Florida; mortality rates of 90–100% have been observed in most affected caves. New England and the mid-Atlantic states have, since 2006, witnessed entire species completely extirpated and others with numbers that have gone from the hundreds of thousands, even millions, to a few hundred or less. Nova Scotia, Quebec, Ontario, and New Brunswick have witnessed identical die offs, with the Canadian government making preparations to protect all remaining bat populations in its territory. Scientific evidence suggests that longer winters where the fungus has a longer period to infect bats result in greater mortality. In 2014, the infection crossed the Mississippi River, and in 2017, it was found on bats in Texas. Bats are natural reservoirs for a large number of zoonotic pathogens , including rabies , endemic in many bat populations, histoplasmosis both directly and in guano, Nipah and Hendra viruses , and possibly the ebola virus , whose natural reservoir is yet unknown. Their high mobility, broad distribution, long life spans, substantial sympatry (range overlap) of species, and social behaviour make bats favourable hosts and vectors of disease. Reviews have found different answers as to whether bats have more zoonotic viruses than other mammal groups. One 2015 review found that bats, rodents, and primates all harbored significantly more zoonotic viruses (which can be transmitted to humans) than other mammal groups, though the differences among the aforementioned three groups were not significant (bats have no more zoonotic viruses than rodents and primates). Another 2020 review of mammals and birds found that the identity of the taxonomic groups did not have any impact on the probability of harboring zoonotic viruses. Instead, more diverse groups had greater viral diversity. They seem to be highly resistant to many of the pathogens they carry, suggesting a degree of adaptation to their immune systems. Their interactions with livestock and pets, including predation by vampire bats, accidental encounters, and the scavenging of bat carcasses, compound the risk of zoonotic transmission. Bats are implicated in the emergence of severe acute respiratory syndrome (SARS) in China, since they serve as natural hosts for coronaviruses , several from a single cave in Yunnan , one of which developed into the SARS virus. However, they neither cause nor spread COVID-19 . Some bats lead solitary lives, while others live in colonies of more than a million. For instance, the Mexican free-tailed bat fly for more than one thousand miles to the 100-foot (30 m) wide cave known as Bracken Cave every March to October which plays home to an astonishing twenty million of the species, whereas a mouse-eared bat lives an almost completely solitary life. Living in large colonies lessens the risk to an individual of predation. Temperate bat species may swarm at hibernation sites as autumn approaches. This may serve to introduce young to hibernation sites, signal reproduction in adults and allow adults to breed with those from other groups. Several species have a fission-fusion social structure , where large numbers of bats congregate in one roosting area, along with breaking up and mixing of subgroups. Within these societies, bats are able to maintain long-term relationships. Some of these relationships consist of matrilineally related females and their dependent offspring. Food sharing and mutual grooming may occur in certain species, such as the common vampire bat ( Desmodus rotundus ), and these strengthen social bonds. Homosexual fellatio has been observed in the Bonin Flying Fox Pteropus pselaphon and the Indian Flying Fox Pteropus medius , though the function and purpose of this behaviour is not clear. Bats are among the most vocal of mammals and produce calls to attract mates, find roost partners and defend resources. These calls are typically low-frequency and can travel long distances. Mexican free-tailed bats are one of the few species to "sing" like birds. Males sing to attract females. Songs have three phrases: chirps, trills and buzzes, the former having "A" and "B" syllables. Bat songs are highly stereotypical but with variation in syllable number, phrase order, and phrase repetitions between individuals. Among greater spear-nosed bats ( Phyllostomus hastatus ), females produce loud, broadband calls among their roost mates to form group cohesion. Calls differ between roosting groups and may arise from vocal learning. In a study on captive Egyptian fruit bats, 70% of the directed calls could be identified by the researchers as to which individual bat made it, and 60% could be categorised into four contexts: squabbling over food, jostling over position in their sleeping cluster, protesting over mating attempts and arguing when perched in close proximity to each other. The animals made slightly different sounds when communicating with different individual bats, especially those of the opposite sex. In the highly sexually dimorphic hammer-headed bat ( Hypsignathus monstrosus ), males produce deep, resonating, monotonous calls to attract females. Bats in flight make vocal signals for traffic control. Greater bulldog bats honk when on a collision course with each other. Bats also communicate by other means. Male little yellow-shouldered bats ( Sturnira lilium ) have shoulder glands that produce a spicy odour during the breeding season. Like many other species, they have hair specialised for retaining and dispersing secretions. Such hair forms a conspicuous collar around the necks of the some Old World megabat males. Male greater sac-winged bats ( Saccopteryx bilineata ) have sacs in their wings in which they mix body secretions like saliva and urine to create a perfume that they sprinkle on roost sites, a behaviour known as "salting". Salting may be accompanied by singing. Most bat species are polygynous , where males mate with multiple females. Male pipistrelle, noctule and vampire bats may claim and defend resources that attract females, such as roost sites, and mate with those females. Males unable to claim a site are forced to live on the periphery where they have less reproductive success. Promiscuity , where both sexes mate with multiple partners, exists in species like the Mexican free-tailed bat and the little brown bat. There appears to be bias towards certain males among females in these bats. In a few species, such as the yellow-winged bat and spectral bat, adult males and females form monogamous pairs. Lek mating , where males aggregate and compete for female choice through display, is rare in bats but occurs in the hammerheaded bat. For temperate living bats, mating takes place in late summer and early autumn. Tropical bats may mate during the dry season. After copulation, the male may leave behind a mating plug to block the sperm of other males and thus ensure his paternity. In hibernating species, males are known to mate with females in torpor. Female bats use a variety of strategies to control the timing of pregnancy and the birth of young, to make delivery coincide with maximum food ability and other ecological factors. Females of some species have delayed fertilisation, in which sperm is stored in the reproductive tract for several months after mating. Mating occurs in late summer to early autumn but fertilisation does not occur until the following late winter to early spring. Other species exhibit delayed implantation , in which the egg is fertilised after mating, but remains free in the reproductive tract until external conditions become favourable for giving birth and caring for the offspring. In another strategy, fertilisation and implantation both occur, but development of the foetus is delayed until good conditions prevail. During the delayed development the mother keeps the fertilised egg alive with nutrients. This process can go on for a long period, because of the advanced gas exchange system. For temperate living bats, births typically take place in May or June in the northern hemisphere; births in the southern hemisphere occur in November and December. Tropical species give birth at the beginning of the rainy season. In most bat species, females carry and give birth to a single pup per litter. At birth, a bat pup can be up to 40 percent of the mother's weight, and the pelvic girdle of the female can expand during birth as the two-halves are connected by a flexible ligament. Females typically give birth in a head-up or horizontal position, using gravity to make birthing easier. The young emerges rear-first, possibly to prevent the wings from getting tangled, and the female cradles it in her wing and tail membranes. In many species, females give birth and raise their young in maternity colonies and may assist each other in birthing. Most of the care for a young bat comes from the mother. In monogamous species, the father plays a role. Allo-suckling, where a female suckles another mother's young, occurs in several species. This may serve to increase colony size in species where females return to their natal colony to breed. A young bat's ability to fly coincides with the development of an adult body and forelimb length. For the little brown bat, this occurs about eighteen days after birth. Weaning of young for most species takes place in under eighty days. The common vampire bat nurses its offspring beyond that and young vampire bats achieve independence later in life than other species. This is probably due to the species' blood-based diet, which is difficult to obtain on a nightly basis. The maximum lifespan of bats is three-and-a-half times longer than other mammals of similar size. Six species have been recorded to live over thirty years in the wild: the brown long-eared bat ( Plecotus auritus ), the little brown bat ( Myotis lucifugus ), the Siberian bat ( Myotis sibiricus ), the lesser mouse-eared bat ( Myotis blythii ) the greater horseshoe bat ( Rhinolophus ferrumequinum ), and the Indian flying fox ( Pteropus giganteus ). One hypothesis consistent with the rate-of-living theory links this to the fact that they slow down their metabolic rate while hibernating ; bats that hibernate, on average, have a longer lifespan than bats that do not. Another hypothesis is that flying has reduced their mortality rate, which would also be true for birds and gliding mammals. Bat species that give birth to multiple pups generally have a shorter lifespan than species that give birth to only a single pup. Cave-roosting species may have a longer lifespan than non-roosting species because of the decreased predation in caves. A male Siberian bat was recaptured in the wild after 41 years, making it the oldest known bat. Some bats lead solitary lives, while others live in colonies of more than a million. For instance, the Mexican free-tailed bat fly for more than one thousand miles to the 100-foot (30 m) wide cave known as Bracken Cave every March to October which plays home to an astonishing twenty million of the species, whereas a mouse-eared bat lives an almost completely solitary life. Living in large colonies lessens the risk to an individual of predation. Temperate bat species may swarm at hibernation sites as autumn approaches. This may serve to introduce young to hibernation sites, signal reproduction in adults and allow adults to breed with those from other groups. Several species have a fission-fusion social structure , where large numbers of bats congregate in one roosting area, along with breaking up and mixing of subgroups. Within these societies, bats are able to maintain long-term relationships. Some of these relationships consist of matrilineally related females and their dependent offspring. Food sharing and mutual grooming may occur in certain species, such as the common vampire bat ( Desmodus rotundus ), and these strengthen social bonds. Homosexual fellatio has been observed in the Bonin Flying Fox Pteropus pselaphon and the Indian Flying Fox Pteropus medius , though the function and purpose of this behaviour is not clear.Bats are among the most vocal of mammals and produce calls to attract mates, find roost partners and defend resources. These calls are typically low-frequency and can travel long distances. Mexican free-tailed bats are one of the few species to "sing" like birds. Males sing to attract females. Songs have three phrases: chirps, trills and buzzes, the former having "A" and "B" syllables. Bat songs are highly stereotypical but with variation in syllable number, phrase order, and phrase repetitions between individuals. Among greater spear-nosed bats ( Phyllostomus hastatus ), females produce loud, broadband calls among their roost mates to form group cohesion. Calls differ between roosting groups and may arise from vocal learning. In a study on captive Egyptian fruit bats, 70% of the directed calls could be identified by the researchers as to which individual bat made it, and 60% could be categorised into four contexts: squabbling over food, jostling over position in their sleeping cluster, protesting over mating attempts and arguing when perched in close proximity to each other. The animals made slightly different sounds when communicating with different individual bats, especially those of the opposite sex. In the highly sexually dimorphic hammer-headed bat ( Hypsignathus monstrosus ), males produce deep, resonating, monotonous calls to attract females. Bats in flight make vocal signals for traffic control. Greater bulldog bats honk when on a collision course with each other. Bats also communicate by other means. Male little yellow-shouldered bats ( Sturnira lilium ) have shoulder glands that produce a spicy odour during the breeding season. Like many other species, they have hair specialised for retaining and dispersing secretions. Such hair forms a conspicuous collar around the necks of the some Old World megabat males. Male greater sac-winged bats ( Saccopteryx bilineata ) have sacs in their wings in which they mix body secretions like saliva and urine to create a perfume that they sprinkle on roost sites, a behaviour known as "salting". Salting may be accompanied by singing. Most bat species are polygynous , where males mate with multiple females. Male pipistrelle, noctule and vampire bats may claim and defend resources that attract females, such as roost sites, and mate with those females. Males unable to claim a site are forced to live on the periphery where they have less reproductive success. Promiscuity , where both sexes mate with multiple partners, exists in species like the Mexican free-tailed bat and the little brown bat. There appears to be bias towards certain males among females in these bats. In a few species, such as the yellow-winged bat and spectral bat, adult males and females form monogamous pairs. Lek mating , where males aggregate and compete for female choice through display, is rare in bats but occurs in the hammerheaded bat. For temperate living bats, mating takes place in late summer and early autumn. Tropical bats may mate during the dry season. After copulation, the male may leave behind a mating plug to block the sperm of other males and thus ensure his paternity. In hibernating species, males are known to mate with females in torpor. Female bats use a variety of strategies to control the timing of pregnancy and the birth of young, to make delivery coincide with maximum food ability and other ecological factors. Females of some species have delayed fertilisation, in which sperm is stored in the reproductive tract for several months after mating. Mating occurs in late summer to early autumn but fertilisation does not occur until the following late winter to early spring. Other species exhibit delayed implantation , in which the egg is fertilised after mating, but remains free in the reproductive tract until external conditions become favourable for giving birth and caring for the offspring. In another strategy, fertilisation and implantation both occur, but development of the foetus is delayed until good conditions prevail. During the delayed development the mother keeps the fertilised egg alive with nutrients. This process can go on for a long period, because of the advanced gas exchange system. For temperate living bats, births typically take place in May or June in the northern hemisphere; births in the southern hemisphere occur in November and December. Tropical species give birth at the beginning of the rainy season. In most bat species, females carry and give birth to a single pup per litter. At birth, a bat pup can be up to 40 percent of the mother's weight, and the pelvic girdle of the female can expand during birth as the two-halves are connected by a flexible ligament. Females typically give birth in a head-up or horizontal position, using gravity to make birthing easier. The young emerges rear-first, possibly to prevent the wings from getting tangled, and the female cradles it in her wing and tail membranes. In many species, females give birth and raise their young in maternity colonies and may assist each other in birthing. Most of the care for a young bat comes from the mother. In monogamous species, the father plays a role. Allo-suckling, where a female suckles another mother's young, occurs in several species. This may serve to increase colony size in species where females return to their natal colony to breed. A young bat's ability to fly coincides with the development of an adult body and forelimb length. For the little brown bat, this occurs about eighteen days after birth. Weaning of young for most species takes place in under eighty days. The common vampire bat nurses its offspring beyond that and young vampire bats achieve independence later in life than other species. This is probably due to the species' blood-based diet, which is difficult to obtain on a nightly basis. The maximum lifespan of bats is three-and-a-half times longer than other mammals of similar size. Six species have been recorded to live over thirty years in the wild: the brown long-eared bat ( Plecotus auritus ), the little brown bat ( Myotis lucifugus ), the Siberian bat ( Myotis sibiricus ), the lesser mouse-eared bat ( Myotis blythii ) the greater horseshoe bat ( Rhinolophus ferrumequinum ), and the Indian flying fox ( Pteropus giganteus ). One hypothesis consistent with the rate-of-living theory links this to the fact that they slow down their metabolic rate while hibernating ; bats that hibernate, on average, have a longer lifespan than bats that do not. Another hypothesis is that flying has reduced their mortality rate, which would also be true for birds and gliding mammals. Bat species that give birth to multiple pups generally have a shorter lifespan than species that give birth to only a single pup. Cave-roosting species may have a longer lifespan than non-roosting species because of the decreased predation in caves. A male Siberian bat was recaptured in the wild after 41 years, making it the oldest known bat. Conservation statuses of bats as of 2020 according to the IUCN (1,314 species in total) Groups such as the Bat Conservation International aim to increase awareness of bats' ecological roles and the environmental threats they face. In the United Kingdom, all bats are protected under the Wildlife and Countryside Acts , and disturbing a bat or its roost can be punished with a heavy fine. In Sarawak , Malaysia, "all bats" are protected under the Wildlife Protection Ordinance 1998 , but species such as the hairless bat ( Cheiromeles torquatus ) are still eaten by the local communities. Humans have caused the extinction of several species of bat in modern history, the most recent being the Christmas Island pipistrelle ( Pipistrellus murrayi ), which was declared extinct in 2009. Many people put up bat houses to attract bats. The 1991 University of Florida bat house is the largest occupied artificial roost in the world, with around 400,000 residents. In Britain, thickwalled and partly underground World War II pillboxes have been converted to make roosts for bats, and purpose-built bat houses are occasionally built to mitigate damage to habitat from road or other developments. Cave gates are sometimes installed to limit human entry into caves with sensitive or endangered bat species. The gates are designed not to limit the airflow, and thus to maintain the cave's micro-ecosystem. Of the 47 species of bats found in the United States, 35 are known to use human structures, including buildings and bridges. Fourteen species use bat houses. Bats are eaten in countries across Africa, Asia and the Pacific Rim. In some cases, such as in Guam, flying foxes have become endangered through being hunted for food. There is evidence that suggests that wind turbines might create sufficient barotrauma (pressure damage) to kill bats. Bats have typical mammalian lungs , which are thought to be more sensitive to sudden air pressure changes than the lungs of birds , making them more liable to fatal rupture. Bats may be attracted to turbines, perhaps seeking roosts, increasing the death rate. Acoustic deterrents may help to reduce bat mortality at wind farms. The diagnosis and contribution of barotrauma to bat deaths near wind turbine blades have been disputed by other research comparing dead bats found near wind turbines with bats killed by impact with buildings in areas with no turbines. Since bats are mammals, yet can fly, they are considered to be liminal beings in various traditions. In many cultures, including in Europe, bats are associated with darkness, death, witchcraft, and malevolence. Among Native Americans such as the Creek , Cherokee and Apache , the bat is identified as a trickster . In Tanzania, a winged batlike creature known as Popobawa is believed to be a shapeshifting evil spirit that assaults and sodomises its victims. In Aztec mythology , bats symbolised the land of the dead, destruction, and decay. An East Nigerian tale tells that the bat developed its nocturnal habits after causing the death of his partner, the bush-rat, and now hides by day to avoid arrest. More positive depictions of bats exist in some cultures. In China, bats have been associated with happiness, joy and good fortune. Five bats are used to symbolise the "Five Blessings": longevity, wealth, health, love of virtue and peaceful death. The bat is sacred in Tonga and is often considered the physical manifestation of a separable soul . In the Zapotec civilisation of Mesoamerica, the bat god presided over corn and fertility. The Weird Sisters in Shakespeare's Macbeth used the fur of a bat in their brew. In Western culture , the bat is often a symbol of the night and its foreboding nature. The bat is a primary animal associated with fictional characters of the night, both villainous vampires , such as Count Dracula and before him Varney the Vampire , and heroes, such as the DC Comics character Batman . Kenneth Oppel 's Silverwing novels narrate the adventures of a young bat, based on the silver-haired bat of North America. The bat is sometimes used as a heraldic symbol in Spain and France, appearing in the coats of arms of the towns of Valencia , Palma de Mallorca , Fraga , Albacete , and Montchauvet . Three US states have an official state bat . Texas and Oklahoma are represented by the Mexican free-tailed bat, while Virginia is represented by the Virginia big-eared bat ( Corynorhinus townsendii virginianus ). Insectivorous bats in particular are especially helpful to farmers, as they control populations of agricultural pests and reduce the need to use pesticides . It has been estimated that bats save the agricultural industry of the United States anywhere from $ 3.7 billion to $53 billion per year in pesticides and damage to crops. This also prevents the overuse of pesticides, which can pollute the surrounding environment, and may lead to resistance in future generations of insects. Bat dung, a type of guano , is rich in nitrates and is mined from caves for use as fertiliser . During the US Civil War , saltpetre was collected from caves to make gunpowder . At the time, it was believed that the nitrate all came from the bat guano, but it is now known that most of it is produced by nitrifying bacteria . The Congress Avenue Bridge in Austin, Texas , is the summer home to North America's largest urban bat colony, an estimated 1,500,000 Mexican free-tailed bats. About 100,000 tourists a year visit the bridge at twilight to watch the bats leave the roost. Conservation statuses of bats as of 2020 according to the IUCN (1,314 species in total) Groups such as the Bat Conservation International aim to increase awareness of bats' ecological roles and the environmental threats they face. In the United Kingdom, all bats are protected under the Wildlife and Countryside Acts , and disturbing a bat or its roost can be punished with a heavy fine. In Sarawak , Malaysia, "all bats" are protected under the Wildlife Protection Ordinance 1998 , but species such as the hairless bat ( Cheiromeles torquatus ) are still eaten by the local communities. Humans have caused the extinction of several species of bat in modern history, the most recent being the Christmas Island pipistrelle ( Pipistrellus murrayi ), which was declared extinct in 2009. Many people put up bat houses to attract bats. The 1991 University of Florida bat house is the largest occupied artificial roost in the world, with around 400,000 residents. In Britain, thickwalled and partly underground World War II pillboxes have been converted to make roosts for bats, and purpose-built bat houses are occasionally built to mitigate damage to habitat from road or other developments. Cave gates are sometimes installed to limit human entry into caves with sensitive or endangered bat species. The gates are designed not to limit the airflow, and thus to maintain the cave's micro-ecosystem. Of the 47 species of bats found in the United States, 35 are known to use human structures, including buildings and bridges. Fourteen species use bat houses. Bats are eaten in countries across Africa, Asia and the Pacific Rim. In some cases, such as in Guam, flying foxes have become endangered through being hunted for food. There is evidence that suggests that wind turbines might create sufficient barotrauma (pressure damage) to kill bats. Bats have typical mammalian lungs , which are thought to be more sensitive to sudden air pressure changes than the lungs of birds , making them more liable to fatal rupture. Bats may be attracted to turbines, perhaps seeking roosts, increasing the death rate. Acoustic deterrents may help to reduce bat mortality at wind farms. The diagnosis and contribution of barotrauma to bat deaths near wind turbine blades have been disputed by other research comparing dead bats found near wind turbines with bats killed by impact with buildings in areas with no turbines. Since bats are mammals, yet can fly, they are considered to be liminal beings in various traditions. In many cultures, including in Europe, bats are associated with darkness, death, witchcraft, and malevolence. Among Native Americans such as the Creek , Cherokee and Apache , the bat is identified as a trickster . In Tanzania, a winged batlike creature known as Popobawa is believed to be a shapeshifting evil spirit that assaults and sodomises its victims. In Aztec mythology , bats symbolised the land of the dead, destruction, and decay. An East Nigerian tale tells that the bat developed its nocturnal habits after causing the death of his partner, the bush-rat, and now hides by day to avoid arrest. More positive depictions of bats exist in some cultures. In China, bats have been associated with happiness, joy and good fortune. Five bats are used to symbolise the "Five Blessings": longevity, wealth, health, love of virtue and peaceful death. The bat is sacred in Tonga and is often considered the physical manifestation of a separable soul . In the Zapotec civilisation of Mesoamerica, the bat god presided over corn and fertility. The Weird Sisters in Shakespeare's Macbeth used the fur of a bat in their brew. In Western culture , the bat is often a symbol of the night and its foreboding nature. The bat is a primary animal associated with fictional characters of the night, both villainous vampires , such as Count Dracula and before him Varney the Vampire , and heroes, such as the DC Comics character Batman . Kenneth Oppel 's Silverwing novels narrate the adventures of a young bat, based on the silver-haired bat of North America. The bat is sometimes used as a heraldic symbol in Spain and France, appearing in the coats of arms of the towns of Valencia , Palma de Mallorca , Fraga , Albacete , and Montchauvet . Three US states have an official state bat . Texas and Oklahoma are represented by the Mexican free-tailed bat, while Virginia is represented by the Virginia big-eared bat ( Corynorhinus townsendii virginianus ). Insectivorous bats in particular are especially helpful to farmers, as they control populations of agricultural pests and reduce the need to use pesticides . It has been estimated that bats save the agricultural industry of the United States anywhere from $ 3.7 billion to $53 billion per year in pesticides and damage to crops. This also prevents the overuse of pesticides, which can pollute the surrounding environment, and may lead to resistance in future generations of insects. Bat dung, a type of guano , is rich in nitrates and is mined from caves for use as fertiliser . During the US Civil War , saltpetre was collected from caves to make gunpowder . At the time, it was believed that the nitrate all came from the bat guano, but it is now known that most of it is produced by nitrifying bacteria . The Congress Avenue Bridge in Austin, Texas , is the summer home to North America's largest urban bat colony, an estimated 1,500,000 Mexican free-tailed bats. About 100,000 tourists a year visit the bridge at twilight to watch the bats leave the roost.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Brincidofovir/html

Brincidofovir

({[(2S)-1-(4-amino-2-oxo-1,2-dihydropyrimidin-1-yl)-3-hydroxypropan-2-yl]oxy}methyl)[3-(hexadecyloxy)propoxy]phosphinic acid CCCCCCCCCCCCCCCCOCCCOP(=O)(O)CO[C@H](CO)Cn1ccc(N)nc1=O InChI=1S/C27H52N3O7P/c1-2-3-4-5-6-7-8-9-10-11-12-13-14-15-19-35-20-16-21-37-38(33,34)24-36-25(23-31)22-30-18-17-26(28)29-27(30)32/h17-18,25,31H,2-16,19-24H2,1H3,(H,33,34)(H2,28,29,32)/t25-/m0/s1 Key:WXJFKKQWPMNTIM-VWLOTQADSA-N Brincidofovir , sold under the brand name Tembexa , is an antiviral drug used to treat smallpox . Brincidofovir is a prodrug of cidofovir . Conjugated to a lipid , the compound is designed to release cidofovir intracellularly , allowing for higher intracellular and lower plasma concentrations of cidofovir, effectively increasing its activity against dsDNA viruses , as well as oral bioavailability . The most common side effects include diarrhea, nausea, vomiting, and abdominal pain. It carries an FDA-mandated black box warning of an increased risk of death with extended use. Brincidofovir was approved for medical use in the United States in June 2021.Brincidofovir is indicated for the treatment of human smallpox disease caused by variola virus. Brincidofovir is a prodrug that is composed of cidofovir conjugated with a lipid molecule. The lipid aspect of the molecule takes on the action of endogenous lysophosphatidyl choline, which then is able to enter cells in the body which are infected with smallpox. Once the infected cell takes in the drug, the drug cleaves to generate cidofovir. Cidofovir is then consequently phosphorylated to yield cidofovir diphosphate, which is the active drug. Cidofovir diphosphate inhibits the variola virus' DNA polymerase -mediated DNA synthesis. The drug acts as an acyclic nucleotide and incorporates itself into the viral DNA chain, which then stops viral DNA synthesis. The oral bioavailability of Brincidofovir is 13.4% as a tablet and 16.8% in a suspension. The metabolism of the drug is as such: once the drug enters the target infected cell, Brincidofovir's phosphodiester bond is then hydrolyzed to generate cidofovir which is then phosphorylated to the active cidofovir diphosphate. The volume of distribution of the drug is 1230 L. Because smallpox is eradicated, the effectiveness of brincidofovir was studied in animals infected with viruses that are closely related to the variola virus. Effectiveness was determined by measuring animals' survival at the end of the studies. Safety information to support approval of brincidofovir was derived from clinical trials of the drug for a non-smallpox indication, primarily from patients who received hematopoietic stem cell transplants. The U.S. Food and Drug Administration (FDA) granted the application for brincidofovir priority review , fast track , and orphan drug designations. The FDA approved brincidofovir under the agency's Animal Rule, which allows findings from adequate and well-controlled animal efficacy studies to serve as the basis of an approval when it is not feasible or ethical to conduct efficacy trials in humans. Brincidofovir (CMX001) was the subject of widespread social media campaigning in 2014, which was then picked up by national news sources about a boy with an adenovirus infection following a bone marrow transplant . The family requested legal access to the still-unapproved drug outside of any clinical trial , and Chimerix initially denied the request. After a short and intense media campaign, Chimerix got permission from the FDA to start a limited open-label trial which allowed the boy to receive the drug. This media event sparked a debate on the ethics of using social media, the allocation of limited resources of a small company, and the emphasis on the individual over the group. The new use of any drug has the potential to interfere with the process to get the drug approved and widely marketed, through means such as consuming limited staff time that may be needed elsewhere – staff time that has the potential to save thousands of lives in the long-term, rather than one life now – overwhelming manufacturing capabilities, or by causing adverse effects or even death. These adverse events are more likely during these programs, because the people seeking access are usually much sicker than most, and problems experienced by these people can result in an unfavorable and inaccurate perception of the drug's safety profile. In this case, the boy recovered from the infection in 2014, and died in 2016 from complications of cancer. Brincidofovir is one of several experimental drugs administered to a small number of patients to treat Ebola virus disease during the 2014 outbreak. The WHO published a report on the ethics of using unregistered interventions to treat Ebola, where they concluded that "In the particular context of the current Ebola outbreak in West Africa, it is ethically acceptable to offer unproven interventions that have shown promising results in the laboratory and in animal models but have not yet been evaluated for safety and efficacy in humans as potential treatment or prevention." Brincidofovir is under investigation for the treatment of cytomegalovirus , adenovirus , poxvirus , and ebolavirus infections. It has been used off-label for the treatment of monkeypox . As of 2014 [ update ] , brincidofovir is in Phase III clinical trials for use in humans against cytomegalovirus and adenovirus. Preliminary safety data from a database of 1000 patients supported progression into later phase trials, Chimerix announced in December 2015 that the Phase III trials for use of the drug in preventing cytomegalovirus infection in stem cell transplant patients had failed, and in February 2016 shut down two other late-stage trials for use of the drug in preventing infection after kidney transplants . Brincidofovir is not yet FDA approved for adenovirus or cytomegalovirus due to lack of efficacy in clinical trials. In a trial of brincidofovir for patients with CMV brincidofovir was associated with a 15.5% week 24 all-cause mortality compared with 10.1% among placebo recipients. Additionally brincidofovir was associated with increased serious adverse events (57.1% versus 37.6%) compared with placebo. Brincidofovir was initially offered via an FDA expanded access trial; however as of 9 May 2019, Chimerix discontinued clinical trials of brincidofovir for the treatment of adenovirus and discontinued the expanded access program in 2019. After initial studies by the Centers for Disease Control and Prevention (CDC, Atlanta, Georgia, US) in cell culture models, on 6 October 2014, Chimerix received an FDA authorization for emergency investigational new drug applications of brincidofovir for the treatment of Ebola virus disease. Brincidofovir was administered to the first patient diagnosed in the Ebola virus disease outbreak in the US in 2014 . The patient was given the drug starting six days after hospital admission when he was already critically ill; he died four days later. Brincidofovir was also given to Ebola patient Ashoka Mukpo at the Nebraska Medical Center, who had developed the disease and then was pronounced Ebola-free and released from the center on 22 October 2014. In October 2014, Chimerix reported it had been given approval by the FDA to start Phase 2 trials in patients infected with ebolaviruses for brincidofovir's safety, tolerability, and efficacy. Organised by a team of scientists at the University of Oxford, including Peter Horby , Jake Dunning, Laura Merson and Trudie Lang , a trial commenced during January 2015 in Liberia, but was subsequently discontinued. Because of a lack of suitable subjects in Liberia, Oxford University and Médecins Sans Frontières planned to extend the trial to Sierra Leone , where there were still Ebola cases; but on 30 January 2015, the manufacturer decided to withdraw support for the trial and end discussion of future trials. In animal trials brincidofovir has shown activity against cytomegalovirus, adenoviruses , BK virus , poxvirus es, and herpes simplex viruses . Brincidofovir appears to have potential for the treatment of Ebola virus disease , which is somewhat paradoxical, as ebolaviruses are RNA viruses and thus do not contain DNA as the above-mentioned viruses. As of 2014 [ update ] , brincidofovir is in Phase III clinical trials for use in humans against cytomegalovirus and adenovirus. Preliminary safety data from a database of 1000 patients supported progression into later phase trials, Chimerix announced in December 2015 that the Phase III trials for use of the drug in preventing cytomegalovirus infection in stem cell transplant patients had failed, and in February 2016 shut down two other late-stage trials for use of the drug in preventing infection after kidney transplants . Brincidofovir is not yet FDA approved for adenovirus or cytomegalovirus due to lack of efficacy in clinical trials. In a trial of brincidofovir for patients with CMV brincidofovir was associated with a 15.5% week 24 all-cause mortality compared with 10.1% among placebo recipients. Additionally brincidofovir was associated with increased serious adverse events (57.1% versus 37.6%) compared with placebo. Brincidofovir was initially offered via an FDA expanded access trial; however as of 9 May 2019, Chimerix discontinued clinical trials of brincidofovir for the treatment of adenovirus and discontinued the expanded access program in 2019. After initial studies by the Centers for Disease Control and Prevention (CDC, Atlanta, Georgia, US) in cell culture models, on 6 October 2014, Chimerix received an FDA authorization for emergency investigational new drug applications of brincidofovir for the treatment of Ebola virus disease. Brincidofovir was administered to the first patient diagnosed in the Ebola virus disease outbreak in the US in 2014 . The patient was given the drug starting six days after hospital admission when he was already critically ill; he died four days later. Brincidofovir was also given to Ebola patient Ashoka Mukpo at the Nebraska Medical Center, who had developed the disease and then was pronounced Ebola-free and released from the center on 22 October 2014. In October 2014, Chimerix reported it had been given approval by the FDA to start Phase 2 trials in patients infected with ebolaviruses for brincidofovir's safety, tolerability, and efficacy. Organised by a team of scientists at the University of Oxford, including Peter Horby , Jake Dunning, Laura Merson and Trudie Lang , a trial commenced during January 2015 in Liberia, but was subsequently discontinued. Because of a lack of suitable subjects in Liberia, Oxford University and Médecins Sans Frontières planned to extend the trial to Sierra Leone , where there were still Ebola cases; but on 30 January 2015, the manufacturer decided to withdraw support for the trial and end discussion of future trials. In animal trials brincidofovir has shown activity against cytomegalovirus, adenoviruses , BK virus , poxvirus es, and herpes simplex viruses . Brincidofovir appears to have potential for the treatment of Ebola virus disease , which is somewhat paradoxical, as ebolaviruses are RNA viruses and thus do not contain DNA as the above-mentioned viruses.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Sylvia_Mathews_Burwell/html

Sylvia Mathews Burwell

Sylvia Mary Burwell ( née Mathews ; born June 23, 1965) is an American government and non-profit executive who has been the 15th president of American University since June 1, 2017. Burwell is the first woman to serve as the university's president. Burwell earlier served as the 22nd United States Secretary of Health and Human Services . President Barack Obama nominated Burwell on April 11, 2014. Burwell's nomination was confirmed by the Senate on June 5, 2014, by a vote of 78–17. She served as Secretary until the end of the Obama administration. Previously, she had been the Director of the White House Office of Management and Budget from 2013 to 2014. A West Virginia native, Burwell first worked for the United States government in Washington, D.C., during the presidency of Bill Clinton . Burwell helped form the National Economic Council in 1993. Burwell later served as Chief of Staff to Secretary of the Treasury Robert Rubin , Deputy White House Chief of Staff to Erskine Bowles , and finally, deputy director of the Office of Management and Budget . Between her times in government, Burwell served as president of Walmart 's charitable foundation focused on ending hunger, beginning in January 2012. Burwell was earlier the president of the Global Development Program of the Bill & Melinda Gates Foundation , where her program focused on combating world poverty through agricultural development, financial services for the poor, and global libraries. She was chief operating officer and executive director before its reorganization in 2006. She joined the Gates Foundation in 2001, at the end of the Clinton presidency.Mathews was born and raised in Hinton , West Virginia , a small town with a population of approximately 3,000. Her mother, Cleo (née Maroudas) Mathews, was a teacher who also served as Hinton's mayor from 2001 to 2009, and Dr. William Peter Mathews, an optometrist. Her father presided over the local Episcopal Church when there was no minister. Her maternal grandparents, Vasiliki (Mpakares) and Dennis N. Maroudas, were Greek immigrants, as were her paternal grandparents. Her grandparents owned a sweet shop in Hinton. Mathews has one older sister, four years her senior. Mathews first showed an interest in politics while still in grade school , when she became involved with her best friend's father's campaign for county commissioner and Jay Rockefeller 's first campaign for governor. Mathews served as her student body president and played on her school's basketball team. She graduated as valedictorian of her high school class. In 1982, she was a Youth For Understanding exchange student in Japan . While still in college, she served as an intern for West Virginia Congressman Nick Rahall , as a governor's aide to Massachusetts Governor Michael Dukakis , and as a researcher for the Michael Dukakis 1988 presidential campaign . Mathews earned a Bachelor of Arts degree government from Harvard University in 1987. She then enrolled at the University of Oxford , where she became a Rhodes Scholar at Worcester College , and, in her spare time, a rower. She graduated from Oxford with a second bachelor's degree in philosophy, politics, and economics . She has since been appointed as an honorary fellow of Worcester College. Mathews began her career in 1990 as an associate at the New York consulting firm McKinsey & Company . In 1992, Mathews joined the Bill Clinton 1992 presidential campaign and led the economic team for the president-elect. Following Clinton's inauguration, Mathews, with Robert Rubin , helped establish the National Economic Council (NEC). She served as staff director of the NEC from 1993 to 1995. While Mathews was at NEC, the White House pushed for healthcare reform. Mathews was among those in the administration who advocated for finding ways, apart from legislation, to curb healthcare costs. When Rubin became secretary of the treasury in 1995, Mathews became his chief of staff. She testified before a Senate committee during the Whitewater investigations regarding her search of Vince Foster 's garbage and the fate of the documents she discovered. Mathews told the committee she had been looking for an indication as to why Foster had committed suicide and denied ordering any documents destroyed. In 1997 Chief of Staff Erskine Bowles recruited Mathews for deputy chief of staff after being impressed with her intelligence during an Oval Office meeting. Mathews became one of two deputy chiefs of staff , serving alongside John Podesta . She was deputy chief of staff for policy, charged with the task of keeping the White House focused on its agenda amid the impeachment of Clinton . Bowles later praised her as smart, hardworking, and skilled at getting people to work together, saying, "I've never known one person who does all those things as well." Bowles resigned in 1998, at which point Podesta was named chief of staff, and Mathews moved to the Office of Management and Budget (OMB), where she took the role of deputy director under Jack Lew . Mathews remained at OMB for the remainder of Clinton's presidency during a time of three budget surpluses. In 2001 Mathews relocated to Seattle, Washington , to work for the Bill and Melinda Gates Foundation , the largest philanthropic organization in the United States, as an executive vice president. The following year, she became chief operating officer of the Foundation. The Foundation reorganized in 2006, naming Mathews president of the foundation's Global Development Program. Mathews was involved in awarding grants to improve health outcomes in the developing world, including stopping the spread of HIV and other diseases and making contraception more readily available. She served on the board of the University of Washington Medical Center from 2002 to 2005. During that time, the board oversaw an upgrade to the medical center's electronic medical records and system for tracking patient outcomes. The board was also tasked with setting up a compliance program to fix a Medicare billing irregularity that had resulted in a settlement with federal investigators. She was a Director of MetLife and Metropolitan Life Insurance Company from January 2004 to April 2013. Mathews also served on the boards of the Council on Foreign Relations and the Nike Foundation Advisory Group. In 2005 Mathews was chosen by the Wall Street Journal as one of The 50 Women to Watch – 2005 worldwide for her work with the Gates Foundation. [ dead link ] In 2008, known as Sylvia Mathews Burwell following her 2007 marriage, she was named Obama/Biden Transition Agency Review Lead for the Federal Deposit Insurance Corporation . Burwell remained with the Gates Foundation until 2011. She officially joined the Wal-Mart Foundation, which focuses on ending hunger in the United States, as the organization's president in January 2012. [lower-alpha 1] Burwell relocated to Bentonville, Arkansas , for the position. On March 3, 2013, President Barack Obama nominated Burwell to be the director of the White House Office of Management and Budget . A confirmation hearing was held on April 10. Burwell's nomination received bipartisan support, culminating in the U.S. Senate confirming Burwell as Director by a 96–0 vote. With her confirmation, Burwell became only the second woman to serve as OMB Director, the first being Alice Rivlin , who held the position from 1994 to 1996. Burwell entered the job at a time when conservatives wanted to decrease spending and defund Obama's signature healthcare legislation, the Affordable Care Act , also known as Obamacare. Although Congress tried to negotiate a continuing resolution to fund the government pending negotiation of the larger budget, it became clear on September 30, 2013, that no temporary agreement would be reached. Without an agreed-upon budget from Congress, Burwell as Director was tasked with initiating a federal government shutdown , the first U.S. federal government shutdown in 17 years. Burwell sent a memo advising agencies and executive departments to shut down, including the closing of national parks, visitors' centers, and even the " panda-cam " at the National Zoo . The shutdown lasted 16 days. Once the government reopened, Burwell helped negotiate a two-year budget deal to avoid future shutdowns. On April 11, 2014, Obama nominated Burwell to be the next secretary of health and human services , succeeding Kathleen Sebelius , who had announced her resignation the day before. At the time of her nomination, Obama praised Burwell as a "proven manager and she knows how to deliver results." The Senate confirmed Burwell as Secretary on June 5, 2014, by a vote of 78–17. She was sworn into office on June 9, 2014. As of 2014, the secretary oversaw the Department of Health and Human Services (HHS), which included the equivalent of 77,000 full-time employees and the management of several agencies and programs including Medicare and Medicaid , the National Institutes of Health , the Food and Drug Administration , and the Centers for Disease Control and Prevention . At the end of her tenure, Burwell received praise from Democratic and Republican senators. With an Ebola epidemic devastating West Africa , Burwell began holding daily meetings on July 28, 2014, as part of the efforts of the United States government, including the Department of HHS, to prevent the further spread of the disease. Starting on September 30, other Obama administration officials began giving daily public briefings while Burwell took less of a public role, although she did take part in a number of public meetings. In the fall of 2014, the first known death from Ebola in the United States occurred. The Obama administration proposed devoting $6 billion to fight the spread of Ebola, including $2 billion for the State Department and USAID . The plan included provisions to help U.S. hospitals become better prepared and to support global health initiatives aimed at containing the disease in Africa. Congress allocated $5.4 billion to fight Ebola in response to the Obama administration request. Burwell and other Obama administration officials sought to assure the public that the American health system was prepared to deal with Ebola cases and that the chances of a full outbreak in the United States were low. In February 2016, in response to the spread of the Zika virus , the Obama administration requested that Congress appropriate $1.9 billion to fight the spread of the disease. Congress did not initially take action, leaving Burwell to direct the Department of Health and Human Services to reprogram $589 million in funds previously designated as part of the response to Ebola, to fight the spread of the Zika virus. Of the initial Zika funding, the Centers for Disease Control (CDC) received $222 million to lead the domestic fight against the virus with the National Institutes of Health and the Biomedical Advanced Research and Development Authority splitting $152 million for the domestic effort. In response to Congressional complaints that the money was not being spent fast enough, Burwell informed Congress that without further funding, the CDC would deplete its budget to fight Zika by September 30, 2016. After Burwell moved funding from other HHS programs, Congress finally appropriated $1.1 billion to fight the spread of Zika in the United States. By the end of September 2016, the United States reported 23,000 cases in the territory of Puerto Rico , 3,000 cases in the states, and 21 babies born in the United States with microcephaly testing positive for Zika. Burwell's tenure as HHS secretary began ahead of the Affordable Care Act's second open-enrollment period for healthcare insurance in November 2014. In preparation for the enrollment period, Burwell hired additional staff to coordinate operations. The first open-enrollment period, which had occurred during Secretary Sebelius' tenure, was marred by technical difficulties with the Healthcare.gov website. In preparation for the second enrollment period, the HealthCare.gov website underwent various testing actions. The Secretary noted the website had been reconfigured, reducing the number of screens from over seventy to just over a dozen website pages to make the application process smoother. Because of her position as Secretary of HHS, Burwell was the named party in multiple lawsuits related to the Affordable Care Act. One month into her tenure, the Supreme Court decided Burwell vs. Hobby Lobby , where the court struck down the implementation of the Affordable Care Act's contraception mandate as violating Hobby Lobby 's religious freedom. The Supreme Court also decided King v. Burwell , a case in which the Court upheld the Affordable Care Act's subsidies for healthcare plans purchased on federal exchanges. In July 2016, ahead of the 2016 elections , Burwell began touring, giving speeches on the success of the Affordable Care Act and its potential for the future. The election resulted in Republicans winning control of the Presidency and Congress, having campaigned to repeal the law. Burwell continued to advocate for the Affordable Care Act, arguing it was "woven into the fabric of our nation". Since its inception, the law had led to coverage for 20 million more people, and Burwell argued the complexity of the law meant that repealing any part would have effects throughout the healthcare system. Burwell and the Department of HHS devised the "Coverage Matters" campaign to increase public support for the law and to boost enrollment. Less than a week after leaving her position as HHS secretary, American University announced Burwell would serve as the university's next president, its school's highest leadership position despite not having earned a masters or doctoral degree. Burwell began her tenure on June 1, 2017, becoming American's 15th president and the first woman to assume the role. In 2020, Burwell was appointed by the Council on Foreign Relations to co-chair (alongside Frances Townsend ) the Independent Task Force on Improving Pandemic Preparedness. In early August 2023, Burwell announced she would be stepping down as American University's 15th President. A search committee was formed to find Burwell's successor. In March 2024, the University announced it had selected James Madison University President, Jonathan Alger to become American University's 16th President. Burwell stated she intends to continue working as a distinguished lecturer for AU's Sine Institute for Policy and Politics. Burwell's final year as AU's President was overshadowed by a $33 million projected budget shortfall, the University falling in the U.S. News rankings, a 4% tuition raise, and backlash over the University's new indoor protesting ban. Mathews began her career in 1990 as an associate at the New York consulting firm McKinsey & Company . In 1992, Mathews joined the Bill Clinton 1992 presidential campaign and led the economic team for the president-elect. Following Clinton's inauguration, Mathews, with Robert Rubin , helped establish the National Economic Council (NEC). She served as staff director of the NEC from 1993 to 1995. While Mathews was at NEC, the White House pushed for healthcare reform. Mathews was among those in the administration who advocated for finding ways, apart from legislation, to curb healthcare costs. When Rubin became secretary of the treasury in 1995, Mathews became his chief of staff. She testified before a Senate committee during the Whitewater investigations regarding her search of Vince Foster 's garbage and the fate of the documents she discovered. Mathews told the committee she had been looking for an indication as to why Foster had committed suicide and denied ordering any documents destroyed. In 1997 Chief of Staff Erskine Bowles recruited Mathews for deputy chief of staff after being impressed with her intelligence during an Oval Office meeting. Mathews became one of two deputy chiefs of staff , serving alongside John Podesta . She was deputy chief of staff for policy, charged with the task of keeping the White House focused on its agenda amid the impeachment of Clinton . Bowles later praised her as smart, hardworking, and skilled at getting people to work together, saying, "I've never known one person who does all those things as well." Bowles resigned in 1998, at which point Podesta was named chief of staff, and Mathews moved to the Office of Management and Budget (OMB), where she took the role of deputy director under Jack Lew . Mathews remained at OMB for the remainder of Clinton's presidency during a time of three budget surpluses. In 2001 Mathews relocated to Seattle, Washington , to work for the Bill and Melinda Gates Foundation , the largest philanthropic organization in the United States, as an executive vice president. The following year, she became chief operating officer of the Foundation. The Foundation reorganized in 2006, naming Mathews president of the foundation's Global Development Program. Mathews was involved in awarding grants to improve health outcomes in the developing world, including stopping the spread of HIV and other diseases and making contraception more readily available. She served on the board of the University of Washington Medical Center from 2002 to 2005. During that time, the board oversaw an upgrade to the medical center's electronic medical records and system for tracking patient outcomes. The board was also tasked with setting up a compliance program to fix a Medicare billing irregularity that had resulted in a settlement with federal investigators. She was a Director of MetLife and Metropolitan Life Insurance Company from January 2004 to April 2013. Mathews also served on the boards of the Council on Foreign Relations and the Nike Foundation Advisory Group. In 2005 Mathews was chosen by the Wall Street Journal as one of The 50 Women to Watch – 2005 worldwide for her work with the Gates Foundation. [ dead link ] In 2008, known as Sylvia Mathews Burwell following her 2007 marriage, she was named Obama/Biden Transition Agency Review Lead for the Federal Deposit Insurance Corporation . Burwell remained with the Gates Foundation until 2011. She officially joined the Wal-Mart Foundation, which focuses on ending hunger in the United States, as the organization's president in January 2012. [lower-alpha 1] Burwell relocated to Bentonville, Arkansas , for the position. On March 3, 2013, President Barack Obama nominated Burwell to be the director of the White House Office of Management and Budget . A confirmation hearing was held on April 10. Burwell's nomination received bipartisan support, culminating in the U.S. Senate confirming Burwell as Director by a 96–0 vote. With her confirmation, Burwell became only the second woman to serve as OMB Director, the first being Alice Rivlin , who held the position from 1994 to 1996. Burwell entered the job at a time when conservatives wanted to decrease spending and defund Obama's signature healthcare legislation, the Affordable Care Act , also known as Obamacare. Although Congress tried to negotiate a continuing resolution to fund the government pending negotiation of the larger budget, it became clear on September 30, 2013, that no temporary agreement would be reached. Without an agreed-upon budget from Congress, Burwell as Director was tasked with initiating a federal government shutdown , the first U.S. federal government shutdown in 17 years. Burwell sent a memo advising agencies and executive departments to shut down, including the closing of national parks, visitors' centers, and even the " panda-cam " at the National Zoo . The shutdown lasted 16 days. Once the government reopened, Burwell helped negotiate a two-year budget deal to avoid future shutdowns. On April 11, 2014, Obama nominated Burwell to be the next secretary of health and human services , succeeding Kathleen Sebelius , who had announced her resignation the day before. At the time of her nomination, Obama praised Burwell as a "proven manager and she knows how to deliver results." The Senate confirmed Burwell as Secretary on June 5, 2014, by a vote of 78–17. She was sworn into office on June 9, 2014. As of 2014, the secretary oversaw the Department of Health and Human Services (HHS), which included the equivalent of 77,000 full-time employees and the management of several agencies and programs including Medicare and Medicaid , the National Institutes of Health , the Food and Drug Administration , and the Centers for Disease Control and Prevention . At the end of her tenure, Burwell received praise from Democratic and Republican senators. With an Ebola epidemic devastating West Africa , Burwell began holding daily meetings on July 28, 2014, as part of the efforts of the United States government, including the Department of HHS, to prevent the further spread of the disease. Starting on September 30, other Obama administration officials began giving daily public briefings while Burwell took less of a public role, although she did take part in a number of public meetings. In the fall of 2014, the first known death from Ebola in the United States occurred. The Obama administration proposed devoting $6 billion to fight the spread of Ebola, including $2 billion for the State Department and USAID . The plan included provisions to help U.S. hospitals become better prepared and to support global health initiatives aimed at containing the disease in Africa. Congress allocated $5.4 billion to fight Ebola in response to the Obama administration request. Burwell and other Obama administration officials sought to assure the public that the American health system was prepared to deal with Ebola cases and that the chances of a full outbreak in the United States were low. In February 2016, in response to the spread of the Zika virus , the Obama administration requested that Congress appropriate $1.9 billion to fight the spread of the disease. Congress did not initially take action, leaving Burwell to direct the Department of Health and Human Services to reprogram $589 million in funds previously designated as part of the response to Ebola, to fight the spread of the Zika virus. Of the initial Zika funding, the Centers for Disease Control (CDC) received $222 million to lead the domestic fight against the virus with the National Institutes of Health and the Biomedical Advanced Research and Development Authority splitting $152 million for the domestic effort. In response to Congressional complaints that the money was not being spent fast enough, Burwell informed Congress that without further funding, the CDC would deplete its budget to fight Zika by September 30, 2016. After Burwell moved funding from other HHS programs, Congress finally appropriated $1.1 billion to fight the spread of Zika in the United States. By the end of September 2016, the United States reported 23,000 cases in the territory of Puerto Rico , 3,000 cases in the states, and 21 babies born in the United States with microcephaly testing positive for Zika. Burwell's tenure as HHS secretary began ahead of the Affordable Care Act's second open-enrollment period for healthcare insurance in November 2014. In preparation for the enrollment period, Burwell hired additional staff to coordinate operations. The first open-enrollment period, which had occurred during Secretary Sebelius' tenure, was marred by technical difficulties with the Healthcare.gov website. In preparation for the second enrollment period, the HealthCare.gov website underwent various testing actions. The Secretary noted the website had been reconfigured, reducing the number of screens from over seventy to just over a dozen website pages to make the application process smoother. Because of her position as Secretary of HHS, Burwell was the named party in multiple lawsuits related to the Affordable Care Act. One month into her tenure, the Supreme Court decided Burwell vs. Hobby Lobby , where the court struck down the implementation of the Affordable Care Act's contraception mandate as violating Hobby Lobby 's religious freedom. The Supreme Court also decided King v. Burwell , a case in which the Court upheld the Affordable Care Act's subsidies for healthcare plans purchased on federal exchanges. In July 2016, ahead of the 2016 elections , Burwell began touring, giving speeches on the success of the Affordable Care Act and its potential for the future. The election resulted in Republicans winning control of the Presidency and Congress, having campaigned to repeal the law. Burwell continued to advocate for the Affordable Care Act, arguing it was "woven into the fabric of our nation". Since its inception, the law had led to coverage for 20 million more people, and Burwell argued the complexity of the law meant that repealing any part would have effects throughout the healthcare system. Burwell and the Department of HHS devised the "Coverage Matters" campaign to increase public support for the law and to boost enrollment. With an Ebola epidemic devastating West Africa , Burwell began holding daily meetings on July 28, 2014, as part of the efforts of the United States government, including the Department of HHS, to prevent the further spread of the disease. Starting on September 30, other Obama administration officials began giving daily public briefings while Burwell took less of a public role, although she did take part in a number of public meetings. In the fall of 2014, the first known death from Ebola in the United States occurred. The Obama administration proposed devoting $6 billion to fight the spread of Ebola, including $2 billion for the State Department and USAID . The plan included provisions to help U.S. hospitals become better prepared and to support global health initiatives aimed at containing the disease in Africa. Congress allocated $5.4 billion to fight Ebola in response to the Obama administration request. Burwell and other Obama administration officials sought to assure the public that the American health system was prepared to deal with Ebola cases and that the chances of a full outbreak in the United States were low. In February 2016, in response to the spread of the Zika virus , the Obama administration requested that Congress appropriate $1.9 billion to fight the spread of the disease. Congress did not initially take action, leaving Burwell to direct the Department of Health and Human Services to reprogram $589 million in funds previously designated as part of the response to Ebola, to fight the spread of the Zika virus. Of the initial Zika funding, the Centers for Disease Control (CDC) received $222 million to lead the domestic fight against the virus with the National Institutes of Health and the Biomedical Advanced Research and Development Authority splitting $152 million for the domestic effort. In response to Congressional complaints that the money was not being spent fast enough, Burwell informed Congress that without further funding, the CDC would deplete its budget to fight Zika by September 30, 2016. After Burwell moved funding from other HHS programs, Congress finally appropriated $1.1 billion to fight the spread of Zika in the United States. By the end of September 2016, the United States reported 23,000 cases in the territory of Puerto Rico , 3,000 cases in the states, and 21 babies born in the United States with microcephaly testing positive for Zika. Burwell's tenure as HHS secretary began ahead of the Affordable Care Act's second open-enrollment period for healthcare insurance in November 2014. In preparation for the enrollment period, Burwell hired additional staff to coordinate operations. The first open-enrollment period, which had occurred during Secretary Sebelius' tenure, was marred by technical difficulties with the Healthcare.gov website. In preparation for the second enrollment period, the HealthCare.gov website underwent various testing actions. The Secretary noted the website had been reconfigured, reducing the number of screens from over seventy to just over a dozen website pages to make the application process smoother. Because of her position as Secretary of HHS, Burwell was the named party in multiple lawsuits related to the Affordable Care Act. One month into her tenure, the Supreme Court decided Burwell vs. Hobby Lobby , where the court struck down the implementation of the Affordable Care Act's contraception mandate as violating Hobby Lobby 's religious freedom. The Supreme Court also decided King v. Burwell , a case in which the Court upheld the Affordable Care Act's subsidies for healthcare plans purchased on federal exchanges. In July 2016, ahead of the 2016 elections , Burwell began touring, giving speeches on the success of the Affordable Care Act and its potential for the future. The election resulted in Republicans winning control of the Presidency and Congress, having campaigned to repeal the law. Burwell continued to advocate for the Affordable Care Act, arguing it was "woven into the fabric of our nation". Since its inception, the law had led to coverage for 20 million more people, and Burwell argued the complexity of the law meant that repealing any part would have effects throughout the healthcare system. Burwell and the Department of HHS devised the "Coverage Matters" campaign to increase public support for the law and to boost enrollment. Less than a week after leaving her position as HHS secretary, American University announced Burwell would serve as the university's next president, its school's highest leadership position despite not having earned a masters or doctoral degree. Burwell began her tenure on June 1, 2017, becoming American's 15th president and the first woman to assume the role. In 2020, Burwell was appointed by the Council on Foreign Relations to co-chair (alongside Frances Townsend ) the Independent Task Force on Improving Pandemic Preparedness. In early August 2023, Burwell announced she would be stepping down as American University's 15th President. A search committee was formed to find Burwell's successor. In March 2024, the University announced it had selected James Madison University President, Jonathan Alger to become American University's 16th President. Burwell stated she intends to continue working as a distinguished lecturer for AU's Sine Institute for Policy and Politics. Burwell's final year as AU's President was overshadowed by a $33 million projected budget shortfall, the University falling in the U.S. News rankings, a 4% tuition raise, and backlash over the University's new indoor protesting ban. Mathews met lawyer and Seattle native Stephen Burwell in 2005 during her time working for the Gates Foundation. Burwell proposed in Bellepoint Park, a park Mathews had visited often as a child in Hinton, and the pair married in Seattle in 2007. The couple has two children. During Burwell's tenure as Secretary of Health and Human Services, her husband stayed home to care for their children.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Xavi/html

Xavi

Xavier Hernández Creus [lower-alpha 1] ( Spanish pronunciation: [ ˈʃaβjeɾ eɾˈnandeθ ] ; born 25 January 1980), also known as Xavi Hernández ( [ ˈʃaβj eɾˈnandeθ ] ) or simply Xavi ( [ ˈʃaβi ] ), is a Spanish professional football manager and former player who manages La Liga club Barcelona . Widely considered one of the greatest midfielders of all time, Xavi was renowned for his passing, vision, ball retention, and positioning. He won 32 trophies in his career, making him the second-most decorated Spanish player in history, behind former teammate Andrés Iniesta . He was included in the FIFA FIFPro World XI on six occasions: 2008 to 2013, and the UEFA Team of the Year five times: 2008 to 2012. In 2020 Xavi was named in the Ballon d'Or Dream Team , a greatest all-time XI published by France Football . He is one of the few recorded players to have made over 1,000 professional career appearances . Xavi joined La Masia , the Barcelona youth academy at age 11 and made his first-team debut against Mallorca in August 1998, age 18. In all, he played 767 official matches, a former club record—now held by Lionel Messi —and scored 85 goals. Xavi is the first player in the club's history to play 150 European and FIFA Club World Cup matches combined. With Barcelona, Xavi won eight La Liga titles and four UEFA Champions League titles. In 2015, he departed Barcelona for Al Sadd , where he won four trophies before retiring in 2019. With Spain , Xavi won the FIFA World Youth Championship in 1999 , and the Olympic silver medal at the 2000 Olympics . After making his senior team debut in 2000, he was capped 133 times for his country, and was an influential figure in the team's successes. He played an integral role in Spain's victory at the 2010 FIFA World Cup , as well as their wins at UEFA Euro 2008 and UEFA Euro 2012 . He was named Player of the Tournament at UEFA Euro 2008, and was named in the UEFA Euro Team of the Tournament in 2008 and 2012. With two assists in the UEFA Euro 2012 Final , Xavi became the first player to register assists in two separate European finals, after setting up the only goal in the final four years earlier. After the 2014 FIFA World Cup , Xavi announced his retirement from international football. Xavi came third in the 2009 FIFA World Player of the Year , followed by third place for its successor award, the FIFA Ballon d'Or , in 2010 and 2011 . In 2011, he was runner up to Messi for the UEFA Best Player in Europe Award . Xavi was awarded the Prince of Asturias Award in 2012. He was awarded the IFFHS World's Best Playmaker award four times, all straight between 2008 and 2011. After retirement, Xavi transitioned to coaching, and he was named the manager at Qatar Stars League club Al Sadd in May 2019, where he won seven titles in less than three years. In November 2021, Xavi was appointed as manager at his former club Barcelona. He won the 2022–23 Supercopa de España and the 2022–23 La Liga title in his first full season as the club's manager. In January 2024, he announced that he would step down as manager of Barcelona at the end of the 2023–24 season."I've been lucky enough to be brought up on the Barcelona ethos. Which has taught me the value of being part of a team. 'Today for you, tomorrow for me.' Those qualities are essential for life in general." —Xavi on learning the team ethos of Barcelona while at the club's youth system, La Masia . Born in Terrassa , Barcelona , Catalonia , Xavi is a product of FC Barcelona 's La Masia youth system, which he joined at the age of 11 from UFB Jà bac Terrassa and Terrassa FC . His father, Joaquim, was a former player for Sabadell in the first division . His older brother, Óscar , is a former player and manager. Xavi made his way through the youth and reserve teams and was a key member of Josep Maria Gonzalvo 's Barcelona B team that won promotion to the Second Division . Although he was initially inspired by compatriot playmaker Pep Guardiola at Barcelona, as a child Xavi also watched a lot of English football, and looked up to midfielders John Barnes , Paul Gascoigne and Matt Le Tissier . Xavi's progression through the teams earned him a first-team appearance in a Copa Catalunya match against Lleida on 5 May 1998 and he scored his first goal on 18 August 1998 in the 1998 Supercopa de España against Mallorca . His debut in La Liga came against Valencia on 3 October 1998 in a 3–1 victory for Barcelona. Initially featuring intermittently both for the reserve and senior teams, Xavi scored the only goal in a 1–0 victory over Real Valladolid when Barcelona were in tenth position in the league. Sustained impressive performances meant that he became a key member of Louis van Gaal 's title-winning team, finishing his debut season with 26 matches played and being named 1999 La Liga Breakthrough Player of the Year. Xavi became Barcelona's principal playmaker after an injury to Pep Guardiola in the 1999–2000 season. In these years, Barcelona was on the verge of bankruptcy and struggling to keep its place in La Liga's elite. Playing midfield, but in a more defensive role, Xavi made 20 assists and scored 7 goals in those two seasons. On 16 March 2002, he scored his first goal in El Clásico against Real Madrid . Xavi was named the vice-captain in the 2004–05 season , in which he helped Barcelona win La Liga and the 2004 Supercopa de España . He was named La Liga Spanish Player of the Year in 2005. In the 2005–06 season , Xavi tore the ligaments in his left knee in training; he was out of action for four months but returned in April and was on the substitutes bench for Barcelona's win in the 2006 Champions League Final against Arsenal . He also won La Liga and the Supercopa de España again. "Xavi is a player who has the Barcelona DNA: someone who has the taste for good football, someone who is humble and someone who has loyalty to this club. From the first moment I saw him play, I knew he would become the brain behind Barcelona for many years to come." —Former Barcelona coach Pep Guardiola , September 2008. After being named Player of the Tournament at Euro 2008, Xavi spoke to Bayern Munich about a transfer, but newly appointed Barcelona coach Pep Guardiola convinced him that he was too important to the club to be allowed to leave. He was a main part of Barcelona's treble and scored the fourth goal in the 4–1 win in the 2009 Copa del Rey Final against Athletic Bilbao , with a free kick. In La Liga , one of his most significant games was the 6–2 Clásico victory over Real Madrid on 2 May; he assisted four goals – once to Carles Puyol , once to Thierry Henry and twice to Lionel Messi . Xavi helped Barcelona win the 2009 Champions League Final 2–0 against Manchester United , assisting the second goal by crossing to Messi for his header. Prior to the match, Manchester United coach Sir Alex Ferguson heaped praise on the central midfield combination of Xavi and Andrés Iniesta , stating, "I don't think Xavi and Iniesta have ever given the ball away in their lives. They get you on that carousel and they can leave you dizzy." Xavi was voted "UEFA Champions League best midfielder" for his contribution during Barcelona's victorious 2008–09 Champions League campaign . Xavi was the highest assisting player in La Liga with 20, and in the Champions League, with 7; he earned 29 assists overall that season. Xavi was under contract to Barça until 2014 after extending his contract during the 2008–09 season. The new contract made him one of the club's biggest earners, with a salary of €7.5 million a year. During the 2009–10 season , journalists increasingly noted Xavi's contribution to the Barcelona team. For example: "Quite simply the best midfielder of modern football. It could even be argued that Xavi and Matthäus are the two best in this position in history. World class for several years now, it is the past three seasons in particular where the 30-year-old has been untouchable. Xavi's passing is up there with Michel Platini , he creates countless goals with genius through balls while virtually never relinquishing possession." In the 2009–10 season, Xavi again topped the assists table and provided both the assists in Barcelona's 2–0 victory against Real Madrid at the Santiago Bernabéu . Barcelona won the Liga title with a record 99 points, and Xavi was acclaimed Barcelona's second-best player in a season-long vote. On 3 June 2010, Madrid -based newspaper Marca awarded him third place in the annual Trofeo Alfredo di Stéfano award for the best player in La Liga, behind Messi and Cristiano Ronaldo . "Our model was imposed by [Johan] Cruyff; it's an Ajax model. It's all about rondos [piggy in the middle]. Rondo, rondo, rondo" —Xavi speaking in 2011 about the tiki-taka passing style introduced to Barcelona by Johan Cruyff . On 9 June 2010, Xavi signed a new four-year contract with the club, which could be automatically renewed up to 30 June 2016 based on number of games played. On 29 November, he scored his third goal against arch-rivals Real Madrid in a 5–0 home win. On 18 December, he scored another goal against Espanyol in a 5–1 win. In the Champions League , Xavi scored a valuable goal with an assist from David Villa in a home win against Arsenal, that saw Barcelona progress to the quarter-finals. Xavi was one of the three finalists for the 2010 FIFA Ballon d'Or , and finished third in the vote behind his Barcelona teammates Lionel Messi and Andrés Iniesta. He narrowly defeated Messi to win the Player of the Year award from World Soccer magazine. On 2 January 2011, in a league match against Levante , Xavi made his 549th appearance for the club in all competitions, matching the record held by Migueli . Xavi later became the player with the most appearances for Barcelona of all time. On 28 May, Xavi was imperious in the 2011 UEFA Champions League Final at Wembley Stadium in London as Barcelona defeated Manchester United in the showpiece for the second time in three seasons, winning 3–1. Xavi began the 2011–12 season in fine goalscoring form and seemed to grow in his influence of the team despite the long-anticipated return of Cesc Fà bregas and the promotion of Thiago to create added competition for places in Barça' s attacking midfield positions. On 18 December, in the 2011 FIFA Club World Cup Final in Yokohama , Barcelona won 4–0 against Brazilian side Santos as Xavi scored a goal and made an assist to Lionel Messi. After the ball was slightly behind him, Xavi brought the ball down with a cocked leg, effectively using his ankle to control it, before slipping a pass through to Messi, who scored the first goal. Xavi scored the winning goal in the Group H game against A.C. Milan , a vital match for Barcelona's progression in the Champions League knockout stage . In total, Xavi had the best goalscoring return of his career in 2011–12 season with ten Liga goals, two in the Copa del Rey – which Barcelona won – and one in the Club World Cup final win. On 18 December 2012, Barcelona renewed Xavi's contract, extending it until 30 June 2016. He scored a goal against Real Madrid in a 3–2 win for Barcelona. Xavi was named in the FIFA World XI , along with teammates Iniesta, Messi and Dani Alves . Barcelona had virtually secured their La Liga title by the start of 2013, eventually equalling Real Madrid's 100-point record of the previous season. On 16 January 2014, Xavi made his 700th appearance for the first team against Getafe in the Copa del Rey . For the first time in five years, Barcelona ended the season without a major trophy; they were defeated in the Copa del Rey Final by Real Madrid with Gareth Bale scoring a late winner, and lost the league in the last game to Atlético Madrid. In June 2014, it was announced that Xavi would be leaving the club. On 22 July, however, after talks with newly appointed manager and former teammate Luis Enrique , Xavi decided to stay at Camp Nou for one more season. He was also appointed as club captain after Carles Puyol 's retirement. On 25 April 2015, Xavi made his 500th La Liga appearance, becoming the eighth player in history to do so. On 4 June, a farewell event was held at Barcelona for Xavi with players, managers, friends and family paying tribute to him. On 6 June 2015, Xavi came on as a 78th-minute substitute for Andrés Iniesta to make his 767th and final appearance for Barcelona during the 2015 Champions League Final , as the club won its fifth European Cup , beating Juventus at Berlin 's Olympiastadion . Xavi, as club captain, lifted the trophy. This made Barcelona the first club in history to win the treble of domestic league, domestic cup and European Cup twice. Xavi, Iniesta, Messi, Gerard Piqué , Pedro , Sergio Busquets and Dani Alves were part of both treble-winning teams. Xavi's 767 appearances was a club record until surpassed by Lionel Messi in March 2021. On 21 May 2015, Xavi announced that he would join Qatari club Al Sadd at the end of the 2014–15 season on a three-year contract. According to his agent, the deal would involve him becoming an ambassador for the 2022 FIFA World Cup in Qatar , and also start his coaching qualifications. He made his debut for Al Sadd in a 4–0 win over Mesaimeer on 13 September 2015, assisting in the team's first goal. In the following match, he scored his first goal for the club in a 2–2 draw with Umm Salal . Al Sadd ended the league campaign in third position putting them in a place for the next season's AFC Champions League , the elite club competition of the Asian Football Confederation . Xavi scored three goals during the season. In the Champions League, Al Sadd were knocked out from the qualifying rounds by Emirati side Al Jazira on penalties; Xavi missed his spot kick. Xavi won his first trophy with Al Sadd following a 2–1 victory over El Jaish in the Qatar Cup final on 29 April 2017. On 10 November 2017, Xavi said that he would retire when his contract with Al Sadd expired at the end of the 2017–18 season , and would later pursue a coaching career. However, he postponed these plans and signed a two-year contract extension on 24 May 2018. In October 2018, Al Sadd reached the 2018 AFC Champions League semi-finals of the tournament with Xavi as captain but were eliminated 2–1 by Persepolis . On 2 May 2019, Xavi announced that he would be retiring from professional football at the end of the season. On 20 May 2019, Xavi played the final match of his career, a 2–0 defeat to Persepolis in Tehran , Iran which was Al Sadd's final AFC Champions League group match; before the match, he stated that he would like to remain in Qatar after his retirement, and that he would look to begin a coaching career, commenting: "The idea is to start as a coach in Qatar, to test myself and get some experience." Xavi's progression through the teams earned him a first-team appearance in a Copa Catalunya match against Lleida on 5 May 1998 and he scored his first goal on 18 August 1998 in the 1998 Supercopa de España against Mallorca . His debut in La Liga came against Valencia on 3 October 1998 in a 3–1 victory for Barcelona. Initially featuring intermittently both for the reserve and senior teams, Xavi scored the only goal in a 1–0 victory over Real Valladolid when Barcelona were in tenth position in the league. Sustained impressive performances meant that he became a key member of Louis van Gaal 's title-winning team, finishing his debut season with 26 matches played and being named 1999 La Liga Breakthrough Player of the Year. Xavi became Barcelona's principal playmaker after an injury to Pep Guardiola in the 1999–2000 season. In these years, Barcelona was on the verge of bankruptcy and struggling to keep its place in La Liga's elite. Playing midfield, but in a more defensive role, Xavi made 20 assists and scored 7 goals in those two seasons. On 16 March 2002, he scored his first goal in El Clásico against Real Madrid . Xavi was named the vice-captain in the 2004–05 season , in which he helped Barcelona win La Liga and the 2004 Supercopa de España . He was named La Liga Spanish Player of the Year in 2005. In the 2005–06 season , Xavi tore the ligaments in his left knee in training; he was out of action for four months but returned in April and was on the substitutes bench for Barcelona's win in the 2006 Champions League Final against Arsenal . He also won La Liga and the Supercopa de España again. "Xavi is a player who has the Barcelona DNA: someone who has the taste for good football, someone who is humble and someone who has loyalty to this club. From the first moment I saw him play, I knew he would become the brain behind Barcelona for many years to come." —Former Barcelona coach Pep Guardiola , September 2008. After being named Player of the Tournament at Euro 2008, Xavi spoke to Bayern Munich about a transfer, but newly appointed Barcelona coach Pep Guardiola convinced him that he was too important to the club to be allowed to leave. He was a main part of Barcelona's treble and scored the fourth goal in the 4–1 win in the 2009 Copa del Rey Final against Athletic Bilbao , with a free kick. In La Liga , one of his most significant games was the 6–2 Clásico victory over Real Madrid on 2 May; he assisted four goals – once to Carles Puyol , once to Thierry Henry and twice to Lionel Messi . Xavi helped Barcelona win the 2009 Champions League Final 2–0 against Manchester United , assisting the second goal by crossing to Messi for his header. Prior to the match, Manchester United coach Sir Alex Ferguson heaped praise on the central midfield combination of Xavi and Andrés Iniesta , stating, "I don't think Xavi and Iniesta have ever given the ball away in their lives. They get you on that carousel and they can leave you dizzy." Xavi was voted "UEFA Champions League best midfielder" for his contribution during Barcelona's victorious 2008–09 Champions League campaign . Xavi was the highest assisting player in La Liga with 20, and in the Champions League, with 7; he earned 29 assists overall that season. Xavi was under contract to Barça until 2014 after extending his contract during the 2008–09 season. The new contract made him one of the club's biggest earners, with a salary of €7.5 million a year. During the 2009–10 season , journalists increasingly noted Xavi's contribution to the Barcelona team. For example: "Quite simply the best midfielder of modern football. It could even be argued that Xavi and Matthäus are the two best in this position in history. World class for several years now, it is the past three seasons in particular where the 30-year-old has been untouchable. Xavi's passing is up there with Michel Platini , he creates countless goals with genius through balls while virtually never relinquishing possession." In the 2009–10 season, Xavi again topped the assists table and provided both the assists in Barcelona's 2–0 victory against Real Madrid at the Santiago Bernabéu . Barcelona won the Liga title with a record 99 points, and Xavi was acclaimed Barcelona's second-best player in a season-long vote. On 3 June 2010, Madrid -based newspaper Marca awarded him third place in the annual Trofeo Alfredo di Stéfano award for the best player in La Liga, behind Messi and Cristiano Ronaldo . "Our model was imposed by [Johan] Cruyff; it's an Ajax model. It's all about rondos [piggy in the middle]. Rondo, rondo, rondo" —Xavi speaking in 2011 about the tiki-taka passing style introduced to Barcelona by Johan Cruyff . On 9 June 2010, Xavi signed a new four-year contract with the club, which could be automatically renewed up to 30 June 2016 based on number of games played. On 29 November, he scored his third goal against arch-rivals Real Madrid in a 5–0 home win. On 18 December, he scored another goal against Espanyol in a 5–1 win. In the Champions League , Xavi scored a valuable goal with an assist from David Villa in a home win against Arsenal, that saw Barcelona progress to the quarter-finals. Xavi was one of the three finalists for the 2010 FIFA Ballon d'Or , and finished third in the vote behind his Barcelona teammates Lionel Messi and Andrés Iniesta. He narrowly defeated Messi to win the Player of the Year award from World Soccer magazine. On 2 January 2011, in a league match against Levante , Xavi made his 549th appearance for the club in all competitions, matching the record held by Migueli . Xavi later became the player with the most appearances for Barcelona of all time. On 28 May, Xavi was imperious in the 2011 UEFA Champions League Final at Wembley Stadium in London as Barcelona defeated Manchester United in the showpiece for the second time in three seasons, winning 3–1. Xavi began the 2011–12 season in fine goalscoring form and seemed to grow in his influence of the team despite the long-anticipated return of Cesc Fà bregas and the promotion of Thiago to create added competition for places in Barça' s attacking midfield positions. On 18 December, in the 2011 FIFA Club World Cup Final in Yokohama , Barcelona won 4–0 against Brazilian side Santos as Xavi scored a goal and made an assist to Lionel Messi. After the ball was slightly behind him, Xavi brought the ball down with a cocked leg, effectively using his ankle to control it, before slipping a pass through to Messi, who scored the first goal. Xavi scored the winning goal in the Group H game against A.C. Milan , a vital match for Barcelona's progression in the Champions League knockout stage . In total, Xavi had the best goalscoring return of his career in 2011–12 season with ten Liga goals, two in the Copa del Rey – which Barcelona won – and one in the Club World Cup final win. On 18 December 2012, Barcelona renewed Xavi's contract, extending it until 30 June 2016. He scored a goal against Real Madrid in a 3–2 win for Barcelona. Xavi was named in the FIFA World XI , along with teammates Iniesta, Messi and Dani Alves . Barcelona had virtually secured their La Liga title by the start of 2013, eventually equalling Real Madrid's 100-point record of the previous season. On 16 January 2014, Xavi made his 700th appearance for the first team against Getafe in the Copa del Rey . For the first time in five years, Barcelona ended the season without a major trophy; they were defeated in the Copa del Rey Final by Real Madrid with Gareth Bale scoring a late winner, and lost the league in the last game to Atlético Madrid. In June 2014, it was announced that Xavi would be leaving the club. On 22 July, however, after talks with newly appointed manager and former teammate Luis Enrique , Xavi decided to stay at Camp Nou for one more season. He was also appointed as club captain after Carles Puyol 's retirement. On 25 April 2015, Xavi made his 500th La Liga appearance, becoming the eighth player in history to do so. On 4 June, a farewell event was held at Barcelona for Xavi with players, managers, friends and family paying tribute to him. On 6 June 2015, Xavi came on as a 78th-minute substitute for Andrés Iniesta to make his 767th and final appearance for Barcelona during the 2015 Champions League Final , as the club won its fifth European Cup , beating Juventus at Berlin 's Olympiastadion . Xavi, as club captain, lifted the trophy. This made Barcelona the first club in history to win the treble of domestic league, domestic cup and European Cup twice. Xavi, Iniesta, Messi, Gerard Piqué , Pedro , Sergio Busquets and Dani Alves were part of both treble-winning teams. Xavi's 767 appearances was a club record until surpassed by Lionel Messi in March 2021. Xavi's progression through the teams earned him a first-team appearance in a Copa Catalunya match against Lleida on 5 May 1998 and he scored his first goal on 18 August 1998 in the 1998 Supercopa de España against Mallorca . His debut in La Liga came against Valencia on 3 October 1998 in a 3–1 victory for Barcelona. Initially featuring intermittently both for the reserve and senior teams, Xavi scored the only goal in a 1–0 victory over Real Valladolid when Barcelona were in tenth position in the league. Sustained impressive performances meant that he became a key member of Louis van Gaal 's title-winning team, finishing his debut season with 26 matches played and being named 1999 La Liga Breakthrough Player of the Year. Xavi became Barcelona's principal playmaker after an injury to Pep Guardiola in the 1999–2000 season. In these years, Barcelona was on the verge of bankruptcy and struggling to keep its place in La Liga's elite. Playing midfield, but in a more defensive role, Xavi made 20 assists and scored 7 goals in those two seasons. On 16 March 2002, he scored his first goal in El Clásico against Real Madrid . Xavi was named the vice-captain in the 2004–05 season , in which he helped Barcelona win La Liga and the 2004 Supercopa de España . He was named La Liga Spanish Player of the Year in 2005. In the 2005–06 season , Xavi tore the ligaments in his left knee in training; he was out of action for four months but returned in April and was on the substitutes bench for Barcelona's win in the 2006 Champions League Final against Arsenal . He also won La Liga and the Supercopa de España again. "Xavi is a player who has the Barcelona DNA: someone who has the taste for good football, someone who is humble and someone who has loyalty to this club. From the first moment I saw him play, I knew he would become the brain behind Barcelona for many years to come." —Former Barcelona coach Pep Guardiola , September 2008. After being named Player of the Tournament at Euro 2008, Xavi spoke to Bayern Munich about a transfer, but newly appointed Barcelona coach Pep Guardiola convinced him that he was too important to the club to be allowed to leave. He was a main part of Barcelona's treble and scored the fourth goal in the 4–1 win in the 2009 Copa del Rey Final against Athletic Bilbao , with a free kick. In La Liga , one of his most significant games was the 6–2 Clásico victory over Real Madrid on 2 May; he assisted four goals – once to Carles Puyol , once to Thierry Henry and twice to Lionel Messi . Xavi helped Barcelona win the 2009 Champions League Final 2–0 against Manchester United , assisting the second goal by crossing to Messi for his header. Prior to the match, Manchester United coach Sir Alex Ferguson heaped praise on the central midfield combination of Xavi and Andrés Iniesta , stating, "I don't think Xavi and Iniesta have ever given the ball away in their lives. They get you on that carousel and they can leave you dizzy." Xavi was voted "UEFA Champions League best midfielder" for his contribution during Barcelona's victorious 2008–09 Champions League campaign . Xavi was the highest assisting player in La Liga with 20, and in the Champions League, with 7; he earned 29 assists overall that season. Xavi was under contract to Barça until 2014 after extending his contract during the 2008–09 season. The new contract made him one of the club's biggest earners, with a salary of €7.5 million a year. During the 2009–10 season , journalists increasingly noted Xavi's contribution to the Barcelona team. For example: "Quite simply the best midfielder of modern football. It could even be argued that Xavi and Matthäus are the two best in this position in history. World class for several years now, it is the past three seasons in particular where the 30-year-old has been untouchable. Xavi's passing is up there with Michel Platini , he creates countless goals with genius through balls while virtually never relinquishing possession." In the 2009–10 season, Xavi again topped the assists table and provided both the assists in Barcelona's 2–0 victory against Real Madrid at the Santiago Bernabéu . Barcelona won the Liga title with a record 99 points, and Xavi was acclaimed Barcelona's second-best player in a season-long vote. On 3 June 2010, Madrid -based newspaper Marca awarded him third place in the annual Trofeo Alfredo di Stéfano award for the best player in La Liga, behind Messi and Cristiano Ronaldo . "Our model was imposed by [Johan] Cruyff; it's an Ajax model. It's all about rondos [piggy in the middle]. Rondo, rondo, rondo" —Xavi speaking in 2011 about the tiki-taka passing style introduced to Barcelona by Johan Cruyff . On 9 June 2010, Xavi signed a new four-year contract with the club, which could be automatically renewed up to 30 June 2016 based on number of games played. On 29 November, he scored his third goal against arch-rivals Real Madrid in a 5–0 home win. On 18 December, he scored another goal against Espanyol in a 5–1 win. In the Champions League , Xavi scored a valuable goal with an assist from David Villa in a home win against Arsenal, that saw Barcelona progress to the quarter-finals. Xavi was one of the three finalists for the 2010 FIFA Ballon d'Or , and finished third in the vote behind his Barcelona teammates Lionel Messi and Andrés Iniesta. He narrowly defeated Messi to win the Player of the Year award from World Soccer magazine. On 2 January 2011, in a league match against Levante , Xavi made his 549th appearance for the club in all competitions, matching the record held by Migueli . Xavi later became the player with the most appearances for Barcelona of all time. On 28 May, Xavi was imperious in the 2011 UEFA Champions League Final at Wembley Stadium in London as Barcelona defeated Manchester United in the showpiece for the second time in three seasons, winning 3–1. Xavi began the 2011–12 season in fine goalscoring form and seemed to grow in his influence of the team despite the long-anticipated return of Cesc Fà bregas and the promotion of Thiago to create added competition for places in Barça' s attacking midfield positions. On 18 December, in the 2011 FIFA Club World Cup Final in Yokohama , Barcelona won 4–0 against Brazilian side Santos as Xavi scored a goal and made an assist to Lionel Messi. After the ball was slightly behind him, Xavi brought the ball down with a cocked leg, effectively using his ankle to control it, before slipping a pass through to Messi, who scored the first goal. Xavi scored the winning goal in the Group H game against A.C. Milan , a vital match for Barcelona's progression in the Champions League knockout stage . In total, Xavi had the best goalscoring return of his career in 2011–12 season with ten Liga goals, two in the Copa del Rey – which Barcelona won – and one in the Club World Cup final win. On 18 December 2012, Barcelona renewed Xavi's contract, extending it until 30 June 2016. He scored a goal against Real Madrid in a 3–2 win for Barcelona. Xavi was named in the FIFA World XI , along with teammates Iniesta, Messi and Dani Alves . Barcelona had virtually secured their La Liga title by the start of 2013, eventually equalling Real Madrid's 100-point record of the previous season. On 16 January 2014, Xavi made his 700th appearance for the first team against Getafe in the Copa del Rey . For the first time in five years, Barcelona ended the season without a major trophy; they were defeated in the Copa del Rey Final by Real Madrid with Gareth Bale scoring a late winner, and lost the league in the last game to Atlético Madrid. In June 2014, it was announced that Xavi would be leaving the club. On 22 July, however, after talks with newly appointed manager and former teammate Luis Enrique , Xavi decided to stay at Camp Nou for one more season. He was also appointed as club captain after Carles Puyol 's retirement. On 25 April 2015, Xavi made his 500th La Liga appearance, becoming the eighth player in history to do so. On 4 June, a farewell event was held at Barcelona for Xavi with players, managers, friends and family paying tribute to him. On 6 June 2015, Xavi came on as a 78th-minute substitute for Andrés Iniesta to make his 767th and final appearance for Barcelona during the 2015 Champions League Final , as the club won its fifth European Cup , beating Juventus at Berlin 's Olympiastadion . Xavi, as club captain, lifted the trophy. This made Barcelona the first club in history to win the treble of domestic league, domestic cup and European Cup twice. Xavi, Iniesta, Messi, Gerard Piqué , Pedro , Sergio Busquets and Dani Alves were part of both treble-winning teams. Xavi's 767 appearances was a club record until surpassed by Lionel Messi in March 2021. On 21 May 2015, Xavi announced that he would join Qatari club Al Sadd at the end of the 2014–15 season on a three-year contract. According to his agent, the deal would involve him becoming an ambassador for the 2022 FIFA World Cup in Qatar , and also start his coaching qualifications. He made his debut for Al Sadd in a 4–0 win over Mesaimeer on 13 September 2015, assisting in the team's first goal. In the following match, he scored his first goal for the club in a 2–2 draw with Umm Salal . Al Sadd ended the league campaign in third position putting them in a place for the next season's AFC Champions League , the elite club competition of the Asian Football Confederation . Xavi scored three goals during the season. In the Champions League, Al Sadd were knocked out from the qualifying rounds by Emirati side Al Jazira on penalties; Xavi missed his spot kick. Xavi won his first trophy with Al Sadd following a 2–1 victory over El Jaish in the Qatar Cup final on 29 April 2017. On 10 November 2017, Xavi said that he would retire when his contract with Al Sadd expired at the end of the 2017–18 season , and would later pursue a coaching career. However, he postponed these plans and signed a two-year contract extension on 24 May 2018. In October 2018, Al Sadd reached the 2018 AFC Champions League semi-finals of the tournament with Xavi as captain but were eliminated 2–1 by Persepolis . On 2 May 2019, Xavi announced that he would be retiring from professional football at the end of the season. On 20 May 2019, Xavi played the final match of his career, a 2–0 defeat to Persepolis in Tehran , Iran which was Al Sadd's final AFC Champions League group match; before the match, he stated that he would like to remain in Qatar after his retirement, and that he would look to begin a coaching career, commenting: "The idea is to start as a coach in Qatar, to test myself and get some experience." Xavi played for Spain at the 2000 Olympics , 2002 World Cup , Euro 2004 , 2006 World Cup , Euro 2008 , 2009 Confederations Cup , 2010 World Cup , Euro 2012 , 2013 Confederations Cup and the 2014 World Cup . In 1999 he was part of the Spanish team that won FIFA World Youth Championship in Nigeria, with Xavi also scoring two goals in the tournament. Xavi was named Euro 2008's player of the tournament after Spain defeated Germany 1–0 in the final. Xavi was dominant in midfield, where his passing and reading of the game was pivotal to Spain's success, as he led his nation to their first silverware since the 1964 European Championship . Andy Roxburgh , head of UEFA 's technical committee, said, "We have chosen Xavi because he epitomizes the Spanish style of play. He was influential in the whole possession, passing and penetrating kind of game that Spain played." Xavi scored the first goal in the semi-final against Russia , which Spain won 3–0. In the final , he made the pass from which Fernando Torres scored the winning goal. Xavi was named in Spain's squad for the 2010 World Cup in South Africa, with Spain eventually winning their first World Cup . He provided the most accurate passes, 599 with a passing success rate of 91%, and he crossed the ball inside the 18-yard box more than any other player in the tournament. In the final he made 57 accurate forward half passes. Xavi also covered 80.20 kilometres throughout the competitions, averaging approximately 11.5 kilometres per game, more than any other player. In the final , he covered a distance of almost 15 kilometres. Xavi is the beating heart of this Spanish team, the man dictating the tiki-taka pulse of pass after pass. He may be just 5ft 7in with a curiously hunched gait but no player more influences the way his whole team plays. He doesn't score, doesn't really tackle: he just passes and passes with a precision and wit unmatched by any of his peers. During the round of 16 match against Portugal , Xavi provided a backheel pass in the 63rd minute to David Villa. Although Villa had his shot with his left foot blocked by goalkeeper Eduardo , he then put in the rebound with his right foot for the winning goal. In the semi-final against Germany, Xavi crossed from a corner to the edge of the six-yard box, where Carles Puyol scored with a header into the top-right corner. Spain dominated possession throughout the competition, averaging 59% possession during their three group matches, and 44 passes per shot throughout the entire World Cup, in large part thanks to midfield trio of Xavi, Iniesta, and Xabi Alonso , who were singled out in the media for their role in Spain's title–run; Spain also completed more passes (3,547) than any World Cup team since 1966 . Xavi played for Spain at Euro 2012 which Spain won by defeating Italy 4–0 in the final . Xavi attempted 136 passes (127 completed, 94% success rate) during Spain's 4–0 victory in the group stage match against the Republic of Ireland , more than any other player in a European Championship match. The previous record of 117 had been set by Ronald Koeman in a Euro 1992 match between the Netherlands and Denmark . Xavi and Andrés Iniesta made 229 passes in the match, more than the combined Irish team managed. "Pum, pum, pum, pum" was how Xavi described the rhythmic sound of the ball moving between himself and his midfield partner. With Xavi providing two assists in the final, for Jordi Alba and Fernando Torres, he became the first player to register assists in two European Championship finals. Spain's UEFA Euro 2012 victory made Xavi the most decorated player in Spanish football history, a status that he previously shared with Carles Puyol, who missed the tournament. On 5 August 2014, following the 2014 World Cup where Spain were eliminated at the group stage, Xavi announced his retirement from international football, having made 133 appearances in a 14-year period. Spain's World Cup-winning manager Vicente del Bosque paid tribute, stating that Xavi was "a key part of the team's style of play" and "he was more important to us than even the manager", also adding, "We will miss him both on and off the pitch. He is a player who we hold in great esteem both personally and as a player. He is and always will be a person and a player who is greatly valued by the federation , the coaching staff and by myself." Xavi was named Euro 2008's player of the tournament after Spain defeated Germany 1–0 in the final. Xavi was dominant in midfield, where his passing and reading of the game was pivotal to Spain's success, as he led his nation to their first silverware since the 1964 European Championship . Andy Roxburgh , head of UEFA 's technical committee, said, "We have chosen Xavi because he epitomizes the Spanish style of play. He was influential in the whole possession, passing and penetrating kind of game that Spain played." Xavi scored the first goal in the semi-final against Russia , which Spain won 3–0. In the final , he made the pass from which Fernando Torres scored the winning goal. Xavi was named in Spain's squad for the 2010 World Cup in South Africa, with Spain eventually winning their first World Cup . He provided the most accurate passes, 599 with a passing success rate of 91%, and he crossed the ball inside the 18-yard box more than any other player in the tournament. In the final he made 57 accurate forward half passes. Xavi also covered 80.20 kilometres throughout the competitions, averaging approximately 11.5 kilometres per game, more than any other player. In the final , he covered a distance of almost 15 kilometres. Xavi is the beating heart of this Spanish team, the man dictating the tiki-taka pulse of pass after pass. He may be just 5ft 7in with a curiously hunched gait but no player more influences the way his whole team plays. He doesn't score, doesn't really tackle: he just passes and passes with a precision and wit unmatched by any of his peers. During the round of 16 match against Portugal , Xavi provided a backheel pass in the 63rd minute to David Villa. Although Villa had his shot with his left foot blocked by goalkeeper Eduardo , he then put in the rebound with his right foot for the winning goal. In the semi-final against Germany, Xavi crossed from a corner to the edge of the six-yard box, where Carles Puyol scored with a header into the top-right corner. Spain dominated possession throughout the competition, averaging 59% possession during their three group matches, and 44 passes per shot throughout the entire World Cup, in large part thanks to midfield trio of Xavi, Iniesta, and Xabi Alonso , who were singled out in the media for their role in Spain's title–run; Spain also completed more passes (3,547) than any World Cup team since 1966 . Xavi played for Spain at Euro 2012 which Spain won by defeating Italy 4–0 in the final . Xavi attempted 136 passes (127 completed, 94% success rate) during Spain's 4–0 victory in the group stage match against the Republic of Ireland , more than any other player in a European Championship match. The previous record of 117 had been set by Ronald Koeman in a Euro 1992 match between the Netherlands and Denmark . Xavi and Andrés Iniesta made 229 passes in the match, more than the combined Irish team managed. "Pum, pum, pum, pum" was how Xavi described the rhythmic sound of the ball moving between himself and his midfield partner. With Xavi providing two assists in the final, for Jordi Alba and Fernando Torres, he became the first player to register assists in two European Championship finals. Spain's UEFA Euro 2012 victory made Xavi the most decorated player in Spanish football history, a status that he previously shared with Carles Puyol, who missed the tournament. On 5 August 2014, following the 2014 World Cup where Spain were eliminated at the group stage, Xavi announced his retirement from international football, having made 133 appearances in a 14-year period. Spain's World Cup-winning manager Vicente del Bosque paid tribute, stating that Xavi was "a key part of the team's style of play" and "he was more important to us than even the manager", also adding, "We will miss him both on and off the pitch. He is a player who we hold in great esteem both personally and as a player. He is and always will be a person and a player who is greatly valued by the federation , the coaching staff and by myself." On 28 May 2019 it was announced that Xavi would take over as manager of Al Sadd on a two-year contract. Xavi helped the club reach the semi-finals of the AFC Champions League , where they were eliminated by Al-Hilal FC 6–5 on aggregate. In the league, the club finished third. In the 2019–20 season, Xavi led his team to win one domestic trophy, the Qatar Cup . In the 2020 AFC Champions League , Al Sadd reached the round of 16 but were eliminated 1–0 by Persepolis . During his 97 games in charge of Al Sadd, spanning two and a half years, he led the club to seven trophies. On 3 November 2021, Al Sadd drew 3–3 against Al-Duhail in his final game in-charge. Two days later Al Sadd announced Xavi's move to Barcelona after his release clause was paid. On 6 November 2021, Xavi returned to his former club Barcelona as the new manager replacing Ronald Koeman , on a contract until June 2024. Following his arrival, Xavi implemented stricter rules for the players which included re-introduction of fines, early arrival for training and tracking of players' off pitch activities. In his first game in charge, Barcelona defeated local rival Espanyol by a 1–0 scoreline at the Camp Nou in La Liga to win his first Catalan Derby as manager. On 4 December, Xavi suffered his first defeat as Barcelona manager after losing 1–0 to Real Betis at home in La Liga. In Xavi's first Champions League campaign, he took charge with two group stage matches remaining. After drawing 0–0 with Benfica at the Camp Nou on 23 November and losing 3–0 to Bayern Munich on 8 December at the Allianz Arena , Barcelona finished third in the group stage which put them in the Europa League knockout round play-offs . On 12 January 2022, in his first Clásico in charge, Barcelona were beaten by Real Madrid 2–3 at the end of extra-time in the Supercopa de España semi-final . Barcelona suffered an early exit from the Copa del Rey after being beaten by Athletic Bilbao 3–2 at the end of extra-time in the round of 16 . In the winter transfer window, Barcelona strengthened their attack with the signings of Ferran Torres and Pierre-Emerick Aubameyang and Adama Traoré on loan. After a difficult first few months for Xavi, Barcelona quickly turned around their form with the new signings playing a big role in the process. The team entered a 14-match unbeaten streak starting with a 0–1 victory over Alavés in La Liga, during this run they scored four goals in 6 out of 11 matches and also qualified for the quarter-finals of the Europa League. On 20 March, Xavi won his first Clásico as manager beating Real Madrid 0–4 in La Liga at the Santiago Bernabéu ending their five-match Clásico losing streak and extending their unbeaten run to 12 matches. On 14 April, Xavi and his men who were on the verge of a monumental comeback, were knocked out of the UEL quarter-finals by Eintracht Frankfurt , bringing their fifteen-game unbeaten run to an end. In La Liga, he led Barcelona to a second-placed finish from ninth position when he took charge. In the 2022–23 UEFA Champions League , Barcelona finished third in their group behind Bayern Munich and Inter Milan to drop to the Europa League for the second consecutive season. On 15 January 2023, Barcelona won their first title under Xavi, following a 3–1 victory against Real Madrid in the Supercopa de España Final . On 14 May 2023, Barcelona clinched the 2022–23 La Liga title after defeating rivals Espanyol 4–2, with Xavi leading the club to its first league title since the 2018–19 season. On 22 September 2023, it was announced that he extended his contract at the club until 2025. A string of disappointing results across December and January, including 4–1 and 4–2 cup losses to Real Madrid and Athletic Bilbao respectively, led to increased pressure and scrutiny on Xavi. Following a 3–5 home loss to Villarreal on 27 January, leaving the club 10 points behind league leaders Real Madrid, he announced that he would leave the club after the conclusion of the season. On April 16, 2024, he was sent off after a display of dissent towards referee István Kovács during the UEFA Champions League quarter-final clash between Barcelona and Paris Saint-Germain. During the post-match press conference, Xavi expressed that the red card given to Barcelona defender Ronald Araújo by the Romanian referee was a pivotal moment that significantly influenced the outcome of the game. On 28 May 2019 it was announced that Xavi would take over as manager of Al Sadd on a two-year contract. Xavi helped the club reach the semi-finals of the AFC Champions League , where they were eliminated by Al-Hilal FC 6–5 on aggregate. In the league, the club finished third. In the 2019–20 season, Xavi led his team to win one domestic trophy, the Qatar Cup . In the 2020 AFC Champions League , Al Sadd reached the round of 16 but were eliminated 1–0 by Persepolis . During his 97 games in charge of Al Sadd, spanning two and a half years, he led the club to seven trophies. On 3 November 2021, Al Sadd drew 3–3 against Al-Duhail in his final game in-charge. Two days later Al Sadd announced Xavi's move to Barcelona after his release clause was paid. On 6 November 2021, Xavi returned to his former club Barcelona as the new manager replacing Ronald Koeman , on a contract until June 2024. Following his arrival, Xavi implemented stricter rules for the players which included re-introduction of fines, early arrival for training and tracking of players' off pitch activities. In his first game in charge, Barcelona defeated local rival Espanyol by a 1–0 scoreline at the Camp Nou in La Liga to win his first Catalan Derby as manager. On 4 December, Xavi suffered his first defeat as Barcelona manager after losing 1–0 to Real Betis at home in La Liga. In Xavi's first Champions League campaign, he took charge with two group stage matches remaining. After drawing 0–0 with Benfica at the Camp Nou on 23 November and losing 3–0 to Bayern Munich on 8 December at the Allianz Arena , Barcelona finished third in the group stage which put them in the Europa League knockout round play-offs . On 12 January 2022, in his first Clásico in charge, Barcelona were beaten by Real Madrid 2–3 at the end of extra-time in the Supercopa de España semi-final . Barcelona suffered an early exit from the Copa del Rey after being beaten by Athletic Bilbao 3–2 at the end of extra-time in the round of 16 . In the winter transfer window, Barcelona strengthened their attack with the signings of Ferran Torres and Pierre-Emerick Aubameyang and Adama Traoré on loan. After a difficult first few months for Xavi, Barcelona quickly turned around their form with the new signings playing a big role in the process. The team entered a 14-match unbeaten streak starting with a 0–1 victory over Alavés in La Liga, during this run they scored four goals in 6 out of 11 matches and also qualified for the quarter-finals of the Europa League. On 20 March, Xavi won his first Clásico as manager beating Real Madrid 0–4 in La Liga at the Santiago Bernabéu ending their five-match Clásico losing streak and extending their unbeaten run to 12 matches. On 14 April, Xavi and his men who were on the verge of a monumental comeback, were knocked out of the UEL quarter-finals by Eintracht Frankfurt , bringing their fifteen-game unbeaten run to an end. In La Liga, he led Barcelona to a second-placed finish from ninth position when he took charge. In the 2022–23 UEFA Champions League , Barcelona finished third in their group behind Bayern Munich and Inter Milan to drop to the Europa League for the second consecutive season. On 15 January 2023, Barcelona won their first title under Xavi, following a 3–1 victory against Real Madrid in the Supercopa de España Final . On 14 May 2023, Barcelona clinched the 2022–23 La Liga title after defeating rivals Espanyol 4–2, with Xavi leading the club to its first league title since the 2018–19 season. On 22 September 2023, it was announced that he extended his contract at the club until 2025. A string of disappointing results across December and January, including 4–1 and 4–2 cup losses to Real Madrid and Athletic Bilbao respectively, led to increased pressure and scrutiny on Xavi. Following a 3–5 home loss to Villarreal on 27 January, leaving the club 10 points behind league leaders Real Madrid, he announced that he would leave the club after the conclusion of the season. On April 16, 2024, he was sent off after a display of dissent towards referee István Kovács during the UEFA Champions League quarter-final clash between Barcelona and Paris Saint-Germain. During the post-match press conference, Xavi expressed that the red card given to Barcelona defender Ronald Araújo by the Romanian referee was a pivotal moment that significantly influenced the outcome of the game. Xavi is widely considered one of the best midfielders of all time, relying largely on his ability to find and exploit space as a deep-lying playmaker . As he said, "That's what I do: look for spaces. All day. I'm always looking." Finding space, he would appear for a teammate to receive and then move the ball on, with his coach Pep Guardiola putting it: "I get the ball, I give the ball, I get the ball, I give the ball." A diminutive, composed, agile, and technically skilled player with a slender physique and a low centre of gravity, these characteristics compensated for his lack of pace or physicality. Xavi's signature move when in possession involved him performing a 360 degree turn, a feint known as la pelopina , that allowed him to move away from the opposing player , retain possession, and gave him space and time on the ball to think about his next pass. In his youth, he had also played as a centre-back , before being shifted to a midfield role. While primarily a central midfielder with Barcelona, he often played in a more advanced midfield role with Spain. "I think I haven't changed at all to what I am now. I've been a passer since a young age. I liked passing with the rest of the players and my friends when we played football on the streets, in the main square, and at school. I think I was very similar to what people see in the stadium." Xavi on his own style of play, November 2014. Although he was not known for his tackling ability, or for being prolific in front of goal, Xavi's outstanding vision, "metronomic" pinpoint accurate passing, excellent off the ball movement, superb reading of the game, positional sense, and world-class ball control allowed him to create chances for teammates and dictate the flow of play in midfield, while rarely relinquishing possession. These qualities were displayed by his performance during Spain's 2010 World Cup victory, where he maintained a 91% passing success rate throughout the entire tournament, in addition to providing two assists , while Spain dominated possession throughout the competition. Xavi's ability to control games earned him the sobriquet, The Puppet Master . Jorge Valdano opined, "If football was a science, Xavi would have discovered the formula. With a ball at his feet, no one else has ever communicated so intelligently with every player on the pitch." Barcelona president Sandro Rosell believed that Xavi, together with Lionel Messi , Andrés Iniesta and Sergio Busquets , perfected the club's tiki-taka style of play, a style introduced to the club by former coach Johan Cruyff . Despite primarily being a creative player, however, he was also capable of scoring goals himself in addition to assisting them. Named in the Ballon d'Or Dream Team , a greatest all-time XI, Xavi's creativity, range of passing, and unique set of skills have led many in the sport to regard him as one of the greatest passers and one of the finest playmakers in history. In addition to his playing ability, Xavi was also praised for his leadership. Upon transitioning into management, Xavi continues to hold coaching principles and style of play consistent with the Barcelona style popularized by Johan Cruyff and influenced by his playing career under Pep Guardiola . [ citation needed ] When describing his man-management philosophy, Xavi explained that "The matter of managing a dressing room is almost more important than the tactical matter. At the end of the day we become half coaches, half psychologists. Being an elite footballer made more empathetic to the players who don't play as much and I also know what the growth of a footballer feels like, and who needs a more loving approach. This gives me a sense of control over the dressing room." Xavi cites about his coaching influences in an interview revealing as follows: "Having a lot of coaches in my career made me take a little bit from all of them: from Van Gaal, from Rijkaard, from Guardiola, from Luis Enrique, from Iñaki Sáez, from Luis Aragonés. I got my masters in man-management from Aragonés and my masters in tactics from Guardiola." Xavi has a sponsorship deal with German sportswear and equipment supplier Adidas and has appeared in Adidas commercials alongside Lionel Messi, Luis Suárez and Robin van Persie . Xavi has worn Adidas Predator boots. In November 2014, Xavi appeared in FIFA 's "11 against Ebola " campaign with a selection of top football players from around the world, including Cristiano Ronaldo , Neymar , Gareth Bale and Didier Drogba . Under the slogan "Together, we can beat Ebola", FIFA's campaign was done in conjunction with the Confederation of African Football (CAF) and health experts, with the players holding up 11 messages to raise awareness of the disease and ways to combat it. Since July 2013, Xavi has been married to Núria Cunillera. They have a daughter, Asia, born in 2016 and a son, Dan, born in 2018. Barcelona Al Sadd Spain U20 Spain Individual Al Sadd Barcelona IndividualBarcelona Al Sadd Spain U20 Spain IndividualAl Sadd Barcelona Individual

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/International_Mutual_Aid/html

International Mutual Aid

International Mutual Aid (IMA) is a Maryland 501(c)(3) registered nonprofit organization working to provide disaster and emergency medical assistance to underserved populations outside of the US. International Mutual Aid was founded in November 2014 in response to the Ebola virus epidemic in West Africa . IMA deployed a medical team to Kono District , Sierra Leone in December 2014. This team remained in place for the duration of the Kono Ebola epidemic, coordinating with local resources to run a free primary care clinic, conduct Ebola surveillance, contact tracing, initial treatment for suspect Ebola cases, and provide public education. International Mutual Aid remains engaged in healthcare system strengthening efforts in Kono District, Sierra Leone. Kono .

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Anthony_Fauci/html

Anthony Fauci

Anthony Stephen Fauci ( / ˈ f aʊ tʃ i / FOW -chee ; born December 24, 1940) is an American physician-scientist and immunologist who served as the director of the National Institute of Allergy and Infectious Diseases (NIAID) from 1984 to 2022, and the chief medical advisor to the president from 2021 to 2022. Fauci was one of the world's most frequently cited scientists across all scientific journals from 1983 to 2002. In 2008, President George W. Bush awarded him the Presidential Medal of Freedom , the highest civilian award in the United States, for his work on the AIDS relief program PEPFAR . Fauci received his undergraduate education at the College of the Holy Cross and his Doctor of Medicine from Cornell University . As a physician with the National Institutes of Health (NIH), Fauci served the American public health sector for more than fifty years and has acted as an advisor to every U.S. president since Ronald Reagan . During his time as director of the NIAID, he made contributions to HIV/AIDS research and other immunodeficiency diseases, both as a research scientist and as the head of the NIAID. During the COVID-19 pandemic , Fauci served under President Donald Trump as one of the lead members of the White House Coronavirus Task Force . His advice was frequently contradicted by Trump, and Trump's supporters alleged that Fauci was trying to politically undermine Trump's run for reelection. After Joe Biden took office, Fauci began serving as one of the lead members of the White House COVID-19 Response Team and as Biden's chief medical advisor . Fauci stepped down on December 31, 2022.Fauci was born on December 24, 1940, in Brooklyn , New York City, to Eugenia Lillian ( née Abys; 1909–1965) and Stephen A. Fauci (1910–2008) as the youngest of two children. His father, a pharmacist, attended Columbia University and owned a pharmacy. Fauci worked with his mother and sister at the pharmacy's register and also delivered prescriptions. The pharmacy was located in the Dyker Heights section of Brooklyn, directly beneath the family apartment, previously in the Bensonhurst neighborhood. When he was a child, Fauci developed a fascination with World War II , and played basketball and baseball . Fauci's grandparents immigrated to the United States from Italy in the late 19th century. His paternal grandparents, Antonino Fauci and Calogera Guardino, were from Sciacca , and his maternal grandparents were from Naples . His maternal grandmother, Raffaella Trematerra, was a seamstress and his maternal grandfather, Giovanni Abys, was a Swiss-born artist noted for his landscape and portrait painting, magazine illustrations in Italy, as well as graphic design for commercial labels. Fauci grew up Catholic , but also considers himself a humanist who "has faith in the goodness of mankind", stating that he thinks "that there are a lot of things about organized religion that are unfortunate, and [that he tends] to like to stay away from it." In December 2023, Fauci stated that he still considers himself a Roman Catholic, but he does not practice his faith anymore for "a number of complicated reasons"; clarifying his relationship with the Catholic Church, he stated: I'm not against it. I identify myself as a Catholic. I was raised, I was baptized, I was confirmed, I was married in the Church. My children were baptized in the Church. But as far as practicing it, it seems almost like a pro forma thing that I don't really need to do. Fauci attended Regis High School , a competitive Jesuit school on Manhattan's Upper East Side , where he captained the school's basketball team despite standing only 5 ft 7 in (1.70 m) tall. He decided halfway through high school to become a physician. After graduating in 1958, Fauci enrolled in the College of the Holy Cross , graduating in 1962 with a Bachelor of Arts degree in classics with a pre-med track. Fauci then attended Cornell University 's Medical College (now Weill Cornell Medicine ), graduating with a Doctor of Medicine degree in 1966 ranked first in his class. At Cornell, he focused on adult internal medicine, mainly infectious diseases and the immune system. Fauci then did an internship and residency in internal medicine at New York Hospital-Cornell Medical Center (now Weill Cornell Medical Center ). After completing his medical residency in 1968, Fauci joined the National Institutes of Health (NIH) as a clinical associate in the National Institute of Allergy and Infectious Diseases 's (NIAID) Laboratory of Clinical Investigation (LCI). He became head of the LCI's Clinical Physiology Section in 1974, and in 1980 was appointed chief of the NIAID's Laboratory of Immunoregulation. He became director of the NIAID in 1984. Fauci has been offered the position of director of the NIH several times, but has declined each time. Fauci has been at the forefront of U.S. efforts to contend with viral diseases like HIV/AIDS , SARS , the Swine flu , MERS , Ebola , and COVID-19 . He played a significant role in the early 2000s in creating the President's Emergency Plan for AIDS Relief (PEPFAR) and in driving development of biodefense drugs and vaccines following the 9/11 terrorist attacks . Fauci has been a visiting professor at many medical centers and has received numerous honorary doctorates from universities in the U.S. and abroad. Fauci has made important scientific observations that contributed to the understanding of the regulation of the human immune response and is recognized for delineating the mechanisms whereby immunosuppressive agents adapt to that response. He developed therapies for formerly fatal diseases such as polyarteritis nodosa , granulomatosis with polyangiitis , and lymphomatoid granulomatosis . In a 1985 Stanford University Arthritis Center Survey, members of the American Rheumatism Association ranked Fauci's work on the treatment of polyarteritis nodosa and granulomatosis with polyangiitis as one of the most important advances in patient management in rheumatology over the previous 20 years. Fauci discovered how to re-dose cancer drugs in a way that turned a 98 percent mortality rate of the disorder vasculitis into a 93 percent remission rate. Fauci has contributed to the understanding of how HIV destroys the body's natural defense system, progressing to AIDS . He has outlined the mechanisms of induction of HIV expression by endogenous cytokines . Fauci has worked to develop strategies for the therapy and immune reconstitution of patients with the disease, as well as for a vaccine to prevent HIV infection . His current [ as of? ] research is concentrated on identifying the nature of the immunopathogenic mechanisms of HIV infection and the scope of the body's immune responses to HIV. In 2003, the Institute for Scientific Information stated that from 1983 to 2002, "Fauci was the 13th most-cited scientist among the 2.5 to 3.0 million authors in all disciplines throughout the world who published articles in scientific journals." As a government scientist under seven presidents, Fauci has been described as "a consistent spokesperson for science, a person who more than any other figure has brokered a generational peace" between the two worlds of science and politics. In a 2020 interview with The Guardian , Fauci remarked, "My career and my identity has really been defined by HIV." He was one of the leading researchers during the AIDS epidemic in the early 1980s. In 1981, he and his team of researchers began looking for a vaccine or treatment for this novel virus, though they would meet a number of obstacles. In October 1988, protesters came to the National Institute of Allergy and Infectious Diseases. Fauci, who had become the institute's director in 1984, bore the brunt of the anger from the LGBTQ+ community who were largely ignored by the government. Leading AIDS activist Larry Kramer attacked Fauci relentlessly in the media. He called him an "incompetent idiot" and a "pill-pushing" tool of the medical establishment. Fauci did not have control over drug approval though many people felt he was not doing enough. Fauci did make an effort in the late 1980s to reach out to the LGBTQ+ community in New York and San Francisco to find ways he and the NIAID could find a solution. Fauci was also praised for engaging with AIDS advocates, and he helped to make experimental AIDS treatments more accessible. Though Fauci was initially admonished for his treatment of the AIDS epidemic, his work in the community was eventually acknowledged. Kramer, who had spent years hating Fauci for his treatment of the HIV/AIDS epidemic, eventually called him "the only true and great hero" among government officials during the AIDS crisis. Fauci was criticized over what some said was a delayed response from the U.S. government to the HIV/AIDS epidemic, including delays in the promotion of experimental HIV/AIDS drugs. In 2014, Sean Strub of HuffPost criticized Fauci for "delaying promotion of an AIDS treatment that would have prevented tens of thousands of deaths in the first years of the epidemic" and accused him of "rewriting history." Political commentator Helen Andrews defended Fauci's actions during the epidemic in a 2021 article, writing: The idea that Fauci was "wrong" about A.I.D.S., which some of his contemporary opponents repeat, is unfair. His most notorious error was a 1983 paper suggesting "routine close contact, as within a family household," might spread the disease, but it was an understandable mistake given what was known at the time and he corrected it within a year, lightning speed by the standards of academic publishing. He behaved more responsibly than some of his peers when it came to speculating about a heterosexual A.I.D.S. epidemic around the corner. He was not one of the hysteria-mongers—though he did benefit from the hysteria when negotiating budgets with Congress. Fauci was the main architect of President's Emergency Plan for AIDS Relief (PEPFAR), an HIV/AIDS program responsible for saving over 20 million lives in the developing world. In a meeting with reporters on September 17, 2009, Fauci predicted that the H1N1 virus causing the 2009 swine flu pandemic could infect as many as one in three Americans, more than the amount of Americans usually infected by the seasonal flu . On October 16, 2014, in a United States congressional hearing regarding the Ebola virus crisis, Fauci, who, as the director of the National Institute of Allergy and Infectious Diseases (NIAID) had been discussing the importance of screening for weeks, testified that NIAID was still some distance away from producing sufficient quantities of cures or vaccines for widespread trials. Specifically, Fauci said, "While NIAID is an active participant in the global effort to address the public health emergency occurring in west Africa, it is important to recognize that we are still in the early stages of understanding how infection with the Ebola virus can be treated and prevented." Fauci also remarked in the hearing: "As we continue to expedite research while enforcing high safety and efficacy standards, the implementation of the public health measures already known to contain prior Ebola virus outbreaks and the implementation of treatment strategies such as fluid and electrolyte replacement is essential to preventing additional infections, treating those already infected, protecting healthcare providers, and ultimately bringing this epidemic to an end." According to The Washington Post , prior to the COVID-19 pandemic, Fauci was "mostly unknown outside the medical community". Fauci had not met with Trump until three years after he was inaugurated as president. Fauci was a member of the White House Coronavirus Task Force established in late January 2020, under President Donald Trump , to deal with the COVID-19 pandemic . He became a de facto public health spokesperson for the office of the president during the pandemic, and a strong advocate for ongoing social distancing efforts in the United States. In interviews on January 21, January 26, and February 17, Fauci commented on COVID-19. He said that at the time of the interviews ("right now"), COVID-19 was not a "major threat" to the American public, with the risk to the American public being "low", but that it was "an evolving situation", and that "public health officials need to take [COVID-19] very seriously". In the latter interview, Fauci said that COVID-19 could become a "global pandemic which would then have significant implications for" the United States. In March 2020, he predicted that the infection fatality rate would likely be close to 1%, which was ten times more severe than the 0.1% reported rate for seasonal flu. In a March 8, 2020, interview, Fauci stated that "right now in the United States, people [who are not infected] should not be walking around with masks", but "if you want to do it, that's fine". In the same interview, Fauci said that buying masks "could lead to a shortage of masks for the people who really need" them: "When you think masks, you should think of healthcare providers needing them". When Fauci made this comment, America's top surgical mask maker was struggling to produce enough masks to meet the increased demand. On April 3, the CDC reversed course, quoting recent studies that showed asymptomatic transmission of the virus, thus advocating for the public to wear non-surgical masks to reduce community transmission while Fauci advocated for wearing facial coverings in public. Fauci's shifting advice on wearing face masks drew criticism, which Fauci responded to by arguing that changes in policy were necessary as scientists learned more about COVID-19. In mid-April, when asked about social distancing and stay-at-home measures, Fauci said that if the administration had "started mitigation earlier" more lives could have been saved, and "no one is going to deny that." He added that the decision-making for implementing mitigation measures was "complicated", and "there was a lot of pushback about shutting things down back then." Fauci's comments were met with a hostile response from former Republican congressional candidate DeAnna Lorraine. Trump retweeted Lorraine's response, which included the call to "#FireFauci." "Fire Fauci" has also been chanted by anti-lockdown protesters in various locations, including Florida and Texas. As a result, the White House denied that Trump was firing Fauci, and blamed the media for overreacting. Fauci was criticized by right-wing pundits and received death threats that necessitated a security detail. In an interview with 60 Minutes in 2020, he mentioned that other members of his family, including his wife and daughters, had been repeatedly harassed since the pandemic began. In June 2020, Fauci said that he was "very concerned" that the ongoing protests against police brutality would cause "surges" in COVID-19 cases, stating that the "large crowds" are a "perfect set-up" for the virus to spread. In July 2020, Fauci advised the public to "avoid crowds of any type". On July 6, 2020, Fauci spoke on a Facebook livestream , offering his opinion that the country's situation pertaining to COVID-19 "is really not good", pointing to more than 55,000 new cases on July 4, 2020. He said the United States was "still knee-deep in the first wave" of cases, and was experiencing a "resurgence of infections". On July 7, 2020, during a press conference, Fauci stated that it was a "false narrative to take comfort in a lower rate of death" for COVID-19 in the country: "There's so many other things that are very dangerous and bad about this virus, don't get yourself into false complacency." Both Trump and the White House had cited the falling death rate as proof of success of the Trump administration's response. After this appearance by Fauci, the White House cancelled three media appearances that had been scheduled for him later that week. On July 7, 2020, Trump contradicted Fauci's comments describing a dire situation in the country, with Trump saying: "I think we are in a good place. I disagree with [Fauci]." While there were disagreements, Trump also at times praised Fauci. On July 9, 2020, Trump publicly opined that Fauci "is a nice man, but he's made a lot of mistakes." By July 12, 2020, a White House official told media outlets that "several White House officials are concerned about the number of times Dr. Fauci has been wrong on things", passing to the media a list of purported mistakes made by Fauci during the outbreak. Included were statements Fauci made during a February 29, 2020, interview where he stated that "at this moment, there is no need to change anything that you're doing on a day-by-day basis." However, the White House list neglected to mention that in that same interview, Fauci had stated that the risk could change, "when you start to see community spread", and that the disease could morph into "a major outbreak" in the country. As late as September 23, 2020, when U.S. coronavirus fatalities exceeded 200,000, conservatives continued to question Fauci's and the Centers for Disease Control and Prevention 's (CDC) recommendations for responding to the pandemic. In a hearing before the Senate's Health, Education, Labor, and Pensions Committee , Kentucky's Senator Rand Paul asked him if he had "second thoughts" about his mitigation recommendations, including keeping six feet of distance from others and mask-wearing, claiming, "our death rate is essentially worse than Sweden's ." Fauci stood by the guidelines, indicating Sweden's fatality rate exceeded those of other Scandinavian countries, and said the comparison between Sweden and the U.S. was not legitimate. Fauci said the recommendations remained valid. After Paul then asserted New York's high fatality rate showed that mitigation efforts were insufficient, Fauci replied, "You've misconstrued that, Senator, and you've done that repetitively in the past." Fauci explained further that New York State had succeeded in getting the virus under control by following the CDC's clinical guidelines. Paul had made numerous claims about herd immunity , Sweden's interventions to combat the pandemic, the contention that the populations of Asian countries have greater resilience against COVID-19, and statements about death rates due to the virus. Fauci would have several intense exchanges with Paul. In October 2020, Fauci objected after his words, "I can't imagine that anybody could be doing more" were featured in an advertisement from the Trump campaign touting Trump's handling of the pandemic. Fauci said he did not consent to the ad, his words were taken out of context (he was actually referring to how hard the Coronavirus Task Force was working), and he had never made a political endorsement in his career. Also, in October, Fauci criticized the Great Barrington Declaration 's "focused protection" herd immunity strategy, calling it "ridiculous", "total nonsense" and "very dangerous", saying that it would lead to a large number of avoidable deaths. Fauci said that 30 percent of the population had underlying health conditions that made them vulnerable to the virus and that "older adults, even those who are otherwise healthy, are far more likely than young adults to become seriously ill if they get COVID-19." He added, "This idea that we have the power to protect the vulnerable is total nonsense because history has shown that that's not the case. And if you talk to anybody who has any experience in epidemiology and infectious diseases, they will tell you that that is risky, and you'll wind up with many more infections of vulnerable people, which will lead to hospitalizations and deaths. So I think that we just got to look that square in the eye and say it's nonsense." On October 18, 2020, Fauci mentioned that he "wasn't surprised" Donald Trump contracted COVID-19. The next day, during a presidential call, Trump called Fauci "a disaster" and said that "people are tired of COVID." During a campaign rally in Phoenix, Arizona , on October 19, Trump launched attacks on his political rival Joe Biden , saying that Biden "wants to listen to Dr. Fauci" regarding the handling of the pandemic, upon which Biden merely replied "Yes" on Twitter. On October 31, The Washington Post published an extensive interview with Fauci, in which he voiced a candid assessment of the administration's COVID-19 policies and was critical of the influence of presidential advisor Scott Atlas . Shortly after midnight on November 2, 2020, Trump insinuated he would fire Fauci "after the election" while on stage at a campaign rally at Miami-Opa Locka Executive Airport in Opa-locka, Florida . At the rally, he made false claims that the pandemic was "rounding the turn" and was met by audience chants of "Fire Fauci!", to which he responded, "Don't tell anybody, but let me wait until after the election ... I appreciate the advice." Despite the rhetoric, Fauci was not fired. On December 2, the United Kingdom became the first western country to license a vaccine against the coronavirus ( Pfizer-BioNTech ). In response, Fauci said that the U.S. Food and Drug Administration (FDA) was proceeding "the correct way" and said the UK "really rushed through that approval". The next day Fauci apologized, telling the BBC "I have a great deal of confidence in what the UK does both scientifically and from a regulator standpoint. Our process is one that takes more time than it takes in the UK ... I did not mean to imply any sloppiness even though it came out that way." On January 3, 2021, President Trump tweeted, "The number of cases and deaths of the China Virus is far exaggerated in the United States because of [the CDC's] ridiculous method of determination compared to other countries". That same morning, Fauci responded in an interview on NBC's Meet the Press , "The numbers are real. We have well over 300,000 deaths. We are averaging two- to three thousand deaths per day. All you need to do ... is go into the trenches, go into the hospitals, go into the intensive care units and see what is happening. Those are real numbers, real people, and real deaths." When asked if the 2021 United States Capitol attack was a COVID-19 superspreader event , Fauci stated: "I think for those people there, they probably put themselves at an increased risk because they essentially did not adhere to the fundamentals of public health and COVID-19 context which is universal wearing of masks, keeping physical distance, avoiding crowds in congregate settings. The fact that it was outdoors is a little bit better than if they were indoors completely. But you can still have a super spreader situation when you do things in a crowded way." On January 23, 2021, Fauci was quoted saying that letting the science speak on the pandemic got him "into a little bit of trouble" and got "push-back from people in the White House, including the president", during the Trump administration. Fauci was also reportedly blocked from appearing on The Rachel Maddow Show for some time because the Trump administration "didn't like the way [Maddow handles] things and they didn't want me on [the show]." On December 3, 2020, President-elect Joe Biden asked Fauci, in addition to remaining in his role as director of the NIAID, to serve as the chief medical advisor to the president in the Biden administration . Fauci accepted the offer. After the inauguration of Joe Biden in January 2021, Fauci said he experienced a "liberating feeling" in being able to speak freely about science without interference from the new administration. He pictured Biden's administration as committed to being "completely transparent, open and honest". Fauci was involved in the development of the Biden administration's plan for a nationwide COVID-19 vaccine rollout. In early April 2021, Fauci said of the current situation in the United States that "It's almost a race between getting people vaccinated and this surge that seems to want to increase". In early May 2021, when asked if the CDC's summer camp guidance was excessive, Fauci responded by saying that "I wouldn't call them excessive, but they certainly are conservative" and added that the guidance "looks a bit strict" and "a bit stringent". Also in early May, Fauci said that he is "not convinced" that COVID-19 originated naturally and that "we should continue to investigate what went on in China until we continue to find out to the best of our ability what happened". In mid-May 2021, Fauci said that Americans who are fully vaccinated against COVID-19 no longer need to wear masks outdoors, except for in "completely crowded situations". This guidance was updated in July 2021 to recommend that all people wear masks regardless of vaccination status, in what Fauci said was due to the much more contagious Delta variant. In May 2021, Fauci denied that the National Institutes of Health supported " gain-of-function research " at the Wuhan Institute of Virology . In early June 2021, over 3,000 internal government emails sent by Fauci from January to June 2020 were obtained by media outlets through Freedom of Information Act (FOIA) requests. These emails contain information about how the United States and Fauci initially responded to COVID-19. On June 22, 2021, Fauci said that the SARS-CoV-2 Delta variant is the "greatest threat" to eliminating COVID-19 in the United States. In December 2021, Fauci, along with virologist Jeffery K. Taubenberger and David M. Morens endorsed the development of a universal coronavirus vaccine , advocating in favor of "an international collaborative effort to extensively sample coronaviruses from bats as well as wild and farmed animals to help understand the full "universe" of existing and emerging coronaviruses." In February 2022, Fauci told the Financial Times that "As we get out of the full-blown pandemic phase of Covid-19, which we are certainly heading out of, these decisions will increasingly be made on a local level rather than centrally decided or mandated. There will also be more people making their own decisions on how they want to deal with the virus." In March 2022, Fauci said that the United States should expect an increase in COVID-19 cases from the BA.2 subvariant of Omicron , but that it might not lead to a severe increase in hospitalizations and deaths. On April 27, 2022, Fauci said that the United States was "out of the full-blown explosive pandemic phase" of COVID-19. On May 15, 2022, Fauci said that he would resign if Donald Trump wins the 2024 U.S. presidential election . In a July 2022 interview with Politico , Fauci had been reported to be "leaving by the end of President Joe Biden's term", though he later clarified he may step down from his role as NIAID director. Fauci also told Politico he is seeking to "help repair the widespread partisan polarization that has divided the nation and politicized science". On August 22, 2022, Fauci announced that he will step down from his position in December "to pursue the next chapter" of his career. He stepped down from his position on December 31 of that same year. On June 26, 2023, Georgetown University announced that Fauci would join its faculty as a distinguished professor , teaching in both the School of Medicine and McCourt School of Public Policy , effective July 1. Fauci has made important scientific observations that contributed to the understanding of the regulation of the human immune response and is recognized for delineating the mechanisms whereby immunosuppressive agents adapt to that response. He developed therapies for formerly fatal diseases such as polyarteritis nodosa , granulomatosis with polyangiitis , and lymphomatoid granulomatosis . In a 1985 Stanford University Arthritis Center Survey, members of the American Rheumatism Association ranked Fauci's work on the treatment of polyarteritis nodosa and granulomatosis with polyangiitis as one of the most important advances in patient management in rheumatology over the previous 20 years. Fauci discovered how to re-dose cancer drugs in a way that turned a 98 percent mortality rate of the disorder vasculitis into a 93 percent remission rate. Fauci has contributed to the understanding of how HIV destroys the body's natural defense system, progressing to AIDS . He has outlined the mechanisms of induction of HIV expression by endogenous cytokines . Fauci has worked to develop strategies for the therapy and immune reconstitution of patients with the disease, as well as for a vaccine to prevent HIV infection . His current [ as of? ] research is concentrated on identifying the nature of the immunopathogenic mechanisms of HIV infection and the scope of the body's immune responses to HIV. In 2003, the Institute for Scientific Information stated that from 1983 to 2002, "Fauci was the 13th most-cited scientist among the 2.5 to 3.0 million authors in all disciplines throughout the world who published articles in scientific journals." As a government scientist under seven presidents, Fauci has been described as "a consistent spokesperson for science, a person who more than any other figure has brokered a generational peace" between the two worlds of science and politics. In a 2020 interview with The Guardian , Fauci remarked, "My career and my identity has really been defined by HIV." He was one of the leading researchers during the AIDS epidemic in the early 1980s. In 1981, he and his team of researchers began looking for a vaccine or treatment for this novel virus, though they would meet a number of obstacles. In October 1988, protesters came to the National Institute of Allergy and Infectious Diseases. Fauci, who had become the institute's director in 1984, bore the brunt of the anger from the LGBTQ+ community who were largely ignored by the government. Leading AIDS activist Larry Kramer attacked Fauci relentlessly in the media. He called him an "incompetent idiot" and a "pill-pushing" tool of the medical establishment. Fauci did not have control over drug approval though many people felt he was not doing enough. Fauci did make an effort in the late 1980s to reach out to the LGBTQ+ community in New York and San Francisco to find ways he and the NIAID could find a solution. Fauci was also praised for engaging with AIDS advocates, and he helped to make experimental AIDS treatments more accessible. Though Fauci was initially admonished for his treatment of the AIDS epidemic, his work in the community was eventually acknowledged. Kramer, who had spent years hating Fauci for his treatment of the HIV/AIDS epidemic, eventually called him "the only true and great hero" among government officials during the AIDS crisis. Fauci was criticized over what some said was a delayed response from the U.S. government to the HIV/AIDS epidemic, including delays in the promotion of experimental HIV/AIDS drugs. In 2014, Sean Strub of HuffPost criticized Fauci for "delaying promotion of an AIDS treatment that would have prevented tens of thousands of deaths in the first years of the epidemic" and accused him of "rewriting history." Political commentator Helen Andrews defended Fauci's actions during the epidemic in a 2021 article, writing: The idea that Fauci was "wrong" about A.I.D.S., which some of his contemporary opponents repeat, is unfair. His most notorious error was a 1983 paper suggesting "routine close contact, as within a family household," might spread the disease, but it was an understandable mistake given what was known at the time and he corrected it within a year, lightning speed by the standards of academic publishing. He behaved more responsibly than some of his peers when it came to speculating about a heterosexual A.I.D.S. epidemic around the corner. He was not one of the hysteria-mongers—though he did benefit from the hysteria when negotiating budgets with Congress. Fauci was the main architect of President's Emergency Plan for AIDS Relief (PEPFAR), an HIV/AIDS program responsible for saving over 20 million lives in the developing world. In a meeting with reporters on September 17, 2009, Fauci predicted that the H1N1 virus causing the 2009 swine flu pandemic could infect as many as one in three Americans, more than the amount of Americans usually infected by the seasonal flu . On October 16, 2014, in a United States congressional hearing regarding the Ebola virus crisis, Fauci, who, as the director of the National Institute of Allergy and Infectious Diseases (NIAID) had been discussing the importance of screening for weeks, testified that NIAID was still some distance away from producing sufficient quantities of cures or vaccines for widespread trials. Specifically, Fauci said, "While NIAID is an active participant in the global effort to address the public health emergency occurring in west Africa, it is important to recognize that we are still in the early stages of understanding how infection with the Ebola virus can be treated and prevented." Fauci also remarked in the hearing: "As we continue to expedite research while enforcing high safety and efficacy standards, the implementation of the public health measures already known to contain prior Ebola virus outbreaks and the implementation of treatment strategies such as fluid and electrolyte replacement is essential to preventing additional infections, treating those already infected, protecting healthcare providers, and ultimately bringing this epidemic to an end." According to The Washington Post , prior to the COVID-19 pandemic, Fauci was "mostly unknown outside the medical community". Fauci had not met with Trump until three years after he was inaugurated as president. Fauci was a member of the White House Coronavirus Task Force established in late January 2020, under President Donald Trump , to deal with the COVID-19 pandemic . He became a de facto public health spokesperson for the office of the president during the pandemic, and a strong advocate for ongoing social distancing efforts in the United States. In interviews on January 21, January 26, and February 17, Fauci commented on COVID-19. He said that at the time of the interviews ("right now"), COVID-19 was not a "major threat" to the American public, with the risk to the American public being "low", but that it was "an evolving situation", and that "public health officials need to take [COVID-19] very seriously". In the latter interview, Fauci said that COVID-19 could become a "global pandemic which would then have significant implications for" the United States. In March 2020, he predicted that the infection fatality rate would likely be close to 1%, which was ten times more severe than the 0.1% reported rate for seasonal flu. In a March 8, 2020, interview, Fauci stated that "right now in the United States, people [who are not infected] should not be walking around with masks", but "if you want to do it, that's fine". In the same interview, Fauci said that buying masks "could lead to a shortage of masks for the people who really need" them: "When you think masks, you should think of healthcare providers needing them". When Fauci made this comment, America's top surgical mask maker was struggling to produce enough masks to meet the increased demand. On April 3, the CDC reversed course, quoting recent studies that showed asymptomatic transmission of the virus, thus advocating for the public to wear non-surgical masks to reduce community transmission while Fauci advocated for wearing facial coverings in public. Fauci's shifting advice on wearing face masks drew criticism, which Fauci responded to by arguing that changes in policy were necessary as scientists learned more about COVID-19. In mid-April, when asked about social distancing and stay-at-home measures, Fauci said that if the administration had "started mitigation earlier" more lives could have been saved, and "no one is going to deny that." He added that the decision-making for implementing mitigation measures was "complicated", and "there was a lot of pushback about shutting things down back then." Fauci's comments were met with a hostile response from former Republican congressional candidate DeAnna Lorraine. Trump retweeted Lorraine's response, which included the call to "#FireFauci." "Fire Fauci" has also been chanted by anti-lockdown protesters in various locations, including Florida and Texas. As a result, the White House denied that Trump was firing Fauci, and blamed the media for overreacting. Fauci was criticized by right-wing pundits and received death threats that necessitated a security detail. In an interview with 60 Minutes in 2020, he mentioned that other members of his family, including his wife and daughters, had been repeatedly harassed since the pandemic began. In June 2020, Fauci said that he was "very concerned" that the ongoing protests against police brutality would cause "surges" in COVID-19 cases, stating that the "large crowds" are a "perfect set-up" for the virus to spread. In July 2020, Fauci advised the public to "avoid crowds of any type". On July 6, 2020, Fauci spoke on a Facebook livestream , offering his opinion that the country's situation pertaining to COVID-19 "is really not good", pointing to more than 55,000 new cases on July 4, 2020. He said the United States was "still knee-deep in the first wave" of cases, and was experiencing a "resurgence of infections". On July 7, 2020, during a press conference, Fauci stated that it was a "false narrative to take comfort in a lower rate of death" for COVID-19 in the country: "There's so many other things that are very dangerous and bad about this virus, don't get yourself into false complacency." Both Trump and the White House had cited the falling death rate as proof of success of the Trump administration's response. After this appearance by Fauci, the White House cancelled three media appearances that had been scheduled for him later that week. On July 7, 2020, Trump contradicted Fauci's comments describing a dire situation in the country, with Trump saying: "I think we are in a good place. I disagree with [Fauci]." While there were disagreements, Trump also at times praised Fauci. On July 9, 2020, Trump publicly opined that Fauci "is a nice man, but he's made a lot of mistakes." By July 12, 2020, a White House official told media outlets that "several White House officials are concerned about the number of times Dr. Fauci has been wrong on things", passing to the media a list of purported mistakes made by Fauci during the outbreak. Included were statements Fauci made during a February 29, 2020, interview where he stated that "at this moment, there is no need to change anything that you're doing on a day-by-day basis." However, the White House list neglected to mention that in that same interview, Fauci had stated that the risk could change, "when you start to see community spread", and that the disease could morph into "a major outbreak" in the country. As late as September 23, 2020, when U.S. coronavirus fatalities exceeded 200,000, conservatives continued to question Fauci's and the Centers for Disease Control and Prevention 's (CDC) recommendations for responding to the pandemic. In a hearing before the Senate's Health, Education, Labor, and Pensions Committee , Kentucky's Senator Rand Paul asked him if he had "second thoughts" about his mitigation recommendations, including keeping six feet of distance from others and mask-wearing, claiming, "our death rate is essentially worse than Sweden's ." Fauci stood by the guidelines, indicating Sweden's fatality rate exceeded those of other Scandinavian countries, and said the comparison between Sweden and the U.S. was not legitimate. Fauci said the recommendations remained valid. After Paul then asserted New York's high fatality rate showed that mitigation efforts were insufficient, Fauci replied, "You've misconstrued that, Senator, and you've done that repetitively in the past." Fauci explained further that New York State had succeeded in getting the virus under control by following the CDC's clinical guidelines. Paul had made numerous claims about herd immunity , Sweden's interventions to combat the pandemic, the contention that the populations of Asian countries have greater resilience against COVID-19, and statements about death rates due to the virus. Fauci would have several intense exchanges with Paul. In October 2020, Fauci objected after his words, "I can't imagine that anybody could be doing more" were featured in an advertisement from the Trump campaign touting Trump's handling of the pandemic. Fauci said he did not consent to the ad, his words were taken out of context (he was actually referring to how hard the Coronavirus Task Force was working), and he had never made a political endorsement in his career. Also, in October, Fauci criticized the Great Barrington Declaration 's "focused protection" herd immunity strategy, calling it "ridiculous", "total nonsense" and "very dangerous", saying that it would lead to a large number of avoidable deaths. Fauci said that 30 percent of the population had underlying health conditions that made them vulnerable to the virus and that "older adults, even those who are otherwise healthy, are far more likely than young adults to become seriously ill if they get COVID-19." He added, "This idea that we have the power to protect the vulnerable is total nonsense because history has shown that that's not the case. And if you talk to anybody who has any experience in epidemiology and infectious diseases, they will tell you that that is risky, and you'll wind up with many more infections of vulnerable people, which will lead to hospitalizations and deaths. So I think that we just got to look that square in the eye and say it's nonsense." On October 18, 2020, Fauci mentioned that he "wasn't surprised" Donald Trump contracted COVID-19. The next day, during a presidential call, Trump called Fauci "a disaster" and said that "people are tired of COVID." During a campaign rally in Phoenix, Arizona , on October 19, Trump launched attacks on his political rival Joe Biden , saying that Biden "wants to listen to Dr. Fauci" regarding the handling of the pandemic, upon which Biden merely replied "Yes" on Twitter. On October 31, The Washington Post published an extensive interview with Fauci, in which he voiced a candid assessment of the administration's COVID-19 policies and was critical of the influence of presidential advisor Scott Atlas . Shortly after midnight on November 2, 2020, Trump insinuated he would fire Fauci "after the election" while on stage at a campaign rally at Miami-Opa Locka Executive Airport in Opa-locka, Florida . At the rally, he made false claims that the pandemic was "rounding the turn" and was met by audience chants of "Fire Fauci!", to which he responded, "Don't tell anybody, but let me wait until after the election ... I appreciate the advice." Despite the rhetoric, Fauci was not fired. On December 2, the United Kingdom became the first western country to license a vaccine against the coronavirus ( Pfizer-BioNTech ). In response, Fauci said that the U.S. Food and Drug Administration (FDA) was proceeding "the correct way" and said the UK "really rushed through that approval". The next day Fauci apologized, telling the BBC "I have a great deal of confidence in what the UK does both scientifically and from a regulator standpoint. Our process is one that takes more time than it takes in the UK ... I did not mean to imply any sloppiness even though it came out that way." On January 3, 2021, President Trump tweeted, "The number of cases and deaths of the China Virus is far exaggerated in the United States because of [the CDC's] ridiculous method of determination compared to other countries". That same morning, Fauci responded in an interview on NBC's Meet the Press , "The numbers are real. We have well over 300,000 deaths. We are averaging two- to three thousand deaths per day. All you need to do ... is go into the trenches, go into the hospitals, go into the intensive care units and see what is happening. Those are real numbers, real people, and real deaths." When asked if the 2021 United States Capitol attack was a COVID-19 superspreader event , Fauci stated: "I think for those people there, they probably put themselves at an increased risk because they essentially did not adhere to the fundamentals of public health and COVID-19 context which is universal wearing of masks, keeping physical distance, avoiding crowds in congregate settings. The fact that it was outdoors is a little bit better than if they were indoors completely. But you can still have a super spreader situation when you do things in a crowded way." On January 23, 2021, Fauci was quoted saying that letting the science speak on the pandemic got him "into a little bit of trouble" and got "push-back from people in the White House, including the president", during the Trump administration. Fauci was also reportedly blocked from appearing on The Rachel Maddow Show for some time because the Trump administration "didn't like the way [Maddow handles] things and they didn't want me on [the show]." On December 3, 2020, President-elect Joe Biden asked Fauci, in addition to remaining in his role as director of the NIAID, to serve as the chief medical advisor to the president in the Biden administration . Fauci accepted the offer. After the inauguration of Joe Biden in January 2021, Fauci said he experienced a "liberating feeling" in being able to speak freely about science without interference from the new administration. He pictured Biden's administration as committed to being "completely transparent, open and honest". Fauci was involved in the development of the Biden administration's plan for a nationwide COVID-19 vaccine rollout. In early April 2021, Fauci said of the current situation in the United States that "It's almost a race between getting people vaccinated and this surge that seems to want to increase". In early May 2021, when asked if the CDC's summer camp guidance was excessive, Fauci responded by saying that "I wouldn't call them excessive, but they certainly are conservative" and added that the guidance "looks a bit strict" and "a bit stringent". Also in early May, Fauci said that he is "not convinced" that COVID-19 originated naturally and that "we should continue to investigate what went on in China until we continue to find out to the best of our ability what happened". In mid-May 2021, Fauci said that Americans who are fully vaccinated against COVID-19 no longer need to wear masks outdoors, except for in "completely crowded situations". This guidance was updated in July 2021 to recommend that all people wear masks regardless of vaccination status, in what Fauci said was due to the much more contagious Delta variant. In May 2021, Fauci denied that the National Institutes of Health supported " gain-of-function research " at the Wuhan Institute of Virology . In early June 2021, over 3,000 internal government emails sent by Fauci from January to June 2020 were obtained by media outlets through Freedom of Information Act (FOIA) requests. These emails contain information about how the United States and Fauci initially responded to COVID-19. On June 22, 2021, Fauci said that the SARS-CoV-2 Delta variant is the "greatest threat" to eliminating COVID-19 in the United States. In December 2021, Fauci, along with virologist Jeffery K. Taubenberger and David M. Morens endorsed the development of a universal coronavirus vaccine , advocating in favor of "an international collaborative effort to extensively sample coronaviruses from bats as well as wild and farmed animals to help understand the full "universe" of existing and emerging coronaviruses." In February 2022, Fauci told the Financial Times that "As we get out of the full-blown pandemic phase of Covid-19, which we are certainly heading out of, these decisions will increasingly be made on a local level rather than centrally decided or mandated. There will also be more people making their own decisions on how they want to deal with the virus." In March 2022, Fauci said that the United States should expect an increase in COVID-19 cases from the BA.2 subvariant of Omicron , but that it might not lead to a severe increase in hospitalizations and deaths. On April 27, 2022, Fauci said that the United States was "out of the full-blown explosive pandemic phase" of COVID-19. On May 15, 2022, Fauci said that he would resign if Donald Trump wins the 2024 U.S. presidential election . In a July 2022 interview with Politico , Fauci had been reported to be "leaving by the end of President Joe Biden's term", though he later clarified he may step down from his role as NIAID director. Fauci also told Politico he is seeking to "help repair the widespread partisan polarization that has divided the nation and politicized science". On August 22, 2022, Fauci announced that he will step down from his position in December "to pursue the next chapter" of his career. He stepped down from his position on December 31 of that same year. Fauci had not met with Trump until three years after he was inaugurated as president. Fauci was a member of the White House Coronavirus Task Force established in late January 2020, under President Donald Trump , to deal with the COVID-19 pandemic . He became a de facto public health spokesperson for the office of the president during the pandemic, and a strong advocate for ongoing social distancing efforts in the United States. In interviews on January 21, January 26, and February 17, Fauci commented on COVID-19. He said that at the time of the interviews ("right now"), COVID-19 was not a "major threat" to the American public, with the risk to the American public being "low", but that it was "an evolving situation", and that "public health officials need to take [COVID-19] very seriously". In the latter interview, Fauci said that COVID-19 could become a "global pandemic which would then have significant implications for" the United States. In March 2020, he predicted that the infection fatality rate would likely be close to 1%, which was ten times more severe than the 0.1% reported rate for seasonal flu. In a March 8, 2020, interview, Fauci stated that "right now in the United States, people [who are not infected] should not be walking around with masks", but "if you want to do it, that's fine". In the same interview, Fauci said that buying masks "could lead to a shortage of masks for the people who really need" them: "When you think masks, you should think of healthcare providers needing them". When Fauci made this comment, America's top surgical mask maker was struggling to produce enough masks to meet the increased demand. On April 3, the CDC reversed course, quoting recent studies that showed asymptomatic transmission of the virus, thus advocating for the public to wear non-surgical masks to reduce community transmission while Fauci advocated for wearing facial coverings in public. Fauci's shifting advice on wearing face masks drew criticism, which Fauci responded to by arguing that changes in policy were necessary as scientists learned more about COVID-19. In mid-April, when asked about social distancing and stay-at-home measures, Fauci said that if the administration had "started mitigation earlier" more lives could have been saved, and "no one is going to deny that." He added that the decision-making for implementing mitigation measures was "complicated", and "there was a lot of pushback about shutting things down back then." Fauci's comments were met with a hostile response from former Republican congressional candidate DeAnna Lorraine. Trump retweeted Lorraine's response, which included the call to "#FireFauci." "Fire Fauci" has also been chanted by anti-lockdown protesters in various locations, including Florida and Texas. As a result, the White House denied that Trump was firing Fauci, and blamed the media for overreacting. Fauci was criticized by right-wing pundits and received death threats that necessitated a security detail. In an interview with 60 Minutes in 2020, he mentioned that other members of his family, including his wife and daughters, had been repeatedly harassed since the pandemic began. In June 2020, Fauci said that he was "very concerned" that the ongoing protests against police brutality would cause "surges" in COVID-19 cases, stating that the "large crowds" are a "perfect set-up" for the virus to spread. In July 2020, Fauci advised the public to "avoid crowds of any type". On July 6, 2020, Fauci spoke on a Facebook livestream , offering his opinion that the country's situation pertaining to COVID-19 "is really not good", pointing to more than 55,000 new cases on July 4, 2020. He said the United States was "still knee-deep in the first wave" of cases, and was experiencing a "resurgence of infections". On July 7, 2020, during a press conference, Fauci stated that it was a "false narrative to take comfort in a lower rate of death" for COVID-19 in the country: "There's so many other things that are very dangerous and bad about this virus, don't get yourself into false complacency." Both Trump and the White House had cited the falling death rate as proof of success of the Trump administration's response. After this appearance by Fauci, the White House cancelled three media appearances that had been scheduled for him later that week. On July 7, 2020, Trump contradicted Fauci's comments describing a dire situation in the country, with Trump saying: "I think we are in a good place. I disagree with [Fauci]." While there were disagreements, Trump also at times praised Fauci. On July 9, 2020, Trump publicly opined that Fauci "is a nice man, but he's made a lot of mistakes." By July 12, 2020, a White House official told media outlets that "several White House officials are concerned about the number of times Dr. Fauci has been wrong on things", passing to the media a list of purported mistakes made by Fauci during the outbreak. Included were statements Fauci made during a February 29, 2020, interview where he stated that "at this moment, there is no need to change anything that you're doing on a day-by-day basis." However, the White House list neglected to mention that in that same interview, Fauci had stated that the risk could change, "when you start to see community spread", and that the disease could morph into "a major outbreak" in the country. As late as September 23, 2020, when U.S. coronavirus fatalities exceeded 200,000, conservatives continued to question Fauci's and the Centers for Disease Control and Prevention 's (CDC) recommendations for responding to the pandemic. In a hearing before the Senate's Health, Education, Labor, and Pensions Committee , Kentucky's Senator Rand Paul asked him if he had "second thoughts" about his mitigation recommendations, including keeping six feet of distance from others and mask-wearing, claiming, "our death rate is essentially worse than Sweden's ." Fauci stood by the guidelines, indicating Sweden's fatality rate exceeded those of other Scandinavian countries, and said the comparison between Sweden and the U.S. was not legitimate. Fauci said the recommendations remained valid. After Paul then asserted New York's high fatality rate showed that mitigation efforts were insufficient, Fauci replied, "You've misconstrued that, Senator, and you've done that repetitively in the past." Fauci explained further that New York State had succeeded in getting the virus under control by following the CDC's clinical guidelines. Paul had made numerous claims about herd immunity , Sweden's interventions to combat the pandemic, the contention that the populations of Asian countries have greater resilience against COVID-19, and statements about death rates due to the virus. Fauci would have several intense exchanges with Paul. In October 2020, Fauci objected after his words, "I can't imagine that anybody could be doing more" were featured in an advertisement from the Trump campaign touting Trump's handling of the pandemic. Fauci said he did not consent to the ad, his words were taken out of context (he was actually referring to how hard the Coronavirus Task Force was working), and he had never made a political endorsement in his career. Also, in October, Fauci criticized the Great Barrington Declaration 's "focused protection" herd immunity strategy, calling it "ridiculous", "total nonsense" and "very dangerous", saying that it would lead to a large number of avoidable deaths. Fauci said that 30 percent of the population had underlying health conditions that made them vulnerable to the virus and that "older adults, even those who are otherwise healthy, are far more likely than young adults to become seriously ill if they get COVID-19." He added, "This idea that we have the power to protect the vulnerable is total nonsense because history has shown that that's not the case. And if you talk to anybody who has any experience in epidemiology and infectious diseases, they will tell you that that is risky, and you'll wind up with many more infections of vulnerable people, which will lead to hospitalizations and deaths. So I think that we just got to look that square in the eye and say it's nonsense." On October 18, 2020, Fauci mentioned that he "wasn't surprised" Donald Trump contracted COVID-19. The next day, during a presidential call, Trump called Fauci "a disaster" and said that "people are tired of COVID." During a campaign rally in Phoenix, Arizona , on October 19, Trump launched attacks on his political rival Joe Biden , saying that Biden "wants to listen to Dr. Fauci" regarding the handling of the pandemic, upon which Biden merely replied "Yes" on Twitter. On October 31, The Washington Post published an extensive interview with Fauci, in which he voiced a candid assessment of the administration's COVID-19 policies and was critical of the influence of presidential advisor Scott Atlas . Shortly after midnight on November 2, 2020, Trump insinuated he would fire Fauci "after the election" while on stage at a campaign rally at Miami-Opa Locka Executive Airport in Opa-locka, Florida . At the rally, he made false claims that the pandemic was "rounding the turn" and was met by audience chants of "Fire Fauci!", to which he responded, "Don't tell anybody, but let me wait until after the election ... I appreciate the advice." Despite the rhetoric, Fauci was not fired. On December 2, the United Kingdom became the first western country to license a vaccine against the coronavirus ( Pfizer-BioNTech ). In response, Fauci said that the U.S. Food and Drug Administration (FDA) was proceeding "the correct way" and said the UK "really rushed through that approval". The next day Fauci apologized, telling the BBC "I have a great deal of confidence in what the UK does both scientifically and from a regulator standpoint. Our process is one that takes more time than it takes in the UK ... I did not mean to imply any sloppiness even though it came out that way." On January 3, 2021, President Trump tweeted, "The number of cases and deaths of the China Virus is far exaggerated in the United States because of [the CDC's] ridiculous method of determination compared to other countries". That same morning, Fauci responded in an interview on NBC's Meet the Press , "The numbers are real. We have well over 300,000 deaths. We are averaging two- to three thousand deaths per day. All you need to do ... is go into the trenches, go into the hospitals, go into the intensive care units and see what is happening. Those are real numbers, real people, and real deaths." When asked if the 2021 United States Capitol attack was a COVID-19 superspreader event , Fauci stated: "I think for those people there, they probably put themselves at an increased risk because they essentially did not adhere to the fundamentals of public health and COVID-19 context which is universal wearing of masks, keeping physical distance, avoiding crowds in congregate settings. The fact that it was outdoors is a little bit better than if they were indoors completely. But you can still have a super spreader situation when you do things in a crowded way." On January 23, 2021, Fauci was quoted saying that letting the science speak on the pandemic got him "into a little bit of trouble" and got "push-back from people in the White House, including the president", during the Trump administration. Fauci was also reportedly blocked from appearing on The Rachel Maddow Show for some time because the Trump administration "didn't like the way [Maddow handles] things and they didn't want me on [the show]." On December 3, 2020, President-elect Joe Biden asked Fauci, in addition to remaining in his role as director of the NIAID, to serve as the chief medical advisor to the president in the Biden administration . Fauci accepted the offer. After the inauguration of Joe Biden in January 2021, Fauci said he experienced a "liberating feeling" in being able to speak freely about science without interference from the new administration. He pictured Biden's administration as committed to being "completely transparent, open and honest". Fauci was involved in the development of the Biden administration's plan for a nationwide COVID-19 vaccine rollout. In early April 2021, Fauci said of the current situation in the United States that "It's almost a race between getting people vaccinated and this surge that seems to want to increase". In early May 2021, when asked if the CDC's summer camp guidance was excessive, Fauci responded by saying that "I wouldn't call them excessive, but they certainly are conservative" and added that the guidance "looks a bit strict" and "a bit stringent". Also in early May, Fauci said that he is "not convinced" that COVID-19 originated naturally and that "we should continue to investigate what went on in China until we continue to find out to the best of our ability what happened". In mid-May 2021, Fauci said that Americans who are fully vaccinated against COVID-19 no longer need to wear masks outdoors, except for in "completely crowded situations". This guidance was updated in July 2021 to recommend that all people wear masks regardless of vaccination status, in what Fauci said was due to the much more contagious Delta variant. In May 2021, Fauci denied that the National Institutes of Health supported " gain-of-function research " at the Wuhan Institute of Virology . In early June 2021, over 3,000 internal government emails sent by Fauci from January to June 2020 were obtained by media outlets through Freedom of Information Act (FOIA) requests. These emails contain information about how the United States and Fauci initially responded to COVID-19. On June 22, 2021, Fauci said that the SARS-CoV-2 Delta variant is the "greatest threat" to eliminating COVID-19 in the United States. In December 2021, Fauci, along with virologist Jeffery K. Taubenberger and David M. Morens endorsed the development of a universal coronavirus vaccine , advocating in favor of "an international collaborative effort to extensively sample coronaviruses from bats as well as wild and farmed animals to help understand the full "universe" of existing and emerging coronaviruses." In February 2022, Fauci told the Financial Times that "As we get out of the full-blown pandemic phase of Covid-19, which we are certainly heading out of, these decisions will increasingly be made on a local level rather than centrally decided or mandated. There will also be more people making their own decisions on how they want to deal with the virus." In March 2022, Fauci said that the United States should expect an increase in COVID-19 cases from the BA.2 subvariant of Omicron , but that it might not lead to a severe increase in hospitalizations and deaths. On April 27, 2022, Fauci said that the United States was "out of the full-blown explosive pandemic phase" of COVID-19. On May 15, 2022, Fauci said that he would resign if Donald Trump wins the 2024 U.S. presidential election . In a July 2022 interview with Politico , Fauci had been reported to be "leaving by the end of President Joe Biden's term", though he later clarified he may step down from his role as NIAID director. Fauci also told Politico he is seeking to "help repair the widespread partisan polarization that has divided the nation and politicized science". On August 22, 2022, Fauci announced that he will step down from his position in December "to pursue the next chapter" of his career. He stepped down from his position on December 31 of that same year. On June 26, 2023, Georgetown University announced that Fauci would join its faculty as a distinguished professor , teaching in both the School of Medicine and McCourt School of Public Policy , effective July 1. Owing to his prominent role in the United States response to numerous global pandemics, most notably HIV/AIDS and COVID-19, Fauci has become the subject of tributes and interpretations across various media, including television, literature, merchandising, and internet memes. Brad Pitt 's performance as Fauci during the 2020 season of Saturday Night Live earned the actor an Emmy nomination, and praise from Fauci. Author Sally Quinn has credited Fauci as the inspiration for the love interest to the protagonist in her bestselling 1991 romance novel Happy Endings . Larry Kramer based the character Dr. Anthony Della Vida on Fauci in his play The Destiny of Me . In the spring of 2020 amidst the COVID-19 pandemic, bakeries across the United States began selling pastries, particularly donuts, with Fauci's face on them to pay tribute to his work in the public health sector. In September 2021, Fauci , a documentary film about Fauci's life and career, was released by Magnolia Pictures . The film was produced by National Geographic Documentary Films . In November 2021, Skyhorse released a book by anti-vaccine activist Robert F. Kennedy Jr. titled The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health . In response, Fauci described the author as "a very disturbed individual". Fauci is a longtime resident of Washington, D.C. The Washington Post reported in 2022 that he has lived in the same "comfortable but modest house since 1977". In 1985, he married Christine Grady , a nurse and bioethicist with the NIH, after they met while treating a patient. Grady is chief of the Department of Bioethics at the National Institutes of Health Clinical Center . Together they have three adult daughters. On June 15, 2022, Fauci tested positive for COVID-19, experiencing mild symptoms. He is fully vaccinated and has received two booster shots. At the time of his retirement, Fauci's annual salary was $480,654, making him the highest paid U.S. federal government employee at the time. Fauci has described himself as "completely nonpolitical". His voter registration shows that he is not affiliated with any political party, although he still votes. Prior to 2020, he had positive relationships with both Democrats and Republicans and considered George W. Bush a close friend: "Obviously there's been appropriate controversy regarding decisions regarding Iraq, but his moral compass about health equity is very strong." Fauci has specifically praised Bush's work to combat HIV/AIDS through PEPFAR, a global health initiative credited with saving over 20 million lives as of 2021 primarily in Sub-Saharan Africa . According to Fauci, "[Bush's] exact words to me were, 'We have a moral responsibility as a rich nation to not have people suffer and die merely because of where they live and the circumstances in which they were born'". Former CDC director and CEO of Resolve to Save Lives, Tom Frieden , said that "I have no idea what his politics are. Reagan and both Bushes liked him. Clinton and Obama liked him". On March 23, 2021, Fauci was admitted as an honorary fellow of the Royal College of Physicians of Ireland . Fauci has served as one of the principal editors of Harrison's Principles of Internal Medicine , named on the front cover, from the 11th edition published in 1986, and on through the 12th, 13th, 14th, 15th, 16th, 17th, 18th, 19th, 20th version, and latest (at the time of writing) 21st edition, published in 2022. He was the editor-in-chief of the 14th and 17th editions. Fauci has served as one of the principal editors of Harrison's Principles of Internal Medicine , named on the front cover, from the 11th edition published in 1986, and on through the 12th, 13th, 14th, 15th, 16th, 17th, 18th, 19th, 20th version, and latest (at the time of writing) 21st edition, published in 2022. He was the editor-in-chief of the 14th and 17th editions. In addition to receiving an honorary degree in 2015, Fauci was invited to deliver guest remarks on May 21, 2020, for the Johns Hopkins University Class of 2020. The College of the Holy Cross renamed its science complex the Anthony S. Fauci Integrated Science Complex on June 11, 2022.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Aliko_Dangote/html

Aliko Dangote

Businessman industrialist Aliko Dangote ( Listen ⓘ ) GCON (born 10 April 1957) is a Nigerian businessman and industrialist. He is best known as the founder, chairman, and CEO of the Dangote Group , the largest industrial conglomerate in West Africa . The Bloomberg Billionaires Index estimated his net worth at $ 16.1 billion in November 2023, making him the richest person in Africa , the world's richest black person , and the world's 107th richest person overall. Dangote was born into a wealthy Hausa Muslim family on 10 April 1957 in Kano , which was then part of British Nigeria . His mother, Mariya Sanusi Dantata, was the daughter of businessman Sanusi Dantata . His father, Mohammed Dangote, was a business associate of Dantata. Through his mother, he is the great-grandson of Alhassan Dantata , the richest person in West Africa at the time of his death in 1955. Dangote's brother, Sani (1959/60–2021), was also a businessman. Dangote was educated at the Sheikh Ali Kumasi Madrasa , followed by Capital High School in Kano. In 1978, he graduated from the Government College, Birnin Kudu . He received a bachelor's degree in business studies and administration from Al-Azhar University in Cairo . The Dangote Group was established as a small trading firm in 1977, the same year Dangote relocated to Lagos to expand the company. Dangote received a ₦ 500,000 loan from his uncle to begin trading in commodities, including bagged cement as well as agricultural goods like rice and sugar. In the 1990s, he approached the Central Bank of Nigeria with the idea that it would be less expensive for the bank to allow his transport company to manage their fleet of staff buses, a proposal that was also approved. Today, the Dangote Group is one of the largest conglomerates in Africa, with international operations in Benin , Ghana , Zambia , and Togo . The Dangote Group has moved from being a trading company to being the largest industrial group in Nigeria, encompassing divisions like Dangote Sugar Refinery, Dangote Cement , and Dangote Flour. Dangote Group dominates the sugar market in Nigeria, and its refinery business is the main supplier (70 percent of the market) to the country's soft drink companies, breweries, and confectioners. The company employs more than 11,000 people in West Africa. In July 2012, Dangote approached the Nigerian Ports Authority to lease an abandoned piece of land at the Apapa Port , which was approved. He later built facilities for his sugar company there. It is the largest refinery in Africa and the third largest in the world, producing 800,000 metric tons of sugar annually. The Dangote Group owns salt factories and flour mills and is a major importer of rice, fish, pasta, cement, and fertilizer. The company exports cotton, cashew nuts, cocoa, sesame seeds, and ginger to several countries. Additionally, it has major investments in real estate, banking, transport, textiles, oil, and gas. In February 2022, Dangote announced the completion of the Peugeot assembling facility in Nigeria following his partnership with Stellantis Group , the parent company of Peugeot, and the Kano and Kaduna state governments. The new automobile company, Dangote Peugeot Automobiles Nigeria Limited (DPAN) factory, which is based in Kaduna, commenced operations with the roll-out of the Peugeot 301 , 508 , 3008 , 5008 , and Landtrek . On 22 May 2023 in Lekki , Nigeria, Dangote commissioned the Dangote Refinery . The plant plans to export surplus petrol, turning Africa's biggest oil producer into an export hub for petroleum products. It also plans to export diesel, according to Dangote, who funded the refinery's construction. The refinery is situated on a 6,180-acre (2,500 hectares) site at the Lekki Free Trade Zone , Lekki, Lagos State . It is supplied with crude oil by the largest sub-sea pipeline infrastructure in the world at 1,100 kilometres (680 mi) long.Dangote became Nigeria's first billionaire in 2007. Dangote reportedly added $9.2 billion to his personal wealth in 2013, according to the Bloomberg Billionaires Index , making him the 30th-richest person in the world at the time, and the richest person in Africa. In 2015, the HSBC leaks revealed that Dangote was a HSBC client and that he had assets in a tax haven in the British Virgin Islands . As of June 2022, Dangote is the wealthiest person in Africa , with an estimated net worth of US$20 billion. Dangote had a prominent role in the financing of President Olusegun Obasanjo 's re-election bid in 2003 , to which he gave over N200 million (US$2 million). He contributed N50 million (US$500 thousand) to the National Mosque under the aegis of "Friends of Obasanjo and Atiku". Dangote also contributed N200 million to the Presidential Library. These highly controversial gifts to members of the ruling PDP party have generated significant concerns despite highly publicized anti-corruption drives during Obasanjo's second term. In 2011, Dangote was appointed by President Goodluck Jonathan to serve as a member of his economic management team. In 2017, rumors circulated that Dangote was considering a run for President of Nigeria in the 2019 election . Dangote declined to run and asserted that he does not intend to run for elected office. Instead, Dangote went on to serve on a special advisory committee for Muhammadu Buhari 's reelection campaign. Dangote has worked alongside the Bill & Melinda Gates Foundation on public health issues. In August 2014, he donated ₦ 150 million ( $ 750,000) to assist the Nigerian government's efforts to stop the spread of Ebola . In May 2016, he pledged $10 million to support Nigerians affected by the Boko Haram insurgency . In March 2020, he donated ₦200 million ($500,000) towards the fight against the spread of COVID-19 in Nigeria. In 2019, Dangote and Femi Otedola promised to give the Nigerian national football team $75,000 for every goal scored in the Africans Cup of Nations (AFCON). He is also an avid fan of English football team Arsenal FC and has shown interest in buying the club. In 2020, he donated money to Nigeria's sport ministry to renovate Abuja, the country's national sports stadium. Dangote has worked alongside the Bill & Melinda Gates Foundation on public health issues. In August 2014, he donated ₦ 150 million ( $ 750,000) to assist the Nigerian government's efforts to stop the spread of Ebola . In May 2016, he pledged $10 million to support Nigerians affected by the Boko Haram insurgency . In March 2020, he donated ₦200 million ($500,000) towards the fight against the spread of COVID-19 in Nigeria. In 2019, Dangote and Femi Otedola promised to give the Nigerian national football team $75,000 for every goal scored in the Africans Cup of Nations (AFCON). He is also an avid fan of English football team Arsenal FC and has shown interest in buying the club. In 2020, he donated money to Nigeria's sport ministry to renovate Abuja, the country's national sports stadium. Dangote lives in Lagos . He owns two private jets and reportedly works 12 hours every day from 5 a.m. to 5 p.m. and runs 10 miles on a treadmill almost every day. Dangote married Zainab Dangote in 1977, but they divorced at an unknown date. He was later married to Mariya Muhammad Rufai until their divorce, though the dates of the wedding and divorce are unknown. He has three daughters named Halima , Mariya, and Fatimah, and an adopted son named Abdulrahman. Halima followed him into the business world and is currently his company's executive director of commercial operations. In 2023, singer Davido claimed that Aliko is his godfather.Dangote sits on the board of the Corporate Council on Africa and is a member of the steering committee of the United Nations Secretary-General's Global Education First Initiative, the Clinton Global Initiative and the International Business Council of the World Economic Forum . He was named co-chair of the US-Africa Business Center, in September 2016, by the US Chamber of Commerce . In April 2017, he joined the board of directors of the Clinton Health Access Initiative . He is also on the board of One Campaign . Dangote was appointed the founding Chairman of the Nigeria End Malaria Council by President Buhari in August 2022. He is also a member of the Global End Malaria Council, along with other leaders including Bill Gates, Ray Chambers, and former President Ellen Johnson Sirleaf. Dangote sits on the board of the Corporate Council on Africa and is a member of the steering committee of the United Nations Secretary-General's Global Education First Initiative, the Clinton Global Initiative and the International Business Council of the World Economic Forum . He was named co-chair of the US-Africa Business Center, in September 2016, by the US Chamber of Commerce . In April 2017, he joined the board of directors of the Clinton Health Access Initiative . He is also on the board of One Campaign . Dangote was appointed the founding Chairman of the Nigeria End Malaria Council by President Buhari in August 2022. He is also a member of the Global End Malaria Council, along with other leaders including Bill Gates, Ray Chambers, and former President Ellen Johnson Sirleaf.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Ameyo_Adadevoh/html

Ameyo Adadevoh

Ameyo Stella Adadevoh (27 October 1956 – 19 August 2014) was a Nigerian physician . She is credited with having curbed a wider spread of the Western African Ebola virus epidemic in Nigeria by placing the patient zero , Patrick Sawyer , in quarantine despite pressure from the Liberian government. When threatened by Liberian officials who wanted the patient to be discharged to attend a conference, she resisted the pressure and said, "for the greater public good" she would not release him. She is known for preventing the Nigerian index case from leaving the hospital at the time of diagnosis, thereby playing a key role in curbing the spread of the virus in Nigeria. On 4 August 2014, it was confirmed that she had tested positive for Ebola virus disease and was being treated. Adadevoh died in the afternoon of 19 August 2014. She was survived by her husband Afolabi and son Bankole among other relatives.Ameyo Adadevoh was born in Lagos, Nigeria in October 1956. She spent the majority of her life in Lagos. Her father and great-grandfather, Babatunde Kwaku Adadevoh and Herbert Samuel Macaulay , were both distinguished scientists. Herbert Macaulay was one of the founders of modern Nigeria . Her grandfather was from the Adadevoh family of the Volta Region of Ghana , to which she was very much connected, though she lived in Lagos. Her father Babatunde Kwaku Adadevoh was a physician and former Vice chancellor of the University of Lagos . She was also the grand niece of Nigeria's first president Nnamdi Azikiwe , as well as a great-great-granddaughter of Sara Forbes Bonetta and a great-great-great-granddaughter of Ajayi Crowther . Adadevoh worked at First Consultant Hospital where a statue of her great-grandfather exists. Adadevoh went to preschool at the Mainland Preparatory Primary School in Yaba, Lagos (1961-1962). She spent two years in Boston, Massachusetts before moving back with her family to Lagos. She attended primary school at the Corona School, Yaba in Lagos, Nigeria (1964-1968), then the Queen's School, Ibadan (1969-1974) Nigeria for her secondary school education. Adadevoh graduated from the University of Lagos College of Medicine with a Bachelor of Medicine/Bachelor of Surgery. She served her one-year mandatory housemanship at Lagos University Teaching Hospital in 1981. She spent her residency at Lagos University Teaching Hospital and obtained her West African College of Physicians and Surgeons credential in 1983. She then went to London to complete her fellowship in endocrinology at Hammersmith Hospital . She spent 21 years at the First Consultants Medical Center in Lagos, Nigeria. There, she served as the Lead Consultant Physician and Endocrinologist. Adadevoh was the first to alert the Nigerian Ministry of Health when H1N1 spread to Nigeria in 2012. Adadevoh correctly diagnosed Liberian Patrick Sawyer as Nigeria's first case of Ebola at First Consultant Hospital in Lagos, Nigeria in July 2014. Adadevoh kept Sawyer in the hospital despite his insistence that he simply had a bad case of malaria . Sawyer wanted to attend a business conference in Calabar, Nigeria. Adadevoh led the team that oversaw Sawyer's treatment. Adadevoh also kept him at the hospital despite receiving a request from the Liberian ambassador to release him. She tried to create an isolation area, despite the lack of protective equipment , by raising a wooden barricade outside Sawyer's door. Her work saved Nigeria from widespread infection. At the time of these events, Nigerian doctors were on strike, which could have led to a severe health crisis. She also provided staff with relevant information about the virus, procured protective gear and quickly contacted relevant officials. As a result of her report, the Nigerian government declared a national public health emergency and the Nigerian Ministry of Health set up an Ebola Emergency Operations Center. WHO declared Nigeria to be Ebola-free on 20 October 2014. Ameyo Adadevoh married Afolabi Emmanuel Cardoso on 26 April 1986. The couple had one son, Bankole Cardoso . Adadevoh died from the Ebola virus in quarantine on 19 August 2014 in Lagos, Nigeria. Her body was decontaminated and cremated by the government. Her family obtained her ashes and held a private interment ceremony while upholding the funeral rites also on 12 September 2014, in Lagos. The Dr. Ameyo Adadevoh Health Trust (DRASA), a non-profit health organization, was created in her honour. The film 93 Days is dedicated to Adadevoh and tells the story of the treatment of Sawyer by Adadevoh and other medical staff at First Consultant Medical Center. The film was directed by Steve Gukas . On 27 October 2018, she was honoured with a Google Doodle posthumously on what would have been her 62nd birthday. In February 2020, a road was named after Adadevoh in Abuja, Nigeria's capital city. The road "Ameyo Adadevo Way" is directly linked to Ahmadu Bello Way, one of Abuja's major and longest roads. This is one of the first efforts made by the Nigerian government to honour her valuable contribution to the country in the last weeks of her life. The female undergraduate medical students hostel of Babcock University is also named after her. [ citation needed ]

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Goodluck_Jonathan/html

Goodluck Jonathan

Goodluck Ebele Azikiwe Jonathan GCFR GCON (born 20 November 1957) is a Nigerian politician who served as the president of Nigeria from 2010 to 2015. He lost the 2015 presidential election to former military head of state General Muhammadu Buhari and was the first incumbent president in Nigerian history to concede defeat in an election and therefore allow for a peaceful transition of power . Previously, Jonathan served as the vice president of Nigeria from 2007 to 2010 under the administration of Umaru Musa Yar'Adua ; and in oil-rich Bayelsa State as governor from 2005 to 2007, and deputy governor from 1999 to 2005. Goodluck Jonathan was born on 20 November 1957 in Ogbia to a Christian Ijaw family of canoe makers, in Otuoke, Bayelsa State. His father, Lawrence Ebele Jonathan, was a canoe maker and his mother, Eunice Ayi Ebele Jonathan, was a retired farmer. He attended a Christian primary and secondary school. He received a bachelor's degree in zoology ( second-class honours ), a master's degree in hydrobiology and fisheries biology ; and a doctorate in zoology from the University of Port Harcourt . During his time in the university, he taught at Rivers State College of Education from 1983 to 1993. Before entering into politics in 1998, Jonathan worked as an education inspector, a lecturer and an environmental-protection officer. His political career began when he became involved with the nascent People's Democratic Party (PDP) in the late 1990s. Jonathan entered into politics when General Sani Abacha , who ruled as military head of state of Nigeria from 1993 to 1998, died in office. In the 1999 Bayelsa State gubernatorial election , Diepreye Alamieyeseigha ran for governor under the platform of the Peoples Democratic Party and chose Jonathan as his running mate. Alaimeyeseigha won the election and became the first civilian governor of Bayelsa State in May 1999. They were reelected in 2003 and Jonathan's diligence and loyalty to him earned him the recognition as Nigeria's most hardworking deputy governor. [ citation needed ] On 29 May 1999, Jonathan was sworn in as deputy governor of Bayelsa alongside Diepreye Alamieyeseigha who came in as the governor of the state on the platform of PDP. Jonathan served as Deputy Governor until December 2005. On 9 December 2005, Jonathan, who was the deputy governor at the time, was sworn in as the governor of Bayelsa State upon the impeachment of governor Diepreye Alamieyeseigha by the Bayelsa State Assembly after being charged with money laundering in the United Kingdom . [ citation needed ]On 29 May 1999, Jonathan was sworn in as deputy governor of Bayelsa alongside Diepreye Alamieyeseigha who came in as the governor of the state on the platform of PDP. Jonathan served as Deputy Governor until December 2005. On 9 December 2005, Jonathan, who was the deputy governor at the time, was sworn in as the governor of Bayelsa State upon the impeachment of governor Diepreye Alamieyeseigha by the Bayelsa State Assembly after being charged with money laundering in the United Kingdom . [ citation needed ]As Vice President, Jonathan took a very low profile. While recognising the constitutional limits of the Vice President's office, he participated in cabinet meetings and, by statute, was a member of the National Security Council, the National Defence Council, the Federal Executive Council and chairman of the National Economic Council. Jonathan was named Acting President of Nigeria on 9 February 2010, following a controversial doctrine of necessity from the Senate of Nigeria due to President Yar'Adua's trip to Saudi Arabia in November 2009 for medical treatment. On 10 February 2010, his first day as acting president, Jonathan announced a minor cabinet reshuffle. In accordance with the order of succession in the Nigerian constitution , following President Yar'Adua's death on 5 May 2010, Jonathan, as Acting President, was sworn in as the substantive president of the Federal Republic of Nigeria on 6 May 2010. On 18 May 2010, the National Assembly approved Jonathan's nomination of Kaduna State Governor Namadi Sambo , to replace him as Vice President. For the general election in 2011 , Jonathan and Vice President Sambo attended political events and travelled the country to campaign for the nation's highest office. A year later, on 29 May 2011, he was sworn in as the President of Nigeria and Commander-in-Chief of the Armed Forces of Nigeria, becoming Nigeria's 14th Head of State. He gave his inauguration address where he declared his government was to focus on a Transformation Agenda and promised to continue implementing the seven-point agenda policy framework of President Yar'Adua. He cited anti-corruption, power and electoral reforms as focuses of his administration. He stated that he came to office under "very sad and unusual circumstances". Jonathan was named Acting President of Nigeria on 9 February 2010, following a controversial doctrine of necessity from the Senate of Nigeria due to President Yar'Adua's trip to Saudi Arabia in November 2009 for medical treatment. On 10 February 2010, his first day as acting president, Jonathan announced a minor cabinet reshuffle. In accordance with the order of succession in the Nigerian constitution , following President Yar'Adua's death on 5 May 2010, Jonathan, as Acting President, was sworn in as the substantive president of the Federal Republic of Nigeria on 6 May 2010. On 18 May 2010, the National Assembly approved Jonathan's nomination of Kaduna State Governor Namadi Sambo , to replace him as Vice President. For the general election in 2011 , Jonathan and Vice President Sambo attended political events and travelled the country to campaign for the nation's highest office. A year later, on 29 May 2011, he was sworn in as the President of Nigeria and Commander-in-Chief of the Armed Forces of Nigeria, becoming Nigeria's 14th Head of State. He gave his inauguration address where he declared his government was to focus on a Transformation Agenda and promised to continue implementing the seven-point agenda policy framework of President Yar'Adua. He cited anti-corruption, power and electoral reforms as focuses of his administration. He stated that he came to office under "very sad and unusual circumstances". Under Jonathan's administration, Nigeria rebased its gross domestic product for the first time in over a decade, becoming the largest economy in Africa by overtaking South Africa and Egypt . The Jonathan administration accrued over US$454 billion while in office from oil revenue. Jonathan previously served as an assistant director at the Oil Mineral Producing Areas Development commission between 1993 and 1998. The Jonathan administration oversaw the construction of new railways in the country, including the Abuja-Kaduna railway and conceptualized high-speed rail projects. Construction and beautification of many federal roads in the country, including the Lagos-Benin expressway, Abuja-Lokoja expressway, Enugu-Abakiliki expressway, Onitsha-Owerri highway and most parts of the Enugu-Port Harcourt expressway. Also, construction of the second Niger Bridge between Onitsha and Asaba to relieve the pressure on the old Niger Bridge which was completed in December 1965. Construction of airports across the country. The Akanu Ibiam Airport in Enugu was upgraded into an international airport, directly connecting the South-East region of the country to the outside world for the first time since independence. [ citation needed ] On 2 August 2010, Jonathan launched his 'Roadmap for Power Sector Reform'. Its primary goal was to achieve stable electricity supply in Nigeria. The Power Holding Company of Nigeria , which acted as the nation's electricity provider, was broken up into 15 firms, with Nigeria handing over control of state electricity assets to 15 private bidding companies. The Nigerian government contracted for the services of CPCS Transcom Limited , a Canada-based consulting firm specialising in transportation and energy infrastructure projects, to act as the transaction adviser for the handover of state electricity assets. Historically, the Nigerian power sector has been plagued by blackouts . Economists estimate that power outages have cost Nigeria, Africa's biggest economy, billions of dollars in imported diesel for generators and lost output. In a study conducted by the World Bank , a lack of access to financing and electricity were cited as Nigeria's main obstacles to development, surpassing corruption. Jonathan suspended Sanusi Lamido Sanusi as governor of the Central Bank of Nigeria after a series of public investigations and raising the alarm on the US$20 billion NNPC scandal in a leaked letter which revealed that the Nigeria National Petroleum Corporation failed to account for US$48.9 billion of government oil revenue to the central bank – the NNPC has a history of financial irregularities and oversees the corrupt petroleum industry in Nigeria . Sanusi would go on to reveal the extent of financial recklessness that Nigeria lost a billion dollars a month to diversion of public funds under the Jonathan administration, with oil minister Diezani Alison-Madueke diverting $6 billion (₦1.2 trillion) from the Nigerian treasury. In addition, Jonathan was alleged to have personally ordered over ₦3 trillion ($15 billion) from the Central Bank of Nigeria to support his election and other self-serving projects under the guise of an intervention fund for national security. Charles Soludo , a professor of economics and former governor of the Central Bank of Nigeria, equated Jonathan's financial recklessness to that of former Ugandan president Idi Amin . Ngozi Okonjo-Iweala , an economist and former Finance Minister of Nigeria , pegged Jonathan's administration as the main cause of Nigeria's economic woes in a lecture at George Washington University , although she later denied it. However, none of the corruption allegations against Jonathan have been proven in any law court. Jonathan's government has largely been described as corrupt. According to The Economist , corruption flourished under the Jonathan administration , "who let politicians and their cronies fill their pockets with impunity." Large sums of money have been used improperly multiple times, with ₦ 3.98 trillion (US$20 billion) allegedly going missing and ₦398 billion ($2 billion) of military funds allegedly dispersed amongst high-ranking officials. In 2006, reports released by Wikileaks claimed that Jonathan's wife, Patience Jonathan , was indicted for money-laundering by Nigeria's anti-crime agency, the Economic and Financial Crimes Commission (EFCC). Since May 2015, the Muhammadu Buhari administration reportedly has been fighting corruption that was perpetrated under Jonathan. Some of the former political office holders and appointees that served under Jonathan, as well as party members, have been arrested on various corruption charges. It is alleged that some, including former Finance Minister Nenadi Usman , have returned part of the money they stole. None of these politicians have however been convicted of the alleged crimes. It remains unclear whether or not Jonathan, who is believed to have either masterminded or condoned the corruption, will be arrested. During Jonathan's administration, Nigeria's foreign policy was reviewed to reflect a "citizen-focused" approach, designed to "accord this vision of defending the dignity of humanity the highest priority" and connect foreign policy to domestic policy, while placing a greater emphasis on economic diplomacy. In January 2013, Jonathan reportedly promised $4 million to assist in cleaning up villages that have been affected by a lead poisoning incident. Over 400 children died and Human Rights Watch said that releasing the funds "could be lifesaving for countless children." On 1 January 2012, the Jonathan administration announced the start of a controversial plan to end fuel subsidies. Following the Nigeria Labour Congress ' warning that the country faces many strikes, the country unions followed up with strikes that were matched with civil protests from 9–13 January 2012. Protesters and groups called for Jonathan to resign over the removal of fuel subsidies. After five days of national protests and strikes, on 16 January, Jonathan announced that the pump price of petroleum would be 97 naira per litre compared to a post-subsidy level of 147 naira. In 2012, upon the partial removal of petrol subsidies, the Jonathan administration instituted a subsidy re-investment programme designed to spend the money saved from partial petrol price deregulation on physical infrastructure such as roads, bridges, etc., across the country. The Subsidy Reinvestment and Empowerment Program (SURE-P) was also intended to improve maternal health and reduce maternal mortality. The government followed the advice of international experts that claimed the fuel subsidy ($8 billion per year, or 25% of the government annual budget) was not sustainable. Brookings Institution , a think tank, praised the government's move, arguing that the subsidy crowds out other development spending, like education, and that it discourages investment in the country's economic lifeblood, the oil sector. In his book, "My Transition Hours", Goodluck Jonathan said that subsidy was consuming too much of our revenues and the public believed that the sector was highly corrupt. He mentioned that the Minister of Finance Ngozi Okonjo Iweala briefed him about the corrupt practices that a technical committee she had put together discovered. He said that he was alarmed that billions of naira was being lost by the nation through the subsidy regime. Many prominent Nigerians spoke out against the removal of the subsidy. Former Petroleum Minister Professor Tam David-West spoke out and expressed concern that the planned removal of the fuel subsidy will squeeze the economy, increase inflation, and hurt both businesses and the public. A former military Head of State and a former Minister for Petroleum & Natural Resources, General Muhammadu Buhari , urged Jonathan not to remove the fuel subsidy and to tackle corruption. Yakubu Gowon , another former military Head of State, warned the government that the country's infrastructure should be revived before fuel subsidy removal steps were taken. Former military president Gen. Ibrahim Babangida , joined millions of Nigerians protesting against the removal of the fuel subsidy by the Jonathan administration, saying that the action is ill-timed. In March 2014, President Jonathan inaugurated the 2014 National Conference. The conference was the first of its kind since the 2005 political reform conference, it had 492 delegates that debated on key socio-political national issues impeding national development. On 20 July 2014, Patrick Sawyer , a Liberian-American, flew from Monrovia to Murtala Muhammed International Airport in Lagos , with a stopover at Lomé , Togo. He was subsequently described as having appeared to be "terribly ill" when he left Monrovia. Sawyer became violently ill upon arriving at the airport and died five days later. In response, the Nigerian government observed all of Sawyer's contacts for signs of infection and increased surveillance at all entry points to the country. On 6 August 2014, the Nigerian health minister told reporters: "Yesterday, the first known Nigerian to die of Ebola was recorded. This was one of the nurses that attended to the Liberian. The other five newly confirmed cases are being treated at an isolation ward." The doctor who treated Sawyer, Ameyo Adadevoh , subsequently also died of Ebola. On 22 September 2014, the Nigeria ministry of health announced: "As of today, there is no case of Ebola in Nigeria. All listed contacts who were under surveillance have been followed up for 21 days. "According to the WHO , 20 cases and 8 deaths had been confirmed, along with the imported case, who also died. Four of the dead were health care workers who had cared for Sawyer. In all, 529 contacts had been followed and of that date they had all completed a 21-day mandatory period of surveillance. In January 2014, Jonathan signed into law the Same Sex Marriage Prohibition Act after it was passed by the Senate and House of Representatives . [ citation needed ] The law prohibits gay relationships, membership and other involvement in gay societies and organisations and gay marriages. The bill came after international polls showed that 98% of Nigerians did not think homosexuality should be accepted by society, the highest percentage of any country surveyed. Penalties can be up to 14 years in prison for gay marriages and up to 10 years for other violations of the law. Within a short period, the federal police department compiled a list of 168 gay people who would subsequently be jailed. Within days 38 lesbian and gay people had been jailed, with arrests beginning during Christmas. The anti- LGBT bill stipulates that those who withhold the details of LGBT individuals face prison terms of up to five years. His decision and the law itself have been described as controversial, but according to a poll, 92% of Nigerians supported the ban. Jonathan's administration was heavily criticized for its failure to tackle insecurity. The first major challenge was the October 2010 Independence Day bombing . Okah told the court that President Jonathan and his aides organised the attacks in Abuja in a desperate political strategy to demonise political opponents, including former military head of state General Ibrahim Babangida , and to win popular sympathy ahead of the elections. On 29 May 2011, a few hours after Goodluck Jonathan was sworn in as president, several bombings purportedly by Boko Haram killed 15 and injured 55. [ citation needed ] On 16 June 2011, Boko Haram claimed to have conducted the Abuja police headquarters bombing , the first known suicide attack in Nigeria. [ citation needed ] Two months later the United Nations building in Abuja was bombed , signifying the first time that Boko Haram attacked an international organisation. In December 2011, it carried out attacks in Damaturu killing over a hundred people, subsequently clashing with security forces in December , resulting in at least 68 deaths. [ citation needed ] Two days later on Christmas Day, Boko Haram attacked several Christian churches with bomb blasts and shootings. Following the January 2012 Northern Nigeria attacks , which left over hundreds of casualties, Abubakar Shekau , a former deputy of Mohammed Yusuf , appeared in a video posted on YouTube. [ citation needed ] According to Reuters , Shekau took control of the group after the death of Yusuf in 2009. Authorities had previously believed that Shekau died during the violence in 2009. [ citation needed ] By early 2012, the group was responsible for over 900 deaths. On 8 March 2012, a small Special Boat Service team and the Nigerian Army attempted to rescue two hostages, Chris McManus and Franco Lamolinara, being held in Nigeria by members of the Boko Haram terrorist organisation loyal to al-Qaeda . [ citation needed ] The two hostages were killed before or during the rescue attempt. All the hostage takers were reportedly killed. On 18 March, a bus station was bombed in Kano , with several casualties. [ citation needed ] In May 2013, Nigerian government forces launched an offensive in the Borno region in an attempt to dislodge Boko Haram fighters after a state of emergency was called on 14 May 2013. [ citation needed ] The state of emergency, applied to the states of Borno , Yobe , and Adamawa in northeastern Nigeria. The offensive had initial success, but the Boko Haram rebels were able to regain their strength. Although initially offering amnesty, by June 2013 he ordered a 20-year jail term for anyone found to be in support of Boko Haram. In July 2013, Boko Haram massacred 42 students in Yobe , bringing the school year to an early end in the state. [ citation needed ] On 5 August 2013, Boko Haram launched dual attacks on Bama and Malam Fatori, leaving 35 dead. On 16 January 2014, it was reported that Jonathan had sacked his military high command in response to their inability to end the Islamist-led insurgency in Northern Nigeria. On 14 April, over 200 schoolgirls in Chibok were kidnapped . [ citation needed ] A few weeks later in May, a terrorist offensive was launched against the military in Chibok. Many demonstrations called for the government to be more responsive; Jonathan asked that demonstrators focus on blaming Boko Haram itself for the abductions. Jonathan initially denied that there had been any abduction at all, but then later signaled his government would do a prisoner release in exchange for the kidnapped girls. Discussions then took place in Paris with foreign ministers from France, Britain, the United States and Israel, where he agreed no deals should be struck with terrorists. He then called off the exchange at the last minute on 24 May 2014. [ citation needed ] This reportedly enraged Boko Haram leaders. In May 2014, two bombs exploded in Jos , resulting in the deaths of at least 118 people and the injury or over 56 others. [ citation needed ] During the June 2014 Northern Nigeria attacks , a plaza in the capital city was bombed and hundreds of villagers attacked in a two-day killing spree in Kaduna. [ citation needed ] In November, Boko Haram bombed the city of Kano , attempting to assassinate the Emir Muhammadu Sanusi II . [ citation needed ] Starting in late 2014, Boko Haram militants attacked several Nigerian towns in the North and captured them. [ citation needed ] This prompted the Nigerian government to launch an offensive, and with the help of Chad, Niger, and Cameroon, they have recaptured many areas that were formerly under the control of Boko Haram. In late 2014, Boko Haram seized control of Bama , according to the town's residents. [ citation needed ] In December 2014, it was reported that "people too elderly to flee Gwoza Local Government Area were being rounded up and taken to two schools where the militants opened fire on them. [ citation needed ] " Over 50 elderly people in Bama were killed. A "gory" video was released of insurgents shooting over a hundred civilians in a school dormitory in the town of Bama. Between 3 and 7 January 2015, Boko Haram attacked the town of Baga and killed up to 2,000 people , perhaps the largest massacre by Boko Haram. [ citation needed ] On 10 January 2015, a bomb attack took place at the Monday Market in Maiduguri , killing 19 people. [ citation needed ] The city is considered to be at the heart of the Boko Haram insurgency. In the early hours of 25 January 2015, Boko Haram launched a major assault on the city. [ citation needed ] On 26 January 2015 CNN reported that the attack on Maiduguri by "hundreds of gunmen" had been repelled, but the nearby town of Monguno was captured by Boko Haram. [ citation needed ] The Nigerian Army claimed to have successfully repelled another attack on Maiduguri on 31 January 2015. [ citation needed ] Starting in late January 2015, a coalition of military forces from Nigeria, Chad, Cameroon, and Niger began a counter-insurgency campaign against Boko Haram. [ citation needed ] On 4 February 2015, the Chad Army killed over 200 Boko Haram militants. [ citation needed ] Soon afterwards, Boko Haram launched an attack on the Cameroonian town of Fotokol , killing 81 civilians, 13 Chadian soldiers and 6 Cameroonian soldiers. [ citation needed ] On 17 February 2015 the Nigerian military retook Monguno in a coordinated air and ground assault. [ citation needed ] On 7 March 2015, Boko Haram's leader Abubakar Shekau pledged allegiance to the Islamic State of Iraq and the Levant (ISIL) via an audio message posted on the organisation's Twitter account. [ citation needed ] Nigerian army spokesperson Sami Usman Kukasheka said the pledge was a sign of weakness and that Shekau was like a "drowning man". That same day, five suicide bomb blasts left 54 dead and 143 wounded. On 12 March 2015, ISIL's spokesman Abu Mohammad al-Adnani released an audiotape in which he welcomed the pledge of allegiance, and described it as an expansion of the group's caliphate to West Africa. [ citation needed ] Following its declaration of loyalty to ISIL, Boko Haram was designated as the group's "West Africa Province" (Islamic State West Africa Province, or ISWAP) while Shekau was appointed as its first vali (governor). Furthermore, ISIL started to support Boko Haram, but also began to interfere in its internal matters. For example, ISIL's central leadership attempted to reduce Boko Haram's brutality toward civilians and internal critics, as Shekau's ideology was "too extreme even for the Islamic State". [ citation needed ] On 24 March 2015, residents of Damasak , Nigeria said that Boko Haram had taken more than 400 women and children from the town as they fled from coalition forces. [ citation needed ] On 27 March 2015, the Nigerian army captured Gwoza , which was believed to be the location of Boko Haram headquarters. [ citation needed ] On election day, 28 March 2015, Boko Haram extremists killed 41 people, including a legislator, to discourage hundreds from voting. [ citation needed ] Niger Army soldiers during counter-insurgency operations against Boko Haram in March 2015. In March 2015, Boko Haram lost control of the Northern Nigerian towns of Bama and Gwoza (believed to be their headquarters) to the Nigerian Army . [ citation needed ] The Nigerian authorities said that they had taken back 11 of the 14 districts previously controlled by Boko Haram. [ citation needed ] In April 2016, four Boko Haram camps in the Sambisa Forest were overrun by the Nigerian military who freed nearly 300 females. [ citation needed ] Boko Haram forces were believed to have retreated to the Mandara Mountains , along the Cameroon–Nigeria border . On 16 March 2015, the Nigerian army said that it had recaptured Bama. [ citation needed ] On 27 March 2015, the day before the Nigerian presidential election , the Nigerian Army announced that it had recaptured the town of Gwoza from Boko Haram. [ citation needed ] By April 2015, the Nigerian military was reported to have retaken most of the areas previously controlled by Boko Haram in Northeastern Nigeria, except for the Sambisa Forest . In May 2015, the Nigerian military announced that they had released about 700 women from camps in Sambisa Forest . [ citation needed ] Jonathan believed the APC's popularity was inflated, having made his view clear in an interview with The Cable , Nigeria's Independent Online Newspaper in 2015—just two days to the general elections. Jonathan said "I don't think Nigerians will make the mistake of voting for Buhari. Gen. Buhari, with due respect, is not the right option for Nigeria at this time. It is a gamble that is not worth taking. I may not be perfect as nobody is perfect. But I believe that come Saturday, the majority of Nigerian voters will choose me as the best candidate to lead the nation forward." On 31 March 2015, Jonathan conceded the election to challenger Muhammadu Buhari , who was sworn in to succeed him on 29 May 2015. Jonathan said in a statement he issued on 31 March 2015 that "Nobody's ambition is worth the blood of any Nigerian." Under Jonathan's administration, Nigeria rebased its gross domestic product for the first time in over a decade, becoming the largest economy in Africa by overtaking South Africa and Egypt . The Jonathan administration accrued over US$454 billion while in office from oil revenue. Jonathan previously served as an assistant director at the Oil Mineral Producing Areas Development commission between 1993 and 1998. The Jonathan administration oversaw the construction of new railways in the country, including the Abuja-Kaduna railway and conceptualized high-speed rail projects. Construction and beautification of many federal roads in the country, including the Lagos-Benin expressway, Abuja-Lokoja expressway, Enugu-Abakiliki expressway, Onitsha-Owerri highway and most parts of the Enugu-Port Harcourt expressway. Also, construction of the second Niger Bridge between Onitsha and Asaba to relieve the pressure on the old Niger Bridge which was completed in December 1965. Construction of airports across the country. The Akanu Ibiam Airport in Enugu was upgraded into an international airport, directly connecting the South-East region of the country to the outside world for the first time since independence. [ citation needed ] On 2 August 2010, Jonathan launched his 'Roadmap for Power Sector Reform'. Its primary goal was to achieve stable electricity supply in Nigeria. The Power Holding Company of Nigeria , which acted as the nation's electricity provider, was broken up into 15 firms, with Nigeria handing over control of state electricity assets to 15 private bidding companies. The Nigerian government contracted for the services of CPCS Transcom Limited , a Canada-based consulting firm specialising in transportation and energy infrastructure projects, to act as the transaction adviser for the handover of state electricity assets. Historically, the Nigerian power sector has been plagued by blackouts . Economists estimate that power outages have cost Nigeria, Africa's biggest economy, billions of dollars in imported diesel for generators and lost output. In a study conducted by the World Bank , a lack of access to financing and electricity were cited as Nigeria's main obstacles to development, surpassing corruption. Jonathan suspended Sanusi Lamido Sanusi as governor of the Central Bank of Nigeria after a series of public investigations and raising the alarm on the US$20 billion NNPC scandal in a leaked letter which revealed that the Nigeria National Petroleum Corporation failed to account for US$48.9 billion of government oil revenue to the central bank – the NNPC has a history of financial irregularities and oversees the corrupt petroleum industry in Nigeria . Sanusi would go on to reveal the extent of financial recklessness that Nigeria lost a billion dollars a month to diversion of public funds under the Jonathan administration, with oil minister Diezani Alison-Madueke diverting $6 billion (₦1.2 trillion) from the Nigerian treasury. In addition, Jonathan was alleged to have personally ordered over ₦3 trillion ($15 billion) from the Central Bank of Nigeria to support his election and other self-serving projects under the guise of an intervention fund for national security. Charles Soludo , a professor of economics and former governor of the Central Bank of Nigeria, equated Jonathan's financial recklessness to that of former Ugandan president Idi Amin . Ngozi Okonjo-Iweala , an economist and former Finance Minister of Nigeria , pegged Jonathan's administration as the main cause of Nigeria's economic woes in a lecture at George Washington University , although she later denied it. However, none of the corruption allegations against Jonathan have been proven in any law court.Jonathan's government has largely been described as corrupt. According to The Economist , corruption flourished under the Jonathan administration , "who let politicians and their cronies fill their pockets with impunity." Large sums of money have been used improperly multiple times, with ₦ 3.98 trillion (US$20 billion) allegedly going missing and ₦398 billion ($2 billion) of military funds allegedly dispersed amongst high-ranking officials. In 2006, reports released by Wikileaks claimed that Jonathan's wife, Patience Jonathan , was indicted for money-laundering by Nigeria's anti-crime agency, the Economic and Financial Crimes Commission (EFCC). Since May 2015, the Muhammadu Buhari administration reportedly has been fighting corruption that was perpetrated under Jonathan. Some of the former political office holders and appointees that served under Jonathan, as well as party members, have been arrested on various corruption charges. It is alleged that some, including former Finance Minister Nenadi Usman , have returned part of the money they stole. None of these politicians have however been convicted of the alleged crimes. It remains unclear whether or not Jonathan, who is believed to have either masterminded or condoned the corruption, will be arrested. During Jonathan's administration, Nigeria's foreign policy was reviewed to reflect a "citizen-focused" approach, designed to "accord this vision of defending the dignity of humanity the highest priority" and connect foreign policy to domestic policy, while placing a greater emphasis on economic diplomacy. In January 2013, Jonathan reportedly promised $4 million to assist in cleaning up villages that have been affected by a lead poisoning incident. Over 400 children died and Human Rights Watch said that releasing the funds "could be lifesaving for countless children." On 1 January 2012, the Jonathan administration announced the start of a controversial plan to end fuel subsidies. Following the Nigeria Labour Congress ' warning that the country faces many strikes, the country unions followed up with strikes that were matched with civil protests from 9–13 January 2012. Protesters and groups called for Jonathan to resign over the removal of fuel subsidies. After five days of national protests and strikes, on 16 January, Jonathan announced that the pump price of petroleum would be 97 naira per litre compared to a post-subsidy level of 147 naira. In 2012, upon the partial removal of petrol subsidies, the Jonathan administration instituted a subsidy re-investment programme designed to spend the money saved from partial petrol price deregulation on physical infrastructure such as roads, bridges, etc., across the country. The Subsidy Reinvestment and Empowerment Program (SURE-P) was also intended to improve maternal health and reduce maternal mortality. The government followed the advice of international experts that claimed the fuel subsidy ($8 billion per year, or 25% of the government annual budget) was not sustainable. Brookings Institution , a think tank, praised the government's move, arguing that the subsidy crowds out other development spending, like education, and that it discourages investment in the country's economic lifeblood, the oil sector. In his book, "My Transition Hours", Goodluck Jonathan said that subsidy was consuming too much of our revenues and the public believed that the sector was highly corrupt. He mentioned that the Minister of Finance Ngozi Okonjo Iweala briefed him about the corrupt practices that a technical committee she had put together discovered. He said that he was alarmed that billions of naira was being lost by the nation through the subsidy regime. Many prominent Nigerians spoke out against the removal of the subsidy. Former Petroleum Minister Professor Tam David-West spoke out and expressed concern that the planned removal of the fuel subsidy will squeeze the economy, increase inflation, and hurt both businesses and the public. A former military Head of State and a former Minister for Petroleum & Natural Resources, General Muhammadu Buhari , urged Jonathan not to remove the fuel subsidy and to tackle corruption. Yakubu Gowon , another former military Head of State, warned the government that the country's infrastructure should be revived before fuel subsidy removal steps were taken. Former military president Gen. Ibrahim Babangida , joined millions of Nigerians protesting against the removal of the fuel subsidy by the Jonathan administration, saying that the action is ill-timed. In March 2014, President Jonathan inaugurated the 2014 National Conference. The conference was the first of its kind since the 2005 political reform conference, it had 492 delegates that debated on key socio-political national issues impeding national development. On 20 July 2014, Patrick Sawyer , a Liberian-American, flew from Monrovia to Murtala Muhammed International Airport in Lagos , with a stopover at Lomé , Togo. He was subsequently described as having appeared to be "terribly ill" when he left Monrovia. Sawyer became violently ill upon arriving at the airport and died five days later. In response, the Nigerian government observed all of Sawyer's contacts for signs of infection and increased surveillance at all entry points to the country. On 6 August 2014, the Nigerian health minister told reporters: "Yesterday, the first known Nigerian to die of Ebola was recorded. This was one of the nurses that attended to the Liberian. The other five newly confirmed cases are being treated at an isolation ward." The doctor who treated Sawyer, Ameyo Adadevoh , subsequently also died of Ebola. On 22 September 2014, the Nigeria ministry of health announced: "As of today, there is no case of Ebola in Nigeria. All listed contacts who were under surveillance have been followed up for 21 days. "According to the WHO , 20 cases and 8 deaths had been confirmed, along with the imported case, who also died. Four of the dead were health care workers who had cared for Sawyer. In all, 529 contacts had been followed and of that date they had all completed a 21-day mandatory period of surveillance. In January 2014, Jonathan signed into law the Same Sex Marriage Prohibition Act after it was passed by the Senate and House of Representatives . [ citation needed ] The law prohibits gay relationships, membership and other involvement in gay societies and organisations and gay marriages. The bill came after international polls showed that 98% of Nigerians did not think homosexuality should be accepted by society, the highest percentage of any country surveyed. Penalties can be up to 14 years in prison for gay marriages and up to 10 years for other violations of the law. Within a short period, the federal police department compiled a list of 168 gay people who would subsequently be jailed. Within days 38 lesbian and gay people had been jailed, with arrests beginning during Christmas. The anti- LGBT bill stipulates that those who withhold the details of LGBT individuals face prison terms of up to five years. His decision and the law itself have been described as controversial, but according to a poll, 92% of Nigerians supported the ban. In January 2013, Jonathan reportedly promised $4 million to assist in cleaning up villages that have been affected by a lead poisoning incident. Over 400 children died and Human Rights Watch said that releasing the funds "could be lifesaving for countless children." On 1 January 2012, the Jonathan administration announced the start of a controversial plan to end fuel subsidies. Following the Nigeria Labour Congress ' warning that the country faces many strikes, the country unions followed up with strikes that were matched with civil protests from 9–13 January 2012. Protesters and groups called for Jonathan to resign over the removal of fuel subsidies. After five days of national protests and strikes, on 16 January, Jonathan announced that the pump price of petroleum would be 97 naira per litre compared to a post-subsidy level of 147 naira. In 2012, upon the partial removal of petrol subsidies, the Jonathan administration instituted a subsidy re-investment programme designed to spend the money saved from partial petrol price deregulation on physical infrastructure such as roads, bridges, etc., across the country. The Subsidy Reinvestment and Empowerment Program (SURE-P) was also intended to improve maternal health and reduce maternal mortality. The government followed the advice of international experts that claimed the fuel subsidy ($8 billion per year, or 25% of the government annual budget) was not sustainable. Brookings Institution , a think tank, praised the government's move, arguing that the subsidy crowds out other development spending, like education, and that it discourages investment in the country's economic lifeblood, the oil sector. In his book, "My Transition Hours", Goodluck Jonathan said that subsidy was consuming too much of our revenues and the public believed that the sector was highly corrupt. He mentioned that the Minister of Finance Ngozi Okonjo Iweala briefed him about the corrupt practices that a technical committee she had put together discovered. He said that he was alarmed that billions of naira was being lost by the nation through the subsidy regime. Many prominent Nigerians spoke out against the removal of the subsidy. Former Petroleum Minister Professor Tam David-West spoke out and expressed concern that the planned removal of the fuel subsidy will squeeze the economy, increase inflation, and hurt both businesses and the public. A former military Head of State and a former Minister for Petroleum & Natural Resources, General Muhammadu Buhari , urged Jonathan not to remove the fuel subsidy and to tackle corruption. Yakubu Gowon , another former military Head of State, warned the government that the country's infrastructure should be revived before fuel subsidy removal steps were taken. Former military president Gen. Ibrahim Babangida , joined millions of Nigerians protesting against the removal of the fuel subsidy by the Jonathan administration, saying that the action is ill-timed. In March 2014, President Jonathan inaugurated the 2014 National Conference. The conference was the first of its kind since the 2005 political reform conference, it had 492 delegates that debated on key socio-political national issues impeding national development. On 20 July 2014, Patrick Sawyer , a Liberian-American, flew from Monrovia to Murtala Muhammed International Airport in Lagos , with a stopover at Lomé , Togo. He was subsequently described as having appeared to be "terribly ill" when he left Monrovia. Sawyer became violently ill upon arriving at the airport and died five days later. In response, the Nigerian government observed all of Sawyer's contacts for signs of infection and increased surveillance at all entry points to the country. On 6 August 2014, the Nigerian health minister told reporters: "Yesterday, the first known Nigerian to die of Ebola was recorded. This was one of the nurses that attended to the Liberian. The other five newly confirmed cases are being treated at an isolation ward." The doctor who treated Sawyer, Ameyo Adadevoh , subsequently also died of Ebola. On 22 September 2014, the Nigeria ministry of health announced: "As of today, there is no case of Ebola in Nigeria. All listed contacts who were under surveillance have been followed up for 21 days. "According to the WHO , 20 cases and 8 deaths had been confirmed, along with the imported case, who also died. Four of the dead were health care workers who had cared for Sawyer. In all, 529 contacts had been followed and of that date they had all completed a 21-day mandatory period of surveillance. In January 2014, Jonathan signed into law the Same Sex Marriage Prohibition Act after it was passed by the Senate and House of Representatives . [ citation needed ] The law prohibits gay relationships, membership and other involvement in gay societies and organisations and gay marriages. The bill came after international polls showed that 98% of Nigerians did not think homosexuality should be accepted by society, the highest percentage of any country surveyed. Penalties can be up to 14 years in prison for gay marriages and up to 10 years for other violations of the law. Within a short period, the federal police department compiled a list of 168 gay people who would subsequently be jailed. Within days 38 lesbian and gay people had been jailed, with arrests beginning during Christmas. The anti- LGBT bill stipulates that those who withhold the details of LGBT individuals face prison terms of up to five years. His decision and the law itself have been described as controversial, but according to a poll, 92% of Nigerians supported the ban. Jonathan's administration was heavily criticized for its failure to tackle insecurity. The first major challenge was the October 2010 Independence Day bombing . Okah told the court that President Jonathan and his aides organised the attacks in Abuja in a desperate political strategy to demonise political opponents, including former military head of state General Ibrahim Babangida , and to win popular sympathy ahead of the elections. On 29 May 2011, a few hours after Goodluck Jonathan was sworn in as president, several bombings purportedly by Boko Haram killed 15 and injured 55. [ citation needed ] On 16 June 2011, Boko Haram claimed to have conducted the Abuja police headquarters bombing , the first known suicide attack in Nigeria. [ citation needed ] Two months later the United Nations building in Abuja was bombed , signifying the first time that Boko Haram attacked an international organisation. In December 2011, it carried out attacks in Damaturu killing over a hundred people, subsequently clashing with security forces in December , resulting in at least 68 deaths. [ citation needed ] Two days later on Christmas Day, Boko Haram attacked several Christian churches with bomb blasts and shootings. Following the January 2012 Northern Nigeria attacks , which left over hundreds of casualties, Abubakar Shekau , a former deputy of Mohammed Yusuf , appeared in a video posted on YouTube. [ citation needed ] According to Reuters , Shekau took control of the group after the death of Yusuf in 2009. Authorities had previously believed that Shekau died during the violence in 2009. [ citation needed ] By early 2012, the group was responsible for over 900 deaths. On 8 March 2012, a small Special Boat Service team and the Nigerian Army attempted to rescue two hostages, Chris McManus and Franco Lamolinara, being held in Nigeria by members of the Boko Haram terrorist organisation loyal to al-Qaeda . [ citation needed ] The two hostages were killed before or during the rescue attempt. All the hostage takers were reportedly killed. On 18 March, a bus station was bombed in Kano , with several casualties. [ citation needed ] In May 2013, Nigerian government forces launched an offensive in the Borno region in an attempt to dislodge Boko Haram fighters after a state of emergency was called on 14 May 2013. [ citation needed ] The state of emergency, applied to the states of Borno , Yobe , and Adamawa in northeastern Nigeria. The offensive had initial success, but the Boko Haram rebels were able to regain their strength. Although initially offering amnesty, by June 2013 he ordered a 20-year jail term for anyone found to be in support of Boko Haram. In July 2013, Boko Haram massacred 42 students in Yobe , bringing the school year to an early end in the state. [ citation needed ] On 5 August 2013, Boko Haram launched dual attacks on Bama and Malam Fatori, leaving 35 dead. On 16 January 2014, it was reported that Jonathan had sacked his military high command in response to their inability to end the Islamist-led insurgency in Northern Nigeria. On 14 April, over 200 schoolgirls in Chibok were kidnapped . [ citation needed ] A few weeks later in May, a terrorist offensive was launched against the military in Chibok. Many demonstrations called for the government to be more responsive; Jonathan asked that demonstrators focus on blaming Boko Haram itself for the abductions. Jonathan initially denied that there had been any abduction at all, but then later signaled his government would do a prisoner release in exchange for the kidnapped girls. Discussions then took place in Paris with foreign ministers from France, Britain, the United States and Israel, where he agreed no deals should be struck with terrorists. He then called off the exchange at the last minute on 24 May 2014. [ citation needed ] This reportedly enraged Boko Haram leaders. In May 2014, two bombs exploded in Jos , resulting in the deaths of at least 118 people and the injury or over 56 others. [ citation needed ] During the June 2014 Northern Nigeria attacks , a plaza in the capital city was bombed and hundreds of villagers attacked in a two-day killing spree in Kaduna. [ citation needed ] In November, Boko Haram bombed the city of Kano , attempting to assassinate the Emir Muhammadu Sanusi II . [ citation needed ] Starting in late 2014, Boko Haram militants attacked several Nigerian towns in the North and captured them. [ citation needed ] This prompted the Nigerian government to launch an offensive, and with the help of Chad, Niger, and Cameroon, they have recaptured many areas that were formerly under the control of Boko Haram. In late 2014, Boko Haram seized control of Bama , according to the town's residents. [ citation needed ] In December 2014, it was reported that "people too elderly to flee Gwoza Local Government Area were being rounded up and taken to two schools where the militants opened fire on them. [ citation needed ] " Over 50 elderly people in Bama were killed. A "gory" video was released of insurgents shooting over a hundred civilians in a school dormitory in the town of Bama. Between 3 and 7 January 2015, Boko Haram attacked the town of Baga and killed up to 2,000 people , perhaps the largest massacre by Boko Haram. [ citation needed ] On 10 January 2015, a bomb attack took place at the Monday Market in Maiduguri , killing 19 people. [ citation needed ] The city is considered to be at the heart of the Boko Haram insurgency. In the early hours of 25 January 2015, Boko Haram launched a major assault on the city. [ citation needed ] On 26 January 2015 CNN reported that the attack on Maiduguri by "hundreds of gunmen" had been repelled, but the nearby town of Monguno was captured by Boko Haram. [ citation needed ] The Nigerian Army claimed to have successfully repelled another attack on Maiduguri on 31 January 2015. [ citation needed ] Starting in late January 2015, a coalition of military forces from Nigeria, Chad, Cameroon, and Niger began a counter-insurgency campaign against Boko Haram. [ citation needed ] On 4 February 2015, the Chad Army killed over 200 Boko Haram militants. [ citation needed ] Soon afterwards, Boko Haram launched an attack on the Cameroonian town of Fotokol , killing 81 civilians, 13 Chadian soldiers and 6 Cameroonian soldiers. [ citation needed ] On 17 February 2015 the Nigerian military retook Monguno in a coordinated air and ground assault. [ citation needed ] On 7 March 2015, Boko Haram's leader Abubakar Shekau pledged allegiance to the Islamic State of Iraq and the Levant (ISIL) via an audio message posted on the organisation's Twitter account. [ citation needed ] Nigerian army spokesperson Sami Usman Kukasheka said the pledge was a sign of weakness and that Shekau was like a "drowning man". That same day, five suicide bomb blasts left 54 dead and 143 wounded. On 12 March 2015, ISIL's spokesman Abu Mohammad al-Adnani released an audiotape in which he welcomed the pledge of allegiance, and described it as an expansion of the group's caliphate to West Africa. [ citation needed ] Following its declaration of loyalty to ISIL, Boko Haram was designated as the group's "West Africa Province" (Islamic State West Africa Province, or ISWAP) while Shekau was appointed as its first vali (governor). Furthermore, ISIL started to support Boko Haram, but also began to interfere in its internal matters. For example, ISIL's central leadership attempted to reduce Boko Haram's brutality toward civilians and internal critics, as Shekau's ideology was "too extreme even for the Islamic State". [ citation needed ] On 24 March 2015, residents of Damasak , Nigeria said that Boko Haram had taken more than 400 women and children from the town as they fled from coalition forces. [ citation needed ] On 27 March 2015, the Nigerian army captured Gwoza , which was believed to be the location of Boko Haram headquarters. [ citation needed ] On election day, 28 March 2015, Boko Haram extremists killed 41 people, including a legislator, to discourage hundreds from voting. [ citation needed ] Niger Army soldiers during counter-insurgency operations against Boko Haram in March 2015. In March 2015, Boko Haram lost control of the Northern Nigerian towns of Bama and Gwoza (believed to be their headquarters) to the Nigerian Army . [ citation needed ] The Nigerian authorities said that they had taken back 11 of the 14 districts previously controlled by Boko Haram. [ citation needed ] In April 2016, four Boko Haram camps in the Sambisa Forest were overrun by the Nigerian military who freed nearly 300 females. [ citation needed ] Boko Haram forces were believed to have retreated to the Mandara Mountains , along the Cameroon–Nigeria border . On 16 March 2015, the Nigerian army said that it had recaptured Bama. [ citation needed ] On 27 March 2015, the day before the Nigerian presidential election , the Nigerian Army announced that it had recaptured the town of Gwoza from Boko Haram. [ citation needed ] By April 2015, the Nigerian military was reported to have retaken most of the areas previously controlled by Boko Haram in Northeastern Nigeria, except for the Sambisa Forest . In May 2015, the Nigerian military announced that they had released about 700 women from camps in Sambisa Forest . [ citation needed ]On 29 May 2011, a few hours after Goodluck Jonathan was sworn in as president, several bombings purportedly by Boko Haram killed 15 and injured 55. [ citation needed ] On 16 June 2011, Boko Haram claimed to have conducted the Abuja police headquarters bombing , the first known suicide attack in Nigeria. [ citation needed ] Two months later the United Nations building in Abuja was bombed , signifying the first time that Boko Haram attacked an international organisation. In December 2011, it carried out attacks in Damaturu killing over a hundred people, subsequently clashing with security forces in December , resulting in at least 68 deaths. [ citation needed ] Two days later on Christmas Day, Boko Haram attacked several Christian churches with bomb blasts and shootings. Following the January 2012 Northern Nigeria attacks , which left over hundreds of casualties, Abubakar Shekau , a former deputy of Mohammed Yusuf , appeared in a video posted on YouTube. [ citation needed ] According to Reuters , Shekau took control of the group after the death of Yusuf in 2009. Authorities had previously believed that Shekau died during the violence in 2009. [ citation needed ] By early 2012, the group was responsible for over 900 deaths. On 8 March 2012, a small Special Boat Service team and the Nigerian Army attempted to rescue two hostages, Chris McManus and Franco Lamolinara, being held in Nigeria by members of the Boko Haram terrorist organisation loyal to al-Qaeda . [ citation needed ] The two hostages were killed before or during the rescue attempt. All the hostage takers were reportedly killed. On 18 March, a bus station was bombed in Kano , with several casualties. [ citation needed ] In May 2013, Nigerian government forces launched an offensive in the Borno region in an attempt to dislodge Boko Haram fighters after a state of emergency was called on 14 May 2013. [ citation needed ] The state of emergency, applied to the states of Borno , Yobe , and Adamawa in northeastern Nigeria. The offensive had initial success, but the Boko Haram rebels were able to regain their strength. Although initially offering amnesty, by June 2013 he ordered a 20-year jail term for anyone found to be in support of Boko Haram. In July 2013, Boko Haram massacred 42 students in Yobe , bringing the school year to an early end in the state. [ citation needed ] On 5 August 2013, Boko Haram launched dual attacks on Bama and Malam Fatori, leaving 35 dead. On 16 January 2014, it was reported that Jonathan had sacked his military high command in response to their inability to end the Islamist-led insurgency in Northern Nigeria. On 14 April, over 200 schoolgirls in Chibok were kidnapped . [ citation needed ] A few weeks later in May, a terrorist offensive was launched against the military in Chibok. Many demonstrations called for the government to be more responsive; Jonathan asked that demonstrators focus on blaming Boko Haram itself for the abductions. Jonathan initially denied that there had been any abduction at all, but then later signaled his government would do a prisoner release in exchange for the kidnapped girls. Discussions then took place in Paris with foreign ministers from France, Britain, the United States and Israel, where he agreed no deals should be struck with terrorists. He then called off the exchange at the last minute on 24 May 2014. [ citation needed ] This reportedly enraged Boko Haram leaders. In May 2014, two bombs exploded in Jos , resulting in the deaths of at least 118 people and the injury or over 56 others. [ citation needed ] During the June 2014 Northern Nigeria attacks , a plaza in the capital city was bombed and hundreds of villagers attacked in a two-day killing spree in Kaduna. [ citation needed ] In November, Boko Haram bombed the city of Kano , attempting to assassinate the Emir Muhammadu Sanusi II . [ citation needed ] Starting in late 2014, Boko Haram militants attacked several Nigerian towns in the North and captured them. [ citation needed ] This prompted the Nigerian government to launch an offensive, and with the help of Chad, Niger, and Cameroon, they have recaptured many areas that were formerly under the control of Boko Haram. In late 2014, Boko Haram seized control of Bama , according to the town's residents. [ citation needed ] In December 2014, it was reported that "people too elderly to flee Gwoza Local Government Area were being rounded up and taken to two schools where the militants opened fire on them. [ citation needed ] " Over 50 elderly people in Bama were killed. A "gory" video was released of insurgents shooting over a hundred civilians in a school dormitory in the town of Bama. Between 3 and 7 January 2015, Boko Haram attacked the town of Baga and killed up to 2,000 people , perhaps the largest massacre by Boko Haram. [ citation needed ] On 10 January 2015, a bomb attack took place at the Monday Market in Maiduguri , killing 19 people. [ citation needed ] The city is considered to be at the heart of the Boko Haram insurgency. In the early hours of 25 January 2015, Boko Haram launched a major assault on the city. [ citation needed ] On 26 January 2015 CNN reported that the attack on Maiduguri by "hundreds of gunmen" had been repelled, but the nearby town of Monguno was captured by Boko Haram. [ citation needed ] The Nigerian Army claimed to have successfully repelled another attack on Maiduguri on 31 January 2015. [ citation needed ] Starting in late January 2015, a coalition of military forces from Nigeria, Chad, Cameroon, and Niger began a counter-insurgency campaign against Boko Haram. [ citation needed ] On 4 February 2015, the Chad Army killed over 200 Boko Haram militants. [ citation needed ] Soon afterwards, Boko Haram launched an attack on the Cameroonian town of Fotokol , killing 81 civilians, 13 Chadian soldiers and 6 Cameroonian soldiers. [ citation needed ] On 17 February 2015 the Nigerian military retook Monguno in a coordinated air and ground assault. [ citation needed ] On 7 March 2015, Boko Haram's leader Abubakar Shekau pledged allegiance to the Islamic State of Iraq and the Levant (ISIL) via an audio message posted on the organisation's Twitter account. [ citation needed ] Nigerian army spokesperson Sami Usman Kukasheka said the pledge was a sign of weakness and that Shekau was like a "drowning man". That same day, five suicide bomb blasts left 54 dead and 143 wounded. On 12 March 2015, ISIL's spokesman Abu Mohammad al-Adnani released an audiotape in which he welcomed the pledge of allegiance, and described it as an expansion of the group's caliphate to West Africa. [ citation needed ] Following its declaration of loyalty to ISIL, Boko Haram was designated as the group's "West Africa Province" (Islamic State West Africa Province, or ISWAP) while Shekau was appointed as its first vali (governor). Furthermore, ISIL started to support Boko Haram, but also began to interfere in its internal matters. For example, ISIL's central leadership attempted to reduce Boko Haram's brutality toward civilians and internal critics, as Shekau's ideology was "too extreme even for the Islamic State". [ citation needed ] On 24 March 2015, residents of Damasak , Nigeria said that Boko Haram had taken more than 400 women and children from the town as they fled from coalition forces. [ citation needed ] On 27 March 2015, the Nigerian army captured Gwoza , which was believed to be the location of Boko Haram headquarters. [ citation needed ] On election day, 28 March 2015, Boko Haram extremists killed 41 people, including a legislator, to discourage hundreds from voting. [ citation needed ] Niger Army soldiers during counter-insurgency operations against Boko Haram in March 2015. In March 2015, Boko Haram lost control of the Northern Nigerian towns of Bama and Gwoza (believed to be their headquarters) to the Nigerian Army . [ citation needed ] The Nigerian authorities said that they had taken back 11 of the 14 districts previously controlled by Boko Haram. [ citation needed ] In April 2016, four Boko Haram camps in the Sambisa Forest were overrun by the Nigerian military who freed nearly 300 females. [ citation needed ] Boko Haram forces were believed to have retreated to the Mandara Mountains , along the Cameroon–Nigeria border . On 16 March 2015, the Nigerian army said that it had recaptured Bama. [ citation needed ] On 27 March 2015, the day before the Nigerian presidential election , the Nigerian Army announced that it had recaptured the town of Gwoza from Boko Haram. [ citation needed ] By April 2015, the Nigerian military was reported to have retaken most of the areas previously controlled by Boko Haram in Northeastern Nigeria, except for the Sambisa Forest . In May 2015, the Nigerian military announced that they had released about 700 women from camps in Sambisa Forest . [ citation needed ]Jonathan believed the APC's popularity was inflated, having made his view clear in an interview with The Cable , Nigeria's Independent Online Newspaper in 2015—just two days to the general elections. Jonathan said "I don't think Nigerians will make the mistake of voting for Buhari. Gen. Buhari, with due respect, is not the right option for Nigeria at this time. It is a gamble that is not worth taking. I may not be perfect as nobody is perfect. But I believe that come Saturday, the majority of Nigerian voters will choose me as the best candidate to lead the nation forward." On 31 March 2015, Jonathan conceded the election to challenger Muhammadu Buhari , who was sworn in to succeed him on 29 May 2015. Jonathan said in a statement he issued on 31 March 2015 that "Nobody's ambition is worth the blood of any Nigerian." Since leaving office, Jonathan has continued to defend his administration. In 2019, he was appointed as the honorary special advisor to the Bayelsa Education Trust Fund board. In June 2019, Goodluck Jonathan was named chairperson of the newly inaugurated International Summit Council for Peace. In July 2020, Jonathan was appointed special envoy of the Economic Community of West African States (ECOWAS) to lead mediation talks during the 2020 Malian protests . It was alleged that Jonathan had expressed interest to stand for the 2023 Nigerian presidential election under the All Progressives Congress (APC). To achieve this, the APC primary nomination form was picked up for him by his supporters, which was debunked by his media aide Ikechukwu Eze. In 2023, Jonathan was appointed head of delegation for the African Union and COMESA in the 2023 Zimbabwean general election . On Friday, 25 August 2023, he addressed a press briefing giving Zimbabwe's electoral authority poor ratings. This was in harmony with similar findings by the SADC , SEAM delivered earlier in the same press briefing.It was alleged that Jonathan had expressed interest to stand for the 2023 Nigerian presidential election under the All Progressives Congress (APC). To achieve this, the APC primary nomination form was picked up for him by his supporters, which was debunked by his media aide Ikechukwu Eze. In 2023, Jonathan was appointed head of delegation for the African Union and COMESA in the 2023 Zimbabwean general election . On Friday, 25 August 2023, he addressed a press briefing giving Zimbabwe's electoral authority poor ratings. This was in harmony with similar findings by the SADC , SEAM delivered earlier in the same press briefing.Jonathan is known for sporting his trademark fedora that is commonly worn by inhabitants of the Niger Delta . Jonathan and his wife, Dame Patience Jonathan , have two children, Ariwera (son) and Aruabai (daughter). In 2007, Jonathan declared his assets worth a total of ₦ 295,304,420 (then equivalent to US$8,569,662). Jonathan is known for sporting his trademark fedora that is commonly worn by inhabitants of the Niger Delta . Jonathan and his wife, Dame Patience Jonathan , have two children, Ariwera (son) and Aruabai (daughter). In 2007, Jonathan declared his assets worth a total of ₦ 295,304,420 (then equivalent to US$8,569,662).

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Cuba/html

Cuba

Cuba , [lower-alpha 3] officially the Republic of Cuba , [lower-alpha 4] is an island country , comprising the island of Cuba, Isla de la Juventud , archipelagos , 4,195 islands and cays surrounding the main island. Cuba is located where the northern Caribbean Sea , Gulf of Mexico , and Atlantic Ocean meet. Cuba is located east of the Yucatán Peninsula (Mexico), south of both the American state of Florida and the Bahamas , west of Hispaniola ( Haiti / Dominican Republic ), and north of Jamaica and the Cayman Islands . Havana is the largest city and capital; other major cities include Santiago de Cuba and Camagüey . The official area of the Republic of Cuba is 109,884 km 2 (42,426 sq mi) (without the territorial waters) but a total of 350,730 km 2 (135,420 sq mi) including the exclusive economic zone . Cuba is the second-most populous country in the Caribbean after Haiti, with over 11 million inhabitants. The territory that is now Cuba was inhabited as early as the 4th millennium BC , with the Guanahatabey and Taíno peoples inhabiting the area at the time of Spanish colonization in the 15th century. It was then a colony of Spain , and slavery was abolished in 1886, remaining a colony until the Spanish–American War of 1898, when Cuba was occupied by the United States and gained independence in 1902. In 1940, Cuba implemented a new constitution , but mounting political unrest culminated in the 1952 Cuban coup d'état and the subsequent dictatorship of Fulgencio Batista . The Batista government was overthrown in January 1959 by the 26th of July Movement during the Cuban Revolution . That revolution established communist rule under the leadership of Fidel Castro . The country was a point of contention during the Cold War between the Soviet Union and the United States, and nuclear war nearly broke out during the Cuban Missile Crisis of 1962. Following the dissolution of the Soviet Union , Cuba faced severe economic downturn in the 1990s, known as the Special Period . In 2008, Fidel Castro retired after 49 years; Raúl Castro was elected his successor. Raúl Castro retired as president in 2018 and Miguel Díaz-Canel was elected president by the National Assembly following parliamentary elections . Raúl Castro retired as First Secretary of the Communist Party in 2021 and Díaz-Canel was elected. Cuba is one of a few extant Marxist–Leninist one-party socialist states , in which the role of the vanguard Communist Party is enshrined in the Constitution . Cuba has an authoritarian regime where political opposition is not permitted. Censorship is extensive and independent journalism is repressed; Reporters Without Borders has characterized Cuba as one of the worst countries for press freedom. Culturally, Cuba is considered part of Latin America. It is a multiethnic country whose people , culture and customs derive from diverse origins, including the Taíno Ciboney peoples, the long period of Spanish colonialism, the introduction of enslaved Africans and a close relationship with the Soviet Union during the Cold War. Cuba is a founding member of the United Nations, G77 , Non-Aligned Movement , Organisation of African, Caribbean and Pacific States , ALBA , and Organization of American States . It has one of the world's few planned economies , and its economy is dominated by tourism and the exports of skilled labor, sugar, tobacco, and coffee. Cuba has historically—before and during communist rule—performed better than other countries in the region on several socioeconomic indicators, such as literacy, infant mortality and life expectancy. Cuba has a universal health care system which provides free medical treatment to all Cuban citizens, although challenges include low salaries for doctors, poor facilities, poor provision of equipment, and the frequent absence of essential drugs. A 2023 study by the Cuban Observatory of Human Rights (OCDH), estimated 88% of the population is living in extreme poverty. The traditional diet is of international concern due to micronutrient deficiencies and lack of diversity. As highlighted by the World Food Programme (WFP) of the United Nations, rationed food meets only a fraction of daily nutritional needs for many Cubans, leading to health issues. Historians believe the name Cuba comes from the Taíno language ; however, "its exact derivation [is] unknown". The exact meaning of the name is unclear, but it may be translated either as 'where fertile land is abundant' ( cubao ), or 'great place' ( coabana ). Fringe theory writers who believe that Christopher Columbus was Portuguese state that Cuba was named by Columbus for the town of Cuba in the district of Beja in Portugal. Humans first settled Cuba around 6,000 years ago, descending from migrations from northern South America or Central America. The arrival of humans on Cuba is associated with extinctions of the islands native fauna, particularly its endemic sloths . The Arawakan -speaking ancestors of the Taino people arrived in Cuba in a separate migration from South America around 1,700 years ago. Unlike the previous settlers of Cuba, the Taino practised the production of pottery and intensive agriculture. Descendants of the first settlers of Cuba persisted on the western part of the island until Columbian contact, where they were recorded as the Guanahatabey people, who lived a hunter gatherer lifestyle. After first landing on an island then called Guanahani , Bahamas , on 12 October 1492, Christopher Columbus commanded his three ships: La Pinta , La Niña and the Santa María , discovering Cuba on 27 October 1492, and landing in the northeastern coast on 28 October. (This was near what is now Bariay, Holguín Province .) Columbus claimed the island for the new Kingdom of Spain and named it Isla Juana after John, Prince of Asturias . In 1511, the first Spanish settlement was founded by Diego Velázquez de Cuéllar at Baracoa . Other settlements soon followed, including San Cristobal de la Habana , founded in 1514 (southern coast of the island) and then in 1519 (current place), which later became the capital (1607). The indigenous Taíno were forced to work under the encomienda system, which resembled the feudal system in medieval Europe. Within a century, the indigenous people were virtually wiped out due to multiple factors, primarily Eurasian infectious diseases , to which they had no natural resistance (immunity), aggravated by the harsh conditions of the repressive colonial subjugation. In 1529, a measles outbreak in Cuba killed two-thirds of those few natives who had previously survived smallpox . On 18 May 1539, conquistador Hernando de Soto departed from Havana with some 600 followers into a vast expedition through the American Southeast , starting in Florida , in search of gold, treasure, fame and power. On 1 September 1548, Gonzalo Perez de Angulo was appointed governor of Cuba. He arrived in Santiago, Cuba, on 4 November 1549, and immediately declared the liberty of all natives. He became Cuba's first permanent governor to reside in Havana instead of Santiago, and he built Havana's first church made of masonry. [lower-alpha 5] By 1570, most residents of Cuba comprised a mixture of Spanish, African, and Taíno heritages. Cuba developed slowly and, unlike the plantation islands of the Caribbean, had a diversified agriculture. Most importantly, the colony developed as an urbanized society that primarily supported the Spanish colonial empire. By the mid-18th century, there were 50,000 slaves on the island, compared to 60,000 in Barbados and 300,000 in Virginia ; as well as 450,000 in Saint-Domingue , all of which had large-scale sugarcane plantations. The Seven Years' War , which erupted in 1754 across three continents, eventually arrived in the Spanish Caribbean . Spain's alliance with the French pitched them into direct conflict with the British , and in 1762, a British expedition consisting of dozens of ships and thousands of troops set out from Portsmouth to capture Cuba. The British arrived on 6 June, and by August, had placed Havana under siege . When Havana surrendered, the admiral of the British fleet, George Pocock and the commander of the land forces George Keppel , the 3rd Earl of Albemarle , entered the city, and took control of the western part of the island. The British immediately opened up trade with their North American and Caribbean colonies, causing a rapid transformation of Cuban society. Though Havana, which had become the third-largest city in the Americas, was to enter an era of sustained development and increasing ties with North America during this period, the British occupation of the city proved short-lived. Pressure from London to sugar merchants, fearing a decline in sugar prices, forced negotiations with the Spanish over the captured territories. [ clarification needed ] Less than a year after Britain captured Havana, it signed the 1763 Treaty of Paris together with France and Spain, ending the Seven Years' War. The treaty gave Britain Florida in exchange for Cuba. [lower-alpha 6] Cubans constituted one of the many diverse units which fought alongside Spanish forces during the conquest of British West Florida (1779–81). The largest factor for the growth of Cuba's commerce in the late eighteenth and early nineteenth century was the Haitian Revolution . When the enslaved peoples of what had been the Caribbean's richest colony freed themselves through violent revolt, Cuban planters perceived the region's changing circumstances with both a sense of fear and opportunity. They were afraid because of the prospect that slaves might revolt in Cuba as well, and numerous prohibitions during the 1790s of the sale of slaves in Cuba who had previously been enslaved in French colonies underscored this anxiety. The planters saw opportunity, however, because they thought that they could exploit the situation by transforming Cuba into the slave society and sugar-producing "pearl of the Antilles" that Haiti had been before the revolution. As the historian Ada Ferrer has written, "At a basic level, liberation in Saint-Domingue helped entrench its denial in Cuba. As slavery and colonialism collapsed in the French colony, the Spanish island underwent transformations that were almost the mirror image of Haiti's." Estimates suggest that between 1790 and 1820 some 325,000 Africans were imported to Cuba as slaves, which was four times the amount that had arrived between 1760 and 1790. Although a smaller proportion of the population of Cuba was enslaved, at times, slaves arose in revolt. In 1812, the Aponte Slave Rebellion took place, but it was ultimately suppressed. The population of Cuba in 1817 was 630,980 (of which 291,021 were white, 115,691 were free people of color (mixed-race), and 224,268 black slaves). [lower-alpha 7] In part due to Cuban slaves working primarily in urbanized settings, by the 19th century, the practice of coartacion had developed (or "buying oneself out of slavery", a "uniquely Cuban development"), according to historian Herbert S. Klein. Due to a shortage of white labor, blacks dominated urban industries "to such an extent that when whites in large numbers came to Cuba in the middle of the nineteenth century, they were unable to displace Negro workers." A system of diversified agriculture, with small farms and fewer slaves, served to supply the cities with produce and other goods. In the 1820s, when the rest of Spain's empire in Latin America rebelled and formed independent states , Cuba remained loyal to Spain. Its economy was based on serving the empire. By 1860, Cuba had 213,167 free people of color (39% of its non-white population of 550,000). [lower-alpha 8] Full independence from Spain was the goal of a rebellion in 1868 led by planter Carlos Manuel de Céspedes . De Céspedes, a sugar planter, freed his slaves to fight with him for an independent Cuba. On 27 December 1868, he issued a decree condemning slavery in theory but accepting it in practice and declaring free any slaves whose masters present them for military service. The 1868 rebellion resulted in a prolonged conflict known as the Ten Years' War . A great number of the rebels were volunteers from the Dominican Republic , [lower-alpha 10] and other countries, as well as numerous Chinese indentured servants . [lower-alpha 11] [lower-alpha 12] The United States declined to recognize the new Cuban government, although many European and Latin American nations did so. In 1878, the Pact of Zanjón ended the conflict, with Spain promising greater autonomy to Cuba. [lower-alpha 13] In 1879–80, Cuban patriot Calixto García attempted to start another war known as the Little War but failed to receive enough support. Slavery in Cuba was abolished in 1875 but the process was completed only in 1886. An exiled dissident named José Martí founded the Cuban Revolutionary Party in New York City in 1892. The aim of the party was to achieve Cuban independence from Spain. In January 1895, Martí traveled to Monte Cristi and Santo Domingo in the Dominican Republic to join the efforts of Máximo Gómez . Martí recorded his political views in the Manifesto of Montecristi . Fighting against the Spanish army began in Cuba on 24 February 1895, but Martí was unable to reach Cuba until 11 April 1895. Martí was killed in the Battle of Dos Rios on 19 May 1895. His death immortalized him as Cuba's national hero. Around 200,000 Spanish troops outnumbered the much smaller rebel army, which relied mostly on guerrilla and sabotage tactics. The Spaniards began a campaign of suppression. General Valeriano Weyler , the military governor of Cuba, herded the rural population into what he called reconcentrados , described by international observers as "fortified towns". These are often considered the prototype for 20th-century concentration camps . Between 200,000 and 400,000 Cuban civilians died from starvation and disease in the Spanish concentration camps, numbers verified by the Red Cross and United States Senator Redfield Proctor , a former Secretary of War . American and European protests against Spanish conduct on the island followed. The U.S. battleship USS Maine was sent to protect American interests, but soon after arrival, it exploded in Havana harbor and sank quickly, killing nearly three-quarters of the crew. The cause and responsibility for the sinking of the ship remained unclear after a board of inquiry. Popular opinion in the U.S., fueled by an active press , concluded that the Spanish were to blame and demanded action. Spain and the United States declared war on each other in late April 1898. [lower-alpha 14] [lower-alpha 15] After the Spanish–American War , Spain and the United States signed the Treaty of Paris (1898) , by which Spain ceded Puerto Rico , the Philippines , and Guam to the United States for the sum of US$20 million and Cuba became a protectorate of the United States. Cuba gained formal independence from the U.S. on 20 May 1902, as the Republic of Cuba. Under Cuba's new constitution, the U.S. retained the right to intervene in Cuban affairs and to supervise its finances and foreign relations. Under the Platt Amendment , the U.S. leased the Guantánamo Bay Naval Base from Cuba. Following disputed elections in 1906, the first president, Tomás Estrada Palma , faced an armed revolt by independence war veterans who defeated the meager government forces. The U.S. intervened by occupying Cuba and named Charles Edward Magoon as Governor for three years. Cuban historians have characterized Magoon's governorship as having introduced political and social corruption. In 1908, self-government was restored when José Miguel Gómez was elected president, but the U.S. continued intervening in Cuban affairs. In 1912, the Partido Independiente de Color attempted to establish a separate black republic in Oriente Province, but was suppressed by General Monteagudo with considerable bloodshed. In 1924, Gerardo Machado was elected president. During his administration, tourism increased markedly, and American-owned hotels and restaurants were built to accommodate the influx of tourists. The tourist boom led to increases in gambling and prostitution in Cuba . The Wall Street Crash of 1929 led to a collapse in the price of sugar, political unrest, and repression. Protesting students, known as the Generation of 1930, turned to violence in opposition to the increasingly unpopular Machado. A general strike (in which the Communist Party sided with Machado), uprisings among sugar workers, and an army revolt forced Machado into exile in August 1933. He was replaced by Carlos Manuel de Céspedes y Quesada . In September 1933, the Sergeants' Revolt , led by Sergeant Fulgencio Batista , overthrew Céspedes. A five-member executive committee (the Pentarchy of 1933 ) was chosen to head a provisional government. Ramón Grau San Martín was then appointed as provisional president. Grau resigned in 1934, leaving the way clear for Batista, who dominated Cuban politics for the next 25 years, at first through a series of puppet-presidents. The period from 1933 to 1937 was a time of "virtually unremitting social and political warfare". On balance, during the period 1933–1940 Cuba suffered from fragile politic structures, reflected in the fact that it saw three different presidents in two years (1935–1936), and in the militaristic and repressive policies of Batista as Head of the Army. A new constitution was adopted in 1940, which engineered radical progressive ideas, including the right to labor and health care. Batista was elected president in the same year, holding the post until 1944. He is so far the only non-white Cuban to win the nation's highest political office. His government carried out major social reforms. Several members of the Communist Party held office under his administration. Cuban armed forces were not greatly involved in combat during World War II—though president Batista did suggest a joint U.S.-Latin American assault on Francoist Spain to overthrow its authoritarian regime. Cuba lost six merchant ships during the war, and the Cuban Navy was credited with sinking the German submarine U-176 . Batista adhered to the 1940 constitution's strictures preventing his re-election. Ramon Grau San Martin was the winner of the next election, in 1944. Grau further corroded the base of the already teetering legitimacy of the Cuban political system, in particular by undermining the deeply flawed, though not entirely ineffectual, Congress and Supreme Court. Carlos Prío Socarrás , a protégé of Grau, became president in 1948. The two terms of the Auténtico Party brought an influx of investment, which fueled an economic boom, raised living standards for all segments of society, and created a middle class in most urban areas. After finishing his term in 1944 Batista lived in Florida, returning to Cuba to run for president in 1952. Facing certain electoral defeat, he led a military coup that preempted the election. Back in power, and receiving financial, military, and logistical support from the United States government, Batista suspended the 1940 Constitution and revoked most political liberties, including the right to strike . He then aligned with the wealthiest landowners who owned the largest sugar plantations , and presided over a stagnating economy that widened the gap between rich and poor Cubans. Batista outlawed the Cuban Communist Party in 1952. After the coup, Cuba had Latin America's highest per capita consumption rates of meat, vegetables, cereals, automobiles, telephones and radios, though about one-third of the population was considered poor and enjoyed relatively little of this consumption. However, in his " History Will Absolve Me " speech, Fidel Castro mentioned that national issues relating to land, industrialization, housing, unemployment, education, and health were contemporary problems. In 1958, Cuba was a well-advanced country in comparison to other Latin American regions. Cuba was also affected by perhaps the largest labor union privileges in Latin America, including bans on dismissals and mechanization. They were obtained in large measure "at the cost of the unemployed and the peasants", leading to disparities. Between 1933 and 1958, Cuba extended economic regulations enormously, causing economic problems. Unemployment became a problem as graduates entering the workforce could not find jobs. The middle class, which was comparable to that of the United States [ how? ] , became increasingly dissatisfied with unemployment and political persecution. The labor unions, manipulated by the previous government since 1948 through union "yellowness", supported Batista until the very end. Batista stayed in power until he resigned in December 1958 under the pressure of the US Embassy and as the revolutionary forces headed by Fidel Castro were winning militarily (Santa Clara city, a strategic point in the middle of the country, fell into the rebels hands on December 31, in a conflict known as the Battle of Santa Clara ). In the 1950s, various organizations, including some advocating armed uprising, competed for public support in bringing about political change. In 1956, Fidel Castro and about 80 supporters landed from the yacht Granma in an attempt to start a rebellion against the Batista government. In 1958, Castro's July 26th Movement emerged as the leading revolutionary group. The U.S. supported Castro by imposing a 1958 arms embargo against Batista's government. Batista evaded the American embargo and acquired weapons from the Dominican Republic. [lower-alpha 16] By late 1958, the rebels had broken out of the Sierra Maestra and launched a general popular insurrection . After Castro's fighters captured Santa Clara , Batista fled with his family to the Dominican Republic on 1 January 1959. Later he went into exile on the Portuguese island of Madeira and finally settled in Estoril, near Lisbon. Fidel Castro's forces entered the capital on 8 January 1959. The liberal Manuel Urrutia Lleó became the provisional president. According to Amnesty International , official death sentences from 1959 to 1987 numbered 237 of which all but 21 were carried out. The vast majority of those executed directly following the 1959 Revolution were policemen, politicians, and informers of the Batista regime accused of crimes such as torture and murder, and their public trials and executions had widespread popular support among the Cuban population. The United States government initially reacted favorably to the Cuban Revolution, seeing it as part of a movement to bring democracy to Latin America. Castro's legalization of the Communist Party and the hundreds of executions of Batista agents, policemen, and soldiers that followed caused a deterioration in the relationship between the two countries. The promulgation of the Agrarian Reform Law , expropriating thousands of acres of farmland (including from large U.S. landholders), further worsened relations. In response, between 1960 and 1964 the U.S. imposed a range of sanctions, eventually including a total ban on trade between the countries and a freeze on all Cuban-owned assets in the U.S. In February 1960, Castro signed a commercial agreement with Soviet Vice-Premier Anastas Mikoyan . In March 1960, U.S. President Dwight D. Eisenhower gave his approval to a CIA plan to arm and train a group of Cuban refugees to overthrow the Castro government. The invasion (known as the Bay of Pigs Invasion ) took place on 14 April 1961, during the term of President John F. Kennedy . About 1,400 Cuban exiles disembarked at the Bay of Pigs . Cuban troops and local militias defeated the invasion, killing over 100 invaders and taking the remainder prisoner. In January 1962, Cuba was suspended from the Organization of American States (OAS), and later the same year the OAS started to impose sanctions against Cuba of similar nature to the U.S. sanctions. The Cuban Missile Crisis of October 1962 almost sparked World War III . In 1962 American generals proposed Operation Northwoods which would entail committing terrorist attacks in American cities and against refugees and falsely blaming the attacks on the Cuban government, manufacturing a reason for the United States to invade Cuba. This plan was rejected by President Kennedy. By 1963, Cuba was moving towards a full-fledged communist system modelled on the USSR. During the Cold War, Cuban forces were deployed to all corners of Africa, either as military advisors or as combatants. In 1963, Cuba sent 686 troops together with 22 tanks and other military equipment to support Algeria in the Sand War against Morocco. The Cuban forces remained in Algeria for over a year, providing training to the Algerian army. In 1964, Cuba organized a meeting of Latin American communists in Havana and stoked a civil war in the capital of the Dominican Republic in 1965, which prompted 20,000 U.S. troops to intervene there. Che Guevara engaged in guerrilla activities in Africa and was killed in 1967 while attempting to start a revolution in Bolivia . During the 1970s, Fidel Castro dispatched tens of thousands of troops in support of Soviet-backed wars in Africa. He supported the MPLA in Angola ( Angolan Civil War ) and Mengistu Haile Mariam in Ethiopia ( Ogaden War ). In November 1975, Cuba deployed more than 65,000 troops and 400 Soviet-made tanks in Angola in one of the fastest military mobilizations in history. South Africa developed nuclear weapons due to the threat to its security posed by the presence of large numbers of Cuban troops in Angola . In 1976 and again in 1988 at the Battle of Cuito Cuanavale , the Cubans alongside their MPLA allies defeated UNITA rebels and apartheid South African forces. [lower-alpha 17] In December 1977, Cuba sent its combat troops from Angola, the People's Republic of the Congo, and the Caribbean to Ethiopia, assisted by mechanized Soviet battalions, to help defeat a Somali invasion. On 24 January 1978, Ethiopian and Cuban troops counterattacked, inflicting 3,000 casualties on the Somali forces. In February, Cuban troops launched a major offensive and forced the Somali army back into its own territory. Cuban forces remained in Ethiopia until 9 September 1989. Despite Cuba's small size and the long distance separating it from the Middle East, Castro's Cuba played an active role in the region during the Cold War. In 1972, a major Cuban military mission consisting of tank, air, and artillery specialists was dispatched to South Yemen . Cuban military advisors were sent to Iraq in the mid-1970s but their mission was canceled after Iraq invaded Iran in 1980. The Cubans were also involved in the Syrian-Israeli War of Attrition (November 1973–May 1974) that followed the Yom Kippur War (October 1973). Israeli sources reported the presence of a Cuban tank brigade in the Golan Heights , which was supported by two brigades. The Israelis and the Cuban-Syrian tank forces engaged in battle on the Golan front. : 37–38 The standard of living in the 1970s was "extremely spartan" and discontent was rife. Fidel Castro admitted the failures of economic policies in a 1970 speech. In 1975, the OAS lifted its sanctions against Cuba, with the approval of 16 member states, including the United States. The U.S., however, maintained its own sanctions. In 1979, the U.S. objected to the presence of Soviet combat troops on the island. Following the 1983 coup that resulted in the execution of Grenadian Prime Minister Maurice Bishop and establishment of the military government led by Hudson Austin , U.S. forces invaded Grenada in 1983, overthrowing the regime. Most resistance came from Cuban construction workers, while the Grenadan People's Revolutionary Army and militia surrendered without putting up much of a fight. 24 Cubans were killed, with only 2 of them being professional soldiers, and the remainder were expelled from the island. U.S. casualties amounted to 19 killed, 116 wounded, and 9 helicopters destroyed. During the 1970s and 1980s, Castro supported Marxist insurgencies in Guatemala , El Salvador , and Nicaragua . Cuba gradually withdrew its troops from Angola in 1989–91. An important psychological and political aspect of the Cuban military involvement in Africa was the significant presence of black or mixed-race soldiers among the Cuban forces. [lower-alpha 18] According to one source, more than 300,000 Cuban military personnel and civilian experts were deployed in Africa. The source also states that out of the 50,000 Cubans sent to Angola, half contracted AIDS and that 10,000 Cubans died as a consequence of their military actions in Africa. Soviet troops began to withdraw from Cuba in September 1991, and Castro's rule was severely tested in the aftermath of the Soviet collapse in December 1991 (known in Cuba as the Special Period ). The country faced a severe economic downturn following the withdrawal of Soviet subsidies worth $4 billion to $6 billion annually, resulting in effects such as food and fuel shortages. The government did not accept American donations of food, medicines and cash until 1993. On 5 August 1994, state security dispersed protesters in a spontaneous protest in Havana. From the start of the crisis to 1995, Cuba saw its gross domestic product (GDP) shrink by 35%. It took another five years for its GDP to reach pre-crisis levels. Cuba has since found a new source of aid and support in the People's Republic of China. In addition, Hugo Chávez , then- President of Venezuela , and Evo Morales , former President of Bolivia , became allies and both countries are major oil and gas exporters. In 2003, the government arrested and imprisoned a large number of civil activists, a period known as the "Black Spring" . In February 2008, Fidel Castro resigned as President of the State Council due to the serious gastrointestinal illness which he had suffered since July 2006. On 24 February, the National Assembly elected his brother Raúl Castro the new president. In his inauguration speech, Raúl promised that some of the restrictions on freedom in Cuba would be removed. In March 2009, Raúl Castro removed some of his brother's appointees . On 3 June 2009, the Organization of American States adopted a resolution to end the 47-year ban on Cuban membership of the group. The resolution stated, however, that full membership would be delayed until Cuba was "in conformity with the practices, purposes, and principles of the OAS". Fidel Castro wrote that Cuba would not rejoin the OAS, which, he said, was a "U.S. Trojan horse" and "complicit" in actions taken by the U.S. against Cuba and other Latin American nations. Effective 14 January 2013, Cuba ended the requirement established in 1961, that any citizens who wish to travel abroad were required to obtain an expensive government permit and a letter of invitation. In 1961 the Cuban government had imposed broad restrictions on travel to prevent the mass emigration of people after the 1959 revolution; it approved exit visas only on rare occasions. Requirements were simplified: Cubans need only a passport and a national ID card to leave; and they are allowed to take their young children with them for the first time. However, a passport costs on average five months' salary. Observers expect that Cubans with paying relatives abroad are most likely to be able to take advantage of the new policy. In the first year of the program, over 180,000 left Cuba and returned. As of December 2014 [ update ] , talks with Cuban officials and American officials, including President Barack Obama , resulted in the release of Alan Gross , fifty-two political prisoners, and an unnamed non-citizen agent of the United States in return for the release of three Cuban agents currently imprisoned in the United States. Additionally, while the embargo between the United States and Cuba was not immediately lifted, it was relaxed to allow import, export, and certain limited commerce. Raúl Castro stepped down from the presidency on 19 April 2018 and Miguel Díaz-Canel was elected president by the National Assembly following parliamentary elections . Raúl Castro remained the First Secretary of the Communist Party and retained broad authority, including oversight over the president. Cuba approved a new constitution in 2019. The optional vote attracted 84.4% of eligible voters. 90% of those who voted approved of the new constitution and 9% opposed it. The new constitution states that the Communist Party is the only legitimate political party, describes access to health and education as fundamental rights, imposes presidential term limits, enshrines the right to legal representation upon arrest, recognizes private property, and strengthens the rights of multinationals investing with the state. Any form of discrimination harmful to human dignity is banned under the new constitution. Raúl Castro announced at the Eighth Congress of the Communist Party of Cuba , which began on 16 April 2021, that he was retiring as secretary of the Communist Party. His successor, Miguel Díaz-Canel, was voted in on 19 April. In July 2021, there were several large protests against the government under the banner of Patria y Vida . Cuban exiles also conducted protests overseas. The song associated with the movement received international acclaim including a Latin Grammy Award . On 25 September 2022, Cuba approved a referendum which amended the Family Code to legalise same-sex marriage and allow surrogate pregnancy and same-sex adoption . Gender reassignment surgery and transgender hormone therapy are provided free of charge under Cuba's national healthcare system. The proposed changes were supported by the government and opposed by conservatives and parts of the opposition. Official policies of the Cuban government from 1959 until the 1990s were hostile towards homosexuality, with the LGBT community marginalized on the basis of heteronormativity , traditional gender roles , and strict criteria for moralism . Humans first settled Cuba around 6,000 years ago, descending from migrations from northern South America or Central America. The arrival of humans on Cuba is associated with extinctions of the islands native fauna, particularly its endemic sloths . The Arawakan -speaking ancestors of the Taino people arrived in Cuba in a separate migration from South America around 1,700 years ago. Unlike the previous settlers of Cuba, the Taino practised the production of pottery and intensive agriculture. Descendants of the first settlers of Cuba persisted on the western part of the island until Columbian contact, where they were recorded as the Guanahatabey people, who lived a hunter gatherer lifestyle. After first landing on an island then called Guanahani , Bahamas , on 12 October 1492, Christopher Columbus commanded his three ships: La Pinta , La Niña and the Santa María , discovering Cuba on 27 October 1492, and landing in the northeastern coast on 28 October. (This was near what is now Bariay, Holguín Province .) Columbus claimed the island for the new Kingdom of Spain and named it Isla Juana after John, Prince of Asturias . In 1511, the first Spanish settlement was founded by Diego Velázquez de Cuéllar at Baracoa . Other settlements soon followed, including San Cristobal de la Habana , founded in 1514 (southern coast of the island) and then in 1519 (current place), which later became the capital (1607). The indigenous Taíno were forced to work under the encomienda system, which resembled the feudal system in medieval Europe. Within a century, the indigenous people were virtually wiped out due to multiple factors, primarily Eurasian infectious diseases , to which they had no natural resistance (immunity), aggravated by the harsh conditions of the repressive colonial subjugation. In 1529, a measles outbreak in Cuba killed two-thirds of those few natives who had previously survived smallpox . On 18 May 1539, conquistador Hernando de Soto departed from Havana with some 600 followers into a vast expedition through the American Southeast , starting in Florida , in search of gold, treasure, fame and power. On 1 September 1548, Gonzalo Perez de Angulo was appointed governor of Cuba. He arrived in Santiago, Cuba, on 4 November 1549, and immediately declared the liberty of all natives. He became Cuba's first permanent governor to reside in Havana instead of Santiago, and he built Havana's first church made of masonry. [lower-alpha 5] By 1570, most residents of Cuba comprised a mixture of Spanish, African, and Taíno heritages. Cuba developed slowly and, unlike the plantation islands of the Caribbean, had a diversified agriculture. Most importantly, the colony developed as an urbanized society that primarily supported the Spanish colonial empire. By the mid-18th century, there were 50,000 slaves on the island, compared to 60,000 in Barbados and 300,000 in Virginia ; as well as 450,000 in Saint-Domingue , all of which had large-scale sugarcane plantations. The Seven Years' War , which erupted in 1754 across three continents, eventually arrived in the Spanish Caribbean . Spain's alliance with the French pitched them into direct conflict with the British , and in 1762, a British expedition consisting of dozens of ships and thousands of troops set out from Portsmouth to capture Cuba. The British arrived on 6 June, and by August, had placed Havana under siege . When Havana surrendered, the admiral of the British fleet, George Pocock and the commander of the land forces George Keppel , the 3rd Earl of Albemarle , entered the city, and took control of the western part of the island. The British immediately opened up trade with their North American and Caribbean colonies, causing a rapid transformation of Cuban society. Though Havana, which had become the third-largest city in the Americas, was to enter an era of sustained development and increasing ties with North America during this period, the British occupation of the city proved short-lived. Pressure from London to sugar merchants, fearing a decline in sugar prices, forced negotiations with the Spanish over the captured territories. [ clarification needed ] Less than a year after Britain captured Havana, it signed the 1763 Treaty of Paris together with France and Spain, ending the Seven Years' War. The treaty gave Britain Florida in exchange for Cuba. [lower-alpha 6] Cubans constituted one of the many diverse units which fought alongside Spanish forces during the conquest of British West Florida (1779–81). The largest factor for the growth of Cuba's commerce in the late eighteenth and early nineteenth century was the Haitian Revolution . When the enslaved peoples of what had been the Caribbean's richest colony freed themselves through violent revolt, Cuban planters perceived the region's changing circumstances with both a sense of fear and opportunity. They were afraid because of the prospect that slaves might revolt in Cuba as well, and numerous prohibitions during the 1790s of the sale of slaves in Cuba who had previously been enslaved in French colonies underscored this anxiety. The planters saw opportunity, however, because they thought that they could exploit the situation by transforming Cuba into the slave society and sugar-producing "pearl of the Antilles" that Haiti had been before the revolution. As the historian Ada Ferrer has written, "At a basic level, liberation in Saint-Domingue helped entrench its denial in Cuba. As slavery and colonialism collapsed in the French colony, the Spanish island underwent transformations that were almost the mirror image of Haiti's." Estimates suggest that between 1790 and 1820 some 325,000 Africans were imported to Cuba as slaves, which was four times the amount that had arrived between 1760 and 1790. Although a smaller proportion of the population of Cuba was enslaved, at times, slaves arose in revolt. In 1812, the Aponte Slave Rebellion took place, but it was ultimately suppressed. The population of Cuba in 1817 was 630,980 (of which 291,021 were white, 115,691 were free people of color (mixed-race), and 224,268 black slaves). [lower-alpha 7] In part due to Cuban slaves working primarily in urbanized settings, by the 19th century, the practice of coartacion had developed (or "buying oneself out of slavery", a "uniquely Cuban development"), according to historian Herbert S. Klein. Due to a shortage of white labor, blacks dominated urban industries "to such an extent that when whites in large numbers came to Cuba in the middle of the nineteenth century, they were unable to displace Negro workers." A system of diversified agriculture, with small farms and fewer slaves, served to supply the cities with produce and other goods. In the 1820s, when the rest of Spain's empire in Latin America rebelled and formed independent states , Cuba remained loyal to Spain. Its economy was based on serving the empire. By 1860, Cuba had 213,167 free people of color (39% of its non-white population of 550,000). [lower-alpha 8]Full independence from Spain was the goal of a rebellion in 1868 led by planter Carlos Manuel de Céspedes . De Céspedes, a sugar planter, freed his slaves to fight with him for an independent Cuba. On 27 December 1868, he issued a decree condemning slavery in theory but accepting it in practice and declaring free any slaves whose masters present them for military service. The 1868 rebellion resulted in a prolonged conflict known as the Ten Years' War . A great number of the rebels were volunteers from the Dominican Republic , [lower-alpha 10] and other countries, as well as numerous Chinese indentured servants . [lower-alpha 11] [lower-alpha 12] The United States declined to recognize the new Cuban government, although many European and Latin American nations did so. In 1878, the Pact of Zanjón ended the conflict, with Spain promising greater autonomy to Cuba. [lower-alpha 13] In 1879–80, Cuban patriot Calixto García attempted to start another war known as the Little War but failed to receive enough support. Slavery in Cuba was abolished in 1875 but the process was completed only in 1886. An exiled dissident named José Martí founded the Cuban Revolutionary Party in New York City in 1892. The aim of the party was to achieve Cuban independence from Spain. In January 1895, Martí traveled to Monte Cristi and Santo Domingo in the Dominican Republic to join the efforts of Máximo Gómez . Martí recorded his political views in the Manifesto of Montecristi . Fighting against the Spanish army began in Cuba on 24 February 1895, but Martí was unable to reach Cuba until 11 April 1895. Martí was killed in the Battle of Dos Rios on 19 May 1895. His death immortalized him as Cuba's national hero. Around 200,000 Spanish troops outnumbered the much smaller rebel army, which relied mostly on guerrilla and sabotage tactics. The Spaniards began a campaign of suppression. General Valeriano Weyler , the military governor of Cuba, herded the rural population into what he called reconcentrados , described by international observers as "fortified towns". These are often considered the prototype for 20th-century concentration camps . Between 200,000 and 400,000 Cuban civilians died from starvation and disease in the Spanish concentration camps, numbers verified by the Red Cross and United States Senator Redfield Proctor , a former Secretary of War . American and European protests against Spanish conduct on the island followed. The U.S. battleship USS Maine was sent to protect American interests, but soon after arrival, it exploded in Havana harbor and sank quickly, killing nearly three-quarters of the crew. The cause and responsibility for the sinking of the ship remained unclear after a board of inquiry. Popular opinion in the U.S., fueled by an active press , concluded that the Spanish were to blame and demanded action. Spain and the United States declared war on each other in late April 1898. [lower-alpha 14] [lower-alpha 15]After the Spanish–American War , Spain and the United States signed the Treaty of Paris (1898) , by which Spain ceded Puerto Rico , the Philippines , and Guam to the United States for the sum of US$20 million and Cuba became a protectorate of the United States. Cuba gained formal independence from the U.S. on 20 May 1902, as the Republic of Cuba. Under Cuba's new constitution, the U.S. retained the right to intervene in Cuban affairs and to supervise its finances and foreign relations. Under the Platt Amendment , the U.S. leased the Guantánamo Bay Naval Base from Cuba. Following disputed elections in 1906, the first president, Tomás Estrada Palma , faced an armed revolt by independence war veterans who defeated the meager government forces. The U.S. intervened by occupying Cuba and named Charles Edward Magoon as Governor for three years. Cuban historians have characterized Magoon's governorship as having introduced political and social corruption. In 1908, self-government was restored when José Miguel Gómez was elected president, but the U.S. continued intervening in Cuban affairs. In 1912, the Partido Independiente de Color attempted to establish a separate black republic in Oriente Province, but was suppressed by General Monteagudo with considerable bloodshed. In 1924, Gerardo Machado was elected president. During his administration, tourism increased markedly, and American-owned hotels and restaurants were built to accommodate the influx of tourists. The tourist boom led to increases in gambling and prostitution in Cuba . The Wall Street Crash of 1929 led to a collapse in the price of sugar, political unrest, and repression. Protesting students, known as the Generation of 1930, turned to violence in opposition to the increasingly unpopular Machado. A general strike (in which the Communist Party sided with Machado), uprisings among sugar workers, and an army revolt forced Machado into exile in August 1933. He was replaced by Carlos Manuel de Céspedes y Quesada . In September 1933, the Sergeants' Revolt , led by Sergeant Fulgencio Batista , overthrew Céspedes. A five-member executive committee (the Pentarchy of 1933 ) was chosen to head a provisional government. Ramón Grau San Martín was then appointed as provisional president. Grau resigned in 1934, leaving the way clear for Batista, who dominated Cuban politics for the next 25 years, at first through a series of puppet-presidents. The period from 1933 to 1937 was a time of "virtually unremitting social and political warfare". On balance, during the period 1933–1940 Cuba suffered from fragile politic structures, reflected in the fact that it saw three different presidents in two years (1935–1936), and in the militaristic and repressive policies of Batista as Head of the Army. A new constitution was adopted in 1940, which engineered radical progressive ideas, including the right to labor and health care. Batista was elected president in the same year, holding the post until 1944. He is so far the only non-white Cuban to win the nation's highest political office. His government carried out major social reforms. Several members of the Communist Party held office under his administration. Cuban armed forces were not greatly involved in combat during World War II—though president Batista did suggest a joint U.S.-Latin American assault on Francoist Spain to overthrow its authoritarian regime. Cuba lost six merchant ships during the war, and the Cuban Navy was credited with sinking the German submarine U-176 . Batista adhered to the 1940 constitution's strictures preventing his re-election. Ramon Grau San Martin was the winner of the next election, in 1944. Grau further corroded the base of the already teetering legitimacy of the Cuban political system, in particular by undermining the deeply flawed, though not entirely ineffectual, Congress and Supreme Court. Carlos Prío Socarrás , a protégé of Grau, became president in 1948. The two terms of the Auténtico Party brought an influx of investment, which fueled an economic boom, raised living standards for all segments of society, and created a middle class in most urban areas. After finishing his term in 1944 Batista lived in Florida, returning to Cuba to run for president in 1952. Facing certain electoral defeat, he led a military coup that preempted the election. Back in power, and receiving financial, military, and logistical support from the United States government, Batista suspended the 1940 Constitution and revoked most political liberties, including the right to strike . He then aligned with the wealthiest landowners who owned the largest sugar plantations , and presided over a stagnating economy that widened the gap between rich and poor Cubans. Batista outlawed the Cuban Communist Party in 1952. After the coup, Cuba had Latin America's highest per capita consumption rates of meat, vegetables, cereals, automobiles, telephones and radios, though about one-third of the population was considered poor and enjoyed relatively little of this consumption. However, in his " History Will Absolve Me " speech, Fidel Castro mentioned that national issues relating to land, industrialization, housing, unemployment, education, and health were contemporary problems. In 1958, Cuba was a well-advanced country in comparison to other Latin American regions. Cuba was also affected by perhaps the largest labor union privileges in Latin America, including bans on dismissals and mechanization. They were obtained in large measure "at the cost of the unemployed and the peasants", leading to disparities. Between 1933 and 1958, Cuba extended economic regulations enormously, causing economic problems. Unemployment became a problem as graduates entering the workforce could not find jobs. The middle class, which was comparable to that of the United States [ how? ] , became increasingly dissatisfied with unemployment and political persecution. The labor unions, manipulated by the previous government since 1948 through union "yellowness", supported Batista until the very end. Batista stayed in power until he resigned in December 1958 under the pressure of the US Embassy and as the revolutionary forces headed by Fidel Castro were winning militarily (Santa Clara city, a strategic point in the middle of the country, fell into the rebels hands on December 31, in a conflict known as the Battle of Santa Clara ). After the Spanish–American War , Spain and the United States signed the Treaty of Paris (1898) , by which Spain ceded Puerto Rico , the Philippines , and Guam to the United States for the sum of US$20 million and Cuba became a protectorate of the United States. Cuba gained formal independence from the U.S. on 20 May 1902, as the Republic of Cuba. Under Cuba's new constitution, the U.S. retained the right to intervene in Cuban affairs and to supervise its finances and foreign relations. Under the Platt Amendment , the U.S. leased the Guantánamo Bay Naval Base from Cuba. Following disputed elections in 1906, the first president, Tomás Estrada Palma , faced an armed revolt by independence war veterans who defeated the meager government forces. The U.S. intervened by occupying Cuba and named Charles Edward Magoon as Governor for three years. Cuban historians have characterized Magoon's governorship as having introduced political and social corruption. In 1908, self-government was restored when José Miguel Gómez was elected president, but the U.S. continued intervening in Cuban affairs. In 1912, the Partido Independiente de Color attempted to establish a separate black republic in Oriente Province, but was suppressed by General Monteagudo with considerable bloodshed. In 1924, Gerardo Machado was elected president. During his administration, tourism increased markedly, and American-owned hotels and restaurants were built to accommodate the influx of tourists. The tourist boom led to increases in gambling and prostitution in Cuba . The Wall Street Crash of 1929 led to a collapse in the price of sugar, political unrest, and repression. Protesting students, known as the Generation of 1930, turned to violence in opposition to the increasingly unpopular Machado. A general strike (in which the Communist Party sided with Machado), uprisings among sugar workers, and an army revolt forced Machado into exile in August 1933. He was replaced by Carlos Manuel de Céspedes y Quesada . In September 1933, the Sergeants' Revolt , led by Sergeant Fulgencio Batista , overthrew Céspedes. A five-member executive committee (the Pentarchy of 1933 ) was chosen to head a provisional government. Ramón Grau San Martín was then appointed as provisional president. Grau resigned in 1934, leaving the way clear for Batista, who dominated Cuban politics for the next 25 years, at first through a series of puppet-presidents. The period from 1933 to 1937 was a time of "virtually unremitting social and political warfare". On balance, during the period 1933–1940 Cuba suffered from fragile politic structures, reflected in the fact that it saw three different presidents in two years (1935–1936), and in the militaristic and repressive policies of Batista as Head of the Army.A new constitution was adopted in 1940, which engineered radical progressive ideas, including the right to labor and health care. Batista was elected president in the same year, holding the post until 1944. He is so far the only non-white Cuban to win the nation's highest political office. His government carried out major social reforms. Several members of the Communist Party held office under his administration. Cuban armed forces were not greatly involved in combat during World War II—though president Batista did suggest a joint U.S.-Latin American assault on Francoist Spain to overthrow its authoritarian regime. Cuba lost six merchant ships during the war, and the Cuban Navy was credited with sinking the German submarine U-176 . Batista adhered to the 1940 constitution's strictures preventing his re-election. Ramon Grau San Martin was the winner of the next election, in 1944. Grau further corroded the base of the already teetering legitimacy of the Cuban political system, in particular by undermining the deeply flawed, though not entirely ineffectual, Congress and Supreme Court. Carlos Prío Socarrás , a protégé of Grau, became president in 1948. The two terms of the Auténtico Party brought an influx of investment, which fueled an economic boom, raised living standards for all segments of society, and created a middle class in most urban areas. After finishing his term in 1944 Batista lived in Florida, returning to Cuba to run for president in 1952. Facing certain electoral defeat, he led a military coup that preempted the election. Back in power, and receiving financial, military, and logistical support from the United States government, Batista suspended the 1940 Constitution and revoked most political liberties, including the right to strike . He then aligned with the wealthiest landowners who owned the largest sugar plantations , and presided over a stagnating economy that widened the gap between rich and poor Cubans. Batista outlawed the Cuban Communist Party in 1952. After the coup, Cuba had Latin America's highest per capita consumption rates of meat, vegetables, cereals, automobiles, telephones and radios, though about one-third of the population was considered poor and enjoyed relatively little of this consumption. However, in his " History Will Absolve Me " speech, Fidel Castro mentioned that national issues relating to land, industrialization, housing, unemployment, education, and health were contemporary problems. In 1958, Cuba was a well-advanced country in comparison to other Latin American regions. Cuba was also affected by perhaps the largest labor union privileges in Latin America, including bans on dismissals and mechanization. They were obtained in large measure "at the cost of the unemployed and the peasants", leading to disparities. Between 1933 and 1958, Cuba extended economic regulations enormously, causing economic problems. Unemployment became a problem as graduates entering the workforce could not find jobs. The middle class, which was comparable to that of the United States [ how? ] , became increasingly dissatisfied with unemployment and political persecution. The labor unions, manipulated by the previous government since 1948 through union "yellowness", supported Batista until the very end. Batista stayed in power until he resigned in December 1958 under the pressure of the US Embassy and as the revolutionary forces headed by Fidel Castro were winning militarily (Santa Clara city, a strategic point in the middle of the country, fell into the rebels hands on December 31, in a conflict known as the Battle of Santa Clara ). In the 1950s, various organizations, including some advocating armed uprising, competed for public support in bringing about political change. In 1956, Fidel Castro and about 80 supporters landed from the yacht Granma in an attempt to start a rebellion against the Batista government. In 1958, Castro's July 26th Movement emerged as the leading revolutionary group. The U.S. supported Castro by imposing a 1958 arms embargo against Batista's government. Batista evaded the American embargo and acquired weapons from the Dominican Republic. [lower-alpha 16] By late 1958, the rebels had broken out of the Sierra Maestra and launched a general popular insurrection . After Castro's fighters captured Santa Clara , Batista fled with his family to the Dominican Republic on 1 January 1959. Later he went into exile on the Portuguese island of Madeira and finally settled in Estoril, near Lisbon. Fidel Castro's forces entered the capital on 8 January 1959. The liberal Manuel Urrutia Lleó became the provisional president. According to Amnesty International , official death sentences from 1959 to 1987 numbered 237 of which all but 21 were carried out. The vast majority of those executed directly following the 1959 Revolution were policemen, politicians, and informers of the Batista regime accused of crimes such as torture and murder, and their public trials and executions had widespread popular support among the Cuban population. The United States government initially reacted favorably to the Cuban Revolution, seeing it as part of a movement to bring democracy to Latin America. Castro's legalization of the Communist Party and the hundreds of executions of Batista agents, policemen, and soldiers that followed caused a deterioration in the relationship between the two countries. The promulgation of the Agrarian Reform Law , expropriating thousands of acres of farmland (including from large U.S. landholders), further worsened relations. In response, between 1960 and 1964 the U.S. imposed a range of sanctions, eventually including a total ban on trade between the countries and a freeze on all Cuban-owned assets in the U.S. In February 1960, Castro signed a commercial agreement with Soviet Vice-Premier Anastas Mikoyan . In March 1960, U.S. President Dwight D. Eisenhower gave his approval to a CIA plan to arm and train a group of Cuban refugees to overthrow the Castro government. The invasion (known as the Bay of Pigs Invasion ) took place on 14 April 1961, during the term of President John F. Kennedy . About 1,400 Cuban exiles disembarked at the Bay of Pigs . Cuban troops and local militias defeated the invasion, killing over 100 invaders and taking the remainder prisoner. In January 1962, Cuba was suspended from the Organization of American States (OAS), and later the same year the OAS started to impose sanctions against Cuba of similar nature to the U.S. sanctions. The Cuban Missile Crisis of October 1962 almost sparked World War III . In 1962 American generals proposed Operation Northwoods which would entail committing terrorist attacks in American cities and against refugees and falsely blaming the attacks on the Cuban government, manufacturing a reason for the United States to invade Cuba. This plan was rejected by President Kennedy. By 1963, Cuba was moving towards a full-fledged communist system modelled on the USSR. During the Cold War, Cuban forces were deployed to all corners of Africa, either as military advisors or as combatants. In 1963, Cuba sent 686 troops together with 22 tanks and other military equipment to support Algeria in the Sand War against Morocco. The Cuban forces remained in Algeria for over a year, providing training to the Algerian army. In 1964, Cuba organized a meeting of Latin American communists in Havana and stoked a civil war in the capital of the Dominican Republic in 1965, which prompted 20,000 U.S. troops to intervene there. Che Guevara engaged in guerrilla activities in Africa and was killed in 1967 while attempting to start a revolution in Bolivia . During the 1970s, Fidel Castro dispatched tens of thousands of troops in support of Soviet-backed wars in Africa. He supported the MPLA in Angola ( Angolan Civil War ) and Mengistu Haile Mariam in Ethiopia ( Ogaden War ). In November 1975, Cuba deployed more than 65,000 troops and 400 Soviet-made tanks in Angola in one of the fastest military mobilizations in history. South Africa developed nuclear weapons due to the threat to its security posed by the presence of large numbers of Cuban troops in Angola . In 1976 and again in 1988 at the Battle of Cuito Cuanavale , the Cubans alongside their MPLA allies defeated UNITA rebels and apartheid South African forces. [lower-alpha 17] In December 1977, Cuba sent its combat troops from Angola, the People's Republic of the Congo, and the Caribbean to Ethiopia, assisted by mechanized Soviet battalions, to help defeat a Somali invasion. On 24 January 1978, Ethiopian and Cuban troops counterattacked, inflicting 3,000 casualties on the Somali forces. In February, Cuban troops launched a major offensive and forced the Somali army back into its own territory. Cuban forces remained in Ethiopia until 9 September 1989. Despite Cuba's small size and the long distance separating it from the Middle East, Castro's Cuba played an active role in the region during the Cold War. In 1972, a major Cuban military mission consisting of tank, air, and artillery specialists was dispatched to South Yemen . Cuban military advisors were sent to Iraq in the mid-1970s but their mission was canceled after Iraq invaded Iran in 1980. The Cubans were also involved in the Syrian-Israeli War of Attrition (November 1973–May 1974) that followed the Yom Kippur War (October 1973). Israeli sources reported the presence of a Cuban tank brigade in the Golan Heights , which was supported by two brigades. The Israelis and the Cuban-Syrian tank forces engaged in battle on the Golan front. : 37–38 The standard of living in the 1970s was "extremely spartan" and discontent was rife. Fidel Castro admitted the failures of economic policies in a 1970 speech. In 1975, the OAS lifted its sanctions against Cuba, with the approval of 16 member states, including the United States. The U.S., however, maintained its own sanctions. In 1979, the U.S. objected to the presence of Soviet combat troops on the island. Following the 1983 coup that resulted in the execution of Grenadian Prime Minister Maurice Bishop and establishment of the military government led by Hudson Austin , U.S. forces invaded Grenada in 1983, overthrowing the regime. Most resistance came from Cuban construction workers, while the Grenadan People's Revolutionary Army and militia surrendered without putting up much of a fight. 24 Cubans were killed, with only 2 of them being professional soldiers, and the remainder were expelled from the island. U.S. casualties amounted to 19 killed, 116 wounded, and 9 helicopters destroyed. During the 1970s and 1980s, Castro supported Marxist insurgencies in Guatemala , El Salvador , and Nicaragua . Cuba gradually withdrew its troops from Angola in 1989–91. An important psychological and political aspect of the Cuban military involvement in Africa was the significant presence of black or mixed-race soldiers among the Cuban forces. [lower-alpha 18] According to one source, more than 300,000 Cuban military personnel and civilian experts were deployed in Africa. The source also states that out of the 50,000 Cubans sent to Angola, half contracted AIDS and that 10,000 Cubans died as a consequence of their military actions in Africa. Soviet troops began to withdraw from Cuba in September 1991, and Castro's rule was severely tested in the aftermath of the Soviet collapse in December 1991 (known in Cuba as the Special Period ). The country faced a severe economic downturn following the withdrawal of Soviet subsidies worth $4 billion to $6 billion annually, resulting in effects such as food and fuel shortages. The government did not accept American donations of food, medicines and cash until 1993. On 5 August 1994, state security dispersed protesters in a spontaneous protest in Havana. From the start of the crisis to 1995, Cuba saw its gross domestic product (GDP) shrink by 35%. It took another five years for its GDP to reach pre-crisis levels. Cuba has since found a new source of aid and support in the People's Republic of China. In addition, Hugo Chávez , then- President of Venezuela , and Evo Morales , former President of Bolivia , became allies and both countries are major oil and gas exporters. In 2003, the government arrested and imprisoned a large number of civil activists, a period known as the "Black Spring" . In February 2008, Fidel Castro resigned as President of the State Council due to the serious gastrointestinal illness which he had suffered since July 2006. On 24 February, the National Assembly elected his brother Raúl Castro the new president. In his inauguration speech, Raúl promised that some of the restrictions on freedom in Cuba would be removed. In March 2009, Raúl Castro removed some of his brother's appointees . On 3 June 2009, the Organization of American States adopted a resolution to end the 47-year ban on Cuban membership of the group. The resolution stated, however, that full membership would be delayed until Cuba was "in conformity with the practices, purposes, and principles of the OAS". Fidel Castro wrote that Cuba would not rejoin the OAS, which, he said, was a "U.S. Trojan horse" and "complicit" in actions taken by the U.S. against Cuba and other Latin American nations. Effective 14 January 2013, Cuba ended the requirement established in 1961, that any citizens who wish to travel abroad were required to obtain an expensive government permit and a letter of invitation. In 1961 the Cuban government had imposed broad restrictions on travel to prevent the mass emigration of people after the 1959 revolution; it approved exit visas only on rare occasions. Requirements were simplified: Cubans need only a passport and a national ID card to leave; and they are allowed to take their young children with them for the first time. However, a passport costs on average five months' salary. Observers expect that Cubans with paying relatives abroad are most likely to be able to take advantage of the new policy. In the first year of the program, over 180,000 left Cuba and returned. As of December 2014 [ update ] , talks with Cuban officials and American officials, including President Barack Obama , resulted in the release of Alan Gross , fifty-two political prisoners, and an unnamed non-citizen agent of the United States in return for the release of three Cuban agents currently imprisoned in the United States. Additionally, while the embargo between the United States and Cuba was not immediately lifted, it was relaxed to allow import, export, and certain limited commerce. Raúl Castro stepped down from the presidency on 19 April 2018 and Miguel Díaz-Canel was elected president by the National Assembly following parliamentary elections . Raúl Castro remained the First Secretary of the Communist Party and retained broad authority, including oversight over the president. Cuba approved a new constitution in 2019. The optional vote attracted 84.4% of eligible voters. 90% of those who voted approved of the new constitution and 9% opposed it. The new constitution states that the Communist Party is the only legitimate political party, describes access to health and education as fundamental rights, imposes presidential term limits, enshrines the right to legal representation upon arrest, recognizes private property, and strengthens the rights of multinationals investing with the state. Any form of discrimination harmful to human dignity is banned under the new constitution. Raúl Castro announced at the Eighth Congress of the Communist Party of Cuba , which began on 16 April 2021, that he was retiring as secretary of the Communist Party. His successor, Miguel Díaz-Canel, was voted in on 19 April. In July 2021, there were several large protests against the government under the banner of Patria y Vida . Cuban exiles also conducted protests overseas. The song associated with the movement received international acclaim including a Latin Grammy Award . On 25 September 2022, Cuba approved a referendum which amended the Family Code to legalise same-sex marriage and allow surrogate pregnancy and same-sex adoption . Gender reassignment surgery and transgender hormone therapy are provided free of charge under Cuba's national healthcare system. The proposed changes were supported by the government and opposed by conservatives and parts of the opposition. Official policies of the Cuban government from 1959 until the 1990s were hostile towards homosexuality, with the LGBT community marginalized on the basis of heteronormativity , traditional gender roles , and strict criteria for moralism . The Republic of Cuba is one of the few socialist countries following the Marxist–Leninist ideology. The Constitution of 1976, which defined Cuba as a socialist republic , was replaced by the Constitution of 1992, which is "guided by the ideas of José Martí and the political and social ideas of Marx , Engels and Lenin ." The constitution describes the Communist Party of Cuba as the "leading force of society and of the state". The political system in Cuba reflects the Marxist–Leninist concept of democratic centralism . : 38 The First Secretary of the Communist Party of Cuba is the most senior position in the one-party state . The First Secretary leads the Politburo and the Secretariat , making the office holder the most powerful person in Cuban government . Members of both councils are elected by the National Assembly of People's Power . The President of Cuba, who is also elected by the Assembly, serves for five years and since the ratification of the 2019 Constitution, there is a limit of two consecutive five-year terms. The People's Supreme Court serves as Cuba's highest judicial branch of government. It is also the court of last resort for all appeals against the decisions of provincial courts. Cuba's national legislature, the National Assembly of People's Power ( Asamblea Nacional de Poder Popular ), is the supreme organ of power; 609 members serve five-year terms. The assembly meets twice a year; between sessions legislative power is held by the 31 member Council of Ministers. Candidates for the Assembly are approved by public referendum. All Cuban citizens over 16 who have not been convicted of a criminal offense can vote. Article 131 of the Constitution states that voting shall be "through free, equal and secret vote". Article 136 states: "In order for deputies or delegates to be considered elected they must get more than half the number of valid votes cast in the electoral districts". There are elections in Cuba , but they are not considered democratic. In elections for the National Assembly of People's Power there is only one candidate for each seat, and candidates are nominated by committees that are firmly controlled by the Communist Party. Most legislative districts elect multiple representatives to the Assembly. Voters can select individual candidates on their ballot , select every candidate, or leave every question blank, with no option to vote against candidates. No political party is permitted to nominate candidates or campaign on the island, including the Communist Party. The Communist Party of Cuba has held six party congress meetings since 1975. In 2011, the party stated that there were 800,000 members, and representatives generally constitute at least half of the Councils of state and the National Assembly. The remaining positions are filled by candidates nominally without party affiliation. Other political parties campaign and raise finances internationally, while activity within Cuba by opposition groups is minimal. Cuba is considered an authoritarian regime according to The Economist 's Democracy Index and Freedom in the World reports. More specifically, Cuba is considered a military dictatorship in the Democracy-Dictatorship Index , and has been described as "a militarized society" with the armed forces having long been the most powerful institution in the country. In February 2013, President of the State Council Raúl Castro announced he would resign in 2018, ending his five-year term, and that he hopes to implement permanent term limits for future Cuban presidents, including age limits. After Fidel Castro died on 25 November 2016, the Cuban government declared a nine-day mourning period. During the mourning period Cuban citizens were prohibited from playing loud music, partying, and drinking alcohol. Miguel Díaz-Canel was elected president on 18 April 2018 after the resignation of Raúl Castro. On 19 April 2021, Miguel Díaz-Canel became First Secretary of the Communist Party. He is the first non-Castro to be in such top position since the Cuban revolution of 1959. Cuba has conducted a foreign policy that is uncharacteristic of such a minor, developing country. Under Castro, Cuba was heavily involved in wars in Africa, Central America and Asia. Cuba supported Algeria in 1961–1965, and sent tens of thousands of troops to Angola during the Angolan Civil War . Other countries that featured Cuban involvement include Ethiopia , Guinea , Guinea-Bissau , Mozambique , and Yemen . Lesser known actions include the 1959 missions to the Dominican Republic . The expedition failed, but a prominent monument to its members was erected in their memory in Santo Domingo by the Dominican government, and they feature prominently at the country's Memorial Museum of the Resistance. In 2008, the European Union (EU) and Cuba agreed to resume full relations and cooperation activities. Cuba is a founding member of the Bolivarian Alliance for the Americas . At the end of 2012, tens of thousands of Cuban medical personnel worked abroad, with as many as 30,000 doctors in Venezuela alone via the two countries' oil-for-doctors programme. In 1996, the United States, then under President Bill Clinton , brought in the Cuban Liberty and Democratic Solidarity Act , better known as the Helms–Burton Act . [lower-alpha 19] In 2009, United States President Barack Obama stated on 17 April, in Trinidad and Tobago that "the United States seeks a new beginning with Cuba", and reversed the Bush Administration 's prohibition on travel and remittances by Cuban-Americans from the United States to Cuba. Five years later, an agreement between the United States and Cuba, popularly called the " Cuban thaw ", brokered in part by Canada and Pope Francis , began the process of restoring international relations between the two countries. They agreed to release political prisoners and the United States began the process of creating an embassy in Havana. This was realized on 30 June 2015, when Cuba and the U.S. reached a deal to reopen embassies in their respective capitals on 20 July 2015 and reestablish diplomatic relations. Earlier in the same year, the White House announced that President Obama would remove Cuba from the American government's list of nations that sponsor terrorism, which Cuba reportedly welcomed as "fair". On 17 September 2017, the United States considered closing its Cuban embassy following mysterious medical symptoms experienced by its staff. In the wake of the Russian invasion of Ukraine and the ongoing international isolation of Russia, Cuba emerged as one of the few countries that maintained friendly relations with the Russian Federation. Cuban president Miguel Diaz-Canel visited Vladimir Putin in Moscow in November 2022, where the two leaders opened a monument of Fidel Castro, as well as speaking out against U.S. sanctions against Russia and Cuba. Since 1960, the U.S. embargo on Cuba stands as one of the longest-running trade and economic measures in bilateral relations history, having endured for almost six decades. This action was instated in response to a wave of nationalizations that impacted American properties valued at over US$1 billion, the then U.S. President, Dwight Eisenhower , instated an embargo that prohibited all exports to Cuba, with the exception of medicines and certain foods. This measure was intensified in 1962 under the administration of John F. Kennedy , extending the restrictions to Cuban imports, based on the Foreign Assistance Act approved by Congress in 1961. During the Missile Crisis in 1962, the United States even imposed a naval blockade on Cuba, but this was lifted following the resolution of the crisis. The embargo, however, remained in place and has been modified on several occasions over the years. The Cuban Democracy Act of 1992 states that sanctions will continue "so long as it continues to refuse to move toward democratization and greater respect for human rights". [ non-primary source needed ] American diplomat Lester D. Mallory wrote an internal memo on April 6, 1960, arguing in favor of an embargo: "The only foreseeable means of alienating internal support is through disenchantment and disaffection based on economic dissatisfaction and hardship. [...] to decrease monetary and real wages, to bring about hunger, desperation and overthrow of government." The UN General Assembly has passed a resolution every year since 1992 condemning the embargo and stating that it violates the Charter of the United Nations and international law. Cuba considers the embargo a human rights violation. The impact and effectiveness of the embargo have been subjects of intense debate. While some argue it has been "extraordinarily porous" and isn't the primary cause of Cuba's economic hardships, others see it as a pressure mechanism aimed at driving change in the Cuban government. According to Arturo Lopez Levy, a professor of international relations, it would be more appropriate to refer to the measure as a " blockade " or " siege ", as it goes beyond mere trade restrictions. Other critics of the Cuban government argue that the embargo has been used by the regime as an excuse to justify its own economic and political shortcomings. On 17 December 2014, United States President Barack Obama announced the re-establishment of diplomatic relations with Cuba, pushing for Congress to put an end to the embargo, as well as the United States-run Guantanamo Bay detention camp . These diplomatic improvements were later reversed by the Trump Administration, which enacted new rules and re-enforced the business and travel restrictions which were loosened by the Obama Administration. These sanctions were inherited and strengthened by the Biden Administration. Despite the embargo, Cuba has maintained trade relations with other countries. According to 2019 data, China stands as Cuba's main trading partner, followed by countries such as Spain, the Netherlands, Germany, and Cyprus. Cuba's main exports include tobacco, sugar, and alcoholic beverages, while it primarily imports chicken meat, wheat, corn, and condensed milk. As of 2018 [ update ] , Cuba spent about US$91.8 million on its armed forces or 2.9% of its GDP. In 1985, Cuba devoted more than 10% of its GDP to military expenditures. During the Cold War , Cuba built up one of the largest armed forces in Latin America, second only to that of Brazil . From 1975 until the late 1980s, Soviet military assistance enabled Cuba to upgrade its military capabilities. After the loss of Soviet subsidies, Cuba scaled down the numbers of military personnel, from 235,000 in 1994 to about 49,000 in 2021. In 2017, Cuba signed the UN treaty on the Prohibition of Nuclear Weapons . All law enforcement agencies are maintained under Cuba's Ministry of the Interior, which is supervised by the Revolutionary Armed Forces . In Cuba, citizens can receive police assistance by dialing "106" on their telephones. The police force, which is referred to as "Policía Nacional Revolucionaria" or PNR is then expected to provide help. The Cuban government also has an agency called the Intelligence Directorate that conducts intelligence operations and maintains close ties with the Russian Federal Security Service . The US Justice Department considers Cuba a significant counterintelligence threat. The country is subdivided into 15 provinces and one special municipality (Isla de la Juventud). These were formerly part of six larger historical provinces: Pinar del Río, Habana, Matanzas, Las Villas, Camagüey and Oriente. The present subdivisions closely resemble those of the Spanish military provinces during the Cuban Wars of Independence, when the most troublesome areas were subdivided. The provinces are divided into municipalities. In 2003, the European Union (EU) accused the Cuban government of "continuing flagrant violation of human rights and fundamental freedoms". As of 2009 , [ update ] it has continued to call regularly for social and economic reform in Cuba, along with the unconditional release of all political prisoners . Cuba was ranked 19th by the number of imprisoned journalists of any nation in 2021 [ update ] according to various sources, including the Committee to Protect Journalists and Human Rights Watch. Cuba ranks 171st out of 180 on the 2020 [ update ] World Press Freedom Index . In July 2010, the unofficial Cuban Human Rights Commission said there were 167 political prisoners in Cuba, a fall from 201 at the start of the year. The head of the commission stated that long prison sentences were being replaced by harassment and intimidation. Cuba has conducted a foreign policy that is uncharacteristic of such a minor, developing country. Under Castro, Cuba was heavily involved in wars in Africa, Central America and Asia. Cuba supported Algeria in 1961–1965, and sent tens of thousands of troops to Angola during the Angolan Civil War . Other countries that featured Cuban involvement include Ethiopia , Guinea , Guinea-Bissau , Mozambique , and Yemen . Lesser known actions include the 1959 missions to the Dominican Republic . The expedition failed, but a prominent monument to its members was erected in their memory in Santo Domingo by the Dominican government, and they feature prominently at the country's Memorial Museum of the Resistance. In 2008, the European Union (EU) and Cuba agreed to resume full relations and cooperation activities. Cuba is a founding member of the Bolivarian Alliance for the Americas . At the end of 2012, tens of thousands of Cuban medical personnel worked abroad, with as many as 30,000 doctors in Venezuela alone via the two countries' oil-for-doctors programme. In 1996, the United States, then under President Bill Clinton , brought in the Cuban Liberty and Democratic Solidarity Act , better known as the Helms–Burton Act . [lower-alpha 19] In 2009, United States President Barack Obama stated on 17 April, in Trinidad and Tobago that "the United States seeks a new beginning with Cuba", and reversed the Bush Administration 's prohibition on travel and remittances by Cuban-Americans from the United States to Cuba. Five years later, an agreement between the United States and Cuba, popularly called the " Cuban thaw ", brokered in part by Canada and Pope Francis , began the process of restoring international relations between the two countries. They agreed to release political prisoners and the United States began the process of creating an embassy in Havana. This was realized on 30 June 2015, when Cuba and the U.S. reached a deal to reopen embassies in their respective capitals on 20 July 2015 and reestablish diplomatic relations. Earlier in the same year, the White House announced that President Obama would remove Cuba from the American government's list of nations that sponsor terrorism, which Cuba reportedly welcomed as "fair". On 17 September 2017, the United States considered closing its Cuban embassy following mysterious medical symptoms experienced by its staff. In the wake of the Russian invasion of Ukraine and the ongoing international isolation of Russia, Cuba emerged as one of the few countries that maintained friendly relations with the Russian Federation. Cuban president Miguel Diaz-Canel visited Vladimir Putin in Moscow in November 2022, where the two leaders opened a monument of Fidel Castro, as well as speaking out against U.S. sanctions against Russia and Cuba. Since 1960, the U.S. embargo on Cuba stands as one of the longest-running trade and economic measures in bilateral relations history, having endured for almost six decades. This action was instated in response to a wave of nationalizations that impacted American properties valued at over US$1 billion, the then U.S. President, Dwight Eisenhower , instated an embargo that prohibited all exports to Cuba, with the exception of medicines and certain foods. This measure was intensified in 1962 under the administration of John F. Kennedy , extending the restrictions to Cuban imports, based on the Foreign Assistance Act approved by Congress in 1961. During the Missile Crisis in 1962, the United States even imposed a naval blockade on Cuba, but this was lifted following the resolution of the crisis. The embargo, however, remained in place and has been modified on several occasions over the years. The Cuban Democracy Act of 1992 states that sanctions will continue "so long as it continues to refuse to move toward democratization and greater respect for human rights". [ non-primary source needed ] American diplomat Lester D. Mallory wrote an internal memo on April 6, 1960, arguing in favor of an embargo: "The only foreseeable means of alienating internal support is through disenchantment and disaffection based on economic dissatisfaction and hardship. [...] to decrease monetary and real wages, to bring about hunger, desperation and overthrow of government." The UN General Assembly has passed a resolution every year since 1992 condemning the embargo and stating that it violates the Charter of the United Nations and international law. Cuba considers the embargo a human rights violation. The impact and effectiveness of the embargo have been subjects of intense debate. While some argue it has been "extraordinarily porous" and isn't the primary cause of Cuba's economic hardships, others see it as a pressure mechanism aimed at driving change in the Cuban government. According to Arturo Lopez Levy, a professor of international relations, it would be more appropriate to refer to the measure as a " blockade " or " siege ", as it goes beyond mere trade restrictions. Other critics of the Cuban government argue that the embargo has been used by the regime as an excuse to justify its own economic and political shortcomings. On 17 December 2014, United States President Barack Obama announced the re-establishment of diplomatic relations with Cuba, pushing for Congress to put an end to the embargo, as well as the United States-run Guantanamo Bay detention camp . These diplomatic improvements were later reversed by the Trump Administration, which enacted new rules and re-enforced the business and travel restrictions which were loosened by the Obama Administration. These sanctions were inherited and strengthened by the Biden Administration. Despite the embargo, Cuba has maintained trade relations with other countries. According to 2019 data, China stands as Cuba's main trading partner, followed by countries such as Spain, the Netherlands, Germany, and Cyprus. Cuba's main exports include tobacco, sugar, and alcoholic beverages, while it primarily imports chicken meat, wheat, corn, and condensed milk. As of 2018 [ update ] , Cuba spent about US$91.8 million on its armed forces or 2.9% of its GDP. In 1985, Cuba devoted more than 10% of its GDP to military expenditures. During the Cold War , Cuba built up one of the largest armed forces in Latin America, second only to that of Brazil . From 1975 until the late 1980s, Soviet military assistance enabled Cuba to upgrade its military capabilities. After the loss of Soviet subsidies, Cuba scaled down the numbers of military personnel, from 235,000 in 1994 to about 49,000 in 2021. In 2017, Cuba signed the UN treaty on the Prohibition of Nuclear Weapons . All law enforcement agencies are maintained under Cuba's Ministry of the Interior, which is supervised by the Revolutionary Armed Forces . In Cuba, citizens can receive police assistance by dialing "106" on their telephones. The police force, which is referred to as "Policía Nacional Revolucionaria" or PNR is then expected to provide help. The Cuban government also has an agency called the Intelligence Directorate that conducts intelligence operations and maintains close ties with the Russian Federal Security Service . The US Justice Department considers Cuba a significant counterintelligence threat. The country is subdivided into 15 provinces and one special municipality (Isla de la Juventud). These were formerly part of six larger historical provinces: Pinar del Río, Habana, Matanzas, Las Villas, Camagüey and Oriente. The present subdivisions closely resemble those of the Spanish military provinces during the Cuban Wars of Independence, when the most troublesome areas were subdivided. The provinces are divided into municipalities.In 2003, the European Union (EU) accused the Cuban government of "continuing flagrant violation of human rights and fundamental freedoms". As of 2009 , [ update ] it has continued to call regularly for social and economic reform in Cuba, along with the unconditional release of all political prisoners . Cuba was ranked 19th by the number of imprisoned journalists of any nation in 2021 [ update ] according to various sources, including the Committee to Protect Journalists and Human Rights Watch. Cuba ranks 171st out of 180 on the 2020 [ update ] World Press Freedom Index . In July 2010, the unofficial Cuban Human Rights Commission said there were 167 political prisoners in Cuba, a fall from 201 at the start of the year. The head of the commission stated that long prison sentences were being replaced by harassment and intimidation. The Cuban state asserts its adherence to socialist principles in organizing its largely state-controlled planned economy . Most of the means of production are owned and run by the government and most of the labor force is employed by the state. Recent years have seen a trend toward more private sector employment. By 2006, public sector employment was 78% and private sector 22%, compared to 91.8% to 8.2% in 1981. Government spending is 78.1% of GDP. Since the early 2010s, following the initial market reforms, it has become popular to describe the economy as being, or moving toward, market socialism . Any firm that hires a Cuban must pay the Cuban government, which in turn pays the employee in Cuban pesos. The average monthly wage as of July 2013 [ update ] was 466 Cuban pesos —about US$19. However, after a reform in January 2021, the minimum wage is about 2100 CUP (US$18) and the median wage is about 4000 CUP (US$33). [ citation needed ] Cuba had Cuban pesos (CUP) set at par with the US dollar before 1959. Every Cuban household has a ration book (known as libreta ) entitling it to a monthly supply of food and other staples, which are provided at nominal cost. According to the Havana Consulting Group, in 2014, remittances to Cuba amounted to US$3,129 million, the seventh highest in Latin America. In 2019, remittances had grown to US$6,616 million, but dropped down to US$1,967 million in 2020, due to the COVID-19 pandemic. The pandemic has also devastated Cuba's tourist industry, which along with a tightening of U.S. sanctions, has led to large increase in emigration among younger working-age Cubans. It has been described as a crisis that is "threatening the stability" of Cuba, which "already has one of the hemisphere's oldest populations". According to a controversial 2023 report by the Cuban Observatory of Human Rights (OCDH), 88% of Cuban citizens live in extreme poverty. The report stated that Cubans were concerned about food security and the difficulty in acquiring basic goods. According to the World Bank , Cuba's GDP per capita was $9,500 as of 2020. But according to the CIA World Factbook , it was $12,300 as of 2016. The United Nations Development Programme gave Cuba a Human Development Index (HDI) of 0.764 in 2021. The same United Nations agency estimated the country's Multidimensional Poverty Indice to 0.003 in 2023. Before the 1959 revolution, Cuba was one of the richest countries in Latin America. Significant inequalities existed between city and countryside and between whites and blacks. Health care and education were not available to the rural poor, many of whom were seriously undernourished. The country's economy in the middle part of the 20th century, fuelled by the sale of sugar to the United States, had grown wealthy. Cuba ranked 5th in the hemisphere in per capita income, 3rd in life expectancy, 2nd in per capita ownership of automobiles and telephones, and 1st in the number of television sets per inhabitant. Cuba's literacy rate, 76%, was the fourth highest in Latin America although two-thirds of the people received three years of education or less; one-third never attended school and half the adult population could neither read nor write. Cuba also ranked 11th in the world in the number of doctors per capita, although there was massive inequality in the distribution of doctors; for example more than 60% of all doctors lived and worked in Havana in 1958 and even when they worked outside Havana province they typically worked in other provincial capitals. US companies dominated the Cuban economy before the Revolution, controlling 80% of Cuba's trade. US firms ran public utilities, the railroad, and all of the oil refineries. Two-thirds of food production came from US-owned agro-business enterprises. US developers owned half of the arable land on the island. Just 8% of landholders owned three-quarters of the land. At least 25% of the population was unemployed. 20% of the population received 58% of the income, while the bottom 20% took in just 2%. According to PBS, a thriving middle class held the promise of prosperity and social mobility. According to Cuba historian Louis Perez of the University of North Carolina at Chapel Hill , "Havana was then what Las Vegas has become." After the Cuban Revolution and before the collapse of the Soviet Union, Cuba depended on Moscow for substantial aid and sheltered markets for its exports, valued at $65 billion in subsidies in total from 1960 to 1990. This accounted for between 10% and 40% of Cuban GDP, depending on the year. The loss of these subsidies sent the Cuban economy into a rapid depression known in Cuba as the Special Period , which saw the country's GDP decline by 33% between 1990 and 1993. Cuba took limited free-market oriented measures to alleviate severe shortages of food, consumer goods, and services. These steps included allowing some self-employment in certain retail and light manufacturing sectors, the legalization of the use of the US dollar in business, and the encouragement of tourism . Cuba has developed a unique urban farm system called organopónicos to compensate for the end of food imports from the Soviet Union. The U.S. embargo against Cuba was instituted in 1960 in response to nationalization of U.S.-citizen-held property and was maintained on the grounds of perceived human rights violations. It is widely viewed that the embargo hurt the Cuban economy. In 2009, the Cuban Government estimated this loss at $685 million annually. In 2005, Cuba had exports of US$2.4 billion , ranking 114 of 226 world countries, and imports of US$6.9 billion , ranking 87 of 226 countries. Its major export partners are Canada 17.7%, China 16.9%, Venezuela 12.5%, Netherlands 9%, and Spain 5.9% (2012). Cuba's major exports are sugar, nickel, tobacco, fish, medical products, citrus fruits, and coffee; imports include food, fuel, clothing, and machinery. Cuba presently holds debt in an amount estimated at $13 billion , approximately 38% of GDP. According to The Heritage Foundation , Cuba is dependent on credit accounts that rotate from country to country. Cuba's prior 35% supply of the world's export market for sugar has declined to 10% due to a variety of factors, including a global sugar commodity price drop that made Cuba less competitive on world markets. It was announced in 2008 that wage caps would be abandoned to improve the nation's productivity. Cuba's leadership has called for reforms in the country's agricultural system . In 2008, Raúl Castro began enacting agrarian reforms to boost food production, as at that time 80% of food was imported. The reforms aim to expand land use and increase efficiency. Venezuela supplies Cuba with an estimated 110,000 barrels (17,000 m 3 ) of oil per day in exchange for money and the services of some 44,000 Cubans, most of them medical personnel, in Venezuela. In 2010 [ update ] , Cubans were allowed to build their own houses. According to Raúl Castro, they could now improve their houses, but the government would not endorse these new houses or improvements. There is virtually no homelessness in Cuba, and 85% of Cubans own their homes and pay no property taxes or mortgage interest. Mortgage payments may not exceed 10% of a household's combined income. [ citation needed ] . On 2 August 2011, The New York Times reported that Cuba reaffirmed its intent to legalize "buying and selling" of private property before the year's end. According to experts, the private sale of property could "transform Cuba more than any of the economic reforms announced by President Raúl Castro's government". It would cut more than one million state jobs, including party bureaucrats who resist the changes. The reforms created what some call "New Cuban Economy". In October 2013, Raúl said he intended to merge the two currencies, but as of August 2016 [ update ] , the dual currency system remains in force. In August 2012, a specialist of the "Cubaenergia Company" announced the opening of Cuba's first Solar Power Plant. As a member of the CubaSolar Group, there was also a mention of ten additional plants in 2013. In 2016, the Miami Herald wrote, "... about 27 percent of Cubans earn under $50 per month; 34 percent earn the equivalent of $50 to $100 per month; and 20 percent earn $101 to $200. Twelve percent reported earning $201 to $500 a month; and almost 4 percent said their monthly earnings topped $500, including 1.5 percent who said they earned more than $1,000." In May 2019, Cuba imposed rationing of staples such as chicken, eggs, rice, beans, soap and other basic goods. (Some two-thirds of food in the country is imported.) A spokesperson blamed the increased U.S. trade embargo although economists believe that an equally important problem is the massive decline of aid from Venezuela and the failure of Cuba's state-run oil company which had subsidized fuel costs. In June 2019, the government announced an increase in public sector wages of about 300%, specifically for teachers and health personnel. In October, the government allowed stores to purchase house equipment and similar items, using international currency, and send it to Cuba by the Cuban emigration. The leaders of the government recognized that the new measures were unpopular but necessary to contain the capital flight to other countries as Panamá where Cuban citizens traveled and imported items to resell on the island. Other measures included allowing private companies to export and import, through state companies, resources to produce products and services in Cuba. On January 1, 2021, Cuba's dual currency system was formally ended, and the convertible Cuban peso (CUC) was phased out, leaving the Cuban peso (CUP) as the country's sole currency unit. Cuban citizens had until June 2021 to exchange their CUCs. However, this devalued the Cuban peso and caused economic problems for people who had been previously paid in CUCs, particularly workers in the tourism industry. Also, in February, the government dictated new measures to the private sector, with prohibitions for only 124 activities, in areas like national security, health and educational services. The wages were increased again, between 4 and 9 times, for all the sectors. Also, new facilities were allowed to the state companies, with much more autonomy. The first problem with the new reform, in terms of public opinion, were electricity prices, but that was amended quickly. Other measures corrected were in the prices for private farmers. [ citation needed ] In July 2020, Cuba opened new stores accepting only foreign currency while simultaneously eliminating a special tax on the U.S. dollar to combat an economic crisis arising initially due to economic sanctions imposed by the Trump administration, then later worsened by a lack of tourism during the coronavirus pandemic . These economic sanctions have since been sustained by the Biden administration. Cuba's natural resources include sugar, tobacco, fish, citrus fruits, coffee , beans, rice, potatoes, and livestock. Cuba's most important mineral resource is nickel, with 21% of total exports in 2011. The output of Cuba's nickel mines that year was 71,000 tons, approaching 4% of world production. As of 2013 [ update ] its reserves were estimated at 5.5 million tons, over 7% of the world total. Sherritt International of Canada operates a large nickel mining facility in Moa . Cuba is also a major producer of refined cobalt , a by-product of nickel mining. Oil exploration in 2005 by the US Geological Survey revealed that the North Cuba Basin could produce about 4.6 billion barrels (730,000,000 m 3 ) to 9.3 billion barrels (1.48 × 10 9 m 3 ) of oil. In 2006, Cuba started to test-drill these locations for possible exploitation. Tourism was initially restricted to enclave resorts where tourists would be segregated from Cuban society, referred to as "enclave tourism" and "tourism apartheid". Contact between foreign visitors and ordinary Cubans were de facto illegal between 1992 and 1997. The rapid growth of tourism during the Special Period had widespread social and economic repercussions in Cuba, and led to speculation about the emergence of a two-tier economy. 1.9 million tourists visited Cuba in 2003, predominantly from Canada and the European Union, generating revenue of US$2.1 billion . Cuba recorded 2,688,000 international tourists in 2011, the third-highest figure in the Caribbean (behind the Dominican Republic and Puerto Rico). The medical tourism sector caters to thousands of European, Latin American, Canadian, and American consumers every year. A recent study indicates that Cuba has a potential for mountaineering activity, and that mountaineering could be a key contributor to tourism, along with other activities, e.g. biking, diving, caving. Promoting these resources could contribute to regional development, prosperity, and well-being. The Cuban Justice minister downplays allegations of widespread sex tourism . According to a Government of Canada travel advice website, "Cuba is actively working to prevent child sex tourism, and a number of tourists, including Canadians, have been convicted of offences related to the corruption of minors aged 16 and under. Prison sentences range from 7 to 25 years." Some tourist facilities were extensively damaged on 8 September 2017 when Hurricane Irma hit the island. The storm made landfall in the Camagüey Archipelago; the worst damage was in the keys north of the main island, however, and not in the most significant tourist areas. Before the 1959 revolution, Cuba was one of the richest countries in Latin America. Significant inequalities existed between city and countryside and between whites and blacks. Health care and education were not available to the rural poor, many of whom were seriously undernourished. The country's economy in the middle part of the 20th century, fuelled by the sale of sugar to the United States, had grown wealthy. Cuba ranked 5th in the hemisphere in per capita income, 3rd in life expectancy, 2nd in per capita ownership of automobiles and telephones, and 1st in the number of television sets per inhabitant. Cuba's literacy rate, 76%, was the fourth highest in Latin America although two-thirds of the people received three years of education or less; one-third never attended school and half the adult population could neither read nor write. Cuba also ranked 11th in the world in the number of doctors per capita, although there was massive inequality in the distribution of doctors; for example more than 60% of all doctors lived and worked in Havana in 1958 and even when they worked outside Havana province they typically worked in other provincial capitals. US companies dominated the Cuban economy before the Revolution, controlling 80% of Cuba's trade. US firms ran public utilities, the railroad, and all of the oil refineries. Two-thirds of food production came from US-owned agro-business enterprises. US developers owned half of the arable land on the island. Just 8% of landholders owned three-quarters of the land. At least 25% of the population was unemployed. 20% of the population received 58% of the income, while the bottom 20% took in just 2%. According to PBS, a thriving middle class held the promise of prosperity and social mobility. According to Cuba historian Louis Perez of the University of North Carolina at Chapel Hill , "Havana was then what Las Vegas has become." After the Cuban Revolution and before the collapse of the Soviet Union, Cuba depended on Moscow for substantial aid and sheltered markets for its exports, valued at $65 billion in subsidies in total from 1960 to 1990. This accounted for between 10% and 40% of Cuban GDP, depending on the year. The loss of these subsidies sent the Cuban economy into a rapid depression known in Cuba as the Special Period , which saw the country's GDP decline by 33% between 1990 and 1993. Cuba took limited free-market oriented measures to alleviate severe shortages of food, consumer goods, and services. These steps included allowing some self-employment in certain retail and light manufacturing sectors, the legalization of the use of the US dollar in business, and the encouragement of tourism . Cuba has developed a unique urban farm system called organopónicos to compensate for the end of food imports from the Soviet Union. The U.S. embargo against Cuba was instituted in 1960 in response to nationalization of U.S.-citizen-held property and was maintained on the grounds of perceived human rights violations. It is widely viewed that the embargo hurt the Cuban economy. In 2009, the Cuban Government estimated this loss at $685 million annually. In 2005, Cuba had exports of US$2.4 billion , ranking 114 of 226 world countries, and imports of US$6.9 billion , ranking 87 of 226 countries. Its major export partners are Canada 17.7%, China 16.9%, Venezuela 12.5%, Netherlands 9%, and Spain 5.9% (2012). Cuba's major exports are sugar, nickel, tobacco, fish, medical products, citrus fruits, and coffee; imports include food, fuel, clothing, and machinery. Cuba presently holds debt in an amount estimated at $13 billion , approximately 38% of GDP. According to The Heritage Foundation , Cuba is dependent on credit accounts that rotate from country to country. Cuba's prior 35% supply of the world's export market for sugar has declined to 10% due to a variety of factors, including a global sugar commodity price drop that made Cuba less competitive on world markets. It was announced in 2008 that wage caps would be abandoned to improve the nation's productivity. Cuba's leadership has called for reforms in the country's agricultural system . In 2008, Raúl Castro began enacting agrarian reforms to boost food production, as at that time 80% of food was imported. The reforms aim to expand land use and increase efficiency. Venezuela supplies Cuba with an estimated 110,000 barrels (17,000 m 3 ) of oil per day in exchange for money and the services of some 44,000 Cubans, most of them medical personnel, in Venezuela. In 2010 [ update ] , Cubans were allowed to build their own houses. According to Raúl Castro, they could now improve their houses, but the government would not endorse these new houses or improvements. There is virtually no homelessness in Cuba, and 85% of Cubans own their homes and pay no property taxes or mortgage interest. Mortgage payments may not exceed 10% of a household's combined income. [ citation needed ] . On 2 August 2011, The New York Times reported that Cuba reaffirmed its intent to legalize "buying and selling" of private property before the year's end. According to experts, the private sale of property could "transform Cuba more than any of the economic reforms announced by President Raúl Castro's government". It would cut more than one million state jobs, including party bureaucrats who resist the changes. The reforms created what some call "New Cuban Economy". In October 2013, Raúl said he intended to merge the two currencies, but as of August 2016 [ update ] , the dual currency system remains in force. In August 2012, a specialist of the "Cubaenergia Company" announced the opening of Cuba's first Solar Power Plant. As a member of the CubaSolar Group, there was also a mention of ten additional plants in 2013. In 2016, the Miami Herald wrote, "... about 27 percent of Cubans earn under $50 per month; 34 percent earn the equivalent of $50 to $100 per month; and 20 percent earn $101 to $200. Twelve percent reported earning $201 to $500 a month; and almost 4 percent said their monthly earnings topped $500, including 1.5 percent who said they earned more than $1,000." In May 2019, Cuba imposed rationing of staples such as chicken, eggs, rice, beans, soap and other basic goods. (Some two-thirds of food in the country is imported.) A spokesperson blamed the increased U.S. trade embargo although economists believe that an equally important problem is the massive decline of aid from Venezuela and the failure of Cuba's state-run oil company which had subsidized fuel costs. In June 2019, the government announced an increase in public sector wages of about 300%, specifically for teachers and health personnel. In October, the government allowed stores to purchase house equipment and similar items, using international currency, and send it to Cuba by the Cuban emigration. The leaders of the government recognized that the new measures were unpopular but necessary to contain the capital flight to other countries as Panamá where Cuban citizens traveled and imported items to resell on the island. Other measures included allowing private companies to export and import, through state companies, resources to produce products and services in Cuba. On January 1, 2021, Cuba's dual currency system was formally ended, and the convertible Cuban peso (CUC) was phased out, leaving the Cuban peso (CUP) as the country's sole currency unit. Cuban citizens had until June 2021 to exchange their CUCs. However, this devalued the Cuban peso and caused economic problems for people who had been previously paid in CUCs, particularly workers in the tourism industry. Also, in February, the government dictated new measures to the private sector, with prohibitions for only 124 activities, in areas like national security, health and educational services. The wages were increased again, between 4 and 9 times, for all the sectors. Also, new facilities were allowed to the state companies, with much more autonomy. The first problem with the new reform, in terms of public opinion, were electricity prices, but that was amended quickly. Other measures corrected were in the prices for private farmers. [ citation needed ] In July 2020, Cuba opened new stores accepting only foreign currency while simultaneously eliminating a special tax on the U.S. dollar to combat an economic crisis arising initially due to economic sanctions imposed by the Trump administration, then later worsened by a lack of tourism during the coronavirus pandemic . These economic sanctions have since been sustained by the Biden administration. Cuba's natural resources include sugar, tobacco, fish, citrus fruits, coffee , beans, rice, potatoes, and livestock. Cuba's most important mineral resource is nickel, with 21% of total exports in 2011. The output of Cuba's nickel mines that year was 71,000 tons, approaching 4% of world production. As of 2013 [ update ] its reserves were estimated at 5.5 million tons, over 7% of the world total. Sherritt International of Canada operates a large nickel mining facility in Moa . Cuba is also a major producer of refined cobalt , a by-product of nickel mining. Oil exploration in 2005 by the US Geological Survey revealed that the North Cuba Basin could produce about 4.6 billion barrels (730,000,000 m 3 ) to 9.3 billion barrels (1.48 × 10 9 m 3 ) of oil. In 2006, Cuba started to test-drill these locations for possible exploitation. Tourism was initially restricted to enclave resorts where tourists would be segregated from Cuban society, referred to as "enclave tourism" and "tourism apartheid". Contact between foreign visitors and ordinary Cubans were de facto illegal between 1992 and 1997. The rapid growth of tourism during the Special Period had widespread social and economic repercussions in Cuba, and led to speculation about the emergence of a two-tier economy. 1.9 million tourists visited Cuba in 2003, predominantly from Canada and the European Union, generating revenue of US$2.1 billion . Cuba recorded 2,688,000 international tourists in 2011, the third-highest figure in the Caribbean (behind the Dominican Republic and Puerto Rico). The medical tourism sector caters to thousands of European, Latin American, Canadian, and American consumers every year. A recent study indicates that Cuba has a potential for mountaineering activity, and that mountaineering could be a key contributor to tourism, along with other activities, e.g. biking, diving, caving. Promoting these resources could contribute to regional development, prosperity, and well-being. The Cuban Justice minister downplays allegations of widespread sex tourism . According to a Government of Canada travel advice website, "Cuba is actively working to prevent child sex tourism, and a number of tourists, including Canadians, have been convicted of offences related to the corruption of minors aged 16 and under. Prison sentences range from 7 to 25 years." Some tourist facilities were extensively damaged on 8 September 2017 when Hurricane Irma hit the island. The storm made landfall in the Camagüey Archipelago; the worst damage was in the keys north of the main island, however, and not in the most significant tourist areas. Cuba is an archipelago of 4,195 islands, cays and islets located in the northern Caribbean Sea at the confluence with the Gulf of Mexico and the Atlantic Ocean. It lies between latitudes 19° and 24°N , and longitudes 74° and 85°W . The United States ( Key West, Florida ) lies 150 km (93 miles) across the Straits of Florida to the north and northwest, and The Bahamas (Cay Lobos) 22 km (13.7 mi) to the north. Mexico lies 210 km (130.5 mi) west across the Yucatán Channel (to the closest tip of Cabo Catoche in the State of Quintana Roo ). Haiti is 77 km (47.8 mi) east and Jamaica 140 km (87 mi) south. Cuba is the principal island, surrounded by four smaller groups of islands: the Colorados Archipelago on the northwestern coast, the Sabana-Camagüey Archipelago on the north-central Atlantic coast, the Jardines de la Reina on the south-central coast and the Canarreos Archipelago on the southwestern coast. The main island, named Cuba, is 1,250 km (780 mi) long, constituting most of the nation's land area ( 104,338 km 2 or 40,285 sq mi ) and is the largest island in the Caribbean and 17th-largest island in the world by land area. The main island consists mostly of flat to rolling plains apart from the Sierra Maestra mountains in the southeast, whose highest point is Pico Turquino ( 1,974 m or 6,476 ft ). The second-largest island is Isla de la Juventud (Isle of Youth) in the Canarreos archipelago, with an area of 2,204 km 2 (851 sq mi) . Cuba has an official area (land area) of 109,884 km 2 (42,426 sq mi) . Its area is 110,860 km 2 (42,803 sq mi) including coastal and territorial waters. With the entire island south of the Tropic of Cancer , the local climate is tropical, moderated by northeasterly trade winds that blow year-round. The temperature is also shaped by the Caribbean current, which brings in warm water from the equator. This makes the climate of Cuba warmer than that of Hong Kong, which is at around the same latitude as Cuba but has a subtropical rather than a tropical climate. In general (with local variations), there is a drier season from November to April, and a rainier season from May to October. The average temperature is 21 °C (70 °F) in January and 27 °C (81 °F) in July. The warm temperatures of the Caribbean Sea and the fact that Cuba sits across the entrance to the Gulf of Mexico combine to make the country prone to frequent hurricanes . These are most common in September and October. Hurricane Irma hit the island on 8 September 2017, with winds of 260 km/h (72 m/s) , at the Camagüey Archipelago; the storm reached Ciego de Avila province around midnight and continued to pound Cuba the next day. The worst damage was in the keys north of the main island. Hospitals, warehouses and factories were damaged; much of the north coast was without electricity. By that time, nearly a million people, including tourists, had been evacuated. The Varadero resort area also reported widespread damage; the government believed that repairs could be completed before the start of the main tourist season. Subsequent reports indicated that ten people had been killed during the storm, including seven in Havana, most during building collapses. Sections of the capital had been flooded. Cuba signed the Rio Convention on Biological Diversity on 12 June 1992, and became a party to the convention on 8 March 1994. It has subsequently produced a National Biodiversity Strategy and Action Plan , with one revision, that the convention received on 24 January 2008. The country's fourth national report to the CBD contains a detailed breakdown of the numbers of species of each kingdom of life recorded from Cuba, the main groups being: animals (17,801 species), bacteria (270), chromista (707), fungi, including lichen -forming species (5844), plants (9107) and protozoa (1440). The native bee hummingbird or zunzuncito is the world's smallest known bird, with a length of 55 mm ( 2 + 1 ⁄ 8 in) . The Cuban trogon or tocororo is the national bird of Cuba and an endemic species. Hedychium coronarium , named mariposa in Cuba, is the national flower . Cuba is home to six terrestrial ecoregions: Cuban moist forests , Cuban dry forests , Cuban pine forests , Cuban wetlands, Cuban cactus scrub , and Greater Antilles mangroves . It had a 2019 Forest Landscape Integrity Index mean score of 5.4/10, ranking it 102nd globally out of 172 countries. According to a 2012 study, Cuba is the only country in the world to meet the conditions of sustainable development put forth by the WWF . With the entire island south of the Tropic of Cancer , the local climate is tropical, moderated by northeasterly trade winds that blow year-round. The temperature is also shaped by the Caribbean current, which brings in warm water from the equator. This makes the climate of Cuba warmer than that of Hong Kong, which is at around the same latitude as Cuba but has a subtropical rather than a tropical climate. In general (with local variations), there is a drier season from November to April, and a rainier season from May to October. The average temperature is 21 °C (70 °F) in January and 27 °C (81 °F) in July. The warm temperatures of the Caribbean Sea and the fact that Cuba sits across the entrance to the Gulf of Mexico combine to make the country prone to frequent hurricanes . These are most common in September and October. Hurricane Irma hit the island on 8 September 2017, with winds of 260 km/h (72 m/s) , at the Camagüey Archipelago; the storm reached Ciego de Avila province around midnight and continued to pound Cuba the next day. The worst damage was in the keys north of the main island. Hospitals, warehouses and factories were damaged; much of the north coast was without electricity. By that time, nearly a million people, including tourists, had been evacuated. The Varadero resort area also reported widespread damage; the government believed that repairs could be completed before the start of the main tourist season. Subsequent reports indicated that ten people had been killed during the storm, including seven in Havana, most during building collapses. Sections of the capital had been flooded. Cuba signed the Rio Convention on Biological Diversity on 12 June 1992, and became a party to the convention on 8 March 1994. It has subsequently produced a National Biodiversity Strategy and Action Plan , with one revision, that the convention received on 24 January 2008. The country's fourth national report to the CBD contains a detailed breakdown of the numbers of species of each kingdom of life recorded from Cuba, the main groups being: animals (17,801 species), bacteria (270), chromista (707), fungi, including lichen -forming species (5844), plants (9107) and protozoa (1440). The native bee hummingbird or zunzuncito is the world's smallest known bird, with a length of 55 mm ( 2 + 1 ⁄ 8 in) . The Cuban trogon or tocororo is the national bird of Cuba and an endemic species. Hedychium coronarium , named mariposa in Cuba, is the national flower . Cuba is home to six terrestrial ecoregions: Cuban moist forests , Cuban dry forests , Cuban pine forests , Cuban wetlands, Cuban cactus scrub , and Greater Antilles mangroves . It had a 2019 Forest Landscape Integrity Index mean score of 5.4/10, ranking it 102nd globally out of 172 countries. According to a 2012 study, Cuba is the only country in the world to meet the conditions of sustainable development put forth by the WWF . According to the official census of 2010, Cuba's population was 11,241,161, comprising 5,628,996 men and 5,612,165 women. Its birth rate (9.88 births per thousand population in 2006) is one of the lowest in the Western Hemisphere . Although the country's population has grown by about four million people since 1961, the rate of growth slowed during that period, and the population began to decline in 2006, due to the country's low fertility rate (1.43 children per woman) coupled with emigration. Immigration and emigration have played a prominent part in Cuba's demographic profile. Between the 18th and early 20th century, large waves of Canarian , Catalan , Andalusian , Galician , and other Spanish people immigrated to Cuba. Between 1899 and 1930 alone, close to a million Spaniards entered the country, though many would eventually return to Spain. Other prominent immigrant groups included French, Portuguese , Italian, Russian, Dutch , Greek , British, and Irish, as well as small number of descendants of U.S. citizens who arrived in Cuba in the late 19th and early 20th centuries. As of 2015, the foreign-born population in Cuba was 13,336 inhabitants per the World Bank data. Post-revolution Cuba has been characterized by significant levels of emigration, which has led to a large and influential diaspora community . During the three decades after January 1959, more than one million Cubans of all social classes—constituting 10% of the total population— emigrated to the United States , a proportion that matches the extent of emigration to the U.S. from the Caribbean as a whole during that period. Prior to 13 January 2013, Cuban citizens could not travel abroad, leave or return to Cuba without first obtaining official permission along with applying for a government-issued passport and travel visa, which was often denied. Those who left the country typically did so by sea, in small boats and fragile rafts. On 9 September 1994, the U.S. and Cuban governments agreed that the U.S. would grant at least 20,000 visas annually in exchange for Cuba's pledge to prevent further unlawful departures on boats. In 2023, Cuba is undergoing its most severe socioeconomic crisis since the fall of the Soviet Union , leading to a record number of Cubans fleeing the island. In 2022 alone, the number of Cubans trying to enter the United States, primarily through the Mexican border , surged from 39,000 in 2021 to over 224,000. Many have resorted to selling their homes at very low prices to afford one-way flights to Nicaragua , hoping to travel through Mexico to reach the U.S. For those remaining among the island's 11 million inhabitants, life grows increasingly desperate. Internal migration has led to overpopulation in the capital, Havana, resulting in people living in makeshift shelters or overcrowded buildings, some of which are on the brink of collapse. The island's persistent shortages of food and medicine can be attributed to the U.S. trade embargo in place since 1962 and stringent government control over the economy since 1959. Regular power outages harken back to the early 1990s, a time when Soviet subsidies ended, plunging the island into economic hardship. Cuba's " Special Period " saw the country relying heavily on foreign tourism and the earnings of nationals working abroad. The pandemic, however, severely affected this revenue stream, decreasing the number of tourists by 75% in 2020. Monetary reforms in 2021 introduced shocks of inflation, further exacerbating the country's food scarcity and boosting the black market's prominence. Despite the increasing hardships, the Cuban spirit remains resilient. Access to the internet since 2018 and widespread use of social media have fueled calls for political and economic liberalization. The power of the internet was evident during the Cuban protests of 2021, which were promptly suppressed by the police, with many prominent artists and bloggers detained. As of 2013 the top emigration destinations were the United States, Spain, Italy, Puerto Rico, and Mexico. Following a tightening of U.S. sanctions and damage to the tourist industry by the COVID-19 pandemic, emigration has accelerated. In 2022, more than 2% of the population (almost 250,000 Cubans out of 11 million) migrated to the United States, and thousands more went to other countries, a number "larger than the 1980 Mariel boatlift and the 1994 Cuban rafter crisis combined", which were Cuba's previous largest migration events. As of 2022 Cuba's fertility rate is 1.582 births per woman. Cuba's drop in fertility is among the largest in the Western Hemisphere and is attributed largely to unrestricted access to legal abortion: Cuba's abortion rate was 58.6 per 1000 pregnancies in 1996, compared to an average of 35 in the Caribbean, 27 in Latin America overall, and 48 in Europe. Similarly, the use of contraceptives is also widespread, estimated at 79% of the female population (in the upper third of countries in the Western Hemisphere). Cuba's population is multiethnic, reflecting its complex colonial origins. Intermarriage between diverse groups is widespread, and consequently there is some discrepancy in reports of the country's racial composition: whereas the Institute for Cuban and Cuban-American Studies at the University of Miami determined that 62% of Cubans are black using the one drop rule , the 2002 Cuban census found that a similar proportion of the population, 65.05%, was white. In fact, the Minority Rights Group International determined that "An objective assessment of the situation of Afro-Cubans remains problematic due to scant records and a paucity of systematic studies both pre- and post-revolution. Estimates of the percentage of people of African descent in the Cuban population vary enormously, ranging from 34% to 62%". A 2014 study found that, based on ancestry informative markers (AIM), autosomal genetic ancestry in Cuba is 72% European, 20% African, and 8% Indigenous. Around 35% of maternal lineages derive from Cuban Indigenous People, compared to 39% from Africa and 26% from Europe, but male lineages were European (82%) and African (18%), indicating a historical bias towards mating between foreign men and native women rather than the inverse. Asians make up about 1% of the population, and are largely of Chinese ancestry , followed by Japanese and Filipino . Many are descendants of farm laborers brought to the island by Spanish and American contractors during the 19th and early 20th century. The current recorded number of Cubans with Chinese ancestry is 114,240. Afro-Cubans are descended primarily from the Yoruba people , Bantu people from the Congo basin , Kalabari tribe and Arará from the Dahomey , as well as several thousand North African refugees, most notably the Sahrawi Arabs of Western Sahara . In 2010, the Pew Forum estimated that religious affiliation in Cuba is 59.2% Christian, 23% unaffiliated, 17.4% folk religion (such as santería ), and the remaining 0.4% consisting of other religions. In a 2015 survey sponsored by Univision, 44% of Cubans said they were not religious and 9% did not give an answer while only 34% said they were Christian. Cuba is officially a secular state. Religious freedom increased through the 1980s, with the government amending the constitution in 1992 to drop the state's characterization as atheistic. Roman Catholicism is the largest religion, with its origins in Spanish colonization. Despite less than half of the population identifying as Catholics in 2006, it nonetheless remains the dominant faith. Pope John Paul II and Pope Benedict XVI visited Cuba in 1998 and 2011, respectively, and Pope Francis visited Cuba in September 2015. Prior to each papal visit, the Cuban government pardoned prisoners as a humanitarian gesture. The government's relaxation of restrictions on house churches in the 1990s led to an explosion of Pentecostalism , with some groups claiming as many as 100,000 members. However, Evangelical Protestant denominations, organized into the umbrella Cuban Council of Churches, remain much more vibrant and powerful. The religious landscape of Cuba is also strongly defined by syncretisms of various kinds. Christianity is often practiced in tandem with Santería , a mixture of Catholicism and mostly African faiths, which include a number of cults. La Virgen de la Caridad del Cobre (the Virgin of Cobre ) is the Catholic patroness of Cuba, and a symbol of Cuban culture. In Santería, she has been syncretized with the goddess Oshun . A breakdown of the followers of Afro-Cuban religions showed that most practitioners of Palo Mayombe were black and dark brown-skinned, most practitioners of Vodú were medium brown and light brown-skinned, and most practitioners of Santeria were light brown and white-skinned. Cuba also hosts small communities of Jews (500 in 2012), Muslims , and members of the Bahá'í Faith . Several well-known Cuban religious figures have operated outside the island, including the humanitarian and author Jorge Armando Pérez . The official language of Cuba is Spanish and the vast majority of Cubans speak it. Spanish as spoken in Cuba is known as Cuban Spanish and is a form of Caribbean Spanish . Lucumí , a dialect of the West African language Yoruba , is also used as a liturgical language by practitioners of Santería , and so only as a second language. Haitian Creole is the second-most spoken language in Cuba, and is spoken by Haitian immigrants and their descendants. Other languages spoken by immigrants include Galician and Corsican . The University of Havana was founded in 1728 and there are a number of other well-established colleges and universities . In 1957, just before Castro came to power, the literacy rate was as low as fourth in the region at almost 80% according to the United Nations, yet higher than in Spain. Castro created an entirely state-operated system and banned private institutions. School attendance is compulsory from ages six to the end of basic secondary education (normally at age 15), and all students, regardless of age or gender, wear school uniforms with the color denoting grade level. Primary education lasts for six years, secondary education is divided into basic and pre-university education. Cuba's literacy rate of 99.8 percent is the tenth-highest globally , largely due to the provision of free education at every level. Cuba's high school graduation rate is 94 percent. Higher education is provided by universities, higher institutes, higher pedagogical institutes, and higher polytechnic institutes. The Cuban Ministry of Higher Education operates a distance education program that provides regular afternoon and evening courses in rural areas for agricultural workers. Education has a strong political and ideological emphasis, and students progressing to higher education are expected to have a commitment to the goals of Cuba. Cuba has provided free education to foreign nationals from disadvantaged backgrounds at the Latin American School of Medicine . According to the Webometrics Ranking of World Universities , the top-ranking universities in the country are Universidad de la Habana (1680th worldwide), Instituto Superior Politécnico José Antonio Echeverría (2893rd) and the University of Santiago de Cuba (3831st). After the revolution, Cuba established a free public health system. Cuba's life expectancy at birth is 79.87 years (77.53 for males and 82.35 for females). This ranks Cuba 59th in the world and 4th in the Americas, behind Canada, Chile and the United States. Infant mortality declined from 32 infant deaths per 1,000 live births in 1957, to 10 in 1990–95, 6.1 in 2000–2005 and 5.13 in 2009. Historically, Cuba has ranked high in numbers of medical personnel and has made significant contributions to world health since the 19th century. Today, Cuba has universal health care and despite persistent shortages of medical supplies, there is no shortage of medical personnel. Primary care is available throughout the island and infant and maternal mortality rates compare favorably with those in developed nations. That an impoverished nation like Cuba has health outcomes rivaling the developed world is referred to by researchers as the Cuban Health Paradox. Cuba ranks 30th on the 2019 Bloomberg Healthiest Country Index, the highest ranking of a developing country. The Cuban healthcare system, renowned for its medical services, has emphasized the export of health professionals through international missions, aiding global health efforts. However, while these missions generate significant revenue and serve as a tool for political influence, domestically, Cuba faces challenges including medication shortages and disparities between medical services for locals and foreigners. Despite the income from these missions, only a small fraction of the national budget has been allocated to public health, underscoring contrasting priorities within the nation's healthcare strategy. Disease and infant mortality increased in the 1960s immediately after the revolution, when half of Cuba's 6,000 doctors left the country. Recovery occurred by the 1980s, and the country's health care has been widely praised. The Communist government stated that universal health care was a priority of state planning and progress was made in rural areas. After the revolution, the government increased rural hospitals from one to 62. Like the rest of the Cuban economy , medical care suffered from severe material shortages following the end of Soviet subsidies in 1991, and a tightening of the U.S. embargo in 1992. Challenges include low salaries for doctors, poor facilities, poor provision of equipment, and the frequent absence of essential drugs. Cuba has the highest doctor-to-population ratio in the world and has sent thousands of doctors to more than 40 countries around the world. According to the World Health Organization , Cuba is "known the world over for its ability to train excellent doctors and nurses who can then go out to help other countries in need". As of September 2014 [ update ] , there are around 50,000 Cuban-trained health care workers aiding 66 nations. Cuban physicians have played a leading role in combating the Ebola virus epidemic in West Africa . Preventative medicine is very important within the Cuban medical system, which provides citizens with easy to obtain regular health checks. Import and export of pharmaceutical drugs is done by the Quimefa Pharmaceutical Business Group (FARMACUBA) under the Ministry of Basic Industry (MINBAS). This group also provides technical information for the production of these drugs. Isolated from the West by the US embargo, Cuba developed the successful lung cancer vaccine, Cimavax , which is now available to US researchers for the first time, along with other novel Cuban cancer treatments. The vaccine has been available for free to the Cuban population since 2011. According to Roswell Park Comprehensive Cancer Center CEO Candace Johnson: "They've had to do more with less, so they've had to be even more innovative with how they approach things. For over 40 years, they have had a preeminent immunology community." During the thaw in Cuba–U.S. relations starting in December 2014 under the Obama administration, a growing number of U.S. lung cancer patients traveled to Cuba to receive vaccine treatment. The end of the thaw under the Trump Administration has resulted in a tightening of travel restrictions, making it harder for U.S. citizens to travel to Cuba for treatment. In 2015, Cuba became the first country to eradicate mother-to-child transmission of HIV and syphilis, a milestone hailed by the World Health Organization as "one of the greatest public health achievements possible". The traditional diet in Cuban households has raised international concerns due to its lack of micronutrients and diversity. According to the World Food Programme (WFP), an entity of the United Nations, the average diet in Cuba lacks adequate nutritional quality. This is attributed to various factors, including limited availability of nutrient-rich foods, socioeconomic issues, and poor dietary habits. The WFP's annual report on Cuba supports previous testimonies and evidence, pointing to a concerning situation. Even though the country has rolled out food subsidy programs, many backed by the WFP, the populace's diet remains nutritionally insufficient. Specifically, rationed food covers only a small percentage of the daily energy, protein, and fat requirements for the population aged 14 to 60. Such deficiencies have led to health issues like overweight and obesity, largely due to a diet high in sugars and salts. Additionally, there is a significant disparity in accessing proper nutrition. Individuals without access to foreign currencies and remittances are the most affected. The inadequacy of the minimum wage to meet recommended nutritional requirements is another concern highlighted in the report. The political and socioeconomic landscape has influenced this scenario. The implementation of the " Tarea Ordenamiento ," an economic reform that removed many food subsidies, has spurred alarming inflation, intensifying the shortage of basic foods like cereals, vegetables, dairy, and meat. As a result, Cuban households spend between 55% and 65% of their income on food, a proportion deemed disproportionate compared to international standards. Nevertheless, the report acknowledges the Cuban government's efforts in areas like social protection and universal access to basic services. It highlights Cuba's position in the Human Development Report 2021-2022 and the extensive COVID-19 vaccination coverage. To address food security challenges, the WFP has enhanced its collaboration with Cuban authorities. In 2022, the organization procured essential foods and macronutrients worth $10.7 million in response to alarming figures about anemia prevalence in infants. Amid this nutritional crisis, international interventions and collaborations are anticipated to alleviate the food and nutrition issues plaguing the Cuban populace. Immigration and emigration have played a prominent part in Cuba's demographic profile. Between the 18th and early 20th century, large waves of Canarian , Catalan , Andalusian , Galician , and other Spanish people immigrated to Cuba. Between 1899 and 1930 alone, close to a million Spaniards entered the country, though many would eventually return to Spain. Other prominent immigrant groups included French, Portuguese , Italian, Russian, Dutch , Greek , British, and Irish, as well as small number of descendants of U.S. citizens who arrived in Cuba in the late 19th and early 20th centuries. As of 2015, the foreign-born population in Cuba was 13,336 inhabitants per the World Bank data. Post-revolution Cuba has been characterized by significant levels of emigration, which has led to a large and influential diaspora community . During the three decades after January 1959, more than one million Cubans of all social classes—constituting 10% of the total population— emigrated to the United States , a proportion that matches the extent of emigration to the U.S. from the Caribbean as a whole during that period. Prior to 13 January 2013, Cuban citizens could not travel abroad, leave or return to Cuba without first obtaining official permission along with applying for a government-issued passport and travel visa, which was often denied. Those who left the country typically did so by sea, in small boats and fragile rafts. On 9 September 1994, the U.S. and Cuban governments agreed that the U.S. would grant at least 20,000 visas annually in exchange for Cuba's pledge to prevent further unlawful departures on boats. In 2023, Cuba is undergoing its most severe socioeconomic crisis since the fall of the Soviet Union , leading to a record number of Cubans fleeing the island. In 2022 alone, the number of Cubans trying to enter the United States, primarily through the Mexican border , surged from 39,000 in 2021 to over 224,000. Many have resorted to selling their homes at very low prices to afford one-way flights to Nicaragua , hoping to travel through Mexico to reach the U.S. For those remaining among the island's 11 million inhabitants, life grows increasingly desperate. Internal migration has led to overpopulation in the capital, Havana, resulting in people living in makeshift shelters or overcrowded buildings, some of which are on the brink of collapse. The island's persistent shortages of food and medicine can be attributed to the U.S. trade embargo in place since 1962 and stringent government control over the economy since 1959. Regular power outages harken back to the early 1990s, a time when Soviet subsidies ended, plunging the island into economic hardship. Cuba's " Special Period " saw the country relying heavily on foreign tourism and the earnings of nationals working abroad. The pandemic, however, severely affected this revenue stream, decreasing the number of tourists by 75% in 2020. Monetary reforms in 2021 introduced shocks of inflation, further exacerbating the country's food scarcity and boosting the black market's prominence. Despite the increasing hardships, the Cuban spirit remains resilient. Access to the internet since 2018 and widespread use of social media have fueled calls for political and economic liberalization. The power of the internet was evident during the Cuban protests of 2021, which were promptly suppressed by the police, with many prominent artists and bloggers detained. As of 2013 the top emigration destinations were the United States, Spain, Italy, Puerto Rico, and Mexico. Following a tightening of U.S. sanctions and damage to the tourist industry by the COVID-19 pandemic, emigration has accelerated. In 2022, more than 2% of the population (almost 250,000 Cubans out of 11 million) migrated to the United States, and thousands more went to other countries, a number "larger than the 1980 Mariel boatlift and the 1994 Cuban rafter crisis combined", which were Cuba's previous largest migration events. Immigration and emigration have played a prominent part in Cuba's demographic profile. Between the 18th and early 20th century, large waves of Canarian , Catalan , Andalusian , Galician , and other Spanish people immigrated to Cuba. Between 1899 and 1930 alone, close to a million Spaniards entered the country, though many would eventually return to Spain. Other prominent immigrant groups included French, Portuguese , Italian, Russian, Dutch , Greek , British, and Irish, as well as small number of descendants of U.S. citizens who arrived in Cuba in the late 19th and early 20th centuries. As of 2015, the foreign-born population in Cuba was 13,336 inhabitants per the World Bank data. Post-revolution Cuba has been characterized by significant levels of emigration, which has led to a large and influential diaspora community . During the three decades after January 1959, more than one million Cubans of all social classes—constituting 10% of the total population— emigrated to the United States , a proportion that matches the extent of emigration to the U.S. from the Caribbean as a whole during that period. Prior to 13 January 2013, Cuban citizens could not travel abroad, leave or return to Cuba without first obtaining official permission along with applying for a government-issued passport and travel visa, which was often denied. Those who left the country typically did so by sea, in small boats and fragile rafts. On 9 September 1994, the U.S. and Cuban governments agreed that the U.S. would grant at least 20,000 visas annually in exchange for Cuba's pledge to prevent further unlawful departures on boats. In 2023, Cuba is undergoing its most severe socioeconomic crisis since the fall of the Soviet Union , leading to a record number of Cubans fleeing the island. In 2022 alone, the number of Cubans trying to enter the United States, primarily through the Mexican border , surged from 39,000 in 2021 to over 224,000. Many have resorted to selling their homes at very low prices to afford one-way flights to Nicaragua , hoping to travel through Mexico to reach the U.S. For those remaining among the island's 11 million inhabitants, life grows increasingly desperate. Internal migration has led to overpopulation in the capital, Havana, resulting in people living in makeshift shelters or overcrowded buildings, some of which are on the brink of collapse. The island's persistent shortages of food and medicine can be attributed to the U.S. trade embargo in place since 1962 and stringent government control over the economy since 1959. Regular power outages harken back to the early 1990s, a time when Soviet subsidies ended, plunging the island into economic hardship. Cuba's " Special Period " saw the country relying heavily on foreign tourism and the earnings of nationals working abroad. The pandemic, however, severely affected this revenue stream, decreasing the number of tourists by 75% in 2020. Monetary reforms in 2021 introduced shocks of inflation, further exacerbating the country's food scarcity and boosting the black market's prominence. Despite the increasing hardships, the Cuban spirit remains resilient. Access to the internet since 2018 and widespread use of social media have fueled calls for political and economic liberalization. The power of the internet was evident during the Cuban protests of 2021, which were promptly suppressed by the police, with many prominent artists and bloggers detained. As of 2013 the top emigration destinations were the United States, Spain, Italy, Puerto Rico, and Mexico. Following a tightening of U.S. sanctions and damage to the tourist industry by the COVID-19 pandemic, emigration has accelerated. In 2022, more than 2% of the population (almost 250,000 Cubans out of 11 million) migrated to the United States, and thousands more went to other countries, a number "larger than the 1980 Mariel boatlift and the 1994 Cuban rafter crisis combined", which were Cuba's previous largest migration events. As of 2022 Cuba's fertility rate is 1.582 births per woman. Cuba's drop in fertility is among the largest in the Western Hemisphere and is attributed largely to unrestricted access to legal abortion: Cuba's abortion rate was 58.6 per 1000 pregnancies in 1996, compared to an average of 35 in the Caribbean, 27 in Latin America overall, and 48 in Europe. Similarly, the use of contraceptives is also widespread, estimated at 79% of the female population (in the upper third of countries in the Western Hemisphere). Cuba's population is multiethnic, reflecting its complex colonial origins. Intermarriage between diverse groups is widespread, and consequently there is some discrepancy in reports of the country's racial composition: whereas the Institute for Cuban and Cuban-American Studies at the University of Miami determined that 62% of Cubans are black using the one drop rule , the 2002 Cuban census found that a similar proportion of the population, 65.05%, was white. In fact, the Minority Rights Group International determined that "An objective assessment of the situation of Afro-Cubans remains problematic due to scant records and a paucity of systematic studies both pre- and post-revolution. Estimates of the percentage of people of African descent in the Cuban population vary enormously, ranging from 34% to 62%". A 2014 study found that, based on ancestry informative markers (AIM), autosomal genetic ancestry in Cuba is 72% European, 20% African, and 8% Indigenous. Around 35% of maternal lineages derive from Cuban Indigenous People, compared to 39% from Africa and 26% from Europe, but male lineages were European (82%) and African (18%), indicating a historical bias towards mating between foreign men and native women rather than the inverse. Asians make up about 1% of the population, and are largely of Chinese ancestry , followed by Japanese and Filipino . Many are descendants of farm laborers brought to the island by Spanish and American contractors during the 19th and early 20th century. The current recorded number of Cubans with Chinese ancestry is 114,240. Afro-Cubans are descended primarily from the Yoruba people , Bantu people from the Congo basin , Kalabari tribe and Arará from the Dahomey , as well as several thousand North African refugees, most notably the Sahrawi Arabs of Western Sahara . In 2010, the Pew Forum estimated that religious affiliation in Cuba is 59.2% Christian, 23% unaffiliated, 17.4% folk religion (such as santería ), and the remaining 0.4% consisting of other religions. In a 2015 survey sponsored by Univision, 44% of Cubans said they were not religious and 9% did not give an answer while only 34% said they were Christian. Cuba is officially a secular state. Religious freedom increased through the 1980s, with the government amending the constitution in 1992 to drop the state's characterization as atheistic. Roman Catholicism is the largest religion, with its origins in Spanish colonization. Despite less than half of the population identifying as Catholics in 2006, it nonetheless remains the dominant faith. Pope John Paul II and Pope Benedict XVI visited Cuba in 1998 and 2011, respectively, and Pope Francis visited Cuba in September 2015. Prior to each papal visit, the Cuban government pardoned prisoners as a humanitarian gesture. The government's relaxation of restrictions on house churches in the 1990s led to an explosion of Pentecostalism , with some groups claiming as many as 100,000 members. However, Evangelical Protestant denominations, organized into the umbrella Cuban Council of Churches, remain much more vibrant and powerful. The religious landscape of Cuba is also strongly defined by syncretisms of various kinds. Christianity is often practiced in tandem with Santería , a mixture of Catholicism and mostly African faiths, which include a number of cults. La Virgen de la Caridad del Cobre (the Virgin of Cobre ) is the Catholic patroness of Cuba, and a symbol of Cuban culture. In Santería, she has been syncretized with the goddess Oshun . A breakdown of the followers of Afro-Cuban religions showed that most practitioners of Palo Mayombe were black and dark brown-skinned, most practitioners of Vodú were medium brown and light brown-skinned, and most practitioners of Santeria were light brown and white-skinned. Cuba also hosts small communities of Jews (500 in 2012), Muslims , and members of the Bahá'í Faith . Several well-known Cuban religious figures have operated outside the island, including the humanitarian and author Jorge Armando Pérez .The official language of Cuba is Spanish and the vast majority of Cubans speak it. Spanish as spoken in Cuba is known as Cuban Spanish and is a form of Caribbean Spanish . Lucumí , a dialect of the West African language Yoruba , is also used as a liturgical language by practitioners of Santería , and so only as a second language. Haitian Creole is the second-most spoken language in Cuba, and is spoken by Haitian immigrants and their descendants. Other languages spoken by immigrants include Galician and Corsican . The University of Havana was founded in 1728 and there are a number of other well-established colleges and universities . In 1957, just before Castro came to power, the literacy rate was as low as fourth in the region at almost 80% according to the United Nations, yet higher than in Spain. Castro created an entirely state-operated system and banned private institutions. School attendance is compulsory from ages six to the end of basic secondary education (normally at age 15), and all students, regardless of age or gender, wear school uniforms with the color denoting grade level. Primary education lasts for six years, secondary education is divided into basic and pre-university education. Cuba's literacy rate of 99.8 percent is the tenth-highest globally , largely due to the provision of free education at every level. Cuba's high school graduation rate is 94 percent. Higher education is provided by universities, higher institutes, higher pedagogical institutes, and higher polytechnic institutes. The Cuban Ministry of Higher Education operates a distance education program that provides regular afternoon and evening courses in rural areas for agricultural workers. Education has a strong political and ideological emphasis, and students progressing to higher education are expected to have a commitment to the goals of Cuba. Cuba has provided free education to foreign nationals from disadvantaged backgrounds at the Latin American School of Medicine . According to the Webometrics Ranking of World Universities , the top-ranking universities in the country are Universidad de la Habana (1680th worldwide), Instituto Superior Politécnico José Antonio Echeverría (2893rd) and the University of Santiago de Cuba (3831st). After the revolution, Cuba established a free public health system. Cuba's life expectancy at birth is 79.87 years (77.53 for males and 82.35 for females). This ranks Cuba 59th in the world and 4th in the Americas, behind Canada, Chile and the United States. Infant mortality declined from 32 infant deaths per 1,000 live births in 1957, to 10 in 1990–95, 6.1 in 2000–2005 and 5.13 in 2009. Historically, Cuba has ranked high in numbers of medical personnel and has made significant contributions to world health since the 19th century. Today, Cuba has universal health care and despite persistent shortages of medical supplies, there is no shortage of medical personnel. Primary care is available throughout the island and infant and maternal mortality rates compare favorably with those in developed nations. That an impoverished nation like Cuba has health outcomes rivaling the developed world is referred to by researchers as the Cuban Health Paradox. Cuba ranks 30th on the 2019 Bloomberg Healthiest Country Index, the highest ranking of a developing country. The Cuban healthcare system, renowned for its medical services, has emphasized the export of health professionals through international missions, aiding global health efforts. However, while these missions generate significant revenue and serve as a tool for political influence, domestically, Cuba faces challenges including medication shortages and disparities between medical services for locals and foreigners. Despite the income from these missions, only a small fraction of the national budget has been allocated to public health, underscoring contrasting priorities within the nation's healthcare strategy. Disease and infant mortality increased in the 1960s immediately after the revolution, when half of Cuba's 6,000 doctors left the country. Recovery occurred by the 1980s, and the country's health care has been widely praised. The Communist government stated that universal health care was a priority of state planning and progress was made in rural areas. After the revolution, the government increased rural hospitals from one to 62. Like the rest of the Cuban economy , medical care suffered from severe material shortages following the end of Soviet subsidies in 1991, and a tightening of the U.S. embargo in 1992. Challenges include low salaries for doctors, poor facilities, poor provision of equipment, and the frequent absence of essential drugs. Cuba has the highest doctor-to-population ratio in the world and has sent thousands of doctors to more than 40 countries around the world. According to the World Health Organization , Cuba is "known the world over for its ability to train excellent doctors and nurses who can then go out to help other countries in need". As of September 2014 [ update ] , there are around 50,000 Cuban-trained health care workers aiding 66 nations. Cuban physicians have played a leading role in combating the Ebola virus epidemic in West Africa . Preventative medicine is very important within the Cuban medical system, which provides citizens with easy to obtain regular health checks. Import and export of pharmaceutical drugs is done by the Quimefa Pharmaceutical Business Group (FARMACUBA) under the Ministry of Basic Industry (MINBAS). This group also provides technical information for the production of these drugs. Isolated from the West by the US embargo, Cuba developed the successful lung cancer vaccine, Cimavax , which is now available to US researchers for the first time, along with other novel Cuban cancer treatments. The vaccine has been available for free to the Cuban population since 2011. According to Roswell Park Comprehensive Cancer Center CEO Candace Johnson: "They've had to do more with less, so they've had to be even more innovative with how they approach things. For over 40 years, they have had a preeminent immunology community." During the thaw in Cuba–U.S. relations starting in December 2014 under the Obama administration, a growing number of U.S. lung cancer patients traveled to Cuba to receive vaccine treatment. The end of the thaw under the Trump Administration has resulted in a tightening of travel restrictions, making it harder for U.S. citizens to travel to Cuba for treatment. In 2015, Cuba became the first country to eradicate mother-to-child transmission of HIV and syphilis, a milestone hailed by the World Health Organization as "one of the greatest public health achievements possible". The traditional diet in Cuban households has raised international concerns due to its lack of micronutrients and diversity. According to the World Food Programme (WFP), an entity of the United Nations, the average diet in Cuba lacks adequate nutritional quality. This is attributed to various factors, including limited availability of nutrient-rich foods, socioeconomic issues, and poor dietary habits. The WFP's annual report on Cuba supports previous testimonies and evidence, pointing to a concerning situation. Even though the country has rolled out food subsidy programs, many backed by the WFP, the populace's diet remains nutritionally insufficient. Specifically, rationed food covers only a small percentage of the daily energy, protein, and fat requirements for the population aged 14 to 60. Such deficiencies have led to health issues like overweight and obesity, largely due to a diet high in sugars and salts. Additionally, there is a significant disparity in accessing proper nutrition. Individuals without access to foreign currencies and remittances are the most affected. The inadequacy of the minimum wage to meet recommended nutritional requirements is another concern highlighted in the report. The political and socioeconomic landscape has influenced this scenario. The implementation of the " Tarea Ordenamiento ," an economic reform that removed many food subsidies, has spurred alarming inflation, intensifying the shortage of basic foods like cereals, vegetables, dairy, and meat. As a result, Cuban households spend between 55% and 65% of their income on food, a proportion deemed disproportionate compared to international standards. Nevertheless, the report acknowledges the Cuban government's efforts in areas like social protection and universal access to basic services. It highlights Cuba's position in the Human Development Report 2021-2022 and the extensive COVID-19 vaccination coverage. To address food security challenges, the WFP has enhanced its collaboration with Cuban authorities. In 2022, the organization procured essential foods and macronutrients worth $10.7 million in response to alarming figures about anemia prevalence in infants. Amid this nutritional crisis, international interventions and collaborations are anticipated to alleviate the food and nutrition issues plaguing the Cuban populace. The traditional diet in Cuban households has raised international concerns due to its lack of micronutrients and diversity. According to the World Food Programme (WFP), an entity of the United Nations, the average diet in Cuba lacks adequate nutritional quality. This is attributed to various factors, including limited availability of nutrient-rich foods, socioeconomic issues, and poor dietary habits. The WFP's annual report on Cuba supports previous testimonies and evidence, pointing to a concerning situation. Even though the country has rolled out food subsidy programs, many backed by the WFP, the populace's diet remains nutritionally insufficient. Specifically, rationed food covers only a small percentage of the daily energy, protein, and fat requirements for the population aged 14 to 60. Such deficiencies have led to health issues like overweight and obesity, largely due to a diet high in sugars and salts. Additionally, there is a significant disparity in accessing proper nutrition. Individuals without access to foreign currencies and remittances are the most affected. The inadequacy of the minimum wage to meet recommended nutritional requirements is another concern highlighted in the report. The political and socioeconomic landscape has influenced this scenario. The implementation of the " Tarea Ordenamiento ," an economic reform that removed many food subsidies, has spurred alarming inflation, intensifying the shortage of basic foods like cereals, vegetables, dairy, and meat. As a result, Cuban households spend between 55% and 65% of their income on food, a proportion deemed disproportionate compared to international standards. Nevertheless, the report acknowledges the Cuban government's efforts in areas like social protection and universal access to basic services. It highlights Cuba's position in the Human Development Report 2021-2022 and the extensive COVID-19 vaccination coverage. To address food security challenges, the WFP has enhanced its collaboration with Cuban authorities. In 2022, the organization procured essential foods and macronutrients worth $10.7 million in response to alarming figures about anemia prevalence in infants. Amid this nutritional crisis, international interventions and collaborations are anticipated to alleviate the food and nutrition issues plaguing the Cuban populace. ETECSA opened 118 cybercafes across the country in 2013. The government of Cuba provides an online encyclopedia website called EcuRed that operates in a " wiki " format. Internet access is controlled, and e-mail is closely monitored. Since 2018, access to Internet by mobile data is available. In 2019, 7.1 million Cubans could access the Internet. The prices of connections, since [ clarification needed ] WiFi zones, or mobile data, or from houses through "Nauta Hogar" service have been decreasing, especially since the economic reform of January 2021, when all the salaries increased by at least 5 times, and the prices of Internet remain in the same point. In 2021, it was reported that 7.7 million Cuban people have Internet access. There were 6.14 million mobile connections in Cuba in January 2021. Cuban culture is influenced by its melting pot of cultures, primarily those of Spain , Africa and the indigenous Taínos of Cuba. After the 1959 revolution, the government started a national literacy campaign, offered free education to all and established rigorous sports, ballet, and music programs. Architecture in Cuba was mainly manifested during the colonial period. It brought the culture of Spain with its Baroque influence. The first villas (settlements) were constituted by a church surrounded by several houses. These houses had an interior or central courtyard and were covered with grilles. There are magnificent religious buildings such as the Basílica de San Francisco of Havana. In addition, large forts were built for defense, preventing the attack of pirates and buccaneers. There are several old historic centers in Cuba that were built during the Spanish colonial period, the most remarkable are the four cities inscribed as World Heritage Sites by UNESCO, Havana , Camagüey , Cienfuegos and Trinidad , which has great architectural bastions of all currents and trends from Baroque , Neoclassical to eclectic art, and other preserved colonial towns such as Santiago de Cuba , Matanzas or Remedios . During the Republican period, large buildings were built, such as the Capitol , modeled after the one in Washington , and other large buildings such as the Focsa and the Habana Hilton, later the Habana Libre . One of the most outstanding Cuban architects of the second half of the 20th century was Antonio Quintana Simonetti (1919–1993). After the triumph of the Revolution, architecture received a strong Soviet influence with its desire for symmetry and space saving, and entire new neighborhoods were built in the style of the working-class quarters of Moscow or Minsk . When the Berlin Wall fell, architecture received more diverse currents and there was a boom in 5 star hotels with impressive glass and steel facades in the style of modern skyscrapers in Manhattan or other Latin American metropolises such as Mexico City or Caracas . Cuban cuisine is a fusion of Spanish and Caribbean cuisines . Cuban recipes share spices and techniques with Spanish cooking, with some Caribbean influence in spice and flavor. Food rationing, which has been the norm in Cuba for the last four decades, restricts the common availability of these dishes. The traditional Cuban meal is not served in courses; all food items are served at the same time. The typical meal could consist of plantains, black beans and rice, ropa vieja (shredded beef), Cuban bread , pork with onions, and tropical fruits. Black beans and rice, referred to as moros y cristianos (or moros for short), and plantains are staples of the Cuban diet. Many of the meat dishes are cooked slowly with light sauces. Garlic, cumin, oregano, and bay leaves are the dominant spices. Cuban literature began to find its voice in the early 19th century. Dominant themes of independence and freedom were exemplified by José Martí, who led the Modernist movement in Cuban literature. Writers such as Nicolás Guillén and José Z. Tallet focused on literature as social protest. The poetry and novels of Dulce María Loynaz and José Lezama Lima have been influential. Romanticist Miguel Barnet , who wrote Everyone Dreamed of Cuba , reflects a more melancholy Cuba. Alejo Carpentier was important in the magic realism movement. Writers such as Reinaldo Arenas , Guillermo Cabrera Infante , and Daína Chaviano , Pedro Juan Gutiérrez , Zoé Valdés , Guillermo Rosales and Leonardo Padura have earned international recognition in the post-revolutionary era, though many of these have felt compelled to continue their work in exile due to ideological control of media by the Cuban authorities. However, some Cuban writers continue living and writing in Cuba, including Nancy Morejón. Cuban music is very rich and is the most commonly known expression of Cuban culture. The central form of this music is son , which has been the basis of many other musical styles like " Danzón de nuevo ritmo", mambo , cha-cha-chá and salsa music . Rumba ("de cajón o de solar") music originated in the early Afro-Cuban culture, mixed with Spanish elements of style. The Tres was invented in Cuba from Spanish cordophone instruments models (the instrument is actually a fusion of elements from the Spanish guitar and lute). Other traditional Cuban instruments are of African origin, Taíno origin, or both, such as the maracas , güiro , marímbula and various wooden drums including the mayohuacán . Popular Cuban music of all styles has been enjoyed and praised widely across the world. Cuban classical music, which includes music with strong African and European influences, and features symphonic works as well as music for soloists, has received international acclaim thanks to composers like Ernesto Lecuona . Havana was the heart of the rap scene in Cuba when it began in the 1990s. In December 2012, the director of the Cuban Music Institute, Orlando Vistel, threatened to bar sexually explicit songs and music videos from public radio and television. Recognized Cuban artists include Los Van Van orchestra, known as "the music machinery of Cuba", pianists Chucho Valdés and Frank Fernández , and Omara Portuondo , member of the Buena Vista Social Club . Some U.S.-based singers such as Camila Cabello were born in Cuba. Many Cuban artists have won Grammy Awards . Between the youth, Buena Fe is a popular group. Cuban culture encompasses a wide range of dance forms. Danzón was the official musical genre and dance of Cuba. Mambo music and dance developed originally in Cuba, with further significant developments by Cuban musicians in Mexico and the US. The cha-cha-cha is another dance of Cuban origin, while the Cuban bolero originated in Santiago de Cuba in the last quarter of the 19th century. Concert dance is supported by the government and includes internationally renowned companies such as the Ballet Nacional de Cuba . Salsa dancing originated in Cuba and Cuban salsa is danced around the world. Due to historical associations with the United States, many Cubans participate in sports that are popular in North America, rather than sports traditionally played in other Latin American nations. Baseball is the most popular. Other popular sports include volleyball, boxing , athletics , wrestling , basketball and water sports . Cuba is a dominant force in amateur boxing , consistently achieving high medal tallies in major international competitions. Boxers Rances Barthelemy and Erislandy Lara defected to the U.S. and Mexico respectively. Cuba also provides a national team that competes in the Olympic Games . Jose R. Capablanca was a Cuban world chess champion from 1921 to 1927.Architecture in Cuba was mainly manifested during the colonial period. It brought the culture of Spain with its Baroque influence. The first villas (settlements) were constituted by a church surrounded by several houses. These houses had an interior or central courtyard and were covered with grilles. There are magnificent religious buildings such as the Basílica de San Francisco of Havana. In addition, large forts were built for defense, preventing the attack of pirates and buccaneers. There are several old historic centers in Cuba that were built during the Spanish colonial period, the most remarkable are the four cities inscribed as World Heritage Sites by UNESCO, Havana , Camagüey , Cienfuegos and Trinidad , which has great architectural bastions of all currents and trends from Baroque , Neoclassical to eclectic art, and other preserved colonial towns such as Santiago de Cuba , Matanzas or Remedios . During the Republican period, large buildings were built, such as the Capitol , modeled after the one in Washington , and other large buildings such as the Focsa and the Habana Hilton, later the Habana Libre . One of the most outstanding Cuban architects of the second half of the 20th century was Antonio Quintana Simonetti (1919–1993). After the triumph of the Revolution, architecture received a strong Soviet influence with its desire for symmetry and space saving, and entire new neighborhoods were built in the style of the working-class quarters of Moscow or Minsk . When the Berlin Wall fell, architecture received more diverse currents and there was a boom in 5 star hotels with impressive glass and steel facades in the style of modern skyscrapers in Manhattan or other Latin American metropolises such as Mexico City or Caracas .Cuban cuisine is a fusion of Spanish and Caribbean cuisines . Cuban recipes share spices and techniques with Spanish cooking, with some Caribbean influence in spice and flavor. Food rationing, which has been the norm in Cuba for the last four decades, restricts the common availability of these dishes. The traditional Cuban meal is not served in courses; all food items are served at the same time. The typical meal could consist of plantains, black beans and rice, ropa vieja (shredded beef), Cuban bread , pork with onions, and tropical fruits. Black beans and rice, referred to as moros y cristianos (or moros for short), and plantains are staples of the Cuban diet. Many of the meat dishes are cooked slowly with light sauces. Garlic, cumin, oregano, and bay leaves are the dominant spices.Cuban literature began to find its voice in the early 19th century. Dominant themes of independence and freedom were exemplified by José Martí, who led the Modernist movement in Cuban literature. Writers such as Nicolás Guillén and José Z. Tallet focused on literature as social protest. The poetry and novels of Dulce María Loynaz and José Lezama Lima have been influential. Romanticist Miguel Barnet , who wrote Everyone Dreamed of Cuba , reflects a more melancholy Cuba. Alejo Carpentier was important in the magic realism movement. Writers such as Reinaldo Arenas , Guillermo Cabrera Infante , and Daína Chaviano , Pedro Juan Gutiérrez , Zoé Valdés , Guillermo Rosales and Leonardo Padura have earned international recognition in the post-revolutionary era, though many of these have felt compelled to continue their work in exile due to ideological control of media by the Cuban authorities. However, some Cuban writers continue living and writing in Cuba, including Nancy Morejón. Cuban music is very rich and is the most commonly known expression of Cuban culture. The central form of this music is son , which has been the basis of many other musical styles like " Danzón de nuevo ritmo", mambo , cha-cha-chá and salsa music . Rumba ("de cajón o de solar") music originated in the early Afro-Cuban culture, mixed with Spanish elements of style. The Tres was invented in Cuba from Spanish cordophone instruments models (the instrument is actually a fusion of elements from the Spanish guitar and lute). Other traditional Cuban instruments are of African origin, Taíno origin, or both, such as the maracas , güiro , marímbula and various wooden drums including the mayohuacán . Popular Cuban music of all styles has been enjoyed and praised widely across the world. Cuban classical music, which includes music with strong African and European influences, and features symphonic works as well as music for soloists, has received international acclaim thanks to composers like Ernesto Lecuona . Havana was the heart of the rap scene in Cuba when it began in the 1990s. In December 2012, the director of the Cuban Music Institute, Orlando Vistel, threatened to bar sexually explicit songs and music videos from public radio and television. Recognized Cuban artists include Los Van Van orchestra, known as "the music machinery of Cuba", pianists Chucho Valdés and Frank Fernández , and Omara Portuondo , member of the Buena Vista Social Club . Some U.S.-based singers such as Camila Cabello were born in Cuba. Many Cuban artists have won Grammy Awards . Between the youth, Buena Fe is a popular group. Cuban culture encompasses a wide range of dance forms. Danzón was the official musical genre and dance of Cuba. Mambo music and dance developed originally in Cuba, with further significant developments by Cuban musicians in Mexico and the US. The cha-cha-cha is another dance of Cuban origin, while the Cuban bolero originated in Santiago de Cuba in the last quarter of the 19th century. Concert dance is supported by the government and includes internationally renowned companies such as the Ballet Nacional de Cuba . Salsa dancing originated in Cuba and Cuban salsa is danced around the world.Due to historical associations with the United States, many Cubans participate in sports that are popular in North America, rather than sports traditionally played in other Latin American nations. Baseball is the most popular. Other popular sports include volleyball, boxing , athletics , wrestling , basketball and water sports . Cuba is a dominant force in amateur boxing , consistently achieving high medal tallies in major international competitions. Boxers Rances Barthelemy and Erislandy Lara defected to the U.S. and Mexico respectively. Cuba also provides a national team that competes in the Olympic Games . Jose R. Capablanca was a Cuban world chess champion from 1921 to 1927.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Princess_Christian_Maternity_Hospital/html

Princess Christian Maternity Hospital

Princess Christian Maternity Hospital is a hospital in Freetown , Sierra Leone nicknamed the 'Cottage Hospital'. In May 2006 Ahmad Tejan Kabbah re-opened the hospital alongside Connaught Hospital . Princess Christian Maternity hospital came under severe pressure during the 2014 Ebola virus epidemic in Sierra Leone . Scientific studies have shown that pregnant women are among the least likely to survive an onset of ebola , most likely because the mother's body lowers its immune response to prevent it rejecting the baby. In a previous outbreak in Zaire , 14 out of 15 pregnant women who contracted the disease died. With the country's health facilities completely overrun and already unable to cope with the patient numbers, the authorities decided to place pregnant women last in the queue for treatment, and also segregated them from other ebola patients, under the assumption that there was little that could be done to save them. Most of the pregnant ebola patients were sent to Princess Christian, but with health resources committed elsewhere, the hospital was severely neglected and conditions were so bad that the United Nations proposed closing the hospital altogether.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Cam'ron/html

Cam'ron

Rapper songwriter record producer Actor record executive entrepreneur sports analyst Cameron Ezike Giles (born February 4, 1976), better known by his stage name Cam'ron , is an American rapper. Beginning his career in the early-1990s as Killa Cam , Giles signed with Lance "Un" Rivera 's Untertainment , an imprint of Epic Records to release his first two studio albums Confessions of Fire (1998) and S.D.E. (Sports Drugs & Entertainment) (2000); the former received gold certification by the RIAA . After leaving Epic, Giles signed with Roc-A-Fella Records in 2001 to release his third studio album Come Home with Me the following year. It received platinum certification by the RIAA and spawned the singles " Oh Boy " (featuring Juelz Santana ) and " Hey Ma " (featuring Juelz Santana, Freekey Zeekey and Toya ), which peaked at numbers four and three respectively on the Billboard Hot 100 . His fourth studio album, Purple Haze (2004) was met with similar success and likewise received gold certification by the RIAA. After Giles and his label Diplomat Records parted ways with Roc-A-Fella in 2005 due to disagreements between himself and label-head Jay-Z , Giles signed the label to a distribution deal with Asylum Records . In 2006, Giles released his fifth studio album Killa Season , accompanied by a film of the same name in which Giles starred and made his director-screenwriter debut. In 2009, after taking a hiatus due to his mother's health, Giles returned to music and released his sixth studio album Crime Pays (2009), which peaked at number three on the Billboard 200 . A decade later, he released his seventh album Purple Haze 2 . Aside from his solo career, Giles was first a member of the short-lived hip hop group Children of the Corn , which he formed alongside Big L and Mase in 1993 before disbanding in 1997. He subsequently formed the hip hop collective the Diplomats (also known as Dipset) the same year, alongside his longtime affiliate Jim Jones and cousin Freekey Zekey . He later performed as one half of the duo U.N. (Us Now) with fellow Harlem native Vado ; the duo released two collaborative projects. In addition to the Killa Season film, Giles has acted in other works including the Roc-A-Fella films Paper Soldiers and Paid in Full in 2002.Giles was born and raised in the East Harlem neighborhood of Upper Manhattan, New York City . He was raised by his mother, Fredericka Giles (July 10, 1955 – February 9, 2023). He went to school at the Manhattan Center for Science and Mathematics , where he met his longtime friends Mase and Jim Jones . He was a promising basketball player alongside Mase; however, he was unable to take advantage of scholarship offers due to his poor academic standing. Instead, he enrolled in a college in Texas, without even graduating from high school, but was expelled and returned to Harlem where he began selling drugs before starting his rap career. Giles was eventually introduced to The Notorious B.I.G. through his childhood friend Mase. B.I.G. introduced Giles to Lance Rivera , who signed him to his label, Untertainment. He began his musical career in the mid-1990s, rapping alongside Big L , Mase, and his cousin Bloodshed, in a group called Children of the Corn . After Bloodshed's death in a car accident on March 2, 1997, the group disbanded and the remaining members pursued solo careers. Two years before Big L's murder in 1999, Cam'ron was introduced to The Notorious B.I.G. by Mase who was signed to Bad Boy Records at the time. Biggie was so impressed by Cam'ron that he introduced him to his partner Lance "Un" Rivera who signed Cam'ron to his Untertainment label, distributed by Epic Records. His debut album, Confessions of Fire , was released a year later in July 1998 and included singles such as "3-5-7" (which was also featured in the movie Woo ), and "Horse and Carriage" featuring Mase, which reached the R&B Top Ten. The album achieved gold status and made the Top 10 of both the pop and R&B charts. In 2000, Cam'ron was working with music executive Tommy Mottola and released his second album S.D.E. (Sports Drugs & Entertainment) on Sony/Epic Records. With features from Destiny's Child , Juelz Santana , Jim Jones, N.O.R.E. , and producer Digga, it included the relatively successful singles, "Let Me Know" and "What Means The World To You". The album reached Number 2 on the R&B/Hip-Hop Albums chart, and Number 14 on the Billboard 200. After demanding a release from Sony/Epic Records, Cam'ron signed with his childhood friend and new manager Damon Dash to Roc-A-Fella Records in December 2001, alongside artists such as Jay-Z , Beanie Sigel , Freeway and Memphis Bleek . A reported $4.5 million record deal was agreed upon with Damon Dash and his Roc-A-Fella partners Kareem Biggs and Jay-Z in the form of a record advance. His third and most successful album Come Home with Me was released in 2002 featuring guests such as Jay-Z, Beanie Sigel , and Memphis Bleek , and production from Just Blaze , Kanye West and The Heatmakerz . It included the hit singles " Oh Boy " and " Hey Ma ", which both featured the Diplomats newest member Juelz Santana . The album achieved platinum status and served as a stepping stone for Cam'ron's group the Diplomats to sign with Roc-A-Fella. In 2002, Cam'ron went on to appear in the Damon Dash produced film, Paid in Full , in which he played one of three main characters alongside Mekhi Phifer and Wood Harris . [ citation needed ] In 2006 he started shooting his movie for his album titled Killa Season ; the film would mark both Cam'ron's screenwriting and directorial debuts, as well as his return to acting. Killa Season was released to DVD on April 25, 2006, after a special two-day theatrical release. In March 2003, Cam'ron teamed up with his fellow Diplomats Members Jim Jones , Juelz Santana , and Freekey Zeeky to release the Diplomats ' debut double disc album, Diplomatic Immunity , under Roc-A-Fella/Diplomat Records, which was quickly certified gold by the RIAA . The album featured the lead single "Dipset Anthem", a remix to Cam'rons hit "Hey Ma", and the (street anthem) single "I Really Mean It", as well as featuring production from Kanye West , Just Blaze , and The Heatmakerz . A year later, the Diplomats released their second album, Diplomatic Immunity 2 . On December 7, 2004, Cam'ron's fourth studio album, Purple Haze , was released on Def Jam / Roc-A-Fella Records . It featured collaborations with Kanye West, Jaheim , Twista , Juelz Santana, and various other artists and ultimately reached gold status. The album was also a critical success, being ranked 114th on Pitchfork Media 's Top 200 Albums of the first decade of the 21st century List, and 10th on Rhapsody 's Hip Hop's Best Albums Of The Decade List. However, after feeling that the album was poorly promoted and that his projects were not receiving enough attention, Cam'ron requested his release from Roc-A-Fella Records . On April 28, 2005, Cam'ron officially joined the Warner Music Group under the Asylum Records imprint. He began work on what would be his first project for the new label. Cam'ron's fifth studio album, titled Killa Season , was released on May 16, 2006, featuring production from long-term collaborators The Heatmakerz, Charlmagne and Ty Fyffe , as well as others such as Alchemist and I.N.F.O. Along with the album, Cam'ron released his first film, in which he wrote, directed and starred in, also titled "Killa Season". Despite selling 112,000 units in the first week and debuting at number 2 on the charts, Killa Season failed to have the same sales strength as his two previous releases, but Killa Season became certified gold. After the release of Killa Season and his feud with 50 Cent in 2007, Cam'ron took a three-year hiatus from music after his mother suffered three strokes which left her paralyzed on her left side. He moved to Florida with her to set up her rehabilitation and therapy, and stayed there until she had fully recovered. Cam'ron's 2009 album, Crime Pays was released on Asylum/Diplomat Records, featuring the majority of the production handled by Skitzo and AraabMuzik . Although none of the singles from the album managed to chart, the album still reached number 3 on the Billboard 200 but only sold 150,000 units, making it the lowest selling album of his career. In 2009 Cam'ron formed a new label, Dipset West and new group the U.N. In late 2009–early 2010, Cam'ron released a series of mixtapes hosted by DJ Drama called Boss of All Boses which featured his new upcoming artist Vado . Cam'ron also released a collaboration album with his new group the U.N. which included himself and fellow Harlem rapper Vado titled Heat in Here Vol. 1 ; the first single off the album was "Speaking Tongues" which peaked at No. 82 on the U.S. R&B charts. Cam'ron announced that he would be releasing a joint album with rapper Vado called Gunz n' Butta ; on April 19, 2011, the album was released on E1 Music . In 2013, Vado signed with We the Best Music Group after his personal friendship with Cam'ron eroded, although Vado maintained at the time that they still worked on a business level and had no animosity towards him. After three years Cam'ron and Jim Jones decided to mend their differences and start working together again for the third installment of the Diplomatic Immunity album along with fellow Diplomat members Juelz Santana and Freekey Zekey . Cam'ron announced that The Diplomat album's release would take place around Christmas 2010. The first promotional single featuring the reunited Diplomat members was titled "Salute"; it was produced by AraabMuzik and would later appear on Jim Jones album Capo . In 2012 Cam'ron was featured on rapper/singer Wiz Khalifa 's second studio album O.N.I.F.C. on a song titled "The Bluff". Also In 2012 Cam'ron would be featured on rapper/singer Nicki Minaj 's second studio album Pink Friday: Roman Reloaded on a song titled "I Am Your Leader" along with rapper Rick Ross . In 2013 during an interview Cam'ron discussed his seventh upcoming studio album Killa Season 2 stating that it will feature guest appearances from Dipset , T.I. , Nicki Minaj , and Wiz Khalifa . On October 1, 2013, Cam'ron released his promotional mixtape for the album titled Ghetto Heaven Vol 1 . In January 2014, according to Complex Magazine , Cam'ron and A-Trak were to team up for a collaborative EP to be titled Federal Reserve which would be executive-produced by Dame Dash and have featured appearances by Juelz Santana and Jim Jones . In May, they put out the first single from the album, titled "Dipsh*ts", featuring commentary from Dame Dash and Juelz Santana on the hook and an accompanying official video. On February 11, 2014, Cam'ron along with fashion designer Mark McNairy revealed their " Cape line" during New York fashion week. On October 20, 2014, via his Instagram Cam'ron revealed and released his " Ebola mask" stating on the caption "Ebola is no joking matter, so if u have to be safe, be fashionable". Cam'ron also has a fashion clothing line titled "Dipset USA" which is branded off his former label Diplomat Records. On July 1, 2014, Cam'ron released his 1st of the Month, Vol. 1 EP. On August 1, 2014, Cam'ron released his 1st of the Month, Vol. 2 EP, it included the single "So Bad" featuring Nicki Minaj . On September 1, 2014, Cam'ron released his 1st of the Month, Vol. 3 EP. On October 1, 2014, Cam'ron released his 1st of the Month, Vol. 4 EP. On November 1, 2014, Cam'ron released his 1st of the Month, Vol. 5 EP. On December 1, 2014, Cam'ron released his 1st of the Month, Vol. 6 EP. On December 11, 2014, Cam'ron announced that his next studio album will not be a sequel to his fifth album Killa Season but will be a sequel to his critically acclaimed fourth studio album Purple Haze titled Purple Haze 2 ; Cam'ron also announced that this would be his final album. On December 16, 2014, Cam'ron would release his compilation 1st of the Month: Box Set (Deluxe Edition) . On January 1, 2015, well known DJ Funkmaster Flex announced via his Instagram that he had spoken to fellow Diplomat members Cam'ron, Jim Jones and Juelz Santana about an upcoming Diplomat's mixtape which included fellow member Freekey Zeekey . He also confirmed and stated that he will be hosting the mixtape along with DJ's/Rappers/Producers DJ Khaled , Swizz Beatz and DJ Mustard . In July 2016, he announced that he will release an album called Killa Pink and he promoted his line of signature the Reebok Flea 2's, and announced that the shoe will be released in combination with the album. Giles was born and raised in the East Harlem neighborhood of Upper Manhattan, New York City . He was raised by his mother, Fredericka Giles (July 10, 1955 – February 9, 2023). He went to school at the Manhattan Center for Science and Mathematics , where he met his longtime friends Mase and Jim Jones . He was a promising basketball player alongside Mase; however, he was unable to take advantage of scholarship offers due to his poor academic standing. Instead, he enrolled in a college in Texas, without even graduating from high school, but was expelled and returned to Harlem where he began selling drugs before starting his rap career. Giles was eventually introduced to The Notorious B.I.G. through his childhood friend Mase. B.I.G. introduced Giles to Lance Rivera , who signed him to his label, Untertainment. He began his musical career in the mid-1990s, rapping alongside Big L , Mase, and his cousin Bloodshed, in a group called Children of the Corn . After Bloodshed's death in a car accident on March 2, 1997, the group disbanded and the remaining members pursued solo careers.Two years before Big L's murder in 1999, Cam'ron was introduced to The Notorious B.I.G. by Mase who was signed to Bad Boy Records at the time. Biggie was so impressed by Cam'ron that he introduced him to his partner Lance "Un" Rivera who signed Cam'ron to his Untertainment label, distributed by Epic Records. His debut album, Confessions of Fire , was released a year later in July 1998 and included singles such as "3-5-7" (which was also featured in the movie Woo ), and "Horse and Carriage" featuring Mase, which reached the R&B Top Ten. The album achieved gold status and made the Top 10 of both the pop and R&B charts. In 2000, Cam'ron was working with music executive Tommy Mottola and released his second album S.D.E. (Sports Drugs & Entertainment) on Sony/Epic Records. With features from Destiny's Child , Juelz Santana , Jim Jones, N.O.R.E. , and producer Digga, it included the relatively successful singles, "Let Me Know" and "What Means The World To You". The album reached Number 2 on the R&B/Hip-Hop Albums chart, and Number 14 on the Billboard 200. After demanding a release from Sony/Epic Records, Cam'ron signed with his childhood friend and new manager Damon Dash to Roc-A-Fella Records in December 2001, alongside artists such as Jay-Z , Beanie Sigel , Freeway and Memphis Bleek . A reported $4.5 million record deal was agreed upon with Damon Dash and his Roc-A-Fella partners Kareem Biggs and Jay-Z in the form of a record advance. His third and most successful album Come Home with Me was released in 2002 featuring guests such as Jay-Z, Beanie Sigel , and Memphis Bleek , and production from Just Blaze , Kanye West and The Heatmakerz . It included the hit singles " Oh Boy " and " Hey Ma ", which both featured the Diplomats newest member Juelz Santana . The album achieved platinum status and served as a stepping stone for Cam'ron's group the Diplomats to sign with Roc-A-Fella. In 2002, Cam'ron went on to appear in the Damon Dash produced film, Paid in Full , in which he played one of three main characters alongside Mekhi Phifer and Wood Harris . [ citation needed ] In 2006 he started shooting his movie for his album titled Killa Season ; the film would mark both Cam'ron's screenwriting and directorial debuts, as well as his return to acting. Killa Season was released to DVD on April 25, 2006, after a special two-day theatrical release. In March 2003, Cam'ron teamed up with his fellow Diplomats Members Jim Jones , Juelz Santana , and Freekey Zeeky to release the Diplomats ' debut double disc album, Diplomatic Immunity , under Roc-A-Fella/Diplomat Records, which was quickly certified gold by the RIAA . The album featured the lead single "Dipset Anthem", a remix to Cam'rons hit "Hey Ma", and the (street anthem) single "I Really Mean It", as well as featuring production from Kanye West , Just Blaze , and The Heatmakerz . A year later, the Diplomats released their second album, Diplomatic Immunity 2 . On December 7, 2004, Cam'ron's fourth studio album, Purple Haze , was released on Def Jam / Roc-A-Fella Records . It featured collaborations with Kanye West, Jaheim , Twista , Juelz Santana, and various other artists and ultimately reached gold status. The album was also a critical success, being ranked 114th on Pitchfork Media 's Top 200 Albums of the first decade of the 21st century List, and 10th on Rhapsody 's Hip Hop's Best Albums Of The Decade List. However, after feeling that the album was poorly promoted and that his projects were not receiving enough attention, Cam'ron requested his release from Roc-A-Fella Records . On April 28, 2005, Cam'ron officially joined the Warner Music Group under the Asylum Records imprint. He began work on what would be his first project for the new label. Cam'ron's fifth studio album, titled Killa Season , was released on May 16, 2006, featuring production from long-term collaborators The Heatmakerz, Charlmagne and Ty Fyffe , as well as others such as Alchemist and I.N.F.O. Along with the album, Cam'ron released his first film, in which he wrote, directed and starred in, also titled "Killa Season". Despite selling 112,000 units in the first week and debuting at number 2 on the charts, Killa Season failed to have the same sales strength as his two previous releases, but Killa Season became certified gold. After the release of Killa Season and his feud with 50 Cent in 2007, Cam'ron took a three-year hiatus from music after his mother suffered three strokes which left her paralyzed on her left side. He moved to Florida with her to set up her rehabilitation and therapy, and stayed there until she had fully recovered. Cam'ron's 2009 album, Crime Pays was released on Asylum/Diplomat Records, featuring the majority of the production handled by Skitzo and AraabMuzik . Although none of the singles from the album managed to chart, the album still reached number 3 on the Billboard 200 but only sold 150,000 units, making it the lowest selling album of his career. In 2009 Cam'ron formed a new label, Dipset West and new group the U.N.In late 2009–early 2010, Cam'ron released a series of mixtapes hosted by DJ Drama called Boss of All Boses which featured his new upcoming artist Vado . Cam'ron also released a collaboration album with his new group the U.N. which included himself and fellow Harlem rapper Vado titled Heat in Here Vol. 1 ; the first single off the album was "Speaking Tongues" which peaked at No. 82 on the U.S. R&B charts. Cam'ron announced that he would be releasing a joint album with rapper Vado called Gunz n' Butta ; on April 19, 2011, the album was released on E1 Music . In 2013, Vado signed with We the Best Music Group after his personal friendship with Cam'ron eroded, although Vado maintained at the time that they still worked on a business level and had no animosity towards him. After three years Cam'ron and Jim Jones decided to mend their differences and start working together again for the third installment of the Diplomatic Immunity album along with fellow Diplomat members Juelz Santana and Freekey Zekey . Cam'ron announced that The Diplomat album's release would take place around Christmas 2010. The first promotional single featuring the reunited Diplomat members was titled "Salute"; it was produced by AraabMuzik and would later appear on Jim Jones album Capo . In 2012 Cam'ron was featured on rapper/singer Wiz Khalifa 's second studio album O.N.I.F.C. on a song titled "The Bluff". Also In 2012 Cam'ron would be featured on rapper/singer Nicki Minaj 's second studio album Pink Friday: Roman Reloaded on a song titled "I Am Your Leader" along with rapper Rick Ross . In 2013 during an interview Cam'ron discussed his seventh upcoming studio album Killa Season 2 stating that it will feature guest appearances from Dipset , T.I. , Nicki Minaj , and Wiz Khalifa . On October 1, 2013, Cam'ron released his promotional mixtape for the album titled Ghetto Heaven Vol 1 . In January 2014, according to Complex Magazine , Cam'ron and A-Trak were to team up for a collaborative EP to be titled Federal Reserve which would be executive-produced by Dame Dash and have featured appearances by Juelz Santana and Jim Jones . In May, they put out the first single from the album, titled "Dipsh*ts", featuring commentary from Dame Dash and Juelz Santana on the hook and an accompanying official video. On February 11, 2014, Cam'ron along with fashion designer Mark McNairy revealed their " Cape line" during New York fashion week. On October 20, 2014, via his Instagram Cam'ron revealed and released his " Ebola mask" stating on the caption "Ebola is no joking matter, so if u have to be safe, be fashionable". Cam'ron also has a fashion clothing line titled "Dipset USA" which is branded off his former label Diplomat Records. On July 1, 2014, Cam'ron released his 1st of the Month, Vol. 1 EP. On August 1, 2014, Cam'ron released his 1st of the Month, Vol. 2 EP, it included the single "So Bad" featuring Nicki Minaj . On September 1, 2014, Cam'ron released his 1st of the Month, Vol. 3 EP. On October 1, 2014, Cam'ron released his 1st of the Month, Vol. 4 EP. On November 1, 2014, Cam'ron released his 1st of the Month, Vol. 5 EP. On December 1, 2014, Cam'ron released his 1st of the Month, Vol. 6 EP. On December 11, 2014, Cam'ron announced that his next studio album will not be a sequel to his fifth album Killa Season but will be a sequel to his critically acclaimed fourth studio album Purple Haze titled Purple Haze 2 ; Cam'ron also announced that this would be his final album. On December 16, 2014, Cam'ron would release his compilation 1st of the Month: Box Set (Deluxe Edition) . On January 1, 2015, well known DJ Funkmaster Flex announced via his Instagram that he had spoken to fellow Diplomat members Cam'ron, Jim Jones and Juelz Santana about an upcoming Diplomat's mixtape which included fellow member Freekey Zeekey . He also confirmed and stated that he will be hosting the mixtape along with DJ's/Rappers/Producers DJ Khaled , Swizz Beatz and DJ Mustard . In July 2016, he announced that he will release an album called Killa Pink and he promoted his line of signature the Reebok Flea 2's, and announced that the shoe will be released in combination with the album. In 2002, Cam'ron went on to appear in the Damon Dash produced film, Paid in Full , in which he played one of three main characters alongside Mekhi Phifer and Wood Harris . In 2006, started shooting his movie for his album titled Killa Season , the film would mark both Cam'ron's screenwriting and directorial debuts, as well as his return to acting. Killa Season was released to DVD on April 25, 2006, after a special two-day theatrical release. On February 11, 2014, Cam'ron, along with fashion designer Mark McNairy , revealed their " Cape line" during the New York fashion week. On October 20, 2014, via his Instagram, Cam'ron revealed and released his " Ebola mask", stating on the caption: "Ebola is no joking matter, so if u have to be safe, be fashionable". Cam'ron also has a fashion clothing line titled "Dipset USA" which is branded off his former label Diplomat Records . In 2023, Cam'ron launched an independently-produced sports' news talk show, called It is What It is. Cam'ron's co-host on the show is rapper, Mase . The show's first episode premiered on February 27, 2023, on YouTube. In the months proceeding the show's launch, it has achieved viral success on the internet. According to Cam'ron, he has already turned down several multi-million dollar offers from buyers looking to purchase the show. In 2002, Cam'ron went on to appear in the Damon Dash produced film, Paid in Full , in which he played one of three main characters alongside Mekhi Phifer and Wood Harris . In 2006, started shooting his movie for his album titled Killa Season , the film would mark both Cam'ron's screenwriting and directorial debuts, as well as his return to acting. Killa Season was released to DVD on April 25, 2006, after a special two-day theatrical release. On February 11, 2014, Cam'ron, along with fashion designer Mark McNairy , revealed their " Cape line" during the New York fashion week. On October 20, 2014, via his Instagram, Cam'ron revealed and released his " Ebola mask", stating on the caption: "Ebola is no joking matter, so if u have to be safe, be fashionable". Cam'ron also has a fashion clothing line titled "Dipset USA" which is branded off his former label Diplomat Records . In 2023, Cam'ron launched an independently-produced sports' news talk show, called It is What It is. Cam'ron's co-host on the show is rapper, Mase . The show's first episode premiered on February 27, 2023, on YouTube. In the months proceeding the show's launch, it has achieved viral success on the internet. According to Cam'ron, he has already turned down several multi-million dollar offers from buyers looking to purchase the show. Although there had been rumors of a feud between the two emcees, Cam'ron went public first with a track on "Killa Season" called "You Gotta Love It (Jay-Z Diss)" featuring ex-Dipset member Max B . In the song, Cam'ron takes jabs at Jay-Z's age, his alleged "biting" (stealing) of lyrics, and his current girlfriend. He references Jay-Z using The Notorious B.I.G. 's rhymes, rapping "You ain't the only one with big wallets got it my shit's brolick but ya publishing should go to Miss Wallace." He then released another song "Swagger Jacker (Biter Not a Writer)" to highlight the many songs Jay-Z has borrowed lines from. In the next issue of XXL , Cam'ron explained the beef originated when Jay-Z became CEO and President of Roc-A-Fella Records . In 2010, Cam'ron stated he does not have any issues with Jay-Z anymore. In 2013, on "Pound Cake", a song by Drake , Jay-Z mentioned Cam'ron again by rapping (in the middle of a verse): Now here's the icing on the cake/ Cake, cake-cake, cake-cake, uhh/ I'm just getting started, oh, yeah, we got it bitch/ I've done made more millionaires than the lotto did/ Dame made millions, Bigg made millions/ Ye made millions, Just made millions/ Lyor made millions, Cam made millions/ Beans would tell you if he wasn't in his feelin[g]s Cam replied briefly on "Come and Talk to Me" off of Ghetto Heaven Vol. 1 : She said Jay made you a millionaire? and looked me in the eyes/ Said cake, cake, cake, got that from the pies/ We made each other millions, that was my reply/ had a mill before I met him, baby, that ain't no lie/ See he named some Harlem cats and the homie from the Chi / but my thing, he ain't name nobody from the Stuy On April 26, 2019, he and Jay-Z ended their feud at the re-opened Webster Hall . On February 1, 2007, Cam'ron and 50 Cent had a live argument on The Angie Martinez Show on Hot 97 radio. 50 Cent commented that he felt Koch Entertainment was a "graveyard", meaning major record labels would not work with their artists. Cam'ron then ridiculed the record sales of G-Unit members Lloyd Banks and Mobb Deep by pointing out that Dipset member Jim Jones outsold both of their albums despite not being signed to a major label, and also went on to clarify that his group, The Diplomats, had a distribution deal from several labels. Both rappers released diss songs with videos on YouTube . 50 Cent released "Funeral Music", and suggested in the song that Cam'ron is no longer able to lead The Diplomats and that Jim Jones should take his place. Cam'ron responded with "Curtis" and "Curtis Pt. II", in which he makes fun of 50 Cent's appearance, calling him "a gorilla, with rabbit teeth". 50 Cent responded by releasing " Hold On " with Young Buck . Since 2009, the feud slowly died down, and they eventually reconciled in 2016. Cam'ron revealed in 2007 that he was no longer speaking to his fellow Diplomat members Juelz Santana and Jim Jones, leading to speculation that the group had officially broken up. However, despite admitting that he did not want to contact Jim Jones, he said that he had no hard feelings towards him. In an interview with Miss Info, Cam'ron said: "I still haven't spoken to Jim. But Jim ran with me for over 10 years, he worked hard, and I wish him the best of luck. Everybody thinks I'm mad at Jim. Why am I mad? I told people for years that Jimmy was gonna be a star. So it's better on my resume. I wish him the best." After three years of not speaking, Cam'ron and Jim Jones mended their differences in April 2010. In late 2011, both appeared together on Wolfgang Gartner 's album Weekend in America , on the track "Circus Freaks". On April 22, 2007, Cam'ron was interviewed on 60 Minutes as part of a piece on the Stop Snitchin' movement. He also stated that he would "not help the police" try to locate the shooter saying he is "not a snitch" and helping the police would probably hurt his record sales. He stated in the interview, "Because with the type of business I'm in, it would definitely hurt my business. And the way that I was raised, I just don't do that. I was raised differently, not to tell... It's about business but it's still also a code of ethics" When asked by Anderson Cooper if he would tell the police if a serial killer was living next to him, Cam'ron replied "I would probably move" but would not inform the police. Cam'ron later issued an apology for his comments, calling them an "error in judgement": "Where I come from, once word gets out that you've cooperated with the police that only makes you a bigger target of criminal violence. That is a dark reality in so many neighborhoods like mine across America. I'm not saying its right, but its reality. And it's not unfounded. There's a harsh reality around violence and criminal justice in our inner cities." Cam'ron has had contact with the police in the past. According to The Smoking Gun , New York Police Department records indicate that Giles filed a report with police after he was assaulted at a park in Harlem in 1999. Both Cam'ron and Jim Jones took out their frustrations on former label-mate Kanye West in defense of former CEO Dame Dash (due to their longtime friendship dating back to growing up in Harlem) by releasing a song titled "Toast" rhyming over Kanye West's song " Runaway ". The feud eventually ended, evidenced by Cam'ron, Jim Jones, and Kanye West collaborating on a song called " Christmas in Harlem ".Although there had been rumors of a feud between the two emcees, Cam'ron went public first with a track on "Killa Season" called "You Gotta Love It (Jay-Z Diss)" featuring ex-Dipset member Max B . In the song, Cam'ron takes jabs at Jay-Z's age, his alleged "biting" (stealing) of lyrics, and his current girlfriend. He references Jay-Z using The Notorious B.I.G. 's rhymes, rapping "You ain't the only one with big wallets got it my shit's brolick but ya publishing should go to Miss Wallace." He then released another song "Swagger Jacker (Biter Not a Writer)" to highlight the many songs Jay-Z has borrowed lines from. In the next issue of XXL , Cam'ron explained the beef originated when Jay-Z became CEO and President of Roc-A-Fella Records . In 2010, Cam'ron stated he does not have any issues with Jay-Z anymore. In 2013, on "Pound Cake", a song by Drake , Jay-Z mentioned Cam'ron again by rapping (in the middle of a verse): Now here's the icing on the cake/ Cake, cake-cake, cake-cake, uhh/ I'm just getting started, oh, yeah, we got it bitch/ I've done made more millionaires than the lotto did/ Dame made millions, Bigg made millions/ Ye made millions, Just made millions/ Lyor made millions, Cam made millions/ Beans would tell you if he wasn't in his feelin[g]s Cam replied briefly on "Come and Talk to Me" off of Ghetto Heaven Vol. 1 : She said Jay made you a millionaire? and looked me in the eyes/ Said cake, cake, cake, got that from the pies/ We made each other millions, that was my reply/ had a mill before I met him, baby, that ain't no lie/ See he named some Harlem cats and the homie from the Chi / but my thing, he ain't name nobody from the Stuy On April 26, 2019, he and Jay-Z ended their feud at the re-opened Webster Hall . On February 1, 2007, Cam'ron and 50 Cent had a live argument on The Angie Martinez Show on Hot 97 radio. 50 Cent commented that he felt Koch Entertainment was a "graveyard", meaning major record labels would not work with their artists. Cam'ron then ridiculed the record sales of G-Unit members Lloyd Banks and Mobb Deep by pointing out that Dipset member Jim Jones outsold both of their albums despite not being signed to a major label, and also went on to clarify that his group, The Diplomats, had a distribution deal from several labels. Both rappers released diss songs with videos on YouTube . 50 Cent released "Funeral Music", and suggested in the song that Cam'ron is no longer able to lead The Diplomats and that Jim Jones should take his place. Cam'ron responded with "Curtis" and "Curtis Pt. II", in which he makes fun of 50 Cent's appearance, calling him "a gorilla, with rabbit teeth". 50 Cent responded by releasing " Hold On " with Young Buck . Since 2009, the feud slowly died down, and they eventually reconciled in 2016. Cam'ron revealed in 2007 that he was no longer speaking to his fellow Diplomat members Juelz Santana and Jim Jones, leading to speculation that the group had officially broken up. However, despite admitting that he did not want to contact Jim Jones, he said that he had no hard feelings towards him. In an interview with Miss Info, Cam'ron said: "I still haven't spoken to Jim. But Jim ran with me for over 10 years, he worked hard, and I wish him the best of luck. Everybody thinks I'm mad at Jim. Why am I mad? I told people for years that Jimmy was gonna be a star. So it's better on my resume. I wish him the best." After three years of not speaking, Cam'ron and Jim Jones mended their differences in April 2010. In late 2011, both appeared together on Wolfgang Gartner 's album Weekend in America , on the track "Circus Freaks".On April 22, 2007, Cam'ron was interviewed on 60 Minutes as part of a piece on the Stop Snitchin' movement. He also stated that he would "not help the police" try to locate the shooter saying he is "not a snitch" and helping the police would probably hurt his record sales. He stated in the interview, "Because with the type of business I'm in, it would definitely hurt my business. And the way that I was raised, I just don't do that. I was raised differently, not to tell... It's about business but it's still also a code of ethics" When asked by Anderson Cooper if he would tell the police if a serial killer was living next to him, Cam'ron replied "I would probably move" but would not inform the police. Cam'ron later issued an apology for his comments, calling them an "error in judgement": "Where I come from, once word gets out that you've cooperated with the police that only makes you a bigger target of criminal violence. That is a dark reality in so many neighborhoods like mine across America. I'm not saying its right, but its reality. And it's not unfounded. There's a harsh reality around violence and criminal justice in our inner cities." Cam'ron has had contact with the police in the past. According to The Smoking Gun , New York Police Department records indicate that Giles filed a report with police after he was assaulted at a park in Harlem in 1999. Both Cam'ron and Jim Jones took out their frustrations on former label-mate Kanye West in defense of former CEO Dame Dash (due to their longtime friendship dating back to growing up in Harlem) by releasing a song titled "Toast" rhyming over Kanye West's song " Runaway ". The feud eventually ended, evidenced by Cam'ron, Jim Jones, and Kanye West collaborating on a song called " Christmas in Harlem ".On October 23, 2005, Cam'ron was leaving a nightclub in Washington, D.C., having performed the day before at Howard University . While stopped at a traffic light at the intersection of New York and New Jersey Avenues shortly after midnight, a passenger of a nearby car threatened Cam'ron to "give up" his 2006 Lamborghini . Cam'ron resisted, and the man then shot him. Cam'ron was struck at least once as he was holding the steering wheel, but he was able to drive, going the wrong way on streets and flashing his lights, until a fan drove him to Howard University Hospital. The gunman and passenger drove off, crashed into a parked car, and fled the scene. D.C. Metro Police recovered a cell phone from the scene of the crash, which they tried to use to trace the suspects. He stated that he does not know who shot him, although later, in the song "Gotta Love It" featuring Max B , Cam'ron claims that he saw the gunman throw up the Roc-A-Fella Records diamond hand signal before shots were fired.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Chris_Whitty/html

Chris Whitty

Sir Christopher John MacRae Whitty KCB FRS (born 21 April 1966) is a British epidemiologist , serving as Chief Medical Officer for England and Chief Medical Adviser to the UK Government since 2019. Whitty was Chief Scientific Adviser to the Department of Health and Social Care and Head of the National Institute for Health and Care Research from 2016 to 2021. He was also the Acting Government Chief Scientific Adviser from 2017 to 2018. He is emeritus Gresham Professor of Physic . Since March 2020, Whitty has played a key role in the response to the COVID-19 pandemic in the United Kingdom , alongside Government Chief Scientific Adviser Sir Patrick Vallance . Whitty was appointed Knight Commander of the Order of the Bath (KCB) in the 2022 New Year Honours for services to public health.Whitty was born in Gloucester on 21 April 1966, the first of four sons born to Kenneth and Susannah Whitty. His father was a British Council officer, who was posted to various countries including Nigeria , where the family lived in Kaduna , and Malawi . While Deputy Director of the British Council in Athens , Kenneth Whitty was murdered by militants from the Abu Nidal Organisation , in 1984, when Whitty was 17. His mother was a teacher. His maternal uncle Sir Christopher MacRae was also a diplomat , and his grandmother Grace Summerhayes was a pioneering obstetrician in Africa, who helped set up the first maternity hospital in Ghana in 1928. His paternal grandfather John Whitty MC DSO was killed in World War II and his step grandfather was Sir George Coldstream . Whitty was sent back to the UK for his schooling, where he attended Windlesham House School in Pulborough , West Sussex, and Malvern College , Worcestershire. He then studied at Pembroke College, Oxford ( BA in Physiology, DSc in medical science), Wolfson College, Oxford ( BM BCh in Medicine, 1991, where he was also the founding chair of the National Postgraduate Committee ), the London School of Hygiene & Tropical Medicine ( DTM&H in Tropical Medicine and Hygiene, 1996; MSc in Epidemiology , 1996), Northumbria University ( LLM in Medical Law , 2005), Heriot-Watt University ( MBA in Business Administration, 2010), and The Open University ( DipEcon in Economics). Whitty is a practising National Health Service (NHS) consultant physician at University College London Hospitals (UCLH) and the Hospital for Tropical Diseases , and was Gresham Professor of Physic at Gresham College , a post dating back to 1597. Until becoming CMO he was Professor of Public and International Health at the London School of Hygiene & Tropical Medicine (LSHTM) where he was also Director of the Malaria Centre and he remains a visiting professor there. He worked as a physician and researcher into preventing or treating infectious diseases in the UK, Africa and Asia, especially malaria and other parasitic diseases but also other infections of resource-poor settings. In 2008 the Bill & Melinda Gates Foundation awarded the LSHTM £31 million for malaria research in Africa. At the time, Whitty was the principal investigator for the ACT Consortium, which conducted the research programme. From 2009 to 2015, Whitty was Chief Scientific Adviser and director of research for the Department for International Development (DFID). He led the Research and Evidence Division, which worked on health, agriculture, climate change, energy, infrastructure, economic and governance research. During this time, with co-authors Neil Ferguson and Jeremy Farrar , he wrote an article in Nature titled "Infectious disease: Tough choices to reduce Ebola transmission", explaining the UK government's response to Ebola in support of the government of Sierra Leone, which he took a leading role in designing, including the proposal to build and support centres where people could self-isolate voluntarily if they suspected that they could have the disease. From January 2016 to August 2021, Whitty was Chief Scientific Adviser to the Department of Health and Social Care , responsible for the department's research and development work, including being Head of the National Institute for Health and Care Research (NIHR). From 2017 to 2018, Whitty was also interim Government Chief Scientific Adviser and head of the science and engineering profession in government. During this period Novichok , the military nerve agent, was responsible for the 2018 Salisbury poisonings , and Whitty chaired the government SAGE (Scientific Advisory Group in Emergencies) and advised COBR for the crisis. Whitty was appointed Chief Medical Officer (CMO) for England in 2019. Whitty and two of his deputies, Jenny Harries and Jonathan Van-Tam , took high-profile roles during the COVID-19 outbreak . This included appearing – often with prime minister Boris Johnson and Chief Scientific Adviser Sir Patrick Vallance – in televised news conferences, and giving evidence to parliamentary bodies. From 19 March, Whitty appeared in public information adverts on national television, explaining the government's social-distancing strategy to reduce the spread of the virus during the pandemic. On 27 March, Whitty was reported to be self-isolating owing to symptoms consistent with COVID-19 after Boris Johnson and Health Secretary Matt Hancock had tested positive for the virus. On 6 April, he had reportedly returned to work having recovered from the symptoms of the virus. In July, he told the Lords Science and Technology Committee that elimination of the disease in the UK would be very difficult, a view that was contested by other scientists including members of the Independent SAGE group. At a televised briefing on 12 October where the Prime Minister introduced three tiers of localised restrictions , Whitty said he was "not confident" that the measures in the highest tier would be "enough to get on top of it". Whitty and Vallance presented updated data and forecasts at a televised briefing on 31 October, where the Prime Minister announced stricter measures for the whole of England. During the outbreak, BBC health editor Hugh Pym called him "the official who will probably have the greatest impact on our everyday lives of any individual policymaker in modern times". The Guardian ' s sketch writer, John Crace , described him as "the Geek-in-Chief, whom everyone now regards as the country's de facto prime minister". At the same time, he was compared to James Niven , the Scottish physician known for reducing the death rate of influenza during the 1918 flu pandemic in Manchester . During the Christmas weekend of 2020, Whitty was spotted treating coronavirus patients in London. It was said he "worked the shifts in his capacity as a practising doctor [as] a consultant physician at University College London Hospitals Trust... on the north London hospital's respiratory ward over the weekend and bank holiday Monday". On 26 June 2021 a group of COVID-19 protesters demonstrated outside what appeared to be Whitty's flat in central London. Earlier in the month Whitty was followed down a street by a prominent anti-vaccine activist who shouted at him for being a liar, and in February he was called a liar multiple times while waiting for a takeaway lunch at a street food stall. On 27 June, Whitty was the subject of manhandling, described by Boris Johnson as "despicable harassment", by Lewis Hughes and Jonathan Chew in St James's Park , Westminster , who filmed the event for social media. The Health Secretary, Sajid Javid , said such behaviour would not be tolerated and that those responsible "should be ashamed". The Vaccines Minister, Nadhim Zahawi , said they were "thugs" and should face charges. Hughes subsequently pleaded guilty to a charge of beating and was given an eight-week suspended custodial sentence. He had previously apologised for any "upset" caused and had lost his job as an estate agent over the incident. In January 2022 Chew, who had initially pleaded not guilty, changed his plea and was given an eight-week custodial sentence. From 2009 to 2015, Whitty was Chief Scientific Adviser and director of research for the Department for International Development (DFID). He led the Research and Evidence Division, which worked on health, agriculture, climate change, energy, infrastructure, economic and governance research. During this time, with co-authors Neil Ferguson and Jeremy Farrar , he wrote an article in Nature titled "Infectious disease: Tough choices to reduce Ebola transmission", explaining the UK government's response to Ebola in support of the government of Sierra Leone, which he took a leading role in designing, including the proposal to build and support centres where people could self-isolate voluntarily if they suspected that they could have the disease. From January 2016 to August 2021, Whitty was Chief Scientific Adviser to the Department of Health and Social Care , responsible for the department's research and development work, including being Head of the National Institute for Health and Care Research (NIHR). From 2017 to 2018, Whitty was also interim Government Chief Scientific Adviser and head of the science and engineering profession in government. During this period Novichok , the military nerve agent, was responsible for the 2018 Salisbury poisonings , and Whitty chaired the government SAGE (Scientific Advisory Group in Emergencies) and advised COBR for the crisis. Whitty was appointed Chief Medical Officer (CMO) for England in 2019. Whitty and two of his deputies, Jenny Harries and Jonathan Van-Tam , took high-profile roles during the COVID-19 outbreak . This included appearing – often with prime minister Boris Johnson and Chief Scientific Adviser Sir Patrick Vallance – in televised news conferences, and giving evidence to parliamentary bodies. From 19 March, Whitty appeared in public information adverts on national television, explaining the government's social-distancing strategy to reduce the spread of the virus during the pandemic. On 27 March, Whitty was reported to be self-isolating owing to symptoms consistent with COVID-19 after Boris Johnson and Health Secretary Matt Hancock had tested positive for the virus. On 6 April, he had reportedly returned to work having recovered from the symptoms of the virus. In July, he told the Lords Science and Technology Committee that elimination of the disease in the UK would be very difficult, a view that was contested by other scientists including members of the Independent SAGE group. At a televised briefing on 12 October where the Prime Minister introduced three tiers of localised restrictions , Whitty said he was "not confident" that the measures in the highest tier would be "enough to get on top of it". Whitty and Vallance presented updated data and forecasts at a televised briefing on 31 October, where the Prime Minister announced stricter measures for the whole of England. During the outbreak, BBC health editor Hugh Pym called him "the official who will probably have the greatest impact on our everyday lives of any individual policymaker in modern times". The Guardian ' s sketch writer, John Crace , described him as "the Geek-in-Chief, whom everyone now regards as the country's de facto prime minister". At the same time, he was compared to James Niven , the Scottish physician known for reducing the death rate of influenza during the 1918 flu pandemic in Manchester . During the Christmas weekend of 2020, Whitty was spotted treating coronavirus patients in London. It was said he "worked the shifts in his capacity as a practising doctor [as] a consultant physician at University College London Hospitals Trust... on the north London hospital's respiratory ward over the weekend and bank holiday Monday". On 26 June 2021 a group of COVID-19 protesters demonstrated outside what appeared to be Whitty's flat in central London. Earlier in the month Whitty was followed down a street by a prominent anti-vaccine activist who shouted at him for being a liar, and in February he was called a liar multiple times while waiting for a takeaway lunch at a street food stall. On 27 June, Whitty was the subject of manhandling, described by Boris Johnson as "despicable harassment", by Lewis Hughes and Jonathan Chew in St James's Park , Westminster , who filmed the event for social media. The Health Secretary, Sajid Javid , said such behaviour would not be tolerated and that those responsible "should be ashamed". The Vaccines Minister, Nadhim Zahawi , said they were "thugs" and should face charges. Hughes subsequently pleaded guilty to a charge of beating and was given an eight-week suspended custodial sentence. He had previously apologised for any "upset" caused and had lost his job as an estate agent over the incident. In January 2022 Chew, who had initially pleaded not guilty, changed his plea and was given an eight-week custodial sentence. Whitty and two of his deputies, Jenny Harries and Jonathan Van-Tam , took high-profile roles during the COVID-19 outbreak . This included appearing – often with prime minister Boris Johnson and Chief Scientific Adviser Sir Patrick Vallance – in televised news conferences, and giving evidence to parliamentary bodies. From 19 March, Whitty appeared in public information adverts on national television, explaining the government's social-distancing strategy to reduce the spread of the virus during the pandemic. On 27 March, Whitty was reported to be self-isolating owing to symptoms consistent with COVID-19 after Boris Johnson and Health Secretary Matt Hancock had tested positive for the virus. On 6 April, he had reportedly returned to work having recovered from the symptoms of the virus. In July, he told the Lords Science and Technology Committee that elimination of the disease in the UK would be very difficult, a view that was contested by other scientists including members of the Independent SAGE group. At a televised briefing on 12 October where the Prime Minister introduced three tiers of localised restrictions , Whitty said he was "not confident" that the measures in the highest tier would be "enough to get on top of it". Whitty and Vallance presented updated data and forecasts at a televised briefing on 31 October, where the Prime Minister announced stricter measures for the whole of England. During the outbreak, BBC health editor Hugh Pym called him "the official who will probably have the greatest impact on our everyday lives of any individual policymaker in modern times". The Guardian ' s sketch writer, John Crace , described him as "the Geek-in-Chief, whom everyone now regards as the country's de facto prime minister". At the same time, he was compared to James Niven , the Scottish physician known for reducing the death rate of influenza during the 1918 flu pandemic in Manchester . During the Christmas weekend of 2020, Whitty was spotted treating coronavirus patients in London. It was said he "worked the shifts in his capacity as a practising doctor [as] a consultant physician at University College London Hospitals Trust... on the north London hospital's respiratory ward over the weekend and bank holiday Monday". On 26 June 2021 a group of COVID-19 protesters demonstrated outside what appeared to be Whitty's flat in central London. Earlier in the month Whitty was followed down a street by a prominent anti-vaccine activist who shouted at him for being a liar, and in February he was called a liar multiple times while waiting for a takeaway lunch at a street food stall. On 27 June, Whitty was the subject of manhandling, described by Boris Johnson as "despicable harassment", by Lewis Hughes and Jonathan Chew in St James's Park , Westminster , who filmed the event for social media. The Health Secretary, Sajid Javid , said such behaviour would not be tolerated and that those responsible "should be ashamed". The Vaccines Minister, Nadhim Zahawi , said they were "thugs" and should face charges. Hughes subsequently pleaded guilty to a charge of beating and was given an eight-week suspended custodial sentence. He had previously apologised for any "upset" caused and had lost his job as an estate agent over the incident. In January 2022 Chew, who had initially pleaded not guilty, changed his plea and was given an eight-week custodial sentence. Whitty was appointed Companion of the Order of the Bath (CB) in the 2015 New Year Honours for public and voluntary service to Tropical Medicine in the UK and Africa. He is a fellow of the Academy of Medical Sciences . Public lectures outlining his views on tackling current challenges in medicine and public health include over 20 Gresham lectures on topics such as infectious diseases, public health, cancer, cardiovascular diseases; and the 2017 Harveian Oration and the Milroy Lecture at the Royal College of Physicians . In September 2021, Whitty was awarded an honorary doctorate from the University of Plymouth in recognition of his support for the university's medical science research community. Whitty was appointed Knight Commander of the Order of the Bath (KCB) in the 2022 New Year Honours for services to public health. He was elected a Fellow of the Royal Society in 2023. In 2023 he was awarded the Royal Medal of the Royal Society.

Wiki

Ebola

https://api.wikimedia.org/core/v1/wikipedia/en/page/Indiana_vesiculovirus/html

Indiana vesiculovirus

Vesicular stomatitis Indiana virus Vesicular stomatitis virus Indiana vesiculovirus , formerly Vesicular stomatitis Indiana virus ( VSIV or VSV ) is a virus in the family Rhabdoviridae ; the well-known Rabies lyssavirus belongs to the same family. VSIV can infect insects , cattle, horses and pigs. It has particular importance to farmers in certain regions of the world where it infects cattle. This is because its clinical presentation is identical to the very important foot and mouth disease virus. The virus is zoonotic and leads to a flu-like illness in infected humans. It is also a common laboratory virus used to study the properties of viruses in the family Rhabdoviridae , as well as to study viral evolution . Indiana vesiculovirus is the prototypic member of the genus Vesiculovirus of the family Rhabdoviridae . VSIV is an arbovirus , and its replication occurs in the cytoplasm. Natural VSIV infections encompass two steps, cytolytic infections of mammalian hosts and transmission by insects. In insects, infections are noncytolytic persistent. One confirmed vector of the virus is the phlebotomine sand fly Lutzomyia shannoni . The genome of VSIV is on a single molecule of negative-sense RNA that has 11,161 nucleotides in length, that encodes five major proteins: G protein (G), large protein (L), phosphoprotein (P), matrix protein (M) and nucleoprotein (N): The VSIV G protein, aka VSVG, enables viral entry . It mediates viral attachment to an LDL receptor ( LDLR ) or an LDLR family member present on the host cell. Following binding, the VSIV-LDLR complex is rapidly endocytosed . It then mediates fusion of the viral envelope with the endosomal membrane. VSIV enters the cell through partially clathrin -coated vesicles; virus-containing vesicles contain more clathrin and clathrin adaptor than conventional vesicles. Virus-containing vesicles recruit components of the actin machinery for their interaction, thus inducing its own uptake. VSIV G does not follow the same path as most vesicles because transport of the G protein from the ER to the plasma membrane is interrupted by incubation at 15 °C. Under this condition, the molecules accumulate in both the ER and a subcellular vesicle fraction of low density called the lipid-rich vesicle fraction. The material in the lipid-rich vesicle fraction appears to be a post-ER intermediate in the transport process to the plasma membrane (PM). After infection, the VSIV G gene is expressed and is commonly studied as a model for N -linked glycosylation in the endoplasmic reticulum (ER). It is translated into the rough ER where the Glc 3 - Man 9 - GlcNac 2 oligosaccharide is added by a dolichol -containing protein, to an NXS motif on VSIV G. Sugars are removed gradually as the protein travels to the Golgi apparatus , and it becomes resistant to endoglycosidase H . When synthesized in polarized epithelial cells, the envelope glycoprotein VSV G is targeted to the basolateral PM. VSVG is also a common coat protein for lentiviral vector expression systems used to introduce genetic material into in vitro systems or animal models, mainly because of its extremely broad tropism. [ citation needed ] The VSIV L protein is encoded by half the genome, and combines with the phosphoprotein to catalyze replication of the mRNA. The VSIV M protein is encoded by an mRNA that is 831 nucleotides long and translates to a 229 amino acid-protein. The predicted M protein sequence does not contain any long hydrophobic or nonpolar domains that might promote membrane association. The protein is rich in basic amino acids and contains a highly basic amino terminal domain. [ citation needed ] The VSV N protein is required to initiate genome synthesis. The main sign in animals is oral disease appearing as mucosal vesicles and ulcers in the mouth, but also on the udder and around the coronary band . Animals may show systemic signs such as anorexia, lethargy and pyrexia (fever). Disease usually resolves within two weeks, and animals usually recover completely. Cases of human infection with vesicular stomatitis virus have been described. Most of these cases have been among laboratory workers, veterinarians, and livestock handlers. In most cases, VSV infection has resulted in a short 3 to 5 day illness characterized by fever, headache, myalgia , weakness and occasionally vesicular lesions of the mouth. Serological testing is most commonly performed with an ELISA or complement fixation , and viral isolation can also be attempted. No specific treatment is available, but some animals may require supportive fluids or antibiotics for secondary infections. Control relies on biosecurity protocols, quarantine, isolation and disinfection to ensure the viral disease does not enter a country or herd. The main sign in animals is oral disease appearing as mucosal vesicles and ulcers in the mouth, but also on the udder and around the coronary band . Animals may show systemic signs such as anorexia, lethargy and pyrexia (fever). Disease usually resolves within two weeks, and animals usually recover completely. Cases of human infection with vesicular stomatitis virus have been described. Most of these cases have been among laboratory workers, veterinarians, and livestock handlers. In most cases, VSV infection has resulted in a short 3 to 5 day illness characterized by fever, headache, myalgia , weakness and occasionally vesicular lesions of the mouth. Serological testing is most commonly performed with an ELISA or complement fixation , and viral isolation can also be attempted. No specific treatment is available, but some animals may require supportive fluids or antibiotics for secondary infections. Control relies on biosecurity protocols, quarantine, isolation and disinfection to ensure the viral disease does not enter a country or herd. In healthy human cells the virus cannot reproduce, likely because of the interferon response, which allows the cells to adequately respond to viral infection. The same cannot be said of interferon non-responsive cancer cells, a quality which allows VSIV to grow and lyse oncogenic cells preferentially. Recently, attenuated VSIV with a mutation in its M protein has been found to have oncolytic properties. Research is ongoing, and has shown VSIV to reduce tumor size and spread in melanoma, lung cancer, colon cancer and certain brain tumors in laboratory models of cancer. VSIV was modified to attack HIV -infected T-cells. The modified virus was called a "trojan horse" virus NIH Press Release - Trojan Horse Virus Controls HIV Infection - 09/04/1997 Recombinant VSIV has undergone phase 1 trials as a vaccine for Ebola virus . Recombinant VSIV expressing the Ebola virus glycoprotein has undergone phase III trials in Africa as a vaccine for Ebola virus disease . The vaccine was shown to be 76-100% effective in preventing Ebola virus disease. (see also rVSV-ZEBOV vaccine ) In December 2019, Merck & Co. 's rVSV-ZEBOV vaccine Ervebo was approved by the Food and Drug Administration to treat individuals 18 and older. Replication competent rVSV has also been created expressing proteins of Lassa fever and Marburg virus . In healthy human cells the virus cannot reproduce, likely because of the interferon response, which allows the cells to adequately respond to viral infection. The same cannot be said of interferon non-responsive cancer cells, a quality which allows VSIV to grow and lyse oncogenic cells preferentially. Recently, attenuated VSIV with a mutation in its M protein has been found to have oncolytic properties. Research is ongoing, and has shown VSIV to reduce tumor size and spread in melanoma, lung cancer, colon cancer and certain brain tumors in laboratory models of cancer. VSIV was modified to attack HIV -infected T-cells. The modified virus was called a "trojan horse" virus NIH Press Release - Trojan Horse Virus Controls HIV Infection - 09/04/1997Recombinant VSIV has undergone phase 1 trials as a vaccine for Ebola virus . Recombinant VSIV expressing the Ebola virus glycoprotein has undergone phase III trials in Africa as a vaccine for Ebola virus disease . The vaccine was shown to be 76-100% effective in preventing Ebola virus disease. (see also rVSV-ZEBOV vaccine ) In December 2019, Merck & Co. 's rVSV-ZEBOV vaccine Ervebo was approved by the Food and Drug Administration to treat individuals 18 and older. Replication competent rVSV has also been created expressing proteins of Lassa fever and Marburg virus . The VSIV G protein is routinely used in biomedical research to pseudotype retroviral and lentiviral vectors , conferring the ability to transduce a broad range of mammalian cell types with genes of interest. The VSIV G protein has also been used in cytological studies of trafficking in the endomembrane system . Immunoelectron microscopy suggests that VSIV G protein moves from cis to trans Golgi bodies without being transported between them in vesicles, supporting the cisternal maturation model of Golgi trafficking. VSV is often used to perform quantitative and computational studies on viral genome replication and transcription. Such studies help build a better understanding of viral behavior in the presence and absence of innate immune response . [ citation needed ] In 2020, a possible vaccine against COVID-19 , the disease caused by SARS-CoV-2 , was developed based on modified VSV. The modification involved replacing the VSV's surface protein genes with those for SARS-CoV-2's spike proteins.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Lassa_fever/html

Lassa fever

Lassa fever , also known as Lassa hemorrhagic fever , is a type of viral hemorrhagic fever caused by the Lassa virus . Many of those infected by the virus do not develop symptoms . When symptoms occur they typically include fever , weakness, headaches, vomiting , and muscle pains . Less commonly there may be bleeding from the mouth or gastrointestinal tract . The risk of death once infected is about one percent and frequently occurs within two weeks of the onset of symptoms. Of those who survive, about a quarter have hearing loss , which improves within three months in about half of these cases. The disease is usually initially spread to people via contact with the urine or feces of an infected multimammate mouse . Spread can then occur via direct contact between people. Diagnosis based on symptoms is difficult. Confirmation is by laboratory testing to detect the virus's RNA , antibodies for the virus, or the virus itself in cell culture . Other conditions that may present similarly include Ebola , malaria , typhoid fever , and yellow fever . The Lassa virus is a member of the Arenaviridae family of viruses . There is no vaccine . Prevention requires isolating those who are infected and decreasing contact with the mice. Other efforts to control the spread of disease include having a cat to hunt vermin , and storing food in sealed containers. Treatment is directed at addressing dehydration and improving symptoms. The antiviral medication ribavirin has been recommended, but evidence to support its use is weak. Descriptions of the disease date from the 1950s. The virus was first described in 1969 from a case in the town of Lassa, in Borno State , Nigeria . Lassa fever is relatively common in West Africa including the countries of Nigeria , Liberia , Sierra Leone , Guinea , and Ghana . There are about 300,000 to 500,000 cases which result in 5,000 deaths a year. Onset of symptoms is typically 7 to 21 days after exposure. In 80% of those who are infected few or no symptoms occur. These mild symptoms may include fever, tiredness, weakness, and headache. In 20% of people more severe symptoms such as bleeding gums, breathing problems, vomiting, chest pain, or dangerously low blood pressure may occur. Long term complications may include hearing loss . In those who are pregnant , miscarriage may occur in 95% of child-bearing females . Lassa fever can be difficult to distinguish clinically from other viral hemorrhagic fevers, such as Ebola virus disease . A combination of pharyngitis , pain behind the sternum , presence of excess protein in the urine and fever can indicate Lassa fever with higher specificity. In cases in which death occurs, this typically occurs within 14 days of onset. About 1% of all Lassa virus infections result in death. Approximately 15%-20% of those who have required hospitalization for Lassa fever die. The risk of death is greater in those who are pregnant. A "Swollen baby syndrome" may occur in newborns, infants and toddlers with pitting edema , abdominal distension and bleeding. Lassa virus is a member of the Arenaviridae , a family of negative-sense, single-stranded RNA viruses . Specifically it is an old world arenavirus, which is enveloped, single-stranded, and bi-segmented RNA. Lassa virus contains both a large and a small genome section, with seven lineages identified to date: Lineages I, II, and III from Nigeria ; Lineage IV from Sierra Leone , Guinea , and Liberia ; Lineage V from Cote D'Ivoire and Mali Lineage VI from Togo ; and Lineage VII from Benin . Lassa virus commonly spreads to humans from other animals, specifically the Natal multimammate mouse or African rat, also called the Natal multimammate rat ( Mastomys natalensis ). This is probably the most common mouse in equatorial Africa, common in human households and eaten as a delicacy in some areas. The multimammate mouse can quickly produce a large number of offspring, tends to colonize human settlements, increasing the risk of rodent-human contact, and is found throughout the west, central and eastern parts of the African continent. Once the mouse has become a carrier, it will excrete the virus throughout the rest of its lifetime through feces and urine creating ample opportunity for exposure. The virus is probably transmitted by contact with the feces or urine of animals accessing grain stores in residences. No study has proven presence in breast milk, but the high level of viremia suggests it may be possible. Individuals who are at a higher risk of contracting the infection are those who live in rural areas where Mastomys are discovered, and where sanitation is not prevalent. Infection typically occurs by direct or indirect exposure to animal excrement through the respiratory or gastrointestinal tracts. Inhalation of tiny particles of infectious material (aerosol) is believed to be the most significant means of exposure. It is possible to acquire the infection through broken skin or mucous membranes that are directly exposed to infectious material. Transmission from person to person has been established, presenting a disease risk for healthcare workers. The virus is present in urine for between three and nine weeks after infection, and it can be transmitted in semen for up to three months after becoming infected. Lassa virus is a member of the Arenaviridae , a family of negative-sense, single-stranded RNA viruses . Specifically it is an old world arenavirus, which is enveloped, single-stranded, and bi-segmented RNA. Lassa virus contains both a large and a small genome section, with seven lineages identified to date: Lineages I, II, and III from Nigeria ; Lineage IV from Sierra Leone , Guinea , and Liberia ; Lineage V from Cote D'Ivoire and Mali Lineage VI from Togo ; and Lineage VII from Benin . Lassa virus commonly spreads to humans from other animals, specifically the Natal multimammate mouse or African rat, also called the Natal multimammate rat ( Mastomys natalensis ). This is probably the most common mouse in equatorial Africa, common in human households and eaten as a delicacy in some areas. The multimammate mouse can quickly produce a large number of offspring, tends to colonize human settlements, increasing the risk of rodent-human contact, and is found throughout the west, central and eastern parts of the African continent. Once the mouse has become a carrier, it will excrete the virus throughout the rest of its lifetime through feces and urine creating ample opportunity for exposure. The virus is probably transmitted by contact with the feces or urine of animals accessing grain stores in residences. No study has proven presence in breast milk, but the high level of viremia suggests it may be possible. Individuals who are at a higher risk of contracting the infection are those who live in rural areas where Mastomys are discovered, and where sanitation is not prevalent. Infection typically occurs by direct or indirect exposure to animal excrement through the respiratory or gastrointestinal tracts. Inhalation of tiny particles of infectious material (aerosol) is believed to be the most significant means of exposure. It is possible to acquire the infection through broken skin or mucous membranes that are directly exposed to infectious material. Transmission from person to person has been established, presenting a disease risk for healthcare workers. The virus is present in urine for between three and nine weeks after infection, and it can be transmitted in semen for up to three months after becoming infected. A range of laboratory investigations are performed, where possible, to diagnose the disease and assess its course and complications. The confidence of a diagnosis can be compromised if laboratory tests are not available. One comprising factor is the number of febrile illnesses present in Africa, such as malaria or typhoid fever that could potentially exhibit similar symptoms, particularly for non-specific manifestations of Lassa fever. In cases with abdominal pain , in countries where Lassa is common, Lassa fever is often misdiagnosed as appendicitis and intussusception which delays treatment with the antiviral ribavirin . In West Africa, where Lassa is most common, it is difficult to diagnose due to the absence of proper equipment to perform testing. The FDA has yet to approve a widely validated laboratory test for Lassa, but there are tests that have been able to provide definitive proof of the presence of the LASV virus. These tests include cell cultures, PCR, ELISA antigen assays, plaque neutralization assays, and immunofluorescence essays. However, immunofluorescence essays provide less definitive proof of Lassa infection. An ELISA test for antigen and Immunoglobulin M antibodies give 88% sensitivity and 90% specificity for the presence of the infection. Other laboratory findings in Lassa fever include lymphocytopenia (low white blood cell count), thrombocytopenia (low platelets), and elevated aspartate transaminase levels in the blood. Lassa fever virus can also be found in cerebrospinal fluid . Control of the Mastomys rodent population is impractical, so measures focus on keeping rodents out of homes and food supplies, encouraging effective personal hygiene, storing grain and other foodstuffs in rodent-proof containers, and disposing of garbage far from the home to help sustain clean households. Gloves, masks, laboratory coats, and goggles are advised while in contact with an infected person, to avoid contact with blood and body fluids. These issues in many countries are monitored by a department of public health . In less developed countries, these types of organizations may not have the necessary means to effectively control outbreaks. There is no vaccine for humans as of 2023. Researchers at the United States Army Medical Research Institute of Infectious Diseases facility had a promising vaccine candidate in 2002. They have developed a replication -competent vaccine against Lassa virus based on recombinant vesicular stomatitis virus vectors expressing the Lassa virus glycoprotein. After a single intramuscular injection , test primates have survived lethal challenge, while showing no clinical symptoms. There is no vaccine for humans as of 2023. Researchers at the United States Army Medical Research Institute of Infectious Diseases facility had a promising vaccine candidate in 2002. They have developed a replication -competent vaccine against Lassa virus based on recombinant vesicular stomatitis virus vectors expressing the Lassa virus glycoprotein. After a single intramuscular injection , test primates have survived lethal challenge, while showing no clinical symptoms. Treatment is directed at addressing dehydration and improving symptoms. All persons suspected of Lassa fever infection should be admitted to isolation facilities and their body fluids and excreta properly disposed of. [ citation needed ] The antiviral medication ribavirin has been recommended, but evidence to support its use is weak. Some evidence has found that it may worsen outcomes in certain cases. Fluid replacement, blood transfusions, and medication for low blood pressure may be required. Intravenous interferon therapy has also been used. When Lassa fever infects pregnant women late in their third trimester, inducing delivery is necessary for the mother to have a good chance of survival. This is because the virus has an affinity for the placenta and other highly vascular tissues. The fetus has only a one in ten chance of survival no matter what course of action is taken; hence, the focus is always on saving the life of the mother. Following delivery, women should receive the same treatment as other people with Lassa fever. [ citation needed ]The antiviral medication ribavirin has been recommended, but evidence to support its use is weak. Some evidence has found that it may worsen outcomes in certain cases. Fluid replacement, blood transfusions, and medication for low blood pressure may be required. Intravenous interferon therapy has also been used. When Lassa fever infects pregnant women late in their third trimester, inducing delivery is necessary for the mother to have a good chance of survival. This is because the virus has an affinity for the placenta and other highly vascular tissues. The fetus has only a one in ten chance of survival no matter what course of action is taken; hence, the focus is always on saving the life of the mother. Following delivery, women should receive the same treatment as other people with Lassa fever. [ citation needed ]About 15–20% of hospitalized people with Lassa fever will die from the illness. The overall case fatality rate is estimated to be 1%, but during epidemics , mortality can climb as high as 50%. The mortality rate is greater than 80% when it occurs in pregnant women during their third trimester; fetal death also occurs in nearly all those cases. Abortion decreases the risk of death to the mother. Some survivors experience lasting effects of the disease, and can include partial or complete deafness. Because of treatment with ribavirin , fatality rates have declined. There are about 300,000 to 500,000 cases which result in 5,000 deaths a year. One estimate places the number as high as 3 million cases per year. Estimates of Lassa fever are complicated by the lack of easy-available diagnosis, limited public health surveillance infrastructure, and high clustering of incidence near high intensity sampling. The infection affects females 1.2 times more than males. The age group predominantly infected is 21–30 years. Lassa high risk areas are near the western and eastern extremes of West Africa. As of 2018, the Lassa belt includes Guinea, Nigeria, Sierra Leone and Liberia. As of 2003, 10-16% of people in Sierra Leone and Liberia admitted to hospital had the virus. The case fatality rate for those who are hospitalized for the disease is about 15-20%. Research showed a twofold increase risk of infection for those living in close proximity to someone with infection symptoms within the last year. [ citation needed ] The high risk areas cannot be well defined by any known biogeographical or environmental breaks except for the multimammate rat, particularly Guinea ( Kindia , Faranah and Nzérékoré regions), Liberia (mostly in Lofa , Bong , and Nimba counties), Nigeria (in about 10 of 36 states) and Sierra Leone (typically from Kenema and Kailahun districts). It is less common in the Central African Republic, Mali, Senegal and other nearby countries, and less common yet in Ghana and the Democratic Republic of the Congo. Benin had its first confirmed cases in 2014, and Togo had its first confirmed cases in 2016. As of 2013, the spread of Lassa outside of West Africa had been very limited. Twenty to thirty cases had been described in Europe, as being caused by importation through infected individuals. These cases found outside of West Africa were found to have a high fatality risk because of the delay of diagnosis and treatment due to being unaware of the risk associated with the symptoms. Imported cases have not manifested in larger epidemics outside of Africa due to a lack of human to human transmission in hospital settings. An exception had occurred in 2003 when a healthcare worker became infected before the person showed clear symptoms. An outbreak of Lassa fever occurred in Nigeria during 2018 and spread to 18 of the country's states; it was the largest outbreak of Lassa recorded. On 25 February 2018, there were 1081 suspected cases and 90 reported deaths; 317 of the cases and 72 deaths were confirmed as Lassa which increased to a total of 431 reported cases in 2018. The total cases in Nigeria in 2019 was 810 with 167 deaths, the largest case fatality rate (23.3%) until then. The epidemic started from the second week of the January. By the tenth week the total number of cases has risen to 855 and deaths to 144, the case fatality rate of 16.8%. On the 8th of December 2021, the Nigeria Centre for Disease Control (NCDC) was notified of the death of two persons from Lassa fever. The epidemic took a new form, from 3 to 30 January 2022, 211 laboratory confirmed Lassa fever cases including 40 deaths (case fatality ratio: 19%) have been cumulatively reported in 14 of the 36 Nigerian states and the Federal Capital Territory across the country. In total from January until March, 132 deaths have been reported with a case fatality rate (CFR) of 19.1% which is lower than the CFR for the same period in 2021 (21.0%). Lassa high risk areas are near the western and eastern extremes of West Africa. As of 2018, the Lassa belt includes Guinea, Nigeria, Sierra Leone and Liberia. As of 2003, 10-16% of people in Sierra Leone and Liberia admitted to hospital had the virus. The case fatality rate for those who are hospitalized for the disease is about 15-20%. Research showed a twofold increase risk of infection for those living in close proximity to someone with infection symptoms within the last year. [ citation needed ] The high risk areas cannot be well defined by any known biogeographical or environmental breaks except for the multimammate rat, particularly Guinea ( Kindia , Faranah and Nzérékoré regions), Liberia (mostly in Lofa , Bong , and Nimba counties), Nigeria (in about 10 of 36 states) and Sierra Leone (typically from Kenema and Kailahun districts). It is less common in the Central African Republic, Mali, Senegal and other nearby countries, and less common yet in Ghana and the Democratic Republic of the Congo. Benin had its first confirmed cases in 2014, and Togo had its first confirmed cases in 2016. As of 2013, the spread of Lassa outside of West Africa had been very limited. Twenty to thirty cases had been described in Europe, as being caused by importation through infected individuals. These cases found outside of West Africa were found to have a high fatality risk because of the delay of diagnosis and treatment due to being unaware of the risk associated with the symptoms. Imported cases have not manifested in larger epidemics outside of Africa due to a lack of human to human transmission in hospital settings. An exception had occurred in 2003 when a healthcare worker became infected before the person showed clear symptoms. An outbreak of Lassa fever occurred in Nigeria during 2018 and spread to 18 of the country's states; it was the largest outbreak of Lassa recorded. On 25 February 2018, there were 1081 suspected cases and 90 reported deaths; 317 of the cases and 72 deaths were confirmed as Lassa which increased to a total of 431 reported cases in 2018. The total cases in Nigeria in 2019 was 810 with 167 deaths, the largest case fatality rate (23.3%) until then. The epidemic started from the second week of the January. By the tenth week the total number of cases has risen to 855 and deaths to 144, the case fatality rate of 16.8%. On the 8th of December 2021, the Nigeria Centre for Disease Control (NCDC) was notified of the death of two persons from Lassa fever. The epidemic took a new form, from 3 to 30 January 2022, 211 laboratory confirmed Lassa fever cases including 40 deaths (case fatality ratio: 19%) have been cumulatively reported in 14 of the 36 Nigerian states and the Federal Capital Territory across the country. In total from January until March, 132 deaths have been reported with a case fatality rate (CFR) of 19.1% which is lower than the CFR for the same period in 2021 (21.0%). An outbreak of Lassa fever occurred in Nigeria during 2018 and spread to 18 of the country's states; it was the largest outbreak of Lassa recorded. On 25 February 2018, there were 1081 suspected cases and 90 reported deaths; 317 of the cases and 72 deaths were confirmed as Lassa which increased to a total of 431 reported cases in 2018. The total cases in Nigeria in 2019 was 810 with 167 deaths, the largest case fatality rate (23.3%) until then. The epidemic started from the second week of the January. By the tenth week the total number of cases has risen to 855 and deaths to 144, the case fatality rate of 16.8%. On the 8th of December 2021, the Nigeria Centre for Disease Control (NCDC) was notified of the death of two persons from Lassa fever. The epidemic took a new form, from 3 to 30 January 2022, 211 laboratory confirmed Lassa fever cases including 40 deaths (case fatality ratio: 19%) have been cumulatively reported in 14 of the 36 Nigerian states and the Federal Capital Territory across the country. In total from January until March, 132 deaths have been reported with a case fatality rate (CFR) of 19.1% which is lower than the CFR for the same period in 2021 (21.0%). Lassa fever is endemic in Liberia. From 1 January 2017 through 23 January 2018, 91 suspected cases were reported from six counties: Bong, Grand Bassa, Grand Kru, Lofa, Margibi, and Nimba. Thirty-three of these cases were laboratory confirmed, including 15 deaths (case fatality rate for confirmed cases = 45.4%). In February 2020, a total of 24 confirmed cases with nine associated deaths has been reported from nine health districts in six counties. Grand Bossa and Bong counties account for 20 of the confirmed cases. The disease was identified in Nigeria in 1969. It is named after the town of Lassa, where it was discovered. A prominent expert in the disease, Aniru Conteh , died from the disease. The Lassa virus is one of several viruses identified by WHO as a likely cause of a future epidemic. They therefore list it for urgent research and development to develop new diagnostic tests, vaccines, and medicines. In 2007, SIGA Technologies , studied a medication in guinea pig with Lassa fever. Work on a vaccine is continuing, with multiple approaches showing positive results in animal trials.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Lassa_mammarenavirus/html

Lassa mammarenavirus

Lassa virus Lassa mammarenavirus ( LASV ) is an arenavirus that causes Lassa hemorrhagic fever , a type of viral hemorrhagic fever (VHF), in humans and other primates . Lassa mammarenavirus is an emerging virus and a select agent , requiring Biosafety Level 4-equivalent containment . It is endemic in West African countries, especially Sierra Leone , the Republic of Guinea , Nigeria , and Liberia , where the annual incidence of infection is between 300,000 and 500,000 cases, resulting in 5,000 deaths per year. As of 2012 discoveries within the Mano River region of west Africa have expanded the endemic zone between the two known Lassa endemic regions, indicating that LASV is more widely distributed throughout the tropical wooded savannah ecozone in west Africa. There are no approved vaccines against Lassa fever for use in humans. In 1969, missionary nurse Laura Wine fell ill with a mysterious disease she contracted from an obstetrical patient in Lassa, a village in Borno State , Nigeria. She was then transported to Jos , where she died. Subsequently, two others became infected, one of whom was fifty-two-year-old nurse Lily Pinneo who had cared for Laura Wine. Samples from Pinneo were sent to Yale University in New Haven where a new virus, that would later be known as Lassa mammarenavirus , was isolated for the first time by Jordi Casals-Ariet , Sonja Buckley , and others. Casals contracted the fever, and nearly lost his life; one technician died from it. By 1972, the multimammate rat, Mastomys natalensis , was found to be the main reservoir of the virus in West Africa, able to shed virus in its urine and feces without exhibiting visible symptoms. Lassa viruses are enveloped, single-stranded, bisegmented, ambisense RNA viruses . Their genome is contained in two RNA segments that code for two proteins each, one in each sense, for a total of four viral proteins. The large segment encodes a small zinc finger protein (Z) that regulates transcription and replication, and the RNA polymerase (L). The small segment encodes the nucleoprotein (NP) and the surface glycoprotein precursor (GP, also known as the viral spike ), which is proteolytically cleaved into the envelope glycoproteins GP1 and GP2 that bind to the alpha-dystroglycan receptor and mediate host cell entry. Lassa fever causes hemorrhagic fever frequently shown by immunosuppression. Lassa mammarenavirus replicates very rapidly, and demonstrates temporal control in replication. The first replication step is transcription of mRNA copies of the negative- or minus-sense genome. This ensures an adequate supply of viral proteins for subsequent steps of replication, as the NP and L proteins are translated from the mRNA. The positive- or plus-sense genome, then makes viral complementary RNA (vcRNA) copies of itself. The RNA copies are a template for producing negative-sense progeny, but mRNA is also synthesized from it. The mRNA synthesized from vcRNA are translated to make the GP and Z proteins. This temporal control allows the spike proteins to be produced last, and therefore, delay recognition by the host immune system. [ citation needed ] Nucleotide studies of the genome have shown that Lassa has four lineages: three found in Nigeria and the fourth in Guinea, Liberia, and Sierra Leone. The Nigerian strains seem likely to have been ancestral to the others but additional work is required to confirm this. Lassa mammarenavirus gains entry into the host cell by means of the cell-surface receptor the alpha-dystroglycan (alpha-DG), a versatile receptor for proteins of the extracellular matrix . It shares this receptor with the prototypic Old World arenavirus lymphocytic choriomeningitis virus . Receptor recognition depends on a specific sugar modification of alpha-dystroglycan by a group of glycosyltransferases known as the LARGE proteins. Specific variants of the genes encoding these proteins appear to be under positive selection in West Africa where Lassa is endemic. Alpha-dystroglycan is also used as a receptor by viruses of the New World clade C arenaviruses (Oliveros and Latino viruses). In contrast, the New World arenaviruses of clades A and B, which include the important viruses Machupo , Guanarito , Junin , and Sabia in addition to the non pathogenic Amapari virus, use the transferrin receptor 1 . A small aliphatic amino acid at the GP1 glycoprotein amino acid position 260 is required for high-affinity binding to alpha-DG. In addition, GP1 amino acid position 259 also appears to be important, since all arenaviruses showing high-affinity alpha-DG binding possess a bulky aromatic amino acid (tyrosine or phenylalanine) at this position. [ citation needed ] Unlike most enveloped viruses which use clathrin coated pits for cellular entry and bind to their receptors in a pH dependent fashion, Lassa and lymphocytic choriomeningitis virus instead use an endocytotic pathway independent of clathrin, caveolin , dynamin and actin . Once within the cell the viruses are rapidly delivered to endosomes via vesicular trafficking albeit one that is largely independent of the small GTPases Rab5 and Rab7 . On contact with the endosome pH-dependent membrane fusion occurs mediated by the envelope glycoprotein, which at the lower pH of the endosome binds the lysosome protein LAMP1 which results in membrane fusion and escape from the endosome. [ citation needed ] The life cycle of Lassa mammarenavirus is similar to the Old World arenaviruses. Lassa mammarenavirus enters the cell by the receptor-mediated endocytosis . Which endocytotic pathway is used is not known yet, but at least the cellular entry is sensitive to cholesterol depletion. It was reported that virus internalization is limited upon cholesterol depletion. The receptor used for cell entry is alpha- dystroglycan , a highly conserved and ubiquitously expressed cell surface receptor for extracellular matrix proteins. Dystroglycan, which is later cleaved into alpha-dystroglycan and beta-dystroglycan is originally expressed in most cells to mature tissues, and it provides molecular link between the ECM and the actin-based cytoskeleton. After the virus enters the cell by alpha-dystroglycan mediated endocytosis, the low-pH environment triggers pH-dependent membrane fusion and releases RNP (viral ribonucleoprotein) complex into the cytoplasm. Viral RNA is unpacked, and replication and transcription initiate in the cytoplasm. As replication starts, both S and L RNA genomes synthesize the antigenomic S and L RNAs, and from the antigenomic RNAs, genomic S and L RNA are synthesized. Both genomic and antigenomic RNAs are needed for transcription and translation . The S RNA encodes GP and NP (viral nucleocapsid protein) proteins, while L RNA encodes Z and L proteins. The L protein most likely represents the viral RNA-dependent RNA polymerase. When the cell is infected by the virus, L polymerase is associated with the viral RNP and initiates the transcription of the genomic RNA. The 5' and 3' terminal 19 nt viral promoter regions of both RNA segments are necessary for recognition and binding of the viral polymerase . The primary transcription first transcribes mRNAs from the genomic S and L RNAs, which code NP and L proteins, respectively. Transcription terminates at the stem-loop (SL) structure within the intergenomic region. Arenaviruses use a cap snatching strategy to gain the cap structures from the cellular mRNAs, and it is mediated by the endonuclease activity of the L polymerase and the cap binding activity of NP. Antigenomic RNA transcribes viral genes GPC and Z, encoded in genomic orientation, from S and L segments respectively. The antigenomic RNA also serves as the template for the replication. After translation of GPC, it is posttranslationally modified in the endoplasmic reticulum . GPC is cleaved into GP1 and GP2 at the later stage of the secretory pathway. It has been reported that the cellular protease SKI-1/S1P is responsible for this cleavage. The cleaved glycoproteins are incorporated into the virion envelope when the virus buds and release from the cell membrane. Lassa viruses are enveloped, single-stranded, bisegmented, ambisense RNA viruses . Their genome is contained in two RNA segments that code for two proteins each, one in each sense, for a total of four viral proteins. The large segment encodes a small zinc finger protein (Z) that regulates transcription and replication, and the RNA polymerase (L). The small segment encodes the nucleoprotein (NP) and the surface glycoprotein precursor (GP, also known as the viral spike ), which is proteolytically cleaved into the envelope glycoproteins GP1 and GP2 that bind to the alpha-dystroglycan receptor and mediate host cell entry. Lassa fever causes hemorrhagic fever frequently shown by immunosuppression. Lassa mammarenavirus replicates very rapidly, and demonstrates temporal control in replication. The first replication step is transcription of mRNA copies of the negative- or minus-sense genome. This ensures an adequate supply of viral proteins for subsequent steps of replication, as the NP and L proteins are translated from the mRNA. The positive- or plus-sense genome, then makes viral complementary RNA (vcRNA) copies of itself. The RNA copies are a template for producing negative-sense progeny, but mRNA is also synthesized from it. The mRNA synthesized from vcRNA are translated to make the GP and Z proteins. This temporal control allows the spike proteins to be produced last, and therefore, delay recognition by the host immune system. [ citation needed ] Nucleotide studies of the genome have shown that Lassa has four lineages: three found in Nigeria and the fourth in Guinea, Liberia, and Sierra Leone. The Nigerian strains seem likely to have been ancestral to the others but additional work is required to confirm this. Lassa mammarenavirus gains entry into the host cell by means of the cell-surface receptor the alpha-dystroglycan (alpha-DG), a versatile receptor for proteins of the extracellular matrix . It shares this receptor with the prototypic Old World arenavirus lymphocytic choriomeningitis virus . Receptor recognition depends on a specific sugar modification of alpha-dystroglycan by a group of glycosyltransferases known as the LARGE proteins. Specific variants of the genes encoding these proteins appear to be under positive selection in West Africa where Lassa is endemic. Alpha-dystroglycan is also used as a receptor by viruses of the New World clade C arenaviruses (Oliveros and Latino viruses). In contrast, the New World arenaviruses of clades A and B, which include the important viruses Machupo , Guanarito , Junin , and Sabia in addition to the non pathogenic Amapari virus, use the transferrin receptor 1 . A small aliphatic amino acid at the GP1 glycoprotein amino acid position 260 is required for high-affinity binding to alpha-DG. In addition, GP1 amino acid position 259 also appears to be important, since all arenaviruses showing high-affinity alpha-DG binding possess a bulky aromatic amino acid (tyrosine or phenylalanine) at this position. [ citation needed ] Unlike most enveloped viruses which use clathrin coated pits for cellular entry and bind to their receptors in a pH dependent fashion, Lassa and lymphocytic choriomeningitis virus instead use an endocytotic pathway independent of clathrin, caveolin , dynamin and actin . Once within the cell the viruses are rapidly delivered to endosomes via vesicular trafficking albeit one that is largely independent of the small GTPases Rab5 and Rab7 . On contact with the endosome pH-dependent membrane fusion occurs mediated by the envelope glycoprotein, which at the lower pH of the endosome binds the lysosome protein LAMP1 which results in membrane fusion and escape from the endosome. [ citation needed ]The life cycle of Lassa mammarenavirus is similar to the Old World arenaviruses. Lassa mammarenavirus enters the cell by the receptor-mediated endocytosis . Which endocytotic pathway is used is not known yet, but at least the cellular entry is sensitive to cholesterol depletion. It was reported that virus internalization is limited upon cholesterol depletion. The receptor used for cell entry is alpha- dystroglycan , a highly conserved and ubiquitously expressed cell surface receptor for extracellular matrix proteins. Dystroglycan, which is later cleaved into alpha-dystroglycan and beta-dystroglycan is originally expressed in most cells to mature tissues, and it provides molecular link between the ECM and the actin-based cytoskeleton. After the virus enters the cell by alpha-dystroglycan mediated endocytosis, the low-pH environment triggers pH-dependent membrane fusion and releases RNP (viral ribonucleoprotein) complex into the cytoplasm. Viral RNA is unpacked, and replication and transcription initiate in the cytoplasm. As replication starts, both S and L RNA genomes synthesize the antigenomic S and L RNAs, and from the antigenomic RNAs, genomic S and L RNA are synthesized. Both genomic and antigenomic RNAs are needed for transcription and translation . The S RNA encodes GP and NP (viral nucleocapsid protein) proteins, while L RNA encodes Z and L proteins. The L protein most likely represents the viral RNA-dependent RNA polymerase. When the cell is infected by the virus, L polymerase is associated with the viral RNP and initiates the transcription of the genomic RNA. The 5' and 3' terminal 19 nt viral promoter regions of both RNA segments are necessary for recognition and binding of the viral polymerase . The primary transcription first transcribes mRNAs from the genomic S and L RNAs, which code NP and L proteins, respectively. Transcription terminates at the stem-loop (SL) structure within the intergenomic region. Arenaviruses use a cap snatching strategy to gain the cap structures from the cellular mRNAs, and it is mediated by the endonuclease activity of the L polymerase and the cap binding activity of NP. Antigenomic RNA transcribes viral genes GPC and Z, encoded in genomic orientation, from S and L segments respectively. The antigenomic RNA also serves as the template for the replication. After translation of GPC, it is posttranslationally modified in the endoplasmic reticulum . GPC is cleaved into GP1 and GP2 at the later stage of the secretory pathway. It has been reported that the cellular protease SKI-1/S1P is responsible for this cleavage. The cleaved glycoproteins are incorporated into the virion envelope when the virus buds and release from the cell membrane. Lassa fever is caused by the Lassa mammarenavirus . The symptoms include flu-like illness characterized by fever, general weakness, cough, sore throat, headache, and gastrointestinal manifestations. Hemorrhagic manifestations include vascular permeability. Upon entry, the Lassa mammarenavirus infects almost every tissue in the human body. It starts with the mucosa , intestine, lungs and urinary system, and then progresses to the vascular system. The main targets of the virus are antigen-presenting cells , mainly dendritic cells and endothelial cells. In 2012 it was reported how Lassa mammarenavirus nucleoprotein (NP) sabotages the host's innate immune system response. Generally, when a pathogen enters into a host, innate defense system recognizes the pathogen-associated molecular patterns (PAMP) and activates an immune response. One of the mechanisms detects double stranded RNA (dsRNA), which is only synthesized by negative-sense viruses . In the cytoplasm, dsRNA receptors, such as RIG-I (retinoic acid-inducible gene I) and MDA-5 (melanoma differentiation associated gene 5), detect dsRNAs and initiate signaling pathways that translocate IRF-3 ( interferon regulatory factor 3) and other transcription factors to the nucleus. Translocated transcription factors activate expression of interferons 𝛂 and 𝛃, and these initiate adaptive immunity . NP encoded in Lassa mammarenavirus is essential in viral replication and transcription, but it also suppresses host innate IFN response by inhibiting translocation of IRF-3. NP of Lassa mammarenavirus is reported to have an exonuclease activity to only dsRNAs. the NP dsRNA exonuclease activity counteracts IFN responses by digesting the PAMPs thus allowing the virus to evade host immune responses.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Viral_hemorrhagic_fever/html

Viral hemorrhagic fever

Viral hemorrhagic fevers ( VHFs ) are a diverse group of animal and human illnesses . VHFs may be caused by five distinct families of RNA viruses : the families Filoviridae , Flaviviridae , Rhabdoviridae , and several member families of the Bunyavirales order such as Arenaviridae , and Hantaviridae . All types of VHF are characterized by fever and bleeding disorders and all can progress to high fever, shock and death in many cases. Some of the VHF agents cause relatively mild illnesses, such as the Scandinavian nephropathia epidemica (a hantavirus ), while others, such as Ebola virus , can cause severe, life-threatening disease.Signs and symptoms of VHFs include (by definition) fever and bleeding: The severity of symptoms varies with the type of virus. The "VHF syndrome" (capillary leak, bleeding diathesis , and circulatory compromise leading to shock) appears in a majority of people with filoviral hemorrhagic fevers (e.g., Ebola and Marburg virus ), Crimean–Congo hemorrhagic fever (CCHF), and the South American hemorrhagic fevers caused by arenaviruses , but only in a small minority of patients with dengue or Rift Valley fever .Five families of RNA viruses have been recognised as being able to cause hemorrhagic fevers. [ citation needed ] The pathogen that caused the cocoliztli epidemics in Mexico of 1545 and 1576 is still unknown, and the 1545 epidemic may have been bacterial rather than viral. Different hemorrhagic fever viruses act on the body in different ways, resulting in different symptoms. In most VHFs, it is likely that several mechanisms contribute to symptoms, including liver damage, disseminated intravascular coagulation (DIC), and bone marrow dysfunction. In DIC, small blood clots form in blood vessels throughout the body, removing platelets necessary for clotting from the bloodstream and reducing clotting ability. DIC is thought to cause bleeding in Rift Valley, Marburg, and Ebola fevers. For filoviral hemorrhagic fevers, there are four general mechanisms of pathogenesis. The first mechanism is dissemination of virus due to suppressed responses by macrophages and dendritic cell (antigen presenting cells). The second mechanism is prevention of antigen specific immune response. The third mechanism is apoptosis of lymphocytes. The fourth mechanism is when infected macrophages interact with toxic cytokines , leading to diapedesis and coagulation deficiency. From the vascular perspective, the virus will infect vascular endothelial cells, leading to the reorganization of the VE-cadherin catenin complex (a protein important in cell adhesion). This reorganization creates intercellular gaps in endothelial cells. The gaps lead to increased endothelial permeability and allow blood to escape from the vascular circulatory system. [ citation needed ] The reasons for variation among patients infected with the same virus are unknown but stem from a complex system of virus-host interactions. Dengue fever becomes more virulent during a second infection by means of antibody-dependent enhancement . After the first infection, macrophages display antibodies on their cell membranes specific to the dengue virus. By attaching to these antibodies, dengue viruses from a second infection are better able to infect the macrophages, thus reducing the immune system's ability to fight off infection. [ citation needed ]Definitive diagnosis is usually made at a reference laboratory with advanced biocontainment capabilities. The findings of laboratory investigation vary somewhat between the viruses but in general, there is a decrease in the total white cell count (particularly the lymphocytes ), a decrease in the platelet count, an increase in the blood serum liver enzymes , and reduced blood clotting ability measured as an increase in both the prothrombin (PT) and activated partial thromboplastin times (PTT). The hematocrit may be elevated. The serum urea and creatine may be raised but this is dependent on the hydration status of the patient. The bleeding time tends to be prolonged. [ citation needed ]With the exception of yellow fever vaccine and Ebola vaccines , vaccines for VHF-associated viruses are generally not available. Post-exposure prophylactic (preventive) ribavirin may be effective for some bunyavirus and arenavirus infections. VHF isolation guidelines dictate that all VHF patients (with the exception of dengue patients) should be cared for using strict contact precautions, including hand hygiene, double gloves, gowns, shoe and leg coverings, and face shield or goggles. Lassa, CCHF, Ebola, and Marburg viruses may be particularly prone to nosocomial (hospital-based) spread. Airborne precautions should be utilized including, at a minimum, a fit-tested , HEPA filter-equipped respirator (such as an N95 mask ), a battery-powered, air-purifying respirator, or a positive pressure supplied air respirator to be worn by personnel coming within 1.8 meter (six feet) of a VHF patient. Groups of patients should be cohorted (sequestered) to a separate building or a ward with an isolated air-handling system. Environmental decontamination is typically accomplished with hypochlorite (e.g. bleach) or phenolic disinfectants . Medical management of VHF patients may require intensive supportive care. Antiviral therapy with intravenous ribavirin may be useful in Bunyaviridae and Arenaviridae infections (specifically Lassa fever, RVF, CCHF, and HFRS due to Old World Hantavirus infection) and can be used only under an experimental protocol as IND approved by the U.S. Food and Drug Administration (FDA). Interferon may be effective in Argentine or Bolivian hemorrhagic fevers (also available only as IND). [ citation needed ]The VHF viruses are spread in a variety of ways. Some may be transmitted to humans through a respiratory route. [ citation needed ] The virus is considered by military medical planners to have a potential for aerosol dissemination, weaponization, or likelihood for confusion with similar agents that might be weaponized.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Arenavirus/html

Arenavirus

An arenavirus is a bi- or trisegmented ambisense RNA virus that is a member of the family Arenaviridae . These viruses infect rodents and occasionally humans. A class of novel, highly divergent arenaviruses, properly known as reptarenaviruses, have also been discovered which infect snakes to produce inclusion body disease , mostly in boa constrictors . At least eight arenaviruses are known to cause human disease. The diseases derived from arenaviruses range in severity. Aseptic meningitis, a severe human disease that causes inflammation covering the brain and spinal cord, can arise from the lymphocytic choriomeningitis virus . Hemorrhagic fever syndromes, including Lassa fever , are derived from infections such as Guanarito virus , Junin virus , Lassa virus , Lujo virus , Machupo virus , Sabia virus , or Whitewater Arroyo virus . Because of the epidemiological association with rodents, some arenaviruses and bunyaviruses are designated as roboviruses .Viewed in cross-section, arenaviruses contain grainy particles that are ribosomes acquired from their host cells. It is from this characteristic that they acquired the name arena , from the Latin root meaning sand . The ribosomal structures are not believed to be essential for virus replication. Virus particles, or virions, are pleomorphic (variable in shape) but are often spherical, with a diameter of 60–300 nm, and are covered with surface glycoprotein spikes. The virus contains a beaded nucleocapsid with two single-stranded RNA segments. The nucleocapsid consists of a core of nucleic acid enclosed in a protein coat. Although they are categorized as negative-sense viruses, arenaviruses are ambisense . While sections of their genome encode genes in the negative sense (reverse polarity), other sections encode genes in the opposite (forward/positive sense) direction. This complex gene expression structure is theorized to be a primitive regulatory system, allowing the virus to control what proteins are synthesized at what point in the life cycle. The life cycle of the arenavirus is restricted to the cell cytoplasm. [ citation needed ]Arenaviruses have a segmented RNA genome that consists of two single-stranded ambisense RNAs. As with all negative-sense RNA viruses, the genomic RNA alone is not infectious and the viral replication machinery is required to initiate infection within a host cell. Genomic sense RNA packaged into the arenavirus virion is designated negative-sense RNA, and must first be copied into a positive-sense mRNA in order to produce viral protein . The RNA segments are denoted Small (S), Medium (M; if present), and Large (L), and code for four viral proteins in a unique ambisense coding strategy. For mammarenaviruses and reptarenaviruses, each RNA segment codes for two viral proteins in opposite orientation such that the negative-sense RNA genome serves as the template for transcription of a single mRNA and the positive-sense copy of the RNA genome templates a second mRNA . The separate coding sequences of the two viral proteins are divided by an intergenic region RNA sequence that is predicted to fold into a stable hairpin structure. The extreme termini of each RNA segment contains a 19 nucleotide highly conserved sequence that is critical for recruitment of the viral replication machinery and initiation of viral mRNA transcription and genomic replication . The conserved 5' and 3' RNA termini sequences are complementary and allows each RNA segment to adopt a double-stranded RNA panhandle structure that maintains the termini in close proximity and results in a circular appearance to purified arenavirus genomic templates visualized by electron microscopy . The double-stranded RNA panhandle structure is critical for efficient viral RNA synthesis, but potential interterminal double-stranded RNA interactions must be transiently relieved in order to recruit the viral polymerase . The S-segment RNA is approximately 3.5 kb, and encodes the viral nucleocapsid protein (NP) and glycoprotein (GPC). The L-segment RNA is approximately 7.2 kb, and encodes the viral RNA-dependent RNA-polymerase (L) and a small RING-domain containing protein (Z). The Z protein forms homo oligomers and a structural component of the virions. The formation of these oligomers is an essential step for particle assembly and budding. Binding between Z and the viral envelope glycoprotein complex is required for virion infectivity. Z also interacts with the L and NP proteins. Polymerase activity appears to be modulated by the association between the L and Z proteins. Interaction between the Z and NP proteins is critical for genome packaging. [ citation needed ]The glycoprotein (GP) is synthesised as a precursor molecule. It is cleaved into three parts - GP1, GP2 and a stable signal peptide (SSP). These reactions are catalysed by cellular signal peptidases and the cellular enzyme Subtilisin Kexin Isozyme-1 (SKI-1)/Site-1 Protease (S1P). These processes are essential for fusion competence and incorporation of mature GP into nascent budding virion particles. [ citation needed ]Within the family Arenaviridae , arenaviruses were formerly all placed in the genus Arenavirus , but in 2015 were divided into the genera Mammarenavirus for those with mammalian hosts and Reptarenavirus for those infecting snakes. Reptarenaviruses and mammarenavirus are separated by an impenetrable species barrier. Infected rodents cannot pass disease onto snakes, and IBD in captive snakes is not transmissible to humans. [ citation needed ] A third genus, Hartmanivirus (not to be confused with genus Haartmanvirus of vibrio phages in family Demerecviridae , order Caudovirales ), has also been established, including other species that infect snakes. The organisation of the genome of this genus is typical of arenaviruses but their glycoproteins resemble those of filoviruses . Species in this genus lack the matrix protein. A fourth genus, Antennavirus , has also been established to accommodate two arenaviruses found in striated frogfish ( Antennarius striatus ). A third antennavirus has been detected in Chinook salmon and sockeye salmon . Mammarenaviruses can be divided into two serogroups, which differ genetically and by geographical distribution: When the virus is classified "Old World" this means it was found in the Eastern Hemisphere in places such as Europe, Asia, and Africa. When it is found in the Western Hemisphere, in places such as Argentina, Bolivia, Venezuela, Brazil, and the United States, it is classified "New World". Lymphocytic choriomeningitis (LCM) virus is the only mammarenavirus found worldwide because of its ubiquitous Old World host, the house mouse . Old and New World area viruses appear to have diverged ~45,000 years ago. The Old World Mammarenaviruses originated ~23.1-1.88 thousand years ago, most likely in Southern Africa, while the New World Mammarenaviruses evolved in the Latin America-Caribbean region ~41.4-3.3 thousand years ago. The evolution of the Mammarenavirus genus has been studied. The New World and Old World species diverged less than 45,000 years ago. The New World species evolved between 41,400 and 3,300 years ago in the Latin America-Caribbean region. The Old World species evolved between 23,100 and 1,880 years ago, most likely in southern Africa. Some arenaviruses are zoonotic pathogens and are generally associated with rodent —transmitted disease in humans. Each virus usually is associated with a particular rodent host species in which it is maintained. Arenaviruses persist in nature by infecting rodents first and then transmitted into humans. Humans can be infected through mucosal exposure to aerosols, or by direct contact of abraded skin with the infectious material, derived from infected rodents. Aerosols are fine mists or sprays of rodent dried excreta, especially urine that is dropped in the environment. Most of the Arenaviruses caught by humans are within their own homes when these rodents seek shelter. The virus can be caught in factories, from food that has been contaminated, or within agricultural work areas. Humans' risk of contracting the Arenavirus infection is related to age, race, or sex within the degree of contact with the dried rodent excreta. [ citation needed ]Lymphocytic choriomeningitis (LCM) viruses cause influenza-like febrile illness , but occasionally they may cause meningitis, characteristically accompanied by large numbers of lymphocytes in the cerebrospinal fluid (as the name LCM suggests). Lassa virus causes Lassa fever . Lassa fever is endemic in west Africa. The virus was first isolated from Americans stationed in the village of Lassa, Nigeria. The virus can be transmitted person-to-person. Subclinical diseases: Serological studies suggest that inapparent infections particularly among members of hunting tribes are common. Clinical infections: Lassa fever is characterised by high fever, severe myalgia, coagulopathy, haemorrhagic skin rash, and occasional visceral haemorrhage as well as necrosis of liver and spleen. Other Arenaviruses like Junin virus, Machupo virus cause haemorrhagic fevers. Subclinical diseases: Serological studies suggest that inapparent infections particularly among members of hunting tribes are common. Clinical infections: Lassa fever is characterised by high fever, severe myalgia, coagulopathy, haemorrhagic skin rash, and occasional visceral haemorrhage as well as necrosis of liver and spleen. All of these diseases pose a great threat to public health in the regions where it is taking place. For example, when the Old World Lassa virus turns into Lassa fever, this usually results in a significant amount of mortality. Similarly the New World Junin virus causes Argentine hemorrhagic fever. This fever is a severe illness with hemorrhagic and neurological manifestations and a case fatality of fifteen to thirty percent. The way this virus spreads is through increased traveling to and from endemic regions. This traveling has led to the importation of Lassa fever into non-endemic metropolitan areas all over the world. A new species of arenavirus named the Lujo virus has been linked to five patients who exhibited symptoms of viral hemorrhagic fever in South Africa. The disease originated near Lusaka, Zambia and spread to Johannesburg , South Africa , after the first patient was transported to a hospital there. The results of genetic sequencing tests conducted by epidemiologists at Columbia University in New York City , USA, and at the Special Pathogens Branch of the Centers for Disease Control in Atlanta , USA, provided evidence that the causative agent of the disease is a virus from the family Arenaviridae, which ultimately resulted in the deaths of four out of the five infected in Zambia and South Africa during the outbreak which began in September 2008. [ citation needed ] Arenavirus has also pinpointed as the cause of death of three donor organ recipients in Australia who contracted the virus after receiving kidney and a liver donations from a single infected organ donor in late 2006. All three died in the first week of 2007. WHO and its Global Outbreak Alert and Response Network (GOARN) partners continue to support the Ministries of Health of the two countries in various facets of the outbreak investigation, including laboratory diagnosis, investigations, active case finding and follow-up of contacts. Lymphocytic choriomeningitis (LCM) viruses cause influenza-like febrile illness , but occasionally they may cause meningitis, characteristically accompanied by large numbers of lymphocytes in the cerebrospinal fluid (as the name LCM suggests). Lassa virus causes Lassa fever . Lassa fever is endemic in west Africa. The virus was first isolated from Americans stationed in the village of Lassa, Nigeria. The virus can be transmitted person-to-person. Subclinical diseases: Serological studies suggest that inapparent infections particularly among members of hunting tribes are common. Clinical infections: Lassa fever is characterised by high fever, severe myalgia, coagulopathy, haemorrhagic skin rash, and occasional visceral haemorrhage as well as necrosis of liver and spleen. Other Arenaviruses like Junin virus, Machupo virus cause haemorrhagic fevers. Subclinical diseases: Serological studies suggest that inapparent infections particularly among members of hunting tribes are common. Clinical infections: Lassa fever is characterised by high fever, severe myalgia, coagulopathy, haemorrhagic skin rash, and occasional visceral haemorrhage as well as necrosis of liver and spleen. All of these diseases pose a great threat to public health in the regions where it is taking place. For example, when the Old World Lassa virus turns into Lassa fever, this usually results in a significant amount of mortality. Similarly the New World Junin virus causes Argentine hemorrhagic fever. This fever is a severe illness with hemorrhagic and neurological manifestations and a case fatality of fifteen to thirty percent. The way this virus spreads is through increased traveling to and from endemic regions. This traveling has led to the importation of Lassa fever into non-endemic metropolitan areas all over the world.A new species of arenavirus named the Lujo virus has been linked to five patients who exhibited symptoms of viral hemorrhagic fever in South Africa. The disease originated near Lusaka, Zambia and spread to Johannesburg , South Africa , after the first patient was transported to a hospital there. The results of genetic sequencing tests conducted by epidemiologists at Columbia University in New York City , USA, and at the Special Pathogens Branch of the Centers for Disease Control in Atlanta , USA, provided evidence that the causative agent of the disease is a virus from the family Arenaviridae, which ultimately resulted in the deaths of four out of the five infected in Zambia and South Africa during the outbreak which began in September 2008. [ citation needed ] Arenavirus has also pinpointed as the cause of death of three donor organ recipients in Australia who contracted the virus after receiving kidney and a liver donations from a single infected organ donor in late 2006. All three died in the first week of 2007. WHO and its Global Outbreak Alert and Response Network (GOARN) partners continue to support the Ministries of Health of the two countries in various facets of the outbreak investigation, including laboratory diagnosis, investigations, active case finding and follow-up of contacts. Very few treatment methods are available. The current lack of a licensed vaccine and limited therapeutic options for the arenavirus make it arguably among the most neglected virus groups. The only licensed drug for the treatment of human arenavirus infection is the nucleoside analogue ribavirin . Ribavirin reduces morbidity and mortality in humans infected with certain arenaviruses, such as LASV and JUNV infections, if it is taken in the early stages of the disease. Ribavirin displays mixed success in treating severe arenaviral disease and is associated with significant toxicities. Effective antiviral drugs need to be produced at a low cost, taken orally, and able to withstand tropical climates due to the regions where these infections are occurring. For this reason high throughput screening (HTS) of small molecular libraries could be the answer to finding a better remedy. HTS collects libraries of small synthetic molecules that can be used to identify protein promoting "agonist" molecules or protein inhibiting "antagonist" interactions. With HTS sustainable antiviral drugs can be discovered against possible new human pathogenic viruses. Immunotherapy is another potential approach. Monoclonal antibodies against Junin virus have been tested in animal models. An immunotherapeutic agent active against all tested mammarenaviruses that use the transferrin receptor 1 as their receptor was under investigation in 2020. Effective antiviral drugs need to be produced at a low cost, taken orally, and able to withstand tropical climates due to the regions where these infections are occurring. For this reason high throughput screening (HTS) of small molecular libraries could be the answer to finding a better remedy. HTS collects libraries of small synthetic molecules that can be used to identify protein promoting "agonist" molecules or protein inhibiting "antagonist" interactions. With HTS sustainable antiviral drugs can be discovered against possible new human pathogenic viruses. Immunotherapy is another potential approach. Monoclonal antibodies against Junin virus have been tested in animal models. An immunotherapeutic agent active against all tested mammarenaviruses that use the transferrin receptor 1 as their receptor was under investigation in 2020.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Coalition_for_Epidemic_Preparedness_Innovations/html

Coalition for Epidemic Preparedness Innovations

The Coalition for Epidemic Preparedness Innovations ( CEPI ) is a foundation that takes donations from public, private, philanthropic, and civil society organisations, to finance independent research projects to develop vaccines against emerging infectious diseases (EID). CEPI is focused on the World Health Organization 's (WHO) " blueprint priority diseases ", which include: the Middle East respiratory syndrome-related coronavirus ( MERS-CoV ), the Severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2 ), the Nipah virus , the Lassa fever virus , and the Rift Valley fever virus, as well as the Chikungunya virus and the hypothetical, unknown pathogen " Disease X ". CEPI investment also requires "equitable access" to the vaccines during outbreaks , although subsequent CEPI policy changes may have compromised this criterion. In 2022, CEPI adopted a vision for the world to be able to respond to a pandemic threat with a new vaccine within 100 days. CEPI was conceived in 2015 and formally launched in 2017 at the World Economic Forum (WEF) in Davos , Switzerland. It was co-founded and co-funded with US$460 million from the Bill and Melinda Gates Foundation , the Wellcome Trust , and the governments of India and Norway , and was later joined by the European Union (2019) and the United Kingdom (2020). CEPI is headquartered in Oslo , Norway. The concept for CEPI was outlined in a July 2015 paper in The New England Journal of Medicine , titled "Establishing a Global Vaccine-Development Fund", co-authored by British medical researcher Jeremy Farrar (a director of Wellcome Trust ), American physician Stanley A. Plotkin (co-discoverer of the Rubella vaccine), and American expert in infectious diseases Adel Mahmoud (developer of the HPV vaccine and rotavirus vaccine ). Their concept was further expanded at the 2016 WEF in Davos, where it was discussed as a solution to the problems encountered in developing and distributing a vaccine for the Western African Ebola virus epidemic . Co-founder and funder, Bill Gates said: "The market is not going to solve this problem because epidemics do not come along very often — and when they do you are not allowed to charge some huge premium price for the tools involved". CEPI's creation was also supported and co-funded by the pharmaceutical industry including GlaxoSmithKline (GSK), with CEO Sir Andrew Witty explaining at the WEF, "It is super-disruptive when the red phone rings in our vaccine division because of a health emergency. People do not realise that there's no spare capacity in the world's vaccine production system today". CEPI was formally launched at the 2017 WEF in Davos, with an initial investment of US$460 million by a consortium that included the governments of Norway, Japan, and Germany, The Wellcome Trust, and the Gates Foundation ; India joined a short time afterwards. In a launch interview with the Financial Times (FT), Gates said that a key goal was to reduce the time to develop vaccines from 10 years to less than 12 months. The initial targets were the six EID viruses with known potential to cause major epidemics, being: MERS , Lassa fever , Nipah virus , Ebola , Marburg fever and Zika . The FT reported CEPI would "build the scientific and technological infrastructure for developing vaccines quickly against pathogens that emerge from nowhere to cause a global health crisis, such as Sars in 2002/03 and Zika in 2015/16", and fund research papers on the costs and process of vaccine development. Town & Country listed it as one of the top-10 newsworthy moments from the 2017 Davos. At launch, Norwegian physician John-Arne Røttingen , who led the steering committee for Ebola vaccine trials, served as interim CEO, and CEPI was based at the Norwegian Institute of Public Health in Oslo. In April 2017, Richard J. Hatchett, former director of the U.S. government's Biomedical Advanced Research and Development Authority (BARDA), became the full-time CEO. Hatchett was also a member of the United States Homeland Security Council under George W. Bush , and the United States National Security Council , under Barack Obama . Also in April 2017, CEPI opened an additional office in London, and in October 2017, a further office was opened in Washington, D.C. Nature later stated, "It is by far the largest vaccine development initiative ever against viruses that are potential epidemic threats". In 2020, CEPI was identified by several media outlets as a "key player in the race to develop a vaccine" for coronavirus disease 2019 . At its launch in 2017, CEPI announced five-year financial pledges from its founders that amounted to US$460 million and came from the sovereign governments of Japan (US$125 million), Norway (US$120 million), and Germany (US$10.6 million in 2017 alone, and which later became US$90 million), and from global foundations of the Gates Foundation (US$100 million), and the Wellcome Trust (US$100 million); India was finalising their financial commitment, which was made shortly afterward. A funding target of US$1 billion was set for the first 5 years of operation (i.e. by January 2022). The journal Nature said of the amount raised that: "It is by far the largest vaccine development initiative ever against viruses that are potential epidemic threats". As part of its funding structure, CEPI has used "vaccine bonds" to "frontload" multi-year sovereign funding pledges. In 2019, the International Finance Facility for Immunisation (IFFIm) issued NOK 600 million in vaccine bonds to front-load the commitment by Norway, through Gavi, the Vaccine Alliance , to CEPI. In March 2019, the European Commission granted access to CEPI into the EU's Horizon 2020 programme, and a longer-term financial funding programme. CEPI note presentations that the EU's financial commitment amounts to US$200 million, which when added to the seed amount (including the full German commitment), came to US$740 million. By February 2020, Bloomberg News reported that CEPI had raised a total of US$760 million with additional donations from the governments of Australia, Belgium, Canada, and the U.K. Bloomberg said that "CEPI solves what economists call a 'coordination problem'. It can help pair boutique research and development companies with big vaccine manufacturers, work with regulators to streamline approval processes and resolve patent disputes on the spot. Its scientific advisory committee has executives from Pfizer, Johnson & Johnson, and Japan's Takeda Pharmaceutical, among others". In March 2020, the British government pledged £210 million in funding to CEPI to specifically focus on a vaccine for the coronavirus; making Britain CEPI's largest individual donor. In January 2022, The Wellcome Trust and the Bill & Melinda Gates Foundation pledged $300 million to CEPI. This is part of CEPI's effort to enable the world to reduce vaccine development timelines to 100 days. The founding mission of CEPI was "equitable access" in pandemics: selling vaccines to developing nations at affordable prices. Affordable access to existing patented vaccines had long been a concern for the medical community, and concern mounted in the wake of the struggle to get access to vaccine in the 2013–2016 Ebola epidemic . Averting a repetition of this crisis was the motivating factor behind founding CEPI. CEPI's original policy contained specific measures to prevent some of these market problems. All vaccine-manufacturing contracts would need initial approval by a public review board. The policy also stated that vaccine prices would be set at levels affordable to those needing vaccines and sustainable to the manufacturer. Trade secrets would not be funded by the CEPI. Companies had to share all research data developed with CEPI funds. While CEPI would, controversially, not retain and license the intellectual property developed with CEPI funds (allowing the groups awarded funding to own it), the CEPI retained "step-in" rights: the right to license and use intellectual property developed with CEPI funds for vaccine production, even if the company that had received the funding and taken ownership of the IP later withdrew from the agreement with CEPI. The original policy also required that funded parties pre-register any trials in a clinical trials registry , publish results within a year of study completion (except with compelling reason and permission of CEPI), publish results in open-access articles, and have mechanisms for securely sharing underlying data and results, including negative results, in a way that preserves trial volunteer privacy (see AllTrials for further information). Pharmaceutical corporations, including Johnson & Johnson , Pfizer , and Takeda , objected to the original policy, and these provisions were removed in December 2018, after the CEPI had obtained significant funding. The policy changes met with strong criticism, led by Médecins Sans Frontières . CEPI was also criticized for not following its own policies on transparency, and for removing the requirement that CEPI's board review CEPI's contracts. The CEPI stated that its vaccines would continue to be affordable and available, and published an article discussing the changes, saying that the old policy "while reflective of the idealism that inspired the creation of CEPI, was felt by others not to be pragmatic or reflect the business realities confronted by vaccine developers". It said that several unnamed vaccine manufacturers had declared that they could not work with the CEPI under the original policy. It said that the policy change did not reflect a change in commitment to access, and CEPI would still retain the right to do research and development using intellectual property it had funded, if the old partner was unable to continue. It also said that the CEPI would retain the right to find a new manufacturer if the old manufacturer could not continue, provided the old manufacturer agrees to the transfer of the information and intellectual property to the new one. The New York Times said that CEPI had made a "failed effort to get large pharmaceutical firms to agree to be partners without insisting on substantial profits or proprietary rights to research that CEPI helped to finance and produce," and had replaced specific implementation measures with lip service to its funding mission. The coalition was nominated for the 2021 Nobel Peace Prize by Norwegian MP Carl-Erik Grimstad . The concept for CEPI was outlined in a July 2015 paper in The New England Journal of Medicine , titled "Establishing a Global Vaccine-Development Fund", co-authored by British medical researcher Jeremy Farrar (a director of Wellcome Trust ), American physician Stanley A. Plotkin (co-discoverer of the Rubella vaccine), and American expert in infectious diseases Adel Mahmoud (developer of the HPV vaccine and rotavirus vaccine ). Their concept was further expanded at the 2016 WEF in Davos, where it was discussed as a solution to the problems encountered in developing and distributing a vaccine for the Western African Ebola virus epidemic . Co-founder and funder, Bill Gates said: "The market is not going to solve this problem because epidemics do not come along very often — and when they do you are not allowed to charge some huge premium price for the tools involved". CEPI's creation was also supported and co-funded by the pharmaceutical industry including GlaxoSmithKline (GSK), with CEO Sir Andrew Witty explaining at the WEF, "It is super-disruptive when the red phone rings in our vaccine division because of a health emergency. People do not realise that there's no spare capacity in the world's vaccine production system today". CEPI was formally launched at the 2017 WEF in Davos, with an initial investment of US$460 million by a consortium that included the governments of Norway, Japan, and Germany, The Wellcome Trust, and the Gates Foundation ; India joined a short time afterwards. In a launch interview with the Financial Times (FT), Gates said that a key goal was to reduce the time to develop vaccines from 10 years to less than 12 months. The initial targets were the six EID viruses with known potential to cause major epidemics, being: MERS , Lassa fever , Nipah virus , Ebola , Marburg fever and Zika . The FT reported CEPI would "build the scientific and technological infrastructure for developing vaccines quickly against pathogens that emerge from nowhere to cause a global health crisis, such as Sars in 2002/03 and Zika in 2015/16", and fund research papers on the costs and process of vaccine development. Town & Country listed it as one of the top-10 newsworthy moments from the 2017 Davos. At launch, Norwegian physician John-Arne Røttingen , who led the steering committee for Ebola vaccine trials, served as interim CEO, and CEPI was based at the Norwegian Institute of Public Health in Oslo. In April 2017, Richard J. Hatchett, former director of the U.S. government's Biomedical Advanced Research and Development Authority (BARDA), became the full-time CEO. Hatchett was also a member of the United States Homeland Security Council under George W. Bush , and the United States National Security Council , under Barack Obama . Also in April 2017, CEPI opened an additional office in London, and in October 2017, a further office was opened in Washington, D.C. Nature later stated, "It is by far the largest vaccine development initiative ever against viruses that are potential epidemic threats". In 2020, CEPI was identified by several media outlets as a "key player in the race to develop a vaccine" for coronavirus disease 2019 . At its launch in 2017, CEPI announced five-year financial pledges from its founders that amounted to US$460 million and came from the sovereign governments of Japan (US$125 million), Norway (US$120 million), and Germany (US$10.6 million in 2017 alone, and which later became US$90 million), and from global foundations of the Gates Foundation (US$100 million), and the Wellcome Trust (US$100 million); India was finalising their financial commitment, which was made shortly afterward. A funding target of US$1 billion was set for the first 5 years of operation (i.e. by January 2022). The journal Nature said of the amount raised that: "It is by far the largest vaccine development initiative ever against viruses that are potential epidemic threats". As part of its funding structure, CEPI has used "vaccine bonds" to "frontload" multi-year sovereign funding pledges. In 2019, the International Finance Facility for Immunisation (IFFIm) issued NOK 600 million in vaccine bonds to front-load the commitment by Norway, through Gavi, the Vaccine Alliance , to CEPI. In March 2019, the European Commission granted access to CEPI into the EU's Horizon 2020 programme, and a longer-term financial funding programme. CEPI note presentations that the EU's financial commitment amounts to US$200 million, which when added to the seed amount (including the full German commitment), came to US$740 million. By February 2020, Bloomberg News reported that CEPI had raised a total of US$760 million with additional donations from the governments of Australia, Belgium, Canada, and the U.K. Bloomberg said that "CEPI solves what economists call a 'coordination problem'. It can help pair boutique research and development companies with big vaccine manufacturers, work with regulators to streamline approval processes and resolve patent disputes on the spot. Its scientific advisory committee has executives from Pfizer, Johnson & Johnson, and Japan's Takeda Pharmaceutical, among others". In March 2020, the British government pledged £210 million in funding to CEPI to specifically focus on a vaccine for the coronavirus; making Britain CEPI's largest individual donor. In January 2022, The Wellcome Trust and the Bill & Melinda Gates Foundation pledged $300 million to CEPI. This is part of CEPI's effort to enable the world to reduce vaccine development timelines to 100 days.The founding mission of CEPI was "equitable access" in pandemics: selling vaccines to developing nations at affordable prices. Affordable access to existing patented vaccines had long been a concern for the medical community, and concern mounted in the wake of the struggle to get access to vaccine in the 2013–2016 Ebola epidemic . Averting a repetition of this crisis was the motivating factor behind founding CEPI. CEPI's original policy contained specific measures to prevent some of these market problems. All vaccine-manufacturing contracts would need initial approval by a public review board. The policy also stated that vaccine prices would be set at levels affordable to those needing vaccines and sustainable to the manufacturer. Trade secrets would not be funded by the CEPI. Companies had to share all research data developed with CEPI funds. While CEPI would, controversially, not retain and license the intellectual property developed with CEPI funds (allowing the groups awarded funding to own it), the CEPI retained "step-in" rights: the right to license and use intellectual property developed with CEPI funds for vaccine production, even if the company that had received the funding and taken ownership of the IP later withdrew from the agreement with CEPI. The original policy also required that funded parties pre-register any trials in a clinical trials registry , publish results within a year of study completion (except with compelling reason and permission of CEPI), publish results in open-access articles, and have mechanisms for securely sharing underlying data and results, including negative results, in a way that preserves trial volunteer privacy (see AllTrials for further information). Pharmaceutical corporations, including Johnson & Johnson , Pfizer , and Takeda , objected to the original policy, and these provisions were removed in December 2018, after the CEPI had obtained significant funding. The policy changes met with strong criticism, led by Médecins Sans Frontières . CEPI was also criticized for not following its own policies on transparency, and for removing the requirement that CEPI's board review CEPI's contracts. The CEPI stated that its vaccines would continue to be affordable and available, and published an article discussing the changes, saying that the old policy "while reflective of the idealism that inspired the creation of CEPI, was felt by others not to be pragmatic or reflect the business realities confronted by vaccine developers". It said that several unnamed vaccine manufacturers had declared that they could not work with the CEPI under the original policy. It said that the policy change did not reflect a change in commitment to access, and CEPI would still retain the right to do research and development using intellectual property it had funded, if the old partner was unable to continue. It also said that the CEPI would retain the right to find a new manufacturer if the old manufacturer could not continue, provided the old manufacturer agrees to the transfer of the information and intellectual property to the new one. The New York Times said that CEPI had made a "failed effort to get large pharmaceutical firms to agree to be partners without insisting on substantial profits or proprietary rights to research that CEPI helped to finance and produce," and had replaced specific implementation measures with lip service to its funding mission. CEPI's original policy contained specific measures to prevent some of these market problems. All vaccine-manufacturing contracts would need initial approval by a public review board. The policy also stated that vaccine prices would be set at levels affordable to those needing vaccines and sustainable to the manufacturer. Trade secrets would not be funded by the CEPI. Companies had to share all research data developed with CEPI funds. While CEPI would, controversially, not retain and license the intellectual property developed with CEPI funds (allowing the groups awarded funding to own it), the CEPI retained "step-in" rights: the right to license and use intellectual property developed with CEPI funds for vaccine production, even if the company that had received the funding and taken ownership of the IP later withdrew from the agreement with CEPI. The original policy also required that funded parties pre-register any trials in a clinical trials registry , publish results within a year of study completion (except with compelling reason and permission of CEPI), publish results in open-access articles, and have mechanisms for securely sharing underlying data and results, including negative results, in a way that preserves trial volunteer privacy (see AllTrials for further information). Pharmaceutical corporations, including Johnson & Johnson , Pfizer , and Takeda , objected to the original policy, and these provisions were removed in December 2018, after the CEPI had obtained significant funding. The policy changes met with strong criticism, led by Médecins Sans Frontières . CEPI was also criticized for not following its own policies on transparency, and for removing the requirement that CEPI's board review CEPI's contracts. The CEPI stated that its vaccines would continue to be affordable and available, and published an article discussing the changes, saying that the old policy "while reflective of the idealism that inspired the creation of CEPI, was felt by others not to be pragmatic or reflect the business realities confronted by vaccine developers". It said that several unnamed vaccine manufacturers had declared that they could not work with the CEPI under the original policy. It said that the policy change did not reflect a change in commitment to access, and CEPI would still retain the right to do research and development using intellectual property it had funded, if the old partner was unable to continue. It also said that the CEPI would retain the right to find a new manufacturer if the old manufacturer could not continue, provided the old manufacturer agrees to the transfer of the information and intellectual property to the new one. The New York Times said that CEPI had made a "failed effort to get large pharmaceutical firms to agree to be partners without insisting on substantial profits or proprietary rights to research that CEPI helped to finance and produce," and had replaced specific implementation measures with lip service to its funding mission. The coalition was nominated for the 2021 Nobel Peace Prize by Norwegian MP Carl-Erik Grimstad . CEPI is incorporated under Norwegian law . As of March 2020, a full-time staff of 68 that runs the organisation under the direction of a chief executive officer, Richard Hatchett. In October 2018, CEPI scientists estimated that the costs of developing at least one vaccine for each of the diseases that could escalate into global humanitarian crises was between US$2.8 billion and US$3.7 billion. In November 2019, CEPI discussed its target portfolio was on the WHO 's " blueprint priority diseases ", that included: MERS-CoV, Nipah virus, Lassa fever virus, and Rift Valley fever virus, as well as Chikungunya virus , and the WHO's Disease X . CEPI outlined its projects to update CEPI priorities for establishment of technical and regulatory pathways for vaccine development, develop sustainable manufacturing solutions for vaccine candidates nearing completion, and create investigatory stockpiles of its vaccine candidates for use in emergency situations.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Lujo_mammarenavirus/html

Lujo mammarenavirus

Lujo virus LuJo virus Lusaka/Johannesburg virus Lujo is a bisegmented RNA virus —a member of the family Arenaviridae —and a known cause of viral hemorrhagic fever (VHF) in humans. Its name was suggested by the Special Pathogens Unit of the National Institute for Communicable Diseases of the National Health Laboratory Service (NICD-NHLS) by using the first two letters of the names of the cities involved in the 2008 outbreak of the disease, Lusaka (Zambia) and Johannesburg (Republic of South Africa). It is the second pathogenic Arenavirus to be described from the African continent—the first being Lassa virus —and since 2012 has been classed as a " Select Agent " under U.S. law .Only 5 cases of this virus have ever been reported; all 5 were identified in September and October 2008, and 4 were fatal. Those infections that proved fatal caused death within 10–13 days of showing symptoms. All four patients in which infection proved fatal first showed signs of improvement and then went into respiratory distress, displayed neurological problems, and had circulatory issues that resulted in collapse. The discovery of this novel virus was described following a highly fatal nosocomial (hospital) outbreak of VHF in Johannesburg. The identification of this virus was the first new arenavirus discovered in over 40 years. The first case was a female travel agent who lived in the outskirts of Lusaka. She developed a fever which grew worse with time. She was evacuated to Johannesburg for medical treatment. Almost two weeks later, the paramedic that nursed the patient on the flight to South Africa also fell ill and was also brought to Johannesburg for medical treatment. At this time the connection between these two patients was recognized by the attending physician in the Johannesburg hospital. Together with the NICD-NHLS the clinical syndrome of VHF was recognized and specimens from the second patient were submitted for laboratory confirmation. In addition, a cleaner and a nurse that had contact with the first patient also fell ill. A second nurse was infected through contact with the paramedic. The outbreak had a high case fatality rate with 4 of 5 identified cases resulting in death. The Special Pathogens Unit of the NICD-NHLS together with colleagues from the Special Pathogens Unit of the U.S. Centers for Disease Control and Prevention (CDC) identified the etiological agent of the outbreak as an Old World arenavirus using molecular and serological tests. Sequencing and phylogenetic investigation of partial genome sequencing indicated that this virus was not Lassavirus and likely a previously unreported arenavirus. This was corroborated by full genome sequencing that was conducted by the NICD-NHLS, CDC and collaborators from Columbia University in New York . The distribution of this newly described arenavirus is uncertain. To date this virus has only been reported from a patient from Zambia and a subsequent nosocomial outbreak in South Africa . [ citation needed ]Viruses from the Arenaviridae family, to which Lujo virus belongs, almost always have a rodent reservoir , with one virus in the family having a bat reservoir. Contact with an infected rodent host, its urine or fecal matter, inhalation of dust with virus particles, or eating food containing remnants of the virus can result in human infection. Transmission can also occur via human-to-human contact, as evidenced by the 5 cases from 2008, but it is still not completely clear how the first case was contracted. Both bats and rodents should be considered possible contact points, just to be safe. Though it is not known for sure, it is speculated that the human-to-human transmission occurs from contact with bodily fluids. The incubation period is expected to be 7–13 days. VHF symptoms appear similar to other viruses of the same family, such as Lassa fever. The known symptoms include swelling in the neck and face, sore throat, diarrhea, and a rash resembling measles on the face and body. Blood tests of those infected revealed elevated liver values, white blood cell counts that were first low and then elevated over time, and low platelet counts. In-depth research into Lujo virus and its treatment have been difficult because of the lack of economic and cultural stability of the regions where the only known cases have occurred. Under Treatment with oral ribavirin treatment, the patient 5 continued to deteriorate but the treatment shifted to i.v on day 8 it seemed to have cured the only surviving patient with Lujo Virus, but because the 5 affected in 2008 have been the only cases identified, there has not been much opportunity for further research. Sequencing of the viral genome has shown that this virus belongs to the Old World arenavirus group. Comparisons with other viral genome sequences showed that this virus is equidistant from other Old World and New World arenaviruses. It is distantly similar to the other pathogenic African arenavirus, Lassa fever virus. This virus has been associated with an outbreak of five cases of VHF in September and October 2008. In four cases (80% of total known infections) the infection was fatal. The fifth case was treated with ribavirin early after onset of clinical disease (was detected through active contact tracing), an antiviral drug which is effective in treating Lassa fever , and survived; however, complete ribavirin's effectiveness against Lujo virus remains unknown but may be useful as adjunctive therapy.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Ribavirin/html

Ribavirin

AU : X (High risk) 1-[(2"R",3"R",4"S",5"R")-3,4-dihydroxy-5-(hydroxymethyl)oxolan-2-yl]-1"H"-1,2,4-triazole-3-carboxamide OC[C@@H](O1)[C@@H](O)[C@@H](O)[C@@H]1N2N=C(C(N)=O)N=C2 InChI=1S/C8H12N4O5/c9-6(16)7-10-2-12(11-7)8-5(15)4(14)3(1-13)17-8/h2-5,8,13-15H,1H2,(H2,9,16)/t3-,4-,5-,8-/m1/s1 Y Key:IWUCXVSUMQZMFG-AFCXAGJDSA-N Y Ribavirin , also known as tribavirin , is an antiviral medication used to treat RSV infection , hepatitis C and some viral hemorrhagic fevers . For hepatitis C, it is used in combination with other medications such as simeprevir , sofosbuvir , peginterferon alfa-2b or peginterferon alfa-2a . Among the viral hemorrhagic fevers it is sometimes used for Lassa fever , Crimean–Congo hemorrhagic fever , and Hantavirus infection but should not be used for Ebola or Marburg infections. Ribavirin is taken orally (swallowed by mouth) or inhaled . Despite widespread usage, since the 2010s it has faced scrutiny for a lack of efficacy in treating viral infections it has historically been prescribed for. Common side effects include tiredness, headache, nausea, fever, muscle pains, and an irritable mood. Serious side effects include red blood cell breakdown , liver problems , and allergic reactions . Use during pregnancy results in harm to the baby. Effective birth control is recommended for both males and females for at least seven months during and after use. The mechanism of action of ribavirin is not entirely clear. Ribavirin was patented in 1971 and approved for medical use in 1986. It is on the World Health Organization's List of Essential Medicines . It is available as a generic medication . Ribavirin is used primarily to treat chronic hepatitis C and viral hemorrhagic fevers (which is an orphan indication in most countries). Its efficacy for these purposes has been questioned: it has an FDA boxed warning against its use as a monotherapy (sole drug) for chronic hepatitis C, and thus it may only be prescribed in the United States as an adjunct to one or more other medications. Its efficacy against other viruses, including those that cause viral hemorrhagic fever, has not been conclusively demonstrated, and it is not approved in the United States for treatment of viruses other than HCV. For chronic hepatitis C, the oral (capsule or tablet) form of ribavirin is used only in combination with pegylated interferon alfa . Statins may improve this combination's efficacy in treating hepatitis C. When possible, genotyping of the specific viral strain is done; ribavirin is only used as a dose-escalating [lower-alpha 1] adjuvant to specific combinations of genotypes and other medications. Acute hepatitis C infection (within the first 6 months) often does not require immediate treatment, as many infections eventually resolve without treatment. When the decision is made to treat acute hepatitis C, ribavirin may be used as an adjunct to several drug combinations. However, other medications are preferred. Ribavirin is the only known treatment for a variety of viral hemorrhagic fevers , including Lassa fever , Crimean-Congo hemorrhagic fever , Venezuelan hemorrhagic fever , and Hantavirus infection, although data regarding these infections are scarce and the drug might be effective only in early stages. It is noted by the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) that "Ribavirin has poor in vitro and in vivo activity against the filoviruses ( Ebola and Marburg ) and the flaviviruses ( dengue , yellow fever , Omsk hemorrhagic fever , and Kyasanur forest disease )" The aerosol form has been used in the past to treat respiratory syncytial virus -related diseases in children, although the evidence to support this is rather weak. Despite questions surrounding its efficacy, ribavirin remains the only antiviral known to be effective in treating Lassa fever. It has been used (in combination with ketamine , midazolam , and amantadine ) in treatment of rabies . Experimental data indicate that ribavirin may have useful activity against canine distemper and poxviruses . Ribavirin has also been used as a treatment for herpes simplex virus . One small study found that ribavirin treatment reduced the severity of herpes outbreaks and promoted recovery, as compared with placebo treatment. Another study found that ribavirin potentiated the antiviral effect of acyclovir . Some interest has been seen in its possible use as a treatment for cancers with elevated eukaryotic translation initiation factor eIF4E, especially acute myeloid leukemia (AML) as well as in head and neck cancers. Ribavirin targeted eIF4E in AML patients in monotherapy and combination studies and this corresponded to objective clinical responses including complete remissions. Ribavirin resistance in AML patients arose leading to loss of eIF4E targeting and relapse. Resistance was caused by deactivation of ribavirin through its glucuronidation in AML cells or impaired drug entry/retention in the AML cells. There may be additional forms of ribavirin resistance displayed by cancer cells. In HPV related oropharyngeal cancers, ribavirin reduced levels of phosphorylated form of eIF4E in some patients. The best response here was stable disease but another head and neck study had more promising results. For chronic hepatitis C, the oral (capsule or tablet) form of ribavirin is used only in combination with pegylated interferon alfa . Statins may improve this combination's efficacy in treating hepatitis C. When possible, genotyping of the specific viral strain is done; ribavirin is only used as a dose-escalating [lower-alpha 1] adjuvant to specific combinations of genotypes and other medications. Acute hepatitis C infection (within the first 6 months) often does not require immediate treatment, as many infections eventually resolve without treatment. When the decision is made to treat acute hepatitis C, ribavirin may be used as an adjunct to several drug combinations. However, other medications are preferred. Ribavirin is the only known treatment for a variety of viral hemorrhagic fevers , including Lassa fever , Crimean-Congo hemorrhagic fever , Venezuelan hemorrhagic fever , and Hantavirus infection, although data regarding these infections are scarce and the drug might be effective only in early stages. It is noted by the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) that "Ribavirin has poor in vitro and in vivo activity against the filoviruses ( Ebola and Marburg ) and the flaviviruses ( dengue , yellow fever , Omsk hemorrhagic fever , and Kyasanur forest disease )" The aerosol form has been used in the past to treat respiratory syncytial virus -related diseases in children, although the evidence to support this is rather weak. Despite questions surrounding its efficacy, ribavirin remains the only antiviral known to be effective in treating Lassa fever. It has been used (in combination with ketamine , midazolam , and amantadine ) in treatment of rabies . Experimental data indicate that ribavirin may have useful activity against canine distemper and poxviruses . Ribavirin has also been used as a treatment for herpes simplex virus . One small study found that ribavirin treatment reduced the severity of herpes outbreaks and promoted recovery, as compared with placebo treatment. Another study found that ribavirin potentiated the antiviral effect of acyclovir . Some interest has been seen in its possible use as a treatment for cancers with elevated eukaryotic translation initiation factor eIF4E, especially acute myeloid leukemia (AML) as well as in head and neck cancers. Ribavirin targeted eIF4E in AML patients in monotherapy and combination studies and this corresponded to objective clinical responses including complete remissions. Ribavirin resistance in AML patients arose leading to loss of eIF4E targeting and relapse. Resistance was caused by deactivation of ribavirin through its glucuronidation in AML cells or impaired drug entry/retention in the AML cells. There may be additional forms of ribavirin resistance displayed by cancer cells. In HPV related oropharyngeal cancers, ribavirin reduced levels of phosphorylated form of eIF4E in some patients. The best response here was stable disease but another head and neck study had more promising results. The medication has two FDA "black box" warnings: One raises concerns that use before or during pregnancy by either sex may result in birth defects in the baby, and the other is regarding the risk of red blood cell breakdown. Ribavirin should not be given with zidovudine because of the increased risk of anemia; concurrent use with didanosine should likewise be avoided because of an increased risk of mitochondrial toxicity . It is a guanosine (ribonucleic) analog used to stop viral RNA synthesis and viral mRNA capping, thus, it is a nucleoside analog. Ribavirin is a prodrug , which when metabolized resembles purine RNA nucleotides . In this form, it interferes with RNA metabolism required for viral replication. Over five direct and indirect mechanisms have been proposed for its mechanism of action. The enzyme inosine triphosphate pyrophosphatase (ITPase) dephosphorylates ribavirin triphosphate in vitro to ribavirin monophosphate, and ITPase reduced enzymatic activity present in 30% of humans potentiates mutagenesis in hepatitis C virus. Ribavirin's amide group can make the native nucleoside drug resemble adenosine or guanosine, depending on its rotation. For this reason, when ribavirin is incorporated into RNA, as a base analog of either adenine or guanine, it pairs equally well with either uracil or cytosine , inducing mutations in RNA-dependent replication in RNA viruses. Such hypermutation can be lethal to RNA viruses. Neither of these mechanisms explains ribavirin's effect on many DNA viruses, which is more of a mystery, especially given the complete inactivity of ribavirin's 2' deoxyribose analogue, which suggests that the drug functions only as an RNA nucleoside mimic, and never a DNA nucleoside mimic. Ribavirin 5'-monophosphate inhibits cellular inosine monophosphate dehydrogenase , thereby depleting intracellular pools of GTP. [ failed verification ]Ribavirin's amide group can make the native nucleoside drug resemble adenosine or guanosine, depending on its rotation. For this reason, when ribavirin is incorporated into RNA, as a base analog of either adenine or guanine, it pairs equally well with either uracil or cytosine , inducing mutations in RNA-dependent replication in RNA viruses. Such hypermutation can be lethal to RNA viruses. Neither of these mechanisms explains ribavirin's effect on many DNA viruses, which is more of a mystery, especially given the complete inactivity of ribavirin's 2' deoxyribose analogue, which suggests that the drug functions only as an RNA nucleoside mimic, and never a DNA nucleoside mimic. Ribavirin 5'-monophosphate inhibits cellular inosine monophosphate dehydrogenase , thereby depleting intracellular pools of GTP. [ failed verification ]The eukaryotic translation initiation factor eIF4E plays multiple roles in RNA metabolism with translation being the best described. Biophysical and NMR studies first revealed that ribavirin directly bound the eIF4E,  providing another mechanism for its action. 3 H Ribavirin also interacts with eIF4E in cells. While inosine monophosphate dehydrogenase (IMPDH) presumably only binds the ribavirin monophosphate metabolite (RMP), eIF4E can bind ribavirin and with higher affinity ribavirin's phosphorylated forms. In many cell lines, studies into steady state levels of metabolites indicate that ribavirin triphosphate (RTP) is more abundant than the RMP metabolite which is the IMPDH ligand. RTP binds to eIF4E in its cap-binding site as observed by NMR. Ribavirin inhibits eIF4E activities in cells including in its RNA export, translation and oncogenic activities lines. In AML patients treated with ribavirin, ribavirin blocked the nuclear import of eIF4E through interfering with its interaction with its nuclear importer, Importin 8, thereby impairing its nuclear activities. Clinical relapse in AML patients corresponded to loss of ribavirin binding leading to nuclear re-entry of eIF4E and re-emergence of its nuclear activities. Ribavirin was first made in 1972 under the national cancer institute's Virus-Cancer program. This was done by researchers from International Chemical and Nuclear Corporation including Roberts A. Smith, Joseph T. Witkovski and Roland K. Robins. It was reported that ribavirin was active against a variety of RNA and DNA viruses in culture and in animals, without undue toxicity in the context of cancer chemotherapies. By the late 1970s, the Virus-Cancer program was widely considered a failure, and the drug development was abandoned. [ citation needed ] After the US Government announced that AIDS was caused by a retrovirus in 1984, drugs examined during the Virus-Cancer program and its focus on retroviruses were re-examined. Although the FDA first approved ribavirin as an antiviral in 1986, it was not indicated to treat HIV or AIDS. As a result, many people with AIDS sought to obtain black market ribavirin via buyer's clubs . The drug was approved for investigational use against hantavirus in the United States in 1993, but the results from a non-randomized uncontrolled trial were not encouraging: 71% of recipients became anemic and 47% died. In 2002 with the SARS outbreak , early speculation focused on Ribavirin as a possible anti-SARS agent. Early protocols adopted in Hong Kong adopted a "Hit Hard Hit Early" approach treating SARS with high doses of off-label steroids and Ribavirin. Unfortunately, it later turned out this haphazard approach was at best ineffective and at worst fatal, with many deaths attributed to SARS caused by ribavirin toxicity. Ribavirin is the INN and USAN , whereas tribavirin is the BAN . Brand names of generic forms include Copegus, Ribasphere, Rebetol. Ribavirin is the INN and USAN , whereas tribavirin is the BAN . Brand names of generic forms include Copegus, Ribasphere, Rebetol. Ribavirin is possibly best viewed as a ribosyl purine analogue with an incomplete purine 6-membered ring. This structural resemblance historically prompted replacement of the 2' nitrogen of the triazole with a carbon (which becomes the 5' carbon in an imidazole ), in an attempt to partly "fill out" the second ring--- but to no great effect. Such 5' imidazole riboside derivatives show antiviral activity with 5' hydrogen or halide, but the larger the substituent, the smaller the activity, and all proved less active than ribavirin. Note that two natural products were already known with this imidazole riboside structure: substitution at the 5' carbon with OH results in pyrazofurin , an antibiotic with antiviral properties but unacceptable toxicity, and replacement with an amino group results in the natural purine synthetic precursor 5-aminoimidazole-4-carboxamide-1-β-D-ribofuranoside ( AICAR ), which has only modest antiviral properties. [ citation needed ] The most successful ribavirin derivative to date is the 3-carboxamidine derivative of the parent 3-carboxamide, first reported in 1973 by J. T. Witkowski et al., and now called taribavirin (former names "viramidine" and "ribamidine"). This drug shows a similar spectrum of antiviral activity to ribavirin, which is not surprising as it is now known to be a pro-drug for ribavirin. Taribavirin, however, has useful properties of less erythrocyte-trapping and better liver-targeting than ribavirin. The first property is due to taribavirin's basic amidine group which inhibits drug entry into RBCs, and the second property is probably due to increased concentration of the enzymes which convert amidine to amide in liver tissue. Taribavirin completed phase III human trials in 2012. The most successful ribavirin derivative to date is the 3-carboxamidine derivative of the parent 3-carboxamide, first reported in 1973 by J. T. Witkowski et al., and now called taribavirin (former names "viramidine" and "ribamidine"). This drug shows a similar spectrum of antiviral activity to ribavirin, which is not surprising as it is now known to be a pro-drug for ribavirin. Taribavirin, however, has useful properties of less erythrocyte-trapping and better liver-targeting than ribavirin. The first property is due to taribavirin's basic amidine group which inhibits drug entry into RBCs, and the second property is probably due to increased concentration of the enzymes which convert amidine to amide in liver tissue. Taribavirin completed phase III human trials in 2012.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Lassa/html

Lassa

Lassa may refer to:

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Orthohantavirus/html

Orthohantavirus

Hantavirus Orthohantavirus is a genus of single-stranded, enveloped, negative-sense RNA viruses in the family Hantaviridae within the order Bunyavirales . Members of this genus may be called orthohantaviruses or simply hantaviruses . Orthohantaviruses typically cause chronic asymptomatic infection in rodents . Humans may become infected with hantaviruses through contact with rodent urine, saliva, or feces. Some strains cause potentially fatal diseases in humans, such as hantavirus hemorrhagic fever with renal syndrome (HFRS), or hantavirus pulmonary syndrome (HPS), also known as hantavirus cardiopulmonary syndrome (HCPS), while others have not been associated with known human disease (e.g. Prospect Hill virus ). HPS (HCPS) is a "rare respiratory illness associated with the inhalation of aerosolized rodent excreta (urine and feces) contaminated by hantavirus particles". Human infections of hantaviruses have almost entirely been linked to human contact with rodent excrement; however, in 2005 and 2019, human-to-human transmission of the Andes virus was reported in South America. Orthohantaviruses are named for the Greek word ortho - meaning "straight" or "true" and for the Hantan River in South Korea , where the first member species ( Hantaan virus ) was identified and isolated in 1976 by Ho Wang Lee . Hantavirus infections in humans are associated with two diseases: hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS), caused by Old World and New World hantaviruses, respectively. A common feature of the two diseases is increased vascular permeability, which causes hypotension , thrombocytopenia , and leukocytosis . The pulmonary illness is the more fatal of the two, whereas the hemorrhagic fever is much more common. Treatment for both is primarily supportive as there is no specific treatment for hantavirus infections. While many hantaviruses cause either of the two diseases, some are not known to cause illness, such as the Prospect Hill orthohantavirus . Hemorrhagic fever with renal syndrome (HFRS) is caused chiefly by hantaviruses in Asia and Europe. Clinical presentation varies from subclinical to fatal, depending on the virus. After an incubation period of 2–4 weeks, the typical illness starts with non-specific symptoms such as high fever, chills, headache, backache, abdominal pains, nausea, and vomiting. After the initial period, bleeding under the skin begins, often paired with low blood pressure, followed by further internal bleeding throughout the body. Renal dysfunction leading to further health issues begins thereafter, which may cause death. A more mild form of HFRS that occurs in Europe is called "nephropathia epidemica" (NE). Trench nephritis during World War I is now thought to have been HFRS. [ citation needed ] Hantavirus pulmonary syndrome (HPS), also called hantavirus cardiopulmonary syndrome (HCPS), is usually caused by hantaviruses in the Americas. Its incubation period ranges from 16 to 24 days. Illness initially shows similar symptoms as HFRS. After a few days of non-specific symptoms, sudden onset of progressive, or productive, coughing, shortness of breath, and elevated heart rate occur due to fluid buildup in the lungs . These symptoms are accompanied by impairment of lymphoid organs . Death from cardiovascular shock may occur rapidly after the appearance of severe symptoms. While HCPS is typically associated with New World hantaviruses, the Puumala orthohantavirus in Europe has also caused the syndrome on rare occasions. Hantaviruses are transmitted by contact with the bodily fluids of rodents, particularly from saliva from bites and especially from inhalation of viral particles from urine and feces in aerosols . The manner of transmission is the same for both diseases caused by hantaviruses. Among the HCPS-causing hantaviruses is the Andes orthohantavirus , which is the only hantavirus confirmed to be capable of spreading from person to person, though this is rare. Hemorrhagic fever with renal syndrome (HFRS) is caused chiefly by hantaviruses in Asia and Europe. Clinical presentation varies from subclinical to fatal, depending on the virus. After an incubation period of 2–4 weeks, the typical illness starts with non-specific symptoms such as high fever, chills, headache, backache, abdominal pains, nausea, and vomiting. After the initial period, bleeding under the skin begins, often paired with low blood pressure, followed by further internal bleeding throughout the body. Renal dysfunction leading to further health issues begins thereafter, which may cause death. A more mild form of HFRS that occurs in Europe is called "nephropathia epidemica" (NE). Trench nephritis during World War I is now thought to have been HFRS. [ citation needed ]Hantavirus pulmonary syndrome (HPS), also called hantavirus cardiopulmonary syndrome (HCPS), is usually caused by hantaviruses in the Americas. Its incubation period ranges from 16 to 24 days. Illness initially shows similar symptoms as HFRS. After a few days of non-specific symptoms, sudden onset of progressive, or productive, coughing, shortness of breath, and elevated heart rate occur due to fluid buildup in the lungs . These symptoms are accompanied by impairment of lymphoid organs . Death from cardiovascular shock may occur rapidly after the appearance of severe symptoms. While HCPS is typically associated with New World hantaviruses, the Puumala orthohantavirus in Europe has also caused the syndrome on rare occasions. Hantaviruses are transmitted by contact with the bodily fluids of rodents, particularly from saliva from bites and especially from inhalation of viral particles from urine and feces in aerosols . The manner of transmission is the same for both diseases caused by hantaviruses. Among the HCPS-causing hantaviruses is the Andes orthohantavirus , which is the only hantavirus confirmed to be capable of spreading from person to person, though this is rare. Hantavirus virions are about 80–120 nm in diameter. The lipid bilayer of the viral envelope is about 5 nm thick and is embedded with viral surface proteins to which sugar residues are attached. These glycoproteins, known as Gn and Gc, are encoded by the M segment of the viral genome. They tend to associate ( heterodimerize ) with each other and have both an interior tail and an exterior domain that extends to about 6 nm beyond the envelope surface. [ citation needed ] Inside the envelope are the nucleocapsids. These are composed of many copies of the nucleocapsid protein N, which interact with the three segments of the viral genome to form helical structures. The virally encoded RNA polymerase is also found in the interior. By mass, the virion is greater than 50% protein, 20–30% lipid, and 2–7% carbohydrate. The density of the virions is 1.18 g/cm 3 . These features are common to all members of the family Hantaviridae . [ citation needed ] The genome of hantaviruses is negative-sense, single-stranded RNA . Their genomes are composed of three segments: the small (S), medium (M), and large (L) segments. The S segment, 1–3 kilobases (kb) in length, encodes for the nucleocapsid (N) protein. The M segment, 3.2–4.9 kb in length, encodes a glycoprotein precursor polyprotein that is co-translationally cleaved into the envelope glycoproteins Gn and Gc, alternatively called G1 and G2. The L segment, 6.8–12 kb in length, encodes the L protein which functions primarily as the viral RNA-dependent RNA polymerase used for transcription and replication. Within virions , the genomic RNAs of hantaviruses are thought to complex with the N protein to form helical nucleocapsids, the RNA component of which circularizes due to sequence complementarity between the 5′ and 3′ terminal sequences of genomic segments. [ citation needed ] As with other Bunyavirales , each of the three segments has a consensus 3′-terminal nucleotide sequence (AUCAUCAUC), which is complementary to the 5′-terminal sequence and is distinct from those of the other four genera in the family. These sequences appear to form panhandle structure which seem likely to play a role in replication and encapsidation facilitated by binding with the viral nucleocapsid (N) protein. The large segment is 6530–6550 nucleotides (nt) in length, the medium is 3613–3707 nt in length and the small is 1696–2083 nt in length. [ citation needed ] No nonstructural proteins are known, unlike the other genera in this family. At the 5′ and 3′ of each segment are short noncoding sequences: the noncoding segment in all sequences at the 5′ end is 37–51 nt. The 3′ noncoding regions differ: L segment 38–43 nt; M segment 168–229 nt; and S segment 370–730 nt. The 3′ end of the S segment is conserved between the genera suggesting a functional role. [ citation needed ] Viral entry into host cells initiates by binding to surface cell receptors. Integrins are considered to be the main receptors for hantaviruses in vitro , but complement decay-accelerating factor (DAF) and globular heads of complement C1q receptor (gC1qR) have mediated attachment in cultured cells too. Entry may proceed through a number of possible routes, including clathrin -dependent endocytosis , clathrin-independent receptor-mediated endocytosis, and micro pinocytosis . Viral particles are then transported to late endosomes . Gc-mediated membrane fusion with the endosomal membrane , triggered by low pH , releases the nucleocapsid into the cytoplasm . After the release of the nucleocapsids into cytoplasm, the complexes are targeted to the endoplasmic reticulum–Golgi intermediate compartments (ERGIC) through microtubular -associated movement resulting in the formation of viral factories at ERGIC. [ citation needed ] These factories then facilitate transcription and subsequent translation of the viral proteins. Transcription of viral genes must be initiated by association of the L protein with the three nucleocapsid species. In addition to transcriptase and replicase functions, the viral L protein is also thought to have an endonuclease activity that cleaves cellular messenger RNAs (mRNAs) for the production of capped primers used to initiate transcription of viral mRNAs. As a result of this cap snatching , the mRNAs of hantaviruses are capped and contain nontemplated 5′-terminal extensions. The G1 (or Gn) and G2 (Gc) glycoproteins form hetero-oligomers and are then transported from the endoplasmic reticulum to the Golgi complex , where glycosylation is completed. The L protein produces nascent genomes by replication via a positive-sense RNA intermediate. Hantavirus virions are believed to assemble by association of nucleocapsids with glycoproteins embedded in the membranes of the Golgi, followed by budding into the Golgi cisternae . Nascent virions are then transported in secretory vesicles to the plasma membrane and released by exocytosis . [ citation needed ] The pathogenesis of hantavirus infections is unclear as there is a lack of animal models to describe it (rats and mice do not seem to acquire severe disease). While the primary site of viral replication in the body is not known, in HFRS the main effect is in the blood vessels while in HPS most symptoms are associated with the lungs. In HFRS, there are increased vascular permeability and decreased blood pressure due to endothelial dysfunction and the most dramatic damage is seen in the kidneys, whereas in HPS, the lungs, spleen, and gall bladder are most affected. Early symptoms of HPS tend to present similarly to the flu (muscle aches, fever and fatigue) and usually appear around 2 to 3 weeks after exposure. Later stages of the disease (about 4 to 10 days after symptoms start) include difficulty breathing, shortness of breath and coughing. Findings of significant congruence between phylogenies of hantaviruses and phylogenies of their rodent reservoirs have led to the theory that rodents, although infected by the virus, are not harmed by it because of long-standing hantavirus–rodent host coevolution , although findings in 2008 led to new hypotheses regarding hantavirus evolution. Various hantaviruses have been found to infect multiple rodent species, and cases of cross-species transmission ( host switching ) have been recorded. Additionally, rates of substitution based on nucleotide sequence data reveal that hantavirus clades and rodent subfamilies may not have diverged at the same time. Furthermore, as of 2007 hantaviruses have been found in multiple species of non-rodent shrews and moles. Taking into account the inconsistencies in the theory of coevolution, it was proposed in 2009 that the patterns seen in hantaviruses in relation to their reservoirs could be attributed to preferential host switching directed by geographical proximity and adaptation to specific host types. Another proposal from 2010 is that geographical clustering of hantavirus sequences may have been caused by an isolation-by-distance mechanism. Upon comparison of the hantaviruses found in hosts of orders Rodentia and Eulipotyphla , it was proposed in 2011 that the hantavirus evolutionary history is a mix of both host switching and codivergence and that ancestral shrews or moles, rather than rodents, may have been the early original hosts of ancient hantaviruses. A Bayesian analysis in 2014 suggested a common origin for these viruses ~2000 years ago. The association with particular rodent families appears to have been more recent. The viruses carried by the subfamilies Arvicolinae and Murinae originated in Asia 500–700 years ago. These subsequently spread to Africa , Europe , North America and Siberia possibly carried by their hosts. The species infecting the subfamily Neotominae evolved 500–600 years ago in Central America and then spread toward North America. The species infecting Sigmodontinae evolved in Brazil 400 years ago. Their ancestors may have been a Neotominae-associated virus from northern South America. The evolution of shrew -borne hantaviruses appears to have involved natural occurrences of homologous recombination events and the reassortment of genome segments. The evolution of Tula orthohantavirus carried by the European common vole also appears to have involved homologous recombination events. Hantavirus virions are about 80–120 nm in diameter. The lipid bilayer of the viral envelope is about 5 nm thick and is embedded with viral surface proteins to which sugar residues are attached. These glycoproteins, known as Gn and Gc, are encoded by the M segment of the viral genome. They tend to associate ( heterodimerize ) with each other and have both an interior tail and an exterior domain that extends to about 6 nm beyond the envelope surface. [ citation needed ] Inside the envelope are the nucleocapsids. These are composed of many copies of the nucleocapsid protein N, which interact with the three segments of the viral genome to form helical structures. The virally encoded RNA polymerase is also found in the interior. By mass, the virion is greater than 50% protein, 20–30% lipid, and 2–7% carbohydrate. The density of the virions is 1.18 g/cm 3 . These features are common to all members of the family Hantaviridae . [ citation needed ]The genome of hantaviruses is negative-sense, single-stranded RNA . Their genomes are composed of three segments: the small (S), medium (M), and large (L) segments. The S segment, 1–3 kilobases (kb) in length, encodes for the nucleocapsid (N) protein. The M segment, 3.2–4.9 kb in length, encodes a glycoprotein precursor polyprotein that is co-translationally cleaved into the envelope glycoproteins Gn and Gc, alternatively called G1 and G2. The L segment, 6.8–12 kb in length, encodes the L protein which functions primarily as the viral RNA-dependent RNA polymerase used for transcription and replication. Within virions , the genomic RNAs of hantaviruses are thought to complex with the N protein to form helical nucleocapsids, the RNA component of which circularizes due to sequence complementarity between the 5′ and 3′ terminal sequences of genomic segments. [ citation needed ] As with other Bunyavirales , each of the three segments has a consensus 3′-terminal nucleotide sequence (AUCAUCAUC), which is complementary to the 5′-terminal sequence and is distinct from those of the other four genera in the family. These sequences appear to form panhandle structure which seem likely to play a role in replication and encapsidation facilitated by binding with the viral nucleocapsid (N) protein. The large segment is 6530–6550 nucleotides (nt) in length, the medium is 3613–3707 nt in length and the small is 1696–2083 nt in length. [ citation needed ] No nonstructural proteins are known, unlike the other genera in this family. At the 5′ and 3′ of each segment are short noncoding sequences: the noncoding segment in all sequences at the 5′ end is 37–51 nt. The 3′ noncoding regions differ: L segment 38–43 nt; M segment 168–229 nt; and S segment 370–730 nt. The 3′ end of the S segment is conserved between the genera suggesting a functional role. [ citation needed ]Viral entry into host cells initiates by binding to surface cell receptors. Integrins are considered to be the main receptors for hantaviruses in vitro , but complement decay-accelerating factor (DAF) and globular heads of complement C1q receptor (gC1qR) have mediated attachment in cultured cells too. Entry may proceed through a number of possible routes, including clathrin -dependent endocytosis , clathrin-independent receptor-mediated endocytosis, and micro pinocytosis . Viral particles are then transported to late endosomes . Gc-mediated membrane fusion with the endosomal membrane , triggered by low pH , releases the nucleocapsid into the cytoplasm . After the release of the nucleocapsids into cytoplasm, the complexes are targeted to the endoplasmic reticulum–Golgi intermediate compartments (ERGIC) through microtubular -associated movement resulting in the formation of viral factories at ERGIC. [ citation needed ] These factories then facilitate transcription and subsequent translation of the viral proteins. Transcription of viral genes must be initiated by association of the L protein with the three nucleocapsid species. In addition to transcriptase and replicase functions, the viral L protein is also thought to have an endonuclease activity that cleaves cellular messenger RNAs (mRNAs) for the production of capped primers used to initiate transcription of viral mRNAs. As a result of this cap snatching , the mRNAs of hantaviruses are capped and contain nontemplated 5′-terminal extensions. The G1 (or Gn) and G2 (Gc) glycoproteins form hetero-oligomers and are then transported from the endoplasmic reticulum to the Golgi complex , where glycosylation is completed. The L protein produces nascent genomes by replication via a positive-sense RNA intermediate. Hantavirus virions are believed to assemble by association of nucleocapsids with glycoproteins embedded in the membranes of the Golgi, followed by budding into the Golgi cisternae . Nascent virions are then transported in secretory vesicles to the plasma membrane and released by exocytosis . [ citation needed ]The pathogenesis of hantavirus infections is unclear as there is a lack of animal models to describe it (rats and mice do not seem to acquire severe disease). While the primary site of viral replication in the body is not known, in HFRS the main effect is in the blood vessels while in HPS most symptoms are associated with the lungs. In HFRS, there are increased vascular permeability and decreased blood pressure due to endothelial dysfunction and the most dramatic damage is seen in the kidneys, whereas in HPS, the lungs, spleen, and gall bladder are most affected. Early symptoms of HPS tend to present similarly to the flu (muscle aches, fever and fatigue) and usually appear around 2 to 3 weeks after exposure. Later stages of the disease (about 4 to 10 days after symptoms start) include difficulty breathing, shortness of breath and coughing. Findings of significant congruence between phylogenies of hantaviruses and phylogenies of their rodent reservoirs have led to the theory that rodents, although infected by the virus, are not harmed by it because of long-standing hantavirus–rodent host coevolution , although findings in 2008 led to new hypotheses regarding hantavirus evolution. Various hantaviruses have been found to infect multiple rodent species, and cases of cross-species transmission ( host switching ) have been recorded. Additionally, rates of substitution based on nucleotide sequence data reveal that hantavirus clades and rodent subfamilies may not have diverged at the same time. Furthermore, as of 2007 hantaviruses have been found in multiple species of non-rodent shrews and moles. Taking into account the inconsistencies in the theory of coevolution, it was proposed in 2009 that the patterns seen in hantaviruses in relation to their reservoirs could be attributed to preferential host switching directed by geographical proximity and adaptation to specific host types. Another proposal from 2010 is that geographical clustering of hantavirus sequences may have been caused by an isolation-by-distance mechanism. Upon comparison of the hantaviruses found in hosts of orders Rodentia and Eulipotyphla , it was proposed in 2011 that the hantavirus evolutionary history is a mix of both host switching and codivergence and that ancestral shrews or moles, rather than rodents, may have been the early original hosts of ancient hantaviruses. A Bayesian analysis in 2014 suggested a common origin for these viruses ~2000 years ago. The association with particular rodent families appears to have been more recent. The viruses carried by the subfamilies Arvicolinae and Murinae originated in Asia 500–700 years ago. These subsequently spread to Africa , Europe , North America and Siberia possibly carried by their hosts. The species infecting the subfamily Neotominae evolved 500–600 years ago in Central America and then spread toward North America. The species infecting Sigmodontinae evolved in Brazil 400 years ago. Their ancestors may have been a Neotominae-associated virus from northern South America. The evolution of shrew -borne hantaviruses appears to have involved natural occurrences of homologous recombination events and the reassortment of genome segments. The evolution of Tula orthohantavirus carried by the European common vole also appears to have involved homologous recombination events. Orthohantaviruses belong to the family Hantaviridae and members of both the genus and the family are called hantaviruses. The genus also belongs to the subfamily Mammantavirinae , the mammalian hantaviruses, with three other genera. Orthohantaviruses specifically are mammalian hantaviruses that are transmitted among rodents. The genus contains these 38 species: Hantaviruses that were formerly classified as species in this genus and which were not reassigned as member viruses of any existing species include: Isla Vista hantavirus , also called Isla Vista virus Muleshoe hantavirus , also called Muleshoe virus Rio Segundo hantavirus , also called Rio Segundo virusAccording to the U.S. CDC, the best prevention against contracting hantavirus is to eliminate or minimize contact with rodents in the home, workplace, or campsite. As the virus can be transmitted by rodent saliva, excretions, and bites, control of rats and mice in areas frequented by humans is key for disease prevention. General prevention can be accomplished by disposing of rodent nests, sealing any cracks and holes in homes where mice or rats could enter, setting traps, or laying down poisons or using natural predators such as cats in the home. The duration that hantaviruses remain infectious in the environment varies based on factors such as the rodent's diet, temperature, humidity, and whether indoors or outdoors. The viruses have been demonstrated to remain active for 2–3 days at normal room temperature, while ultraviolet rays in direct sunlight kill them within a few hours. Rodent droppings or urine of indeterminate age, though, should always be treated as infectious. As of 2021 [ update ] , no vaccines against hantaviruses have been approved by the U.S. FDA, but whole virus inactivated bivalent vaccines against Hantaan virus and Seoul virus are available in China and South Korea. In both countries, the use of the vaccine, combined with other preventive measures, has significantly reduced the incidence of hantavirus infections. Apart from these vaccines, four types of vaccines have been researched: DNA vaccines targeting the M genome segment and the S genome segment, subunit vaccines that use recombinant Gn, Gc, and N proteins of the virus, virus vector vaccines that have recombinant hantavirus proteins inserted in them, and virus-like particle vaccines that contain viral proteins, but lack genetic material. Of these, only DNA vaccines have entered into clinical trials. As of 2021 [ update ] , no vaccines against hantaviruses have been approved by the U.S. FDA, but whole virus inactivated bivalent vaccines against Hantaan virus and Seoul virus are available in China and South Korea. In both countries, the use of the vaccine, combined with other preventive measures, has significantly reduced the incidence of hantavirus infections. Apart from these vaccines, four types of vaccines have been researched: DNA vaccines targeting the M genome segment and the S genome segment, subunit vaccines that use recombinant Gn, Gc, and N proteins of the virus, virus vector vaccines that have recombinant hantavirus proteins inserted in them, and virus-like particle vaccines that contain viral proteins, but lack genetic material. Of these, only DNA vaccines have entered into clinical trials. Ribavirin may be a drug for HPS and HFRS, but its effectiveness remains unknown; still, spontaneous recovery is possible with supportive treatment. People with suspected hantavirus infection may be admitted to a hospital, and given oxygen and mechanical ventilation support to help them breathe during the acute pulmonary stage with severe respiratory distress. Immunotherapy, administration of human neutralizing antibodies during acute phases of hantavirus, has been studied only in mice, hamsters, and rats. No controlled clinical trials have been reported. Hantavirus infections have been reported from all continents except Australia. Regions especially affected by HFRS include China , the Korean Peninsula , Russia (Hantaan, Puumala, and Seoul viruses), and Northern and Western Europe ( Puumala and Dobrava virus). Regions with the highest incidences of hantavirus pulmonary syndrome include Argentina , Chile , Brazil , the United States , Canada , and Panama . [ citation needed ] In 2010, a novel hantavirus, Sangassou virus , was isolated in Africa, which causes HFRS. In China, Hong Kong, the Korean Peninsula, and Russia, HFRS is caused by Hantaan, Puumala, and Seoul viruses. In March 2020, a man from Yunnan tested positive for hantavirus. He died while travelling to Shandong for work on a chartered bus. According to the Global Times reports, around 32 other people have been tested for the virus. As of 2005 [ update ] , no human infections have been reported in Australia, though rodents were found to carry antibodies. In Europe, two hantaviruses – Puumala and Dobrava-Belgrade viruses – are known to cause HFRS. Puumala usually causes a generally mild disease, nephropathia epidemica , which typically presents with fever, headache, gastrointestinal symptoms, impaired renal function, and blurred vision. Dobrava infections are similar, except that they often also have hemorrhagic complications. [ citation needed ] Puumala virus is carried by its rodent host, the bank vole ( Clethrionomys glareolus ), and is present throughout most of Europe, except for the Mediterranean region. Four Dobrava virus genotypes are known, each carried by a different rodent species. Genotype Dobrava is found in the yellow-necked mouse ( Apodemus flavicollis ), genotypes Saaremaa and Kurkino in the striped field mouse ( Apodemus agrarius ), and genotype Sochi in the Black Sea field mouse ( Apodemus ponticus ). [ citation needed ] In 2017 alone, the Robert Koch Institute (RKI) in Germany received 1,713 notifications of hantavirus infections. The primary cause of the disease in Canada is Sin Nombre virus-infected deer mice. Between 1989 and 2014, 109 confirmed cases were reported, with the death rate estimated at 29%. The virus exists in deer mice nationwide, but cases were concentrated in western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) with only one case in eastern Canada. In Canada, "[a]ll cases occurred in rural settings and approximately 70% of the cases have been associated with domestic and farming activities." In the United States, minor cases of HPS include Sin Nombre orthohantavirus , New York orthohantavirus , Bayou orthohantavirus , and possibly Black Creek Canal orthohantavirus . [ citation needed ] As of January 2017 [ update ] , 728 cases of hantavirus had been reported in the United States cumulatively since 1995, across 36 states, not including cases with presumed exposure outside the United States. More than 96% of cases have occurred in states west of the Mississippi River . The top 10 states by number of cases reported (which differs slightly from a count ordered by the state of original exposure ) were New Mexico (109), Colorado (104), Arizona (78), California (61), Washington (50), Texas (45), Montana (43), Utah (38), Idaho (21), and Oregon (21); 36% of the total reported cases have resulted in death. In Mexico, rodents have been found to carry hantaviruses include Thomas's giant deer mouse (Megadontomys thomasi) , the pack rat Neotoma picta , Orizaba deer mouse (Peromyscus beatae) , Western harvest mouse (Reithrodontomys megalotis) and Sumichrast's harvest mouse (Reithrodontomys sumichrasti) . Agents of HPS found in South America include the Andes virus (also called Oran, Castelo de Sonhos – Portuguese for "Castle of Dreams", Lechiguanas, Juquitiba, Araraquara, and Bermejo virus, among many other synonyms), which is the only hantavirus that has shown an interpersonal form of transmission, and the Laguna Negra virus , an extremely close relative of the previously known Rio Mamore virus. [ citation needed ] Rodents that have been shown to carry hantaviruses include Abrothrix longipilis and Oligoryzomys longicaudatus . In 2010, a novel hantavirus, Sangassou virus , was isolated in Africa, which causes HFRS. In China, Hong Kong, the Korean Peninsula, and Russia, HFRS is caused by Hantaan, Puumala, and Seoul viruses. In March 2020, a man from Yunnan tested positive for hantavirus. He died while travelling to Shandong for work on a chartered bus. According to the Global Times reports, around 32 other people have been tested for the virus. In March 2020, a man from Yunnan tested positive for hantavirus. He died while travelling to Shandong for work on a chartered bus. According to the Global Times reports, around 32 other people have been tested for the virus. As of 2005 [ update ] , no human infections have been reported in Australia, though rodents were found to carry antibodies. In Europe, two hantaviruses – Puumala and Dobrava-Belgrade viruses – are known to cause HFRS. Puumala usually causes a generally mild disease, nephropathia epidemica , which typically presents with fever, headache, gastrointestinal symptoms, impaired renal function, and blurred vision. Dobrava infections are similar, except that they often also have hemorrhagic complications. [ citation needed ] Puumala virus is carried by its rodent host, the bank vole ( Clethrionomys glareolus ), and is present throughout most of Europe, except for the Mediterranean region. Four Dobrava virus genotypes are known, each carried by a different rodent species. Genotype Dobrava is found in the yellow-necked mouse ( Apodemus flavicollis ), genotypes Saaremaa and Kurkino in the striped field mouse ( Apodemus agrarius ), and genotype Sochi in the Black Sea field mouse ( Apodemus ponticus ). [ citation needed ] In 2017 alone, the Robert Koch Institute (RKI) in Germany received 1,713 notifications of hantavirus infections. The primary cause of the disease in Canada is Sin Nombre virus-infected deer mice. Between 1989 and 2014, 109 confirmed cases were reported, with the death rate estimated at 29%. The virus exists in deer mice nationwide, but cases were concentrated in western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) with only one case in eastern Canada. In Canada, "[a]ll cases occurred in rural settings and approximately 70% of the cases have been associated with domestic and farming activities." In the United States, minor cases of HPS include Sin Nombre orthohantavirus , New York orthohantavirus , Bayou orthohantavirus , and possibly Black Creek Canal orthohantavirus . [ citation needed ] As of January 2017 [ update ] , 728 cases of hantavirus had been reported in the United States cumulatively since 1995, across 36 states, not including cases with presumed exposure outside the United States. More than 96% of cases have occurred in states west of the Mississippi River . The top 10 states by number of cases reported (which differs slightly from a count ordered by the state of original exposure ) were New Mexico (109), Colorado (104), Arizona (78), California (61), Washington (50), Texas (45), Montana (43), Utah (38), Idaho (21), and Oregon (21); 36% of the total reported cases have resulted in death. In Mexico, rodents have been found to carry hantaviruses include Thomas's giant deer mouse (Megadontomys thomasi) , the pack rat Neotoma picta , Orizaba deer mouse (Peromyscus beatae) , Western harvest mouse (Reithrodontomys megalotis) and Sumichrast's harvest mouse (Reithrodontomys sumichrasti) . The primary cause of the disease in Canada is Sin Nombre virus-infected deer mice. Between 1989 and 2014, 109 confirmed cases were reported, with the death rate estimated at 29%. The virus exists in deer mice nationwide, but cases were concentrated in western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) with only one case in eastern Canada. In Canada, "[a]ll cases occurred in rural settings and approximately 70% of the cases have been associated with domestic and farming activities." In the United States, minor cases of HPS include Sin Nombre orthohantavirus , New York orthohantavirus , Bayou orthohantavirus , and possibly Black Creek Canal orthohantavirus . [ citation needed ] As of January 2017 [ update ] , 728 cases of hantavirus had been reported in the United States cumulatively since 1995, across 36 states, not including cases with presumed exposure outside the United States. More than 96% of cases have occurred in states west of the Mississippi River . The top 10 states by number of cases reported (which differs slightly from a count ordered by the state of original exposure ) were New Mexico (109), Colorado (104), Arizona (78), California (61), Washington (50), Texas (45), Montana (43), Utah (38), Idaho (21), and Oregon (21); 36% of the total reported cases have resulted in death. In Mexico, rodents have been found to carry hantaviruses include Thomas's giant deer mouse (Megadontomys thomasi) , the pack rat Neotoma picta , Orizaba deer mouse (Peromyscus beatae) , Western harvest mouse (Reithrodontomys megalotis) and Sumichrast's harvest mouse (Reithrodontomys sumichrasti) . Agents of HPS found in South America include the Andes virus (also called Oran, Castelo de Sonhos – Portuguese for "Castle of Dreams", Lechiguanas, Juquitiba, Araraquara, and Bermejo virus, among many other synonyms), which is the only hantavirus that has shown an interpersonal form of transmission, and the Laguna Negra virus , an extremely close relative of the previously known Rio Mamore virus. [ citation needed ] Rodents that have been shown to carry hantaviruses include Abrothrix longipilis and Oligoryzomys longicaudatus . Hantavirus HFRS was likely first referenced in China in the 12th century. The first clinical recognition was in 1931 in northeast China. Around the same time in the 1930s, NE was identified in Sweden. HFRS came to the recognition of western physicians during the Korean War between 1951 and 1954 when more than 3,000 United Nations soldiers fell ill in an outbreak. In 1976, the first pathogenic hantavirus, the Hantaan orthohantavirus , was isolated from rodents near the Hantan River in South Korea . Other prominent hantaviruses that cause HFRS, including the Dobrava-Belgrade orthohantavirus , Puumala orthohantavirus , and Seoul orthohantavirus , were identified in the years after then and are collectively referred to as the Old World hantaviruses. In 1993, an outbreak of HCPS , then unrecognized, occurred in the Four Corners region of the United States and led to the discovery of the Sin Nombre orthohantavirus . Since then, approximately 43 hantavirus strains, of which 20 are pathogenic, have been found in the Americas and are referred to as the New World hantaviruses. This includes the Andes orthohantavirus , one of the primary causes of HCPS in South America and the only hantavirus known to be capable of person-to-person transmission. In late medieval England a mysterious sweating sickness swept through the country in 1485 just before the Battle of Bosworth Field . Noting that the symptoms overlap with hantavirus pulmonary syndrome, several scientists have theorized that the virus may have been the cause of the disease. The hypothesis was criticized because sweating sickness was recorded as being transmitted from human to human, whereas hantaviruses were not known to spread in this way.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Tick-borne_encephalitis/html

Tick-borne encephalitis

Tick-borne encephalitis ( TBE ) is a viral infectious disease involving the central nervous system . The disease most often manifests as meningitis , encephalitis or meningoencephalitis . Myelitis and spinal paralysis also occurs. In about one third of cases sequelae , predominantly cognitive dysfunction, persist for a year or more. The number of reported cases has been increasing in most countries. TBE is posing a concerning health challenge to Europe, as the number of reported human cases of TBE in all endemic regions of Europe have increased by almost 400% within the last three decades. The tick-borne encephalitis virus is known to infect a range of hosts including ruminants , birds , rodents , carnivores, horses , and humans. The disease can also be spread from animals to humans , with ruminants and dogs providing the principal source of infection for humans. The disease is most often biphasic . After an incubation period of approximately one week (range: 4–28 days) from exposure (tick bite) non-specific symptoms occurs. These symptoms are fever, malaise, headache, nausea, vomiting and myalgias that persist for about 5 days. Then, after approximately one week without symptoms, some of the infected develop neurological symptoms, i.e. meningitis, encephalitis or meningoencephalitis. Myelitis also occurs with or without encephalitis. Sequelae persist for a year or more in approximately one third of people who develop neurological disease. Most common long-term symptoms are headache, concentration difficulties, memory impairment and other symptoms of cognitive dysfunction. Mortality depends on the subtype of the virus. For the European subtype mortality rates are 0.5% to 2% for people who develop neurological disease. In dogs, the disease also manifests as a neurological disorder with signs varying from tremors to seizures and death. In ruminants, neurological disease is also present, and animals may refuse to eat, appear lethargic, and also develop respiratory signs. TBE is caused by tick-borne encephalitis virus , a member of the genus Flavivirus in the family Flaviviridae . It was first isolated in 1937. Three virus sub-types also exist: The former Soviet Union conducted research on tick-borne diseases, including the TBE viruses. It is transmitted by the bite of several species of infected woodland ticks , including Ixodes scapularis , I. ricinus and I. persulcatus , or (rarely) through the non-pasteurized milk of infected cows. Infection acquired through goat milk consumed as raw milk or fresh cheese (Frischkäse) has been documented in 2016 and 2017 in the German state of Baden-Württemberg . None of the infected had neurological disease. It is transmitted by the bite of several species of infected woodland ticks , including Ixodes scapularis , I. ricinus and I. persulcatus , or (rarely) through the non-pasteurized milk of infected cows. Infection acquired through goat milk consumed as raw milk or fresh cheese (Frischkäse) has been documented in 2016 and 2017 in the German state of Baden-Württemberg . None of the infected had neurological disease. Detection of specific IgM and IgG antibodies in patients' sera combined with typical clinical signs, is the principal method for diagnosis. In more complicated situations, e.g. after vaccination, testing for presence of antibodies in cerebrospinal fluid may be necessary. It has been stated that lumbar puncture always should be performed when diagnosing TBE and that pleocytosis in cerebrospinal fluid should be added to the diagnostic criteria. PCR ( polymerase chain reaction ) method is rarely used, since TBE virus RNA is most often not present in patient sera or cerebrospinal fluid at the time of neurological symptoms. Prevention includes non-specific (tick-bite prevention) and specific prophylaxis in the form of a vaccination . Tick checks, while useful for preventing some other tick-borne diseases such as Lyme borreliosis , would not be expected to be effective in the prevention of tick-borne encephalitis as the virus is transmitted within minutes of attachment by the tick. Tick-borne encephalitis vaccines are very effective and available in many disease endemic areas and in travel clinics. Trade names are Encepur N and FSME-Immun CC . There is no specific antiviral treatment for TBE. Symptomatic brain damage requires hospitalization and supportive care based on syndrome severity. Anti-inflammatory drugs , such as corticosteroids , may be considered under specific circumstances for symptomatic relief. Tracheal intubation and respiratory support may be necessary.As of 2011, the disease was most common in Central and Eastern Europe, and Northern Asia. About ten to twelve thousand cases are documented a year but the rates vary widely from one region to another. Most of the variation has been the result of variation in host population, particularly that of deer. In Austria, an extensive vaccination program since the 1970s reduced the incidence in 2013 by roughly 85%. In Germany, during the 2010s, there have been a minimum of 95 (2012) and a maximum of 584 cases (2018) of TBE (or FSME as it is known in German). More than half of the reported cases from 2019 had meningitis , encephalitis or myelitis . The risk of infection was noted to be increasing with age, especially in people older than 40 years and it was greater in men than women. Most cases were acquired in Bavaria (46%) and Baden-Württemberg (37%), much less in Saxony, Hesse, Lower Saxony and other states. Altogether 164 Landkreise are designated TBE-risk areas, including all of Baden-Württemberg except for the city of Heilbronn. In Sweden, most cases of TBE occur in a band running from Stockholm to the west, especially around lakes and the nearby region of the Baltic sea. It reflects the greater population involved in outdoor activities in these areas. Overall, for Europe, the estimated risk is roughly 1 case per 10,000 human-months of woodland activity. Although in some regions of Russia and Slovenia, the prevalence of cases can be as high as 70 cases per 100,000 people per year. Travelers to endemic regions do not often become cases, with only 8 cases reported among U.S. travelers returning from Eurasia between 2000 and 2017, a rate so low that as of 2020 the U.S. Centers for Disease Control and Prevention recommended vaccination only for those who will be extensively exposed in high risk areas.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Prevention_of_viral_hemorrhagic_fever/html

Prevention of viral hemorrhagic fever

Prevention of viral hemorrhagic fever is similar for the different viruses. There are a number of different viral hemorrhagic fevers including Ebola virus disease , Lassa fever , Rift valley fever , Marburg virus disease , Crimean-Congo haemorrhagic fever (CCHF) and yellow fever . Lassa, Ebola, Marburg and CCHF can be spread by direct contact with the body fluids of those infected. Thus the content here covers the prevention of Ebola .The use of standard precautions is recommended with all patients in a healthcare environment. This includes a minimum level of standard precautions for use with all people regardless of their infection status, routine handwashing practices, safe handling and disposal of used needles and syringes, and intensifying standard precautions. It also includes VHF isolation precautions when needed. Limited supplies and resources may prevent a health facility from using all the standard precautions all the time. However, health facilities should establish and maintain a basic, practical level of standard precautions that can be used routinely with patients in their health facility. This requires a source of clean water, routine handwashing before and after any contact with a person who has fever, and safe handling and disposal of sharp instruments and equipment. Washing hands with soap and water eliminates microorganisms from the skin and hands. This provides some protection against transmission of VHF and other diseases. This requires at least cake soap cut into small pieces, soap dishes with openings that allow water to drain away, running water or a bucket kept full with clean water, a bucket for collecting rinse water and a ladle for dipping, if running water is not available, and one-use towels. The handwashing technique that is recommended is to place a piece of soap in the palm of one hand, wash the opposite hand and forearm, rub the surfaces vigorously for at least 10 seconds, move soap to the opposite hand and repeat, use clean water to rinse both hands and then the forearms, dry the hands and forearms with a clean one-use towel, or let rinsed hands and forearms air-dry. Reusable needles and syringes are not recommended. If reusable needles and syringes are used, clean, disinfect and sterilize them before reuse. Needles and syringes used with VHF patients require special care. Cleaning staff should wear two pairs of gloves when handling needles and syringes used with any patient with a known or suspected VHF. In an outbreak situation, several cases occur around the same time. They may be grouped together, and there may be person-to-person transmission. An initial diagnosis of a VHF can be made based on the signs and symptoms of the specific VHF. Suspecting a VHF during a non-outbreak situation in a single case is more difficult. The early symptoms of a VHF include high fever and headache. These are also symptoms for many infections seen at the health facility. Most people who present with fever do not have a VHF. Their fever is more often caused by malaria , typhoid fever , dysentery , severe bacterial infection or other fever-producing illnesses usually seen in the area. The health worker probably will not suspect a VHF until more severe signs develop and the patient does not respond to recommended treatment for other illnesses. However, health workers should be aware of the possibility of VHF in a non-outbreak situation. As soon as a VHF is suspected, VHF isolation precautions should begin. This will help reduce the number of people exposed to the VHF. Isolating the VHF patient will restrict patient access to health facility staff trained to use VHF isolation precautions. Establish a barrier between the VHF patient and uninfected patients, other health facility staff, and visitors. When a VHF case is suspected in the health facility, the following protective clothing should be worn in the isolation area: A scrub suit or inner layer of clothing (an old shirt and trousers brought from home) A pair of thin gloves Rubber boots or overshoes (only if the floor is soiled) A gown or outer layer of clothing (surgical or disposable gown with long sleeves and cuffs) A plastic apron worn over both layers of clothes A second pair of thin or thick gloves. Wearing a second pair of gloves provides an added measure of safety during patient care and when handling contaminated supplies A HEPA-filter (high-efficiency particulate air respirator) or other biosafety mask (or surgical mask if HEPA-filter or other biosafety mask is not available) Cotton head covering Clear eyeglasses or non-fogging goggles When protective clothing is not available or is in short supply, adaptations must be made and used. There are specific recommendation regarding the putting on of protective clothing including: Before entering the changing room, remove jewelry, wallets and other valuables. Remove street clothes and hang them on a hook. Put on the scrub suit or set of old clothes. Enter the changing room. Put on rubber boots. Put on each boot and tuck the trouser leg inside the boot. If overboots are used, tape the top of the boot to the leg with plastic tape. This will help prevent spills from running inside the boots. Put on the first pair of gloves. Look at your hands for cut or broken skin. If the skin is cut or broken, refrain from direct patient contact. Put on one glove at a time. If the scrub suit or set of old clothes has long sleeves, place the edge of each glove under the cuff. When only one pair of gloves is worn, place the edge of the glove over the cuff or gown. If gloves are not available, use plastic bags. Put on one layer now. Attach and close the first layer with tape or elastic bands Put on the outer gown. Pick up the gown from the inside. This is especially important if the gown is being reused Put on the plastic or rubber apron. Put on the second pair of gloves Put on the mask and head cover Put on the protective eyewear. Attach the eyeglasses or goggles behind the head with string or cord to prevent the eyewear from falling off. Introduction Trained oberserver Removing own clothing Examining equipment Hand cleaning Boot covers Inner gloves Coverall N95 respirator surgical hood Outer apron Outer gloves Face shield Verification There are also specific recommendations regarding the removal of protective clothing including: Disinfect the outer pair of gloves, wash the gloved hands in soap and water, dip the gloved hands in 1:100 bleach solution (see below) for one minute Disinfect the apron. Spray or wipe it with 1:100 bleach solution. Disinfect the boots. Use a sprayer containing 1:100 bleach solution to spray boots or hold the foot over a pan or basin and ask another health worker to pour 1:100 bleach solution over the boots or step into a shallow pan containing 1:100 bleach solution and wipe boots on a bleach-drenched cloth Remove the outer pair of gloves Remove the apron and outer gown Disinfect the gloved hands after contact with apron and outer gown. Remove the eyewear, head cover and mask. Remove the boots. Place a towel that has been soaked in 1:100 bleach solution on the floor for health facility staff to stand on when removing boots Remove the inner pair of gloves. Remove inner layer of clothes and dress in street clothes. Wash hands with soap and clean water before leaving the changing roomThere are specific recommendation regarding the putting on of protective clothing including: Before entering the changing room, remove jewelry, wallets and other valuables. Remove street clothes and hang them on a hook. Put on the scrub suit or set of old clothes. Enter the changing room. Put on rubber boots. Put on each boot and tuck the trouser leg inside the boot. If overboots are used, tape the top of the boot to the leg with plastic tape. This will help prevent spills from running inside the boots. Put on the first pair of gloves. Look at your hands for cut or broken skin. If the skin is cut or broken, refrain from direct patient contact. Put on one glove at a time. If the scrub suit or set of old clothes has long sleeves, place the edge of each glove under the cuff. When only one pair of gloves is worn, place the edge of the glove over the cuff or gown. If gloves are not available, use plastic bags. Put on one layer now. Attach and close the first layer with tape or elastic bands Put on the outer gown. Pick up the gown from the inside. This is especially important if the gown is being reused Put on the plastic or rubber apron. Put on the second pair of gloves Put on the mask and head cover Put on the protective eyewear. Attach the eyeglasses or goggles behind the head with string or cord to prevent the eyewear from falling off. Introduction Trained oberserver Removing own clothing Examining equipment Hand cleaning Boot covers Inner gloves Coverall N95 respirator surgical hood Outer apron Outer gloves Face shield VerificationThere are also specific recommendations regarding the removal of protective clothing including: Disinfect the outer pair of gloves, wash the gloved hands in soap and water, dip the gloved hands in 1:100 bleach solution (see below) for one minute Disinfect the apron. Spray or wipe it with 1:100 bleach solution. Disinfect the boots. Use a sprayer containing 1:100 bleach solution to spray boots or hold the foot over a pan or basin and ask another health worker to pour 1:100 bleach solution over the boots or step into a shallow pan containing 1:100 bleach solution and wipe boots on a bleach-drenched cloth Remove the outer pair of gloves Remove the apron and outer gown Disinfect the gloved hands after contact with apron and outer gown. Remove the eyewear, head cover and mask. Remove the boots. Place a towel that has been soaked in 1:100 bleach solution on the floor for health facility staff to stand on when removing boots Remove the inner pair of gloves. Remove inner layer of clothes and dress in street clothes. Wash hands with soap and clean water before leaving the changing roomDisinfection kills almost all bacteria, fungi, viruses, and protozoa. It reduces the number of microorganisms to make equipment and surfaces safer for use. When VHF is suspected in the health facility, all medical, nursing, laboratory and cleaning staff should disinfect: Hands and skin after contact with a VHF patient or infectious body fluids Gloved hands after contact with each VHF patient or after contact with infectious body fluids (when gloves cannot be changed) Thermometers, stethoscopes and other medical instruments after use with each VHF patient Spills of infectious body fluids on the walls and floors Patient excreta and containers contaminated by patient excreta Reusable supplies such as protective clothing and patient bedding Used needles and syringes Two strengths of solution are recommended. 1:10 bleach solution is a strong solution used to disinfect excreta and bodies. It is also used to prepare the 1:100 bleach solution. 1:100 bleach solution is used to disinfect surfaces, medical equipment, patient bedding, reusable protective clothing before it is laundered, rinsing gloves between contact with each patient, rinsing gloves, apron and boots before leaving the patient's room, disinfecting contaminated waste for disposal The dilutions mentioned pertain to a starting concentration of 5% active chlorine , so the 1:10 solution is 0.5% and the 1:100 is 0.05%. These solutions must be prepared new each day as they lose their strength after 24 hours. Two strengths of solution are recommended. 1:10 bleach solution is a strong solution used to disinfect excreta and bodies. It is also used to prepare the 1:100 bleach solution. 1:100 bleach solution is used to disinfect surfaces, medical equipment, patient bedding, reusable protective clothing before it is laundered, rinsing gloves between contact with each patient, rinsing gloves, apron and boots before leaving the patient's room, disinfecting contaminated waste for disposal The dilutions mentioned pertain to a starting concentration of 5% active chlorine , so the 1:10 solution is 0.5% and the 1:100 is 0.05%. These solutions must be prepared new each day as they lose their strength after 24 hours. Direct, unprotected contact during disposal of infectious waste can result in accidental transmission of VHF. For this reason, all contaminated waste produced in the care of the VHF patient must be disposed of safely. All non-reusable items should be destroyed so they cannot be used again. Burning should be carried out at least daily. Liquid waste, including patient excreta, can be disposed of in an isolated latrine or toilet set aside for VHF cases. Burning is the recommended method for disposal of other VHF-contaminated waste. A safe and inexpensive disposal system can be made by using an incinerator or a pit for burning. Use fuel to accelerate the burning and ensure that all waste is completely destroyed. There is risk of transmission in the health facility when a VHF patient dies because the bodies and body fluids of deceased VHF patients remain contagious for several days after death. Family and community members are also at risk if burial practices involve touching and washing the body. Burial should take place as soon as possible after the body is prepared in the health facility. Health facility staff should prepare the body safely and instruct families on what is and is not safe. To prepare the body, protective clothing is recommended per usually with a second pair of thick rubber gloves. The body and the area around it is sprayed with 1:10 bleach solution. The body is placed in a " body bag " (mortuary sack) and it is closed securely. The body bag is sprayed with 1:10 bleach solution. The body is then transported to the burial site as soon as possible. Any person who must touch or carry the body during transport should wear the same protective clothing as is worn in the isolation area. The grave should be at least 2 meters deep. Viewing the body is not possible and the burial ceremony should be limited to family only. The interior of the vehicle where the body was carried should be rinsed with 1:10 bleach solution. Community education and involvement is an important part of the prevention of the spread of VHF.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Marburg_virus_disease/html

Marburg virus disease

Marburg virus disease ( MVD ; formerly Marburg hemorrhagic fever ) is a viral hemorrhagic fever in human and non-human primates caused by either of the two Marburgviruses : Marburg virus (MARV) and Ravn virus (RAVV). Its clinical symptoms are very similar to those of Ebola virus disease (EVD). Egyptian fruit bats are believed to be the normal carrier in nature and Marburg virus RNA has been isolated from them. The most detailed study on the frequency, onset, and duration of MVD clinical signs and symptoms was performed during the 1998–2000 mixed MARV/RAVV disease outbreak. A skin rash , red or purple spots (e.g. petechiae or purpura ), bruises , and hematomas (especially around needle injection sites) are typical hemorrhagic manifestations. However, contrary to popular belief, hemorrhage does not lead to hypovolemia and is not the cause of death (total blood loss is minimal except during labor ). Instead, death occurs due to multiple organ dysfunction syndrome (MODS) due to fluid redistribution, hypotension , disseminated intravascular coagulation , and focal tissue necroses . Clinical phases of Marburg hemorrhagic fever's presentation are described below. Note that phases overlap due to variability between cases.MVD is caused by two viruses; Marburg virus (MARV) and Ravn virus (RAVV) , family Filoviridae. : 458 Marburgviruses are endemic in arid woodlands of equatorial Africa . Most marburgvirus infections were repeatedly associated with people visiting natural caves or working in mines . In 2009, the successful isolation of infectious MARV and RAVV was reported from healthy Egyptian fruit bat caught in caves. This isolation strongly suggests that Old World fruit bats are involved in the natural maintenance of marburgviruses and that visiting bat-infested caves is a risk factor for acquiring marburgvirus infections. Further studies are necessary to establish whether Egyptian rousettes are the actual hosts of MARV and RAVV or whether they get infected via contact with another animal and therefore serve only as intermediate hosts. Another risk factor is contact with nonhuman primates, although only one outbreak of MVD (in 1967) was due to contact with infected monkeys. Contrary to Ebola virus disease (EVD) , which has been associated with heavy rains after long periods of dry weather, triggering factors for spillover of marburgviruses into the human population have not yet been described.MVD is clinically indistinguishable from Ebola virus disease (EVD) , and it can also easily be confused with many other diseases prevalent in Equatorial Africa , such as other viral hemorrhagic fevers , falciparum malaria , typhoid fever , shigellosis , rickettsial diseases such as typhus , cholera , gram-negative sepsis , borreliosis such as relapsing fever or EHEC enteritis . Other infectious diseases that ought to be included in the differential diagnosis include leptospirosis , scrub typhus , plague , Q fever , candidiasis , histoplasmosis , trypanosomiasis , visceral leishmaniasis , hemorrhagic smallpox , measles , and fulminant viral hepatitis . Non-infectious diseases that can be confused with MVD are acute promyelocytic leukemia , hemolytic uremic syndrome , snake envenomation , clotting factor deficiencies/platelet disorders, thrombotic thrombocytopenic purpura , hereditary hemorrhagic telangiectasia , Kawasaki disease , and even warfarin intoxication. The most important indicator that may lead to the suspicion of MVD at clinical examination is the medical history of the patient, in particular the travel and occupational history (which countries and caves were visited?) and the patient's exposure to wildlife (exposure to bats or bat excrements?). MVD can be confirmed by isolation of marburgviruses from or by detection of marburgvirus antigen or genomic or subgenomic RNAs in patient blood or serum samples during the acute phase of MVD. Marburgvirus isolation is usually performed by inoculation of grivet kidney epithelial Vero E6 or MA-104 cell cultures or by inoculation of human adrenal carcinoma SW-13 cells, all of which react to infection with characteristic cytopathic effects . Filovirions can easily be visualized and identified in cell culture by electron microscopy due to their unique filamentous shapes, but electron microscopy cannot differentiate the various filoviruses alone despite some overall length differences. Immunofluorescence assays are used to confirm marburgvirus presence in cell cultures. During an outbreak, virus isolation and electron microscopy are most often not feasible options. The most common diagnostic methods are therefore RT-PCR in conjunction with antigen-capture ELISA , which can be performed in field or mobile hospitals and laboratories. Indirect immunofluorescence assays (IFAs) are not used for diagnosis of MVD in the field anymore. [ citation needed ] Marburg virus disease (MVD) is the official name listed in the World Health Organization 's International Statistical Classification of Diseases and Related Health Problems 10 (ICD-10) for the human disease caused by any of the two marburgviruses Marburg virus (MARV) and Ravn virus (RAVV). In the scientific literature, Marburg hemorrhagic fever (MHF) is often used as an unofficial alternative name for the same disease. Both disease names are derived from the German city Marburg , where MARV was first discovered. Marburg virus disease (MVD) is the official name listed in the World Health Organization 's International Statistical Classification of Diseases and Related Health Problems 10 (ICD-10) for the human disease caused by any of the two marburgviruses Marburg virus (MARV) and Ravn virus (RAVV). In the scientific literature, Marburg hemorrhagic fever (MHF) is often used as an unofficial alternative name for the same disease. Both disease names are derived from the German city Marburg , where MARV was first discovered. The details of the initial transmission of MVD to humans remain incompletely understood. Transmission most likely occurs from Egyptian fruit bats or another natural host, such as non-human primates or through the consumption of bushmeat , but the specific routes and body fluids involved are unknown. Human-to-human transmission of MVD occurs through direct contact with infected bodily fluids such as blood. Transmission events are relatively rare – there have been only 11 recorded outbreaks of MARV between 1975 and 2011, with one event involving both MARV and RAVV. There are currently no Food and Drug Administration -approved vaccines for the prevention of MVD. Many candidate vaccines have been developed and tested in various animal models. Of those, the most promising ones are DNA vaccines or based on Venezuelan equine encephalitis virus replicons , vesicular stomatitis Indiana virus (VSIV) or filovirus-like particles (VLPs) as all of these candidates could protect nonhuman primates from marburgvirus-induced disease. DNA vaccines have entered clinical trials. Marburgviruses are highly infectious , but not very contagious . They do not get transmitted by aerosol during natural MVD outbreaks. Due to the absence of an approved vaccine, prevention of MVD therefore relies predominantly on quarantine of confirmed or high probability cases, proper personal protective equipment , and sterilization and disinfection . [ citation needed ] The natural maintenance hosts of marburgviruses remain to be identified unequivocally. However, the isolation of both MARV and RAVV from bats and the association of several MVD outbreaks with bat-infested mines or caves strongly suggests that bats are involved in Marburg virus transmission to humans. Avoidance of contact with bats and abstaining from visits to caves is highly recommended, but may not be possible for those working in mines or people dependent on bats as a food source. [ citation needed ] Since marburgviruses are not spread via aerosol, the most straightforward prevention method during MVD outbreaks is to avoid direct (skin-to-skin) contact with patients, their excretions and body fluids , and any possibly contaminated materials and utensils. Patients should be isolated, but still are safe to be visited by family members. Medical staff should be trained in and apply strict barrier nursing techniques (disposable face mask, gloves, goggles, and a gown at all times). Traditional burial rituals, especially those requiring embalming of bodies, should be discouraged or modified, ideally with the help of local traditional healers . Marburgviruses are World Health Organization Risk Group 4 Pathogens, requiring Biosafety Level 4-equivalent containment , laboratory researchers have to be properly trained in BSL-4 practices and wear proper personal protective equipment.The natural maintenance hosts of marburgviruses remain to be identified unequivocally. However, the isolation of both MARV and RAVV from bats and the association of several MVD outbreaks with bat-infested mines or caves strongly suggests that bats are involved in Marburg virus transmission to humans. Avoidance of contact with bats and abstaining from visits to caves is highly recommended, but may not be possible for those working in mines or people dependent on bats as a food source. [ citation needed ]Since marburgviruses are not spread via aerosol, the most straightforward prevention method during MVD outbreaks is to avoid direct (skin-to-skin) contact with patients, their excretions and body fluids , and any possibly contaminated materials and utensils. Patients should be isolated, but still are safe to be visited by family members. Medical staff should be trained in and apply strict barrier nursing techniques (disposable face mask, gloves, goggles, and a gown at all times). Traditional burial rituals, especially those requiring embalming of bodies, should be discouraged or modified, ideally with the help of local traditional healers . Marburgviruses are World Health Organization Risk Group 4 Pathogens, requiring Biosafety Level 4-equivalent containment , laboratory researchers have to be properly trained in BSL-4 practices and wear proper personal protective equipment.There is currently no effective marburgvirus-specific therapy for MVD. Treatment is primarily supportive in nature and includes minimizing invasive procedures, balancing fluids and electrolytes to counter dehydration , administration of anticoagulants early in infection to prevent or control disseminated intravascular coagulation , administration of procoagulants late in infection to control hemorrhaging , maintaining oxygen levels, pain management , and administration of antibiotics or antifungals to treat secondary infections. Although supportive care can improve survival chances, marburg virus disease is fatal in the majority of cases. As of 2023 [ update ] the case fatality rate was assessed to be 61.9%. The WHO identifies marburg virus disease as having pandemic potential. Below is a table of outbreaks concerning MVD from 1967 to 2023: MVD was first documented in 1967, when 31 people became ill in the German towns of Marburg and Frankfurt am Main , and in Belgrade , Yugoslavia . The outbreak involved 25 primary MARV infections and seven deaths, and six nonlethal secondary cases. The outbreak was traced to infected grivets (species Chlorocebus aethiops ) imported from an undisclosed location in Uganda and used in developing poliomyelitis vaccines . The monkeys were received by Behringwerke, a Marburg company founded by the first winner of the Nobel Prize in Medicine , Emil von Behring . The company, which at the time was owned by Hoechst , was originally set up to develop sera against tetanus and diphtheria . Primary infections occurred in Behringwerke laboratory staff while working with grivet tissues or tissue cultures without adequate personal protective equipment . Secondary cases involved two physicians , a nurse , a post-mortem attendant, and the wife of a veterinarian . All secondary cases had direct contact, usually involving blood, with a primary case. Both physicians became infected through accidental skin pricks when drawing blood from patients. In 1975, an Australian tourist became infected with MARV in Rhodesia (today Zimbabwe ). He died in a hospital in Johannesburg , South Africa . His girlfriend and an attending nurse were subsequently infected with MVD, but survived. A case of MARV infection occurred in 1980 in Kenya . A French man, who worked as an electrical engineer in a sugar factory in Nzoia (close to Bungoma ) at the base of Mount Elgon (which contains Kitum Cave ), became infected by unknown means and died on 15 January shortly after admission to Nairobi Hospital. The attending physician contracted MVD, but survived. A popular science account of these cases can be found in Richard Preston 's book The Hot Zone (the French man is referred to under the pseudonym "Charles Monet", whereas the physician is identified under his real name, Shem Musoke). In 1987, a single lethal case of RAVV infection occurred in a 15-year-old Danish boy, who spent his vacation in Kisumu , Kenya . He had visited Kitum Cave on Mount Elgon prior to travelling to Mombasa , where he developed clinical signs of infection. The boy died after transfer to Nairobi Hospital. A popular science account of this case can be found in Richard Preston 's book The Hot Zone (the boy is referred to under the pseudonym "Peter Cardinal"). In 1988, researcher Nikolai Ustinov infected himself lethally with MARV after accidentally pricking himself with a syringe used for inoculation of guinea pigs . The accident occurred at the Scientific-Production Association "Vektor" (today the State Research Center of Virology and Biotechnology "Vektor" ) in Koltsovo , USSR (today Russia ). Very little information is publicly available about this MVD case because Ustinov's experiments were classified. A popular science account of this case can be found in Ken Alibek 's book Biohazard . Another laboratory accident occurred at the Scientific-Production Association "Vektor" (today the State Research Center of Virology and Biotechnology "Vektor" ) in Koltsovo , USSR , when a scientist contracted MARV by unknown means. A major MVD outbreak occurred among illegal gold miners around Goroumbwa mine in Durba and Watsa , Democratic Republic of Congo from 1998 to 2000, when co-circulating MARV and RAVV caused 154 cases of MVD and 128 deaths. The outbreak ended with the flooding of the mine. In early 2005, the World Health Organization (WHO) began investigating an outbreak of viral hemorrhagic fever in Angola , which was centered in the northeastern Uíge Province but also affected many other provinces. The Angolan government had to ask for international assistance, pointing out that there were only approximately 1,200 doctors in the entire country, with some provinces having as few as two. Health care workers also complained about a shortage of personal protective equipment such as gloves, gowns, and masks. Médecins Sans Frontières (MSF) reported that when their team arrived at the provincial hospital at the center of the outbreak, they found it operating without water and electricity . Contact tracing was complicated by the fact that the country's roads and other infrastructure were devastated after nearly three decades of civil war and the countryside remained littered with land mines . Americo Boa Vida Hospital in the Angolan capital Luanda set up a special isolation ward to treat infected people from the countryside. Unfortunately, because MVD often results in death, some people came to view hospitals and medical workers with suspicion and treated helpers with hostility. For instance, a specially-equipped isolation ward at the provincial hospital in Uíge was reported to be empty during much of the epidemic, even though the facility was at the center of the outbreak. WHO was forced to implement what it described as a "harm reduction strategy", which entailed distributing disinfectants to affected families who refused hospital care. Of the 252 people who contracted MVD during outbreak, 227 died. In 2007, four miners became infected with marburgviruses in Kamwenge District , Uganda . The first case, a 29-year-old man, became symptomatic on July 4, 2007, was admitted to a hospital on July 7, and died on July 13. Contact tracing revealed that the man had had prolonged close contact with two colleagues (a 22-year-old man and a 23-year-old man), who experienced clinical signs of infection before his disease onset. Both men had been admitted to hospitals in June and survived their infections, which were proven to be due to MARV. A fourth, 25-year-old man, developed MVD clinical signs in September and was shown to be infected with RAVV. He also survived the infection. On July 10, 2008, the Netherlands National Institute for Public Health and the Environment reported that a 41-year-old Dutch woman, who had visited Python Cave in Maramagambo Forest during her holiday in Uganda , had MVD due to MARV infection, and had been admitted to a hospital in the Netherlands . The woman died under treatment in the Leiden University Medical Centre in Leiden on July 11. The Ugandan Ministry of Health closed the cave after this case. On January 9 of that year an infectious diseases physician notified the Colorado Department of Public Health and the Environment that a 44-year-old American woman who had returned from Uganda had been hospitalized with a fever of unknown origin . At the time, serologic testing was negative for viral hemorrhagic fever . She was discharged on January 19, 2008. After the death of the Dutch patient and the discovery that the American woman had visited Python Cave, further testing confirmed the patient demonstrated MARV antibodies and RNA . In October 2017 an outbreak of Marburg virus disease was detected in Kween District , Eastern Uganda. All three initial cases (belonging to one family – two brothers and one sister) had died by 3 November. The fourth case – a health care worker – developed symptoms on 4 November and was admitted to a hospital. The first confirmed case traveled to Kenya before the death. A close contact of the second confirmed case traveled to Kampala . It is reported that several hundred people may have been exposed to infection. In August 2021, two months after the re-emergent Ebola epidemic in the Guéckédou prefecture was declared over, a case of the Marburg disease was confirmed by health authorities through laboratory analysis. Other potential case of the disease in a contact awaits official results. This was the first case of the Marburg hemorrhagic fever confirmed to happen in West Africa. The case of Marburg also has been identified in Guéckédou . During the outbreak, a total of one confirmed case, who died ( CFR =100%), and 173 contacts were identified, including 14 high-risk contacts based on exposure. Among them, 172 were followed for a period of 21 days, of which none developed symptoms. One high-risk contact was lost to follow up. Sequencing of an isolate from the Guinean patient showed that this outbreak was caused by the Angola-like Marburg virus. A colony of Egyptian rousettus bats ( reservoir host of Marburg virus ) was found in close proximity (4.5 km) to the village, where the Marburg virus disease outbreak emerged in 2021. Two sampled fruit bats from this colony were PCR-positive on the Marburg virus. In July 2022, preliminary analysis of samples taken from two patients – both deceased – in Ghana indicated the cases were positive for Marburg. However, per standard procedure, the samples were sent to the Pasteur Institute of Dakar for confirmation. On 17 July 2022 the two cases were confirmed by Ghana, which caused the country to declare a Marburg virus disease outbreak. An additional case was identified, bringing the total to three. A disease outbreak was first reported in Equatorial Guinea on 7 February 2023, and on 13 February 2023, it was identified as being Marburg virus disease. It was the first time the disease was detected in the country. Neighbouring Cameroon detected two suspected cases of Marburg virus disease on 13 February 2023, but they were later ruled out. On 25 February, a suspected case of Marburg was reported in the Spanish city of Valencia , however this case was subsequently discounted. As of 4 April 2023, there were 14 confirmed cases and 28 suspected cases, including ten confirmed deaths from the disease in Equatorial Guinea. On 8 June 2023, the World Health Organization declared the outbreak over. In total, 17 laboratory-confirmed cases and 12 deaths were recorded. All the 23 probable cases reportedly died. Four patients recovered from the virus and have been enrolled in a survivors programme to receive psychosocial and other post-recovery support. A Marburg virus disease outbreak in Tanzania was first reported on 21 March 2023 by the Ministry of Health of Tanzania. This was the first time that Tanzania had reported an outbreak of the disease. On 2 June 2023, Tanzania declared the outbreak over. There were 9 total infections, resulting in 6 total deaths. The WHO identifies marburg virus disease as having pandemic potential. Below is a table of outbreaks concerning MVD from 1967 to 2023:MVD was first documented in 1967, when 31 people became ill in the German towns of Marburg and Frankfurt am Main , and in Belgrade , Yugoslavia . The outbreak involved 25 primary MARV infections and seven deaths, and six nonlethal secondary cases. The outbreak was traced to infected grivets (species Chlorocebus aethiops ) imported from an undisclosed location in Uganda and used in developing poliomyelitis vaccines . The monkeys were received by Behringwerke, a Marburg company founded by the first winner of the Nobel Prize in Medicine , Emil von Behring . The company, which at the time was owned by Hoechst , was originally set up to develop sera against tetanus and diphtheria . Primary infections occurred in Behringwerke laboratory staff while working with grivet tissues or tissue cultures without adequate personal protective equipment . Secondary cases involved two physicians , a nurse , a post-mortem attendant, and the wife of a veterinarian . All secondary cases had direct contact, usually involving blood, with a primary case. Both physicians became infected through accidental skin pricks when drawing blood from patients. In 1975, an Australian tourist became infected with MARV in Rhodesia (today Zimbabwe ). He died in a hospital in Johannesburg , South Africa . His girlfriend and an attending nurse were subsequently infected with MVD, but survived. A case of MARV infection occurred in 1980 in Kenya . A French man, who worked as an electrical engineer in a sugar factory in Nzoia (close to Bungoma ) at the base of Mount Elgon (which contains Kitum Cave ), became infected by unknown means and died on 15 January shortly after admission to Nairobi Hospital. The attending physician contracted MVD, but survived. A popular science account of these cases can be found in Richard Preston 's book The Hot Zone (the French man is referred to under the pseudonym "Charles Monet", whereas the physician is identified under his real name, Shem Musoke). In 1987, a single lethal case of RAVV infection occurred in a 15-year-old Danish boy, who spent his vacation in Kisumu , Kenya . He had visited Kitum Cave on Mount Elgon prior to travelling to Mombasa , where he developed clinical signs of infection. The boy died after transfer to Nairobi Hospital. A popular science account of this case can be found in Richard Preston 's book The Hot Zone (the boy is referred to under the pseudonym "Peter Cardinal"). In 1988, researcher Nikolai Ustinov infected himself lethally with MARV after accidentally pricking himself with a syringe used for inoculation of guinea pigs . The accident occurred at the Scientific-Production Association "Vektor" (today the State Research Center of Virology and Biotechnology "Vektor" ) in Koltsovo , USSR (today Russia ). Very little information is publicly available about this MVD case because Ustinov's experiments were classified. A popular science account of this case can be found in Ken Alibek 's book Biohazard . Another laboratory accident occurred at the Scientific-Production Association "Vektor" (today the State Research Center of Virology and Biotechnology "Vektor" ) in Koltsovo , USSR , when a scientist contracted MARV by unknown means. A major MVD outbreak occurred among illegal gold miners around Goroumbwa mine in Durba and Watsa , Democratic Republic of Congo from 1998 to 2000, when co-circulating MARV and RAVV caused 154 cases of MVD and 128 deaths. The outbreak ended with the flooding of the mine. In early 2005, the World Health Organization (WHO) began investigating an outbreak of viral hemorrhagic fever in Angola , which was centered in the northeastern Uíge Province but also affected many other provinces. The Angolan government had to ask for international assistance, pointing out that there were only approximately 1,200 doctors in the entire country, with some provinces having as few as two. Health care workers also complained about a shortage of personal protective equipment such as gloves, gowns, and masks. Médecins Sans Frontières (MSF) reported that when their team arrived at the provincial hospital at the center of the outbreak, they found it operating without water and electricity . Contact tracing was complicated by the fact that the country's roads and other infrastructure were devastated after nearly three decades of civil war and the countryside remained littered with land mines . Americo Boa Vida Hospital in the Angolan capital Luanda set up a special isolation ward to treat infected people from the countryside. Unfortunately, because MVD often results in death, some people came to view hospitals and medical workers with suspicion and treated helpers with hostility. For instance, a specially-equipped isolation ward at the provincial hospital in Uíge was reported to be empty during much of the epidemic, even though the facility was at the center of the outbreak. WHO was forced to implement what it described as a "harm reduction strategy", which entailed distributing disinfectants to affected families who refused hospital care. Of the 252 people who contracted MVD during outbreak, 227 died. In 2007, four miners became infected with marburgviruses in Kamwenge District , Uganda . The first case, a 29-year-old man, became symptomatic on July 4, 2007, was admitted to a hospital on July 7, and died on July 13. Contact tracing revealed that the man had had prolonged close contact with two colleagues (a 22-year-old man and a 23-year-old man), who experienced clinical signs of infection before his disease onset. Both men had been admitted to hospitals in June and survived their infections, which were proven to be due to MARV. A fourth, 25-year-old man, developed MVD clinical signs in September and was shown to be infected with RAVV. He also survived the infection. On July 10, 2008, the Netherlands National Institute for Public Health and the Environment reported that a 41-year-old Dutch woman, who had visited Python Cave in Maramagambo Forest during her holiday in Uganda , had MVD due to MARV infection, and had been admitted to a hospital in the Netherlands . The woman died under treatment in the Leiden University Medical Centre in Leiden on July 11. The Ugandan Ministry of Health closed the cave after this case. On January 9 of that year an infectious diseases physician notified the Colorado Department of Public Health and the Environment that a 44-year-old American woman who had returned from Uganda had been hospitalized with a fever of unknown origin . At the time, serologic testing was negative for viral hemorrhagic fever . She was discharged on January 19, 2008. After the death of the Dutch patient and the discovery that the American woman had visited Python Cave, further testing confirmed the patient demonstrated MARV antibodies and RNA . In October 2017 an outbreak of Marburg virus disease was detected in Kween District , Eastern Uganda. All three initial cases (belonging to one family – two brothers and one sister) had died by 3 November. The fourth case – a health care worker – developed symptoms on 4 November and was admitted to a hospital. The first confirmed case traveled to Kenya before the death. A close contact of the second confirmed case traveled to Kampala . It is reported that several hundred people may have been exposed to infection. In August 2021, two months after the re-emergent Ebola epidemic in the Guéckédou prefecture was declared over, a case of the Marburg disease was confirmed by health authorities through laboratory analysis. Other potential case of the disease in a contact awaits official results. This was the first case of the Marburg hemorrhagic fever confirmed to happen in West Africa. The case of Marburg also has been identified in Guéckédou . During the outbreak, a total of one confirmed case, who died ( CFR =100%), and 173 contacts were identified, including 14 high-risk contacts based on exposure. Among them, 172 were followed for a period of 21 days, of which none developed symptoms. One high-risk contact was lost to follow up. Sequencing of an isolate from the Guinean patient showed that this outbreak was caused by the Angola-like Marburg virus. A colony of Egyptian rousettus bats ( reservoir host of Marburg virus ) was found in close proximity (4.5 km) to the village, where the Marburg virus disease outbreak emerged in 2021. Two sampled fruit bats from this colony were PCR-positive on the Marburg virus. In July 2022, preliminary analysis of samples taken from two patients – both deceased – in Ghana indicated the cases were positive for Marburg. However, per standard procedure, the samples were sent to the Pasteur Institute of Dakar for confirmation. On 17 July 2022 the two cases were confirmed by Ghana, which caused the country to declare a Marburg virus disease outbreak. An additional case was identified, bringing the total to three. A disease outbreak was first reported in Equatorial Guinea on 7 February 2023, and on 13 February 2023, it was identified as being Marburg virus disease. It was the first time the disease was detected in the country. Neighbouring Cameroon detected two suspected cases of Marburg virus disease on 13 February 2023, but they were later ruled out. On 25 February, a suspected case of Marburg was reported in the Spanish city of Valencia , however this case was subsequently discounted. As of 4 April 2023, there were 14 confirmed cases and 28 suspected cases, including ten confirmed deaths from the disease in Equatorial Guinea. On 8 June 2023, the World Health Organization declared the outbreak over. In total, 17 laboratory-confirmed cases and 12 deaths were recorded. All the 23 probable cases reportedly died. Four patients recovered from the virus and have been enrolled in a survivors programme to receive psychosocial and other post-recovery support. A Marburg virus disease outbreak in Tanzania was first reported on 21 March 2023 by the Ministry of Health of Tanzania. This was the first time that Tanzania had reported an outbreak of the disease. On 2 June 2023, Tanzania declared the outbreak over. There were 9 total infections, resulting in 6 total deaths. Experimentally, recombinant vesicular stomatitis Indiana virus (VSIV) expressing the glycoprotein of MARV has been used successfully in nonhuman primate models as post-exposure prophylaxis. A vaccine candidate has been effective in nonhuman primates. Experimental therapeutic regimens relying on antisense technology have shown promise, with phosphorodiamidate morpholino oligomers (PMOs) targeting the MARV genome New therapies from Sarepta and Tekmira have also been successfully used in humans as well as primates.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Dengue_fever/html

Dengue fever

Dengue fever is a mosquito-borne tropical disease caused by dengue virus . It is frequently asymptomatic ; if symptoms appear they typically begin 3 to 14 days after infection. These may include a high fever , headache , vomiting , muscle and joint pains , and a characteristic skin itching and skin rash . Recovery generally takes two to seven days. In a small proportion of cases, the disease develops into severe dengue (previously known as dengue hemorrhagic fever or dengue shock syndrome) with bleeding , low levels of blood platelets , blood plasma leakage, and dangerously low blood pressure . Dengue virus has four confirmed serotypes ; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. The symptoms of dengue resemble many other diseases including malaria , influenza , and Zika . Blood tests are available to confirm the diagnosis including detecting viral RNA , or antibodies to the virus. There is no specific treatment for dengue fever. In mild cases, treatment is focused on treating pain symptoms. Severe cases of dengue require hospitalisation; treatment of acute dengue is supportive and includes giving fluid either by mouth or intravenously . Dengue is spread by several species of female mosquitoes of the Aedes genus , principally Aedes aegypti . Infection can be prevented by mosquito elimination and the prevention of bites. Two types of dengue vaccine have been approved and are commercially available. Dengvaxia became available in 2016 but it is only recommended to prevent re-infection in individuals who have been previously infected. The second vaccine, Qdenga, became available in 2022 and is suitable for adults, adolescents and children from four years of age. The earliest descriptions of a dengue outbreak date from 1779; its viral cause and spread were understood by the early 20th century. Already endemic in more than one hundred countries, dengue is spreading from tropical and subtropical regions to the Iberian Peninsula and the southern states of the US, partly attributed to climate change. It is classified as a neglected tropical disease . During 2023, more than 5 million infections were reported, with more than 5,000 dengue-related deaths. As most cases are asymptomatic or mild, the actual numbers of dengue cases and deaths are under-reported. Typically, people infected with dengue virus are asymptomatic (80%) or have only mild symptoms such as an uncomplicated fever. Others have more severe illness (5%), and in a small proportion it is life-threatening. The incubation period (time between exposure and onset of symptoms) ranges from 3 to 14 days, but most often it is 4 to 7 days. The characteristic symptoms of mild dengue are sudden-onset fever, headache (typically located behind the eyes), muscle and joint pains, nausea, vomiting, swollen glands and a rash. If this progresses to severe dengue the symptoms are severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums or nose, fatigue, restlessness, blood in vomit or stool, extreme thirst, pale and cold skin, and feelings of weakness. The course of infection is divided into three phases: febrile, critical, and recovery. The febrile phase involves high fever (40 °C/104 °F), and is associated with generalized pain and a headache; this usually lasts two to seven days. There may also be nausea, vomiting, a rash, and pains in the muscle and joints. Most people recover within a week or so. In about 5% of cases, symptoms worsen and can become life-threatening. This is called severe dengue , (formerly called dengue hemorrhagic fever or dengue shock syndrome ). Severe dengue can lead to shock, internal bleeding, organ failure and even death. Warning signs include severe stomach pain, vomiting, difficulty breathing, and blood in the nose, gums, vomit or stools. During this period, there is leakage of plasma from the blood vessels, together with a reduction in platelets . This may result in fluid accumulation in the chest and abdominal cavity as well as depletion of fluid from the circulation and decreased blood supply to vital organs . The recovery phase usually lasts two to three days. The improvement is often striking, and can be accompanied with severe itching and a slow heart rate . Complications following severe dengue include fatigue, somnolence, headache, concentration impairment and memory impairment. A pregnant woman who develops dengue is at higher risk of miscarriage , low birth weight birth, and premature birth . The course of infection is divided into three phases: febrile, critical, and recovery. The febrile phase involves high fever (40 °C/104 °F), and is associated with generalized pain and a headache; this usually lasts two to seven days. There may also be nausea, vomiting, a rash, and pains in the muscle and joints. Most people recover within a week or so. In about 5% of cases, symptoms worsen and can become life-threatening. This is called severe dengue , (formerly called dengue hemorrhagic fever or dengue shock syndrome ). Severe dengue can lead to shock, internal bleeding, organ failure and even death. Warning signs include severe stomach pain, vomiting, difficulty breathing, and blood in the nose, gums, vomit or stools. During this period, there is leakage of plasma from the blood vessels, together with a reduction in platelets . This may result in fluid accumulation in the chest and abdominal cavity as well as depletion of fluid from the circulation and decreased blood supply to vital organs . The recovery phase usually lasts two to three days. The improvement is often striking, and can be accompanied with severe itching and a slow heart rate . Complications following severe dengue include fatigue, somnolence, headache, concentration impairment and memory impairment. A pregnant woman who develops dengue is at higher risk of miscarriage , low birth weight birth, and premature birth . Complications following severe dengue include fatigue, somnolence, headache, concentration impairment and memory impairment. A pregnant woman who develops dengue is at higher risk of miscarriage , low birth weight birth, and premature birth . Dengue virus (DENV) is an RNA virus of the family Flaviviridae ; genus Flavivirus . Other members of the same genus include yellow fever virus , West Nile virus , and Zika virus . Dengue virus genome (genetic material) contains about 11,000 nucleotide bases , which code for the three structural protein molecules (C, prM and E) that form the virus particle and seven other protein molecules that are required for replication of the virus. There are four confirmed strains of the virus, called serotypes , referred to as DENV-1, DENV-2, DENV-3 and DENV-4. The distinctions between the serotypes are based on their antigenicity . Dengue virus is most frequently transmitted by the bite of mosquitos in the Aedes genus, particularly A. aegypti . They prefer to feed at dusk and dawn, but they may bite and thus spread infection at any time of day. Other Aedes species that may transmit the disease include A. albopictus , A. polynesiensis and A. scutellaris . Humans are the primary host of the virus, but it also circulates in nonhuman primates , and can infect other mammals. An infection can be acquired via a single bite. For 2 to 10 days after becoming newly infected, a person's bloodstream will contain a high level of virus particles (the viremic period). A female mosquito that takes a blood meal from the infected host then propagates the virus in the cells lining its gut. Over the next few days, the virus spreads to other tissues including the mosquito's salivary glands and is released into its saliva. Next time the mosquito feeds, the infectious saliva will be injected into the bloodstream of its victim, thus spreading the disease. The virus seems to have no detrimental effect on the mosquito, which remains infected for life. Dengue can also be transmitted via infected blood products and through organ donation . Vertical transmission (from mother to child) during pregnancy or at birth has been reported. The principal risk for infection with dengue is the bite of an infected mosquito. This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed. It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, using mosquito netting while resting, and/or the application of insect repellent ( DEET being the most effective). Chronic diseases – such as asthma, sickle cell anemia, and diabetes mellitus – increase the risk of developing a severe form of the disease. Other risk factors for severe disease include female sex, and high body mass index , Infection with one serotype is thought to produce lifelong immunity to that type, but only short-term protection against the other three. Subsequent re-infection with a different serotype increases the risk of severe complications due to phenomenon known as antibody-dependent enhancement (ADE). The exact mechanism of ADE is not fully understood. It appears that ADE occurs when the antibodies generated during an immune response recognize and bind to a pathogen, but they fail to neutralize it. Instead, the antibody-virus complex has an enhanced ability to bind to the Fcγ receptors of the target immune cells, enabling the virus to infect the cell and reproduce itself. When a mosquito carrying dengue virus bites a person, the virus enters the skin together with the mosquito's saliva. The virus infects nearby skin cells called keratinocytes , as well as specialized immune cell located in the skin, called a Langerhans cells . The Langerhans cells migrate to the lymph nodes , where the infection spreads to white blood cells , and reproduces inside the cells while they move throughout the body. The white blood cells respond by producing several signaling proteins, such as cytokines and interferons , which are responsible for many of the symptoms, such as the fever, the flu-like symptoms, and the severe pains. In severe infection, the virus production inside the body is greatly increased, and many more organs (such as the liver and the bone marrow ) can be affected. Fluid from the bloodstream leaks through the wall of small blood vessels into body cavities due to increased capillary permeability . As a result, blood volume decreases, and the blood pressure becomes so low that it cannot supply sufficient blood to vital organs. The spread of the virus to the bone marrow leads to reduced numbers of platelets, which are necessary for effective blood clotting; this increases the risk of bleeding, the other major complication of dengue fever. The principal risk for infection with dengue is the bite of an infected mosquito. This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed. It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, using mosquito netting while resting, and/or the application of insect repellent (DEET being the most effective); it's also advisable to treat clothing, nets and tents with 0.5% permethrin . Protection of the home can be achieved with door and window screens, by using air conditioning, and by regularly emptying and cleaning all receptacles both indoors and outdoors which may accumulate water (such as buckets, planters, pools or trashcans). The primary method of controlling A. aegypti is by eliminating its habitats . This is done by eliminating open sources of water, or if this is not possible, by adding insecticides or biological control agents to these areas. Generalized spraying with organophosphate or pyrethroid insecticides, while sometimes done, is not thought to be effective. Reducing open collections of water through environmental modification is the preferred method of control, given the concerns of negative health effects from insecticides and greater logistical difficulties with control agents. Ideally, mosquito control would be a community activity, e.g. when all members of a community clear blocked gutters and street drains and keep their yards free of containers with standing water. If residences have direct water connections this eliminates the need for wells or street pumps and water-carrying containers. As of March 2024, there are two vaccines to protect against dengue infection; Dengvaxia and Qdenga . Dengvaxia (formerly CYD-TDV) became available in 2015, and is approved for use in the US, EU and in some Asian and Latin American countries. It is an attenuated virus, is suitable for individuals aged 6–45 years and protects against all four serotypes of dengue. Due to safety concerns about antibody-dependent enhancement (ADE), it should only be given to individuals who have previously been infected with dengue, in order to protect them from reinfection. It is given subcutaneously as three doses at six month intervals. Qdenga (formerly TAK-003) completed clinical trials in 2022 and was approved for use in the European Union in December 2022; it has been approved by a number of other countries including Indonesia and Brazil, and has been recommended by the SAGE committee of the World Health Organization. It is indicated for the prevention of dengue disease in individuals four years of age and older, and can be administered to people who have not been previously infected with dengue. It is a live attenuated vaccine containing the four serotypes of dengue virus, administered subcutaneously as two doses three months apart. Dengue virus (DENV) is an RNA virus of the family Flaviviridae ; genus Flavivirus . Other members of the same genus include yellow fever virus , West Nile virus , and Zika virus . Dengue virus genome (genetic material) contains about 11,000 nucleotide bases , which code for the three structural protein molecules (C, prM and E) that form the virus particle and seven other protein molecules that are required for replication of the virus. There are four confirmed strains of the virus, called serotypes , referred to as DENV-1, DENV-2, DENV-3 and DENV-4. The distinctions between the serotypes are based on their antigenicity . Dengue virus is most frequently transmitted by the bite of mosquitos in the Aedes genus, particularly A. aegypti . They prefer to feed at dusk and dawn, but they may bite and thus spread infection at any time of day. Other Aedes species that may transmit the disease include A. albopictus , A. polynesiensis and A. scutellaris . Humans are the primary host of the virus, but it also circulates in nonhuman primates , and can infect other mammals. An infection can be acquired via a single bite. For 2 to 10 days after becoming newly infected, a person's bloodstream will contain a high level of virus particles (the viremic period). A female mosquito that takes a blood meal from the infected host then propagates the virus in the cells lining its gut. Over the next few days, the virus spreads to other tissues including the mosquito's salivary glands and is released into its saliva. Next time the mosquito feeds, the infectious saliva will be injected into the bloodstream of its victim, thus spreading the disease. The virus seems to have no detrimental effect on the mosquito, which remains infected for life. Dengue can also be transmitted via infected blood products and through organ donation . Vertical transmission (from mother to child) during pregnancy or at birth has been reported. The principal risk for infection with dengue is the bite of an infected mosquito. This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed. It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, using mosquito netting while resting, and/or the application of insect repellent ( DEET being the most effective). Chronic diseases – such as asthma, sickle cell anemia, and diabetes mellitus – increase the risk of developing a severe form of the disease. Other risk factors for severe disease include female sex, and high body mass index , Infection with one serotype is thought to produce lifelong immunity to that type, but only short-term protection against the other three. Subsequent re-infection with a different serotype increases the risk of severe complications due to phenomenon known as antibody-dependent enhancement (ADE). The exact mechanism of ADE is not fully understood. It appears that ADE occurs when the antibodies generated during an immune response recognize and bind to a pathogen, but they fail to neutralize it. Instead, the antibody-virus complex has an enhanced ability to bind to the Fcγ receptors of the target immune cells, enabling the virus to infect the cell and reproduce itself. When a mosquito carrying dengue virus bites a person, the virus enters the skin together with the mosquito's saliva. The virus infects nearby skin cells called keratinocytes , as well as specialized immune cell located in the skin, called a Langerhans cells . The Langerhans cells migrate to the lymph nodes , where the infection spreads to white blood cells , and reproduces inside the cells while they move throughout the body. The white blood cells respond by producing several signaling proteins, such as cytokines and interferons , which are responsible for many of the symptoms, such as the fever, the flu-like symptoms, and the severe pains. In severe infection, the virus production inside the body is greatly increased, and many more organs (such as the liver and the bone marrow ) can be affected. Fluid from the bloodstream leaks through the wall of small blood vessels into body cavities due to increased capillary permeability . As a result, blood volume decreases, and the blood pressure becomes so low that it cannot supply sufficient blood to vital organs. The spread of the virus to the bone marrow leads to reduced numbers of platelets, which are necessary for effective blood clotting; this increases the risk of bleeding, the other major complication of dengue fever. The principal risk for infection with dengue is the bite of an infected mosquito. This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed. It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, using mosquito netting while resting, and/or the application of insect repellent (DEET being the most effective); it's also advisable to treat clothing, nets and tents with 0.5% permethrin . Protection of the home can be achieved with door and window screens, by using air conditioning, and by regularly emptying and cleaning all receptacles both indoors and outdoors which may accumulate water (such as buckets, planters, pools or trashcans). The primary method of controlling A. aegypti is by eliminating its habitats . This is done by eliminating open sources of water, or if this is not possible, by adding insecticides or biological control agents to these areas. Generalized spraying with organophosphate or pyrethroid insecticides, while sometimes done, is not thought to be effective. Reducing open collections of water through environmental modification is the preferred method of control, given the concerns of negative health effects from insecticides and greater logistical difficulties with control agents. Ideally, mosquito control would be a community activity, e.g. when all members of a community clear blocked gutters and street drains and keep their yards free of containers with standing water. If residences have direct water connections this eliminates the need for wells or street pumps and water-carrying containers. As of March 2024, there are two vaccines to protect against dengue infection; Dengvaxia and Qdenga . Dengvaxia (formerly CYD-TDV) became available in 2015, and is approved for use in the US, EU and in some Asian and Latin American countries. It is an attenuated virus, is suitable for individuals aged 6–45 years and protects against all four serotypes of dengue. Due to safety concerns about antibody-dependent enhancement (ADE), it should only be given to individuals who have previously been infected with dengue, in order to protect them from reinfection. It is given subcutaneously as three doses at six month intervals. Qdenga (formerly TAK-003) completed clinical trials in 2022 and was approved for use in the European Union in December 2022; it has been approved by a number of other countries including Indonesia and Brazil, and has been recommended by the SAGE committee of the World Health Organization. It is indicated for the prevention of dengue disease in individuals four years of age and older, and can be administered to people who have not been previously infected with dengue. It is a live attenuated vaccine containing the four serotypes of dengue virus, administered subcutaneously as two doses three months apart. The World Health Organization 's International Classification of Diseases divides dengue fever into two classes: uncomplicated and severe. Severe dengue is defined as that associated with severe bleeding, severe organ dysfunction, or severe plasma leakage. Severe dengue can develop suddenly, sometimes after a few days as the fever subsides. Leakage of plasma from the capillaries results in extreme low blood pressure and hypovolemic shock ; Patients with severe plasma leakage may have fluid accumulation in the lungs or abdomen , insufficient protein in the blood , or thickening of the blood . Severe dengue is a medical emergency which can cause damage to organs, leading to multiple organ failure and death. Mild cases of dengue fever can easily be confused with several common diseases including Influenza , measles , chikungunya , and zika . Dengue, chikungunya and zika share the same mode of transmission ( Aedes mosquitoes) and are often endemic in the same regions, so that it is possible to be infected simultaneously by more than one disease. For travellers, dengue fever diagnosis should be considered in anyone who develops a fever within two weeks of being in the tropics or subtropics . Warning symptoms of severe dengue include abdominal pain, persistent vomiting, odema, bleeding, lethargy, and liver enlargement. Once again, these symptoms can be confused with other diseases such as malaria, gastroenteritis, leptospirosis, and typhus. Blood tests can be used to confirm a diagnosis of dengue. During the first few days of infection, enzyme-linked immunosorbent assay ( ELISA ) can be used to detect the NS1 antigen ; however this antigen is produced by all flaviviruses. Four or five days into the infection, it is possible to reliably detect anti-dengue IgM antibodies, but this does not determine the serotype. Nucleic acid amplification tests provide the most reliable method of diagnosis. As of March 2024, there is no specific antiviral treatment available for dengue fever. Most cases of dengue fever have mild symptoms, and recovery takes place in a few days. No treatment is required for these cases. Acetaminophen (Paracetamol, Tylenol ) may be used to relieve mild fever or pain. Other common pain relievers, including aspirin , ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) should be avoided as they can increase the risk of bleeding complications. For moderate illness, those who can drink, are passing urine, have no warning signs and are otherwise reasonably healthy can be monitored carefully at home. Supportive care with analgesics, fluid replacement, and bed rest are recommended. Severe dengue is a life-threatening emergency, requiring hospitalization and potentially intensive care. Warning signs include dehydration , decreasing platelets and increasing hematocrit . Treatment modes include intravenous fluids, and transfusion with platelets or plasma. Most people with dengue recover without any ongoing problems. The risk of death among those with severe dengue is 0.8% to 2.5%, and with adequate treatment this is less than 1%. However, those who develop significantly low blood pressure may have a fatality rate of up to 26%. The risk of death among children less than five years old is four times greater than among those over the age of 10. Elderly people are also at higher risk of a poor outcome. As of March 2023, dengue is endemic in more than 100 countries with cases reported in every continent with the exception of Antarctica. The Americas, Southeast Asia and the Western Pacific regions are the most seriously affected. It is difficult to estimate the full extent of the disease, as many cases are mild and not correctly diagnosed. WHO currently estimates that 3.9 billion people are at risk of dengue infection. In 2013, it was estimated that 390 million dengue infections occur every year, with 500,000 of these developing severe symptoms and 25,000 deaths. Generally, areas where dengue is endemic have only one serotype of the virus in circulation. The disease is said to be hyperendemic in areas where more than one serotype is circulating; this increases the risk of severe disease on a second or subsequent infection. Infections are most commonly acquired in urban environments where the virus is primarily transmitted by the mosquito species Aedes aegypti . This species has adapted to the urban environment, is generally found close to human habitation, prefers humans as its host, and takes advantage of small bodies of standing water (such as tanks and buckets) in which to breed. In rural settings the virus is transmitted to humans by A. aegypti and other related mosquitoes such as Aedes albopictus . Both these species have expanding ranges. Dengue has increased in incidence in recent decades, with WHO recording a ten fold increase between 2010 and 2019 (from 500,000 to 5 million recorded cases). This increase is tied closely to the increasing range of Aedes mosquitoes, which is attributed to a combination of urbanization , population growth, and an increasingly warm climate . In endemic areas, dengue infections peak when rainfall is optimal for mosquito breeding. The disease infects all races, sexes, and ages equally. In endemic areas, the infection is most commonly seen in children who then acquire a lifelong partial immunity. The first historical record of a case of probable dengue fever is in a Chinese medical encyclopedia from the Jin Dynasty (266–420) which referred to a "water poison" associated with flying insects. The principal mosquito vector of dengue, Aedes aegypti , spread out of Africa in the 15th to 19th centuries due to the slave trade and consequent expansion of international trading. There have been descriptions of epidemics of dengue-like illness in the 17th century, and it is likely that epidemics in Jakarta , Cairo , and Philadelphia during the 18th century were caused by dengue. It is assumed that dengue was constantly present in many tropical urban centres throughout the 19th and early 20th centuries, even though significant outbreaks were infrequent. The marked spread of dengue during and after the Second World War has been attributed partly to disruption caused by the war, and partly to subsequent urbanisation in south-east Asia. As novel serotypes were introduced to regions already endemic with dengue, outbreaks of severe disease followed. The severe hemorrhagic form of the disease was first reported in the Philippines in 1953; by the 1970s, it had become recognised as a major cause of child mortality in Southeast Asia. In Central and South America, the Aedes mosquito had been eradicated in the 1950s; however the eradication program was discontinued in the 1970s and the diesase re-established itself in the region during the 1980s, becoming hyperendemic and causing significant epidemics. Dengue has continued to increase in prevalence during the 21st century, as the mosquito vector continues to expand its range. This is attributed partly to continuing urbanisation, and partly to the impact of a warmer climate. The name came into English in the early 19th century from West Indian Spanish, which borrowed it from the Kiswahili term dinga (in full kidingapopo , "disease caused by an evil spirit"). The borrowed term changed to dengue in Spanish due to this word existing in Spanish with the meaning "fastidiousness" and this folk etymology referring to the dislike of movement by affected patients. Slaves in the West Indies having contracted dengue were said to have the posture and gait of a dandy , and the disease was known as "dandy fever". The term break-bone fever was applied by physician and United States Founding Father Benjamin Rush , in a 1789 report of the 1780 epidemic in Philadelphia , due to the associated muscle and joint pains. In the report title he uses the more formal term "bilious remitting fever". The term dengue fever came into general use only after 1828. Other historical terms include "breakheart fever" and "la dengue". Terms for severe disease include "infectious thrombocytopenic purpura" and "Philippine", "Thai", or "Singapore hemorrhagic fever". The name came into English in the early 19th century from West Indian Spanish, which borrowed it from the Kiswahili term dinga (in full kidingapopo , "disease caused by an evil spirit"). The borrowed term changed to dengue in Spanish due to this word existing in Spanish with the meaning "fastidiousness" and this folk etymology referring to the dislike of movement by affected patients. Slaves in the West Indies having contracted dengue were said to have the posture and gait of a dandy , and the disease was known as "dandy fever". The term break-bone fever was applied by physician and United States Founding Father Benjamin Rush , in a 1789 report of the 1780 epidemic in Philadelphia , due to the associated muscle and joint pains. In the report title he uses the more formal term "bilious remitting fever". The term dengue fever came into general use only after 1828. Other historical terms include "breakheart fever" and "la dengue". Terms for severe disease include "infectious thrombocytopenic purpura" and "Philippine", "Thai", or "Singapore hemorrhagic fever". Research directions include dengue pathogenesis (the process by which the disease develops in humans), as well as the biology, ecology and behaviour of the mosquito vector. Improved diagnostics would enable faster and more appropriate treatment. Attempts are ongoing to develop an antiviral medicine targeting the NS3 or NS5 proteins. In addition to the two vaccines which are already available, several vaccine candidates are in development. Outbreaks of dengue fever increase the need for blood products while decreasing the number of potential blood donors due to potential infection with the virus. Someone who has a dengue infection is typically not allowed to donate blood for at least the next six months. International Anti-Dengue Day is observed every year on 15 June in a number of countries. The idea was first agreed upon in 2010 with the first event held in Jakarta , Indonesia, in 2011. Further events were held in 2012 in Yangon , Myanmar, and in 2013 in Vietnam . Goals are to increase public awareness about dengue, mobilize resources for its prevention and control and, to demonstrate the Southeast Asian region's commitment in tackling the disease. Efforts are ongoing as of 2019 to make it a global event. The Philippines has an awareness month in June since 1998. A National Dengue Day is held in India annually on 16 May. A study estimate that the global burden of dengue in 2013 amounted to US$8·9 billion. Outbreaks of dengue fever increase the need for blood products while decreasing the number of potential blood donors due to potential infection with the virus. Someone who has a dengue infection is typically not allowed to donate blood for at least the next six months. International Anti-Dengue Day is observed every year on 15 June in a number of countries. The idea was first agreed upon in 2010 with the first event held in Jakarta , Indonesia, in 2011. Further events were held in 2012 in Yangon , Myanmar, and in 2013 in Vietnam . Goals are to increase public awareness about dengue, mobilize resources for its prevention and control and, to demonstrate the Southeast Asian region's commitment in tackling the disease. Efforts are ongoing as of 2019 to make it a global event. The Philippines has an awareness month in June since 1998. A National Dengue Day is held in India annually on 16 May. A study estimate that the global burden of dengue in 2013 amounted to US$8·9 billion.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Ebola/html

Ebola

Ebola , also known as Ebola virus disease ( EVD ) and Ebola hemorrhagic fever ( EHF ), is a viral hemorrhagic fever in humans and other primates , caused by ebolaviruses . Symptoms typically start anywhere between two days and three weeks after infection. The first symptoms are usually fever , sore throat , muscle pain , and headaches . These are usually followed by vomiting , diarrhoea , rash and decreased liver and kidney function, at which point some people begin to bleed both internally and externally. It kills between 25% and 90% of those infected – about 50% on average. Death is often due to shock from fluid loss , and typically occurs between six and 16 days after the first symptoms appear. Early treatment of symptoms increases the survival rate considerably compared to late start. An Ebola vaccine was approved by the US FDA in December 2019. The virus spreads through direct contact with body fluids , such as blood from infected humans or other animals, or from contact with items that have recently been contaminated with infected body fluids. There have been no documented cases, either in nature or under laboratory conditions, of spread through the air between humans or other primates . After recovering from Ebola, semen or breast milk may continue to carry the virus for anywhere between several weeks to several months. Fruit bats are believed to be the normal carrier in nature ; they are able to spread the virus without being affected by it. The symptoms of Ebola may resemble those of several other diseases, including malaria , cholera , typhoid fever , meningitis and other viral hemorrhagic fevers. Diagnosis is confirmed by testing blood samples for the presence of viral RNA , viral antibodies or the virus itself. Control of outbreaks requires coordinated medical services and community engagement, including rapid detection, contact tracing of those exposed, quick access to laboratory services, care for those infected, and proper disposal of the dead through cremation or burial. Prevention measures involve wearing proper protective clothing and washing hands when in close proximity to patients and while handling potentially infected bushmeat , as well as thoroughly cooking bushmeat. An Ebola vaccine was approved by the US FDA in December 2019. While there is no approved treatment for Ebola as of 2019 [ update ] , two treatments ( atoltivimab/maftivimab/odesivimab and ansuvimab ) are associated with improved outcomes. Supportive efforts also improve outcomes. These include oral rehydration therapy (drinking slightly sweetened and salty water) or giving intravenous fluids , and treating symptoms. In October 2020, atoltivimab/maftivimab/odesivimab (Inmazeb) was approved for medical use in the United States to treat the disease caused by Zaire ebolavirus . Ebola was first identified in 1976, in two simultaneous outbreaks, one in Nzara (a town in South Sudan ) and the other in Yambuku ( the Democratic Republic of the Congo ), a village near the Ebola River , for which the disease was named. Ebola outbreaks occur intermittently in tropical regions of sub-Saharan Africa . Between 1976 and 2012, according to the World Health Organization , there were 24 outbreaks of Ebola resulting in a total of 2,387 cases, and 1,590 deaths . The largest Ebola outbreak to date was an epidemic in West Africa from December 2013 to January 2016, with 28,646 cases and 11,323 deaths. On 29 March 2016, it was declared to no longer be an emergency. Other outbreaks in Africa began in the Democratic Republic of the Congo in May 2017, and 2018. In July 2019, the World Health Organization declared the Congo Ebola outbreak a world health emergency . The length of time between exposure to the virus and the development of symptoms ( incubation period ) is between 2 and 21 days, and usually between 4 and 10 days. However, recent estimates based on mathematical models predict that around 5% of cases may take longer than 21 days to develop. Symptoms usually begin with a sudden influenza -like stage characterised by fatigue , fever , weakness , decreased appetite , muscular pain , joint pain , headache, and sore throat. The fever is usually higher than 38.3 °C (101 °F) . This is often followed by nausea, vomiting, diarrhoea , abdominal pain, and sometimes hiccups . The combination of severe vomiting and diarrhoea often leads to severe dehydration . Next, shortness of breath and chest pain may occur, along with swelling , headaches , and confusion . In about half of the cases, the skin may develop a maculopapular rash , a flat red area covered with small bumps, five to seven days after symptoms begin. In some cases, internal and external bleeding may occur. This typically begins five to seven days after the first symptoms. All infected people show some decreased blood clotting . Bleeding from mucous membranes or from sites of needle punctures has been reported in 40–50% of cases. This may cause vomiting blood , coughing up of blood , or blood in stool . Bleeding into the skin may create petechiae , purpura , ecchymoses or haematomas (especially around needle injection sites). Bleeding into the whites of the eyes may also occur. Heavy bleeding is uncommon; if it occurs, it is usually in the gastrointestinal tract . The incidence of bleeding into the gastrointestinal tract was reported to be ~58% in the 2001 outbreak in Gabon, but in the 2014–15 outbreak in the US it was ~18%, possibly due to improved prevention of disseminated intravascular coagulation . Recovery may begin between seven and 14 days after first symptoms. Death, if it occurs, follows typically six to sixteen days from first symptoms and is often due to shock from fluid loss . In general, bleeding often indicates a worse outcome, and blood loss may result in death. People are often in a coma near the end of life. Those who survive often have ongoing muscular and joint pain, liver inflammation , and decreased hearing, and may have continued tiredness, continued weakness, decreased appetite, and difficulty returning to pre-illness weight. Problems with vision may develop. It is recommended that survivors of EVD wear condoms for at least twelve months after initial infection or until the semen of a male survivor tests negative for Ebola virus on two separate occasions. Survivors develop antibodies against Ebola that last at least 10 years, but it is unclear whether they are immune to additional infections. The length of time between exposure to the virus and the development of symptoms ( incubation period ) is between 2 and 21 days, and usually between 4 and 10 days. However, recent estimates based on mathematical models predict that around 5% of cases may take longer than 21 days to develop. Symptoms usually begin with a sudden influenza -like stage characterised by fatigue , fever , weakness , decreased appetite , muscular pain , joint pain , headache, and sore throat. The fever is usually higher than 38.3 °C (101 °F) . This is often followed by nausea, vomiting, diarrhoea , abdominal pain, and sometimes hiccups . The combination of severe vomiting and diarrhoea often leads to severe dehydration . Next, shortness of breath and chest pain may occur, along with swelling , headaches , and confusion . In about half of the cases, the skin may develop a maculopapular rash , a flat red area covered with small bumps, five to seven days after symptoms begin. In some cases, internal and external bleeding may occur. This typically begins five to seven days after the first symptoms. All infected people show some decreased blood clotting . Bleeding from mucous membranes or from sites of needle punctures has been reported in 40–50% of cases. This may cause vomiting blood , coughing up of blood , or blood in stool . Bleeding into the skin may create petechiae , purpura , ecchymoses or haematomas (especially around needle injection sites). Bleeding into the whites of the eyes may also occur. Heavy bleeding is uncommon; if it occurs, it is usually in the gastrointestinal tract . The incidence of bleeding into the gastrointestinal tract was reported to be ~58% in the 2001 outbreak in Gabon, but in the 2014–15 outbreak in the US it was ~18%, possibly due to improved prevention of disseminated intravascular coagulation . Recovery may begin between seven and 14 days after first symptoms. Death, if it occurs, follows typically six to sixteen days from first symptoms and is often due to shock from fluid loss . In general, bleeding often indicates a worse outcome, and blood loss may result in death. People are often in a coma near the end of life. Those who survive often have ongoing muscular and joint pain, liver inflammation , and decreased hearing, and may have continued tiredness, continued weakness, decreased appetite, and difficulty returning to pre-illness weight. Problems with vision may develop. It is recommended that survivors of EVD wear condoms for at least twelve months after initial infection or until the semen of a male survivor tests negative for Ebola virus on two separate occasions. Survivors develop antibodies against Ebola that last at least 10 years, but it is unclear whether they are immune to additional infections. EVD in humans is caused by four of six viruses of the genus Ebolavirus . The four are Bundibugyo virus (BDBV), Sudan virus (SUDV), Taï Forest virus (TAFV) and one simply called Ebola virus (EBOV, formerly Zaire Ebola virus). EBOV, species Zaire ebolavirus , is the most dangerous of the known EVD-causing viruses, and is responsible for the largest number of outbreaks. The fifth and sixth viruses, Reston virus (RESTV) and Bombali virus (BOMV), are not thought to cause disease in humans, but have caused disease in other primates. All five viruses are closely related to marburgviruses . Ebolaviruses contain single-stranded, non-infectious RNA genomes . Ebolavirus genomes contain seven genes including 3'-UTR - NP - VP35 - VP40 - GP - VP30 - VP24 - L - 5'-UTR . The genomes of the five different ebolaviruses (BDBV, EBOV, RESTV, SUDV and TAFV) differ in sequence and the number and location of gene overlaps. As with all filoviruses , ebolavirus virions are filamentous particles that may appear in the shape of a shepherd's crook, of a "U" or of a "6," and they may be coiled, toroid or branched. In general, ebolavirions are 80 nanometers (nm) in width and may be as long as 14,000 nm. Their life cycle is thought to begin with a virion attaching to specific cell-surface receptors such as C-type lectins , DC-SIGN , or integrins , which is followed by fusion of the viral envelope with cellular membranes . The virions taken up by the cell then travel to acidic endosomes and lysosomes where the viral envelope glycoprotein GP is cleaved. This processing appears to allow the virus to bind to cellular proteins enabling it to fuse with internal cellular membranes and release the viral nucleocapsid . The Ebolavirus structural glycoprotein (known as GP1,2) is responsible for the virus' ability to bind to and infect targeted cells. The viral RNA polymerase , encoded by the L gene, partially uncoats the nucleocapsid and transcribes the genes into positive-strand mRNAs , which are then translated into structural and nonstructural proteins. The most abundant protein produced is the nucleoprotein, whose concentration in the host cell determines when L switches from gene transcription to genome replication. Replication of the viral genome results in full-length, positive-strand antigenomes that are, in turn, transcribed into genome copies of negative-strand virus progeny. Newly synthesised structural proteins and genomes self-assemble and accumulate near the inside of the cell membrane . Virions bud off from the cell, gaining their envelopes from the cellular membrane from which they bud. The mature progeny particles then infect other cells to repeat the cycle. The genetics of the Ebola virus are difficult to study because of EBOV's virulent characteristics. It is believed that between people, Ebola disease spreads only by direct contact with the blood or other body fluids of a person who has developed symptoms of the disease. Body fluids that may contain Ebola viruses include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and semen . The WHO states that only people who are very sick are able to spread Ebola disease in saliva , and the virus has not been reported to be transmitted through sweat. Most people spread the virus through blood, feces and vomit. Entry points for the virus include the nose, mouth, eyes, open wounds, cuts and abrasions. Ebola may be spread through large droplets ; however, this is believed to occur only when a person is very sick. This contamination can happen if a person is splashed with droplets. Contact with surfaces or objects contaminated by the virus, particularly needles and syringes, may also transmit the infection. The virus is able to survive on objects for a few hours in a dried state, and can survive for a few days within body fluids outside of a person. The Ebola virus may be able to persist for more than three months in the semen after recovery, which could lead to infections via sexual intercourse . Virus persistence in semen for over a year has been recorded in a national screening programme. Ebola may also occur in the breast milk of women after recovery, and it is not known when it is safe to breastfeed again. The virus was also found in the eye of one patient in 2014, two months after it was cleared from his blood. Otherwise, people who have recovered are not infectious. The potential for widespread infections in countries with medical systems capable of observing correct medical isolation procedures is considered low. Usually when someone has symptoms of the disease, they are unable to travel without assistance. Dead bodies remain infectious; thus, people handling human remains in practices such as traditional burial rituals or more modern processes such as embalming are at risk. Of the cases of Ebola infections in Guinea during the 2014 outbreak, 69% are believed to have been contracted via unprotected (or unsuitably protected) contact with infected corpses during certain Guinean burial rituals. Health-care workers treating people with Ebola are at greatest risk of infection. The risk increases when they do not have appropriate protective clothing such as masks, gowns, gloves and eye protection; do not wear it properly; or handle contaminated clothing incorrectly. This risk is particularly common in parts of Africa where the disease mostly occurs and health systems function poorly. There has been transmission in hospitals in some African countries that reuse hypodermic needles. Some health-care centres caring for people with the disease do not have running water. In the United States the spread to two medical workers treating infected patients prompted criticism of inadequate training and procedures. Human-to-human transmission of EBOV through the air has not been reported to occur during EVD outbreaks, and airborne transmission has only been demonstrated in very strict laboratory conditions, and then only from pigs to primates , but not from primates to primates. Spread of EBOV by water, or food other than bushmeat, has not been observed. No spread by mosquitos or other insects has been reported. Other possible methods of transmission are being studied. Airborne transmission among humans is theoretically possible due to the presence of Ebola virus particles in saliva, which can be discharged into the air with a cough or sneeze, but observational data from previous epidemics suggests the actual risk of airborne transmission is low. A number of studies examining airborne transmission broadly concluded that transmission from pigs to primates could happen without direct contact because, unlike humans and primates, pigs with EVD get very high ebolavirus concentrations in their lungs, and not their bloodstream. Therefore, pigs with EVD can spread the disease through droplets in the air or on the ground when they sneeze or cough. By contrast, humans and other primates accumulate the virus throughout their body and specifically in their blood, but not very much in their lungs. It is believed that this is the reason researchers have observed pig to primate transmission without physical contact, but no evidence has been found of primates being infected without actual contact, even in experiments where infected and uninfected primates shared the same air. Although it is not entirely clear how Ebola initially spreads from animals to humans, the spread is believed to involve direct contact with an infected wild animal or fruit bat. Besides bats, other wild animals that are sometimes infected with EBOV include several species of monkeys such as baboons , great apes ( chimpanzees and gorillas ), and duikers (a species of antelope ). Animals may become infected when they eat fruit partially eaten by bats carrying the virus. Fruit production, animal behavior and other factors may trigger outbreaks among animal populations. Evidence indicates that both domestic dogs and pigs can also be infected with EBOV. Dogs do not appear to develop symptoms when they carry the virus, and pigs appear to be able to transmit the virus to at least some primates. Although some dogs in an area in which a human outbreak occurred had antibodies to EBOV, it is unclear whether they played a role in spreading the disease to people. The natural reservoir for Ebola has yet to be confirmed; however, bats are considered to be the most likely candidate. Three types of fruit bats ( Hypsignathus monstrosus , Epomops franqueti and Myonycteris torquata ) were found to possibly carry the virus without getting sick. As of 2013 [ update ] , whether other animals are involved in its spread is not known. Plants, arthropods , rodents , and birds have also been considered possible viral reservoirs. Bats were known to roost in the cotton factory in which the first cases of the 1976 and 1979 outbreaks were observed, and they have also been implicated in Marburg virus infections in 1975 and 1980. Of 24 plant and 19 vertebrate species experimentally inoculated with EBOV, only bats became infected. The bats displayed no clinical signs of disease, which is considered evidence that these bats are a reservoir species of EBOV. In a 2002–2003 survey of 1,030 animals including 679 bats from Gabon and the Republic of the Congo , immunoglobulin G (IgG) immune defense molecules indicative of Ebola infection were found in three bat species; at various periods of study, between 2.2 and 22.6% of bats were found to contain both RNA sequences and IgG molecules indicating Ebola infection. Antibodies against Zaire and Reston viruses have been found in fruit bats in Bangladesh , suggesting that these bats are also potential hosts of the virus and that the filoviruses are present in Asia. Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians and arthropods sampled from regions of EBOV outbreaks, no Ebola virus was detected apart from some genetic traces found in six rodents (belonging to the species Mus setulosus and Praomys ) and one shrew ( Sylvisorex ollula ) collected from the Central African Republic . However, further research efforts have not confirmed rodents as a reservoir. Traces of EBOV were detected in the carcasses of gorillas and chimpanzees during outbreaks in 2001 and 2003, which later became the source of human infections. However, the high rates of death in these species resulting from EBOV infection make it unlikely that these species represent a natural reservoir for the virus. Deforestation has been mentioned as a possible contributor to recent outbreaks, including the West African Ebola virus epidemic . Index cases of EVD have often been close to recently deforested lands. Ebolaviruses contain single-stranded, non-infectious RNA genomes . Ebolavirus genomes contain seven genes including 3'-UTR - NP - VP35 - VP40 - GP - VP30 - VP24 - L - 5'-UTR . The genomes of the five different ebolaviruses (BDBV, EBOV, RESTV, SUDV and TAFV) differ in sequence and the number and location of gene overlaps. As with all filoviruses , ebolavirus virions are filamentous particles that may appear in the shape of a shepherd's crook, of a "U" or of a "6," and they may be coiled, toroid or branched. In general, ebolavirions are 80 nanometers (nm) in width and may be as long as 14,000 nm. Their life cycle is thought to begin with a virion attaching to specific cell-surface receptors such as C-type lectins , DC-SIGN , or integrins , which is followed by fusion of the viral envelope with cellular membranes . The virions taken up by the cell then travel to acidic endosomes and lysosomes where the viral envelope glycoprotein GP is cleaved. This processing appears to allow the virus to bind to cellular proteins enabling it to fuse with internal cellular membranes and release the viral nucleocapsid . The Ebolavirus structural glycoprotein (known as GP1,2) is responsible for the virus' ability to bind to and infect targeted cells. The viral RNA polymerase , encoded by the L gene, partially uncoats the nucleocapsid and transcribes the genes into positive-strand mRNAs , which are then translated into structural and nonstructural proteins. The most abundant protein produced is the nucleoprotein, whose concentration in the host cell determines when L switches from gene transcription to genome replication. Replication of the viral genome results in full-length, positive-strand antigenomes that are, in turn, transcribed into genome copies of negative-strand virus progeny. Newly synthesised structural proteins and genomes self-assemble and accumulate near the inside of the cell membrane . Virions bud off from the cell, gaining their envelopes from the cellular membrane from which they bud. The mature progeny particles then infect other cells to repeat the cycle. The genetics of the Ebola virus are difficult to study because of EBOV's virulent characteristics. It is believed that between people, Ebola disease spreads only by direct contact with the blood or other body fluids of a person who has developed symptoms of the disease. Body fluids that may contain Ebola viruses include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and semen . The WHO states that only people who are very sick are able to spread Ebola disease in saliva , and the virus has not been reported to be transmitted through sweat. Most people spread the virus through blood, feces and vomit. Entry points for the virus include the nose, mouth, eyes, open wounds, cuts and abrasions. Ebola may be spread through large droplets ; however, this is believed to occur only when a person is very sick. This contamination can happen if a person is splashed with droplets. Contact with surfaces or objects contaminated by the virus, particularly needles and syringes, may also transmit the infection. The virus is able to survive on objects for a few hours in a dried state, and can survive for a few days within body fluids outside of a person. The Ebola virus may be able to persist for more than three months in the semen after recovery, which could lead to infections via sexual intercourse . Virus persistence in semen for over a year has been recorded in a national screening programme. Ebola may also occur in the breast milk of women after recovery, and it is not known when it is safe to breastfeed again. The virus was also found in the eye of one patient in 2014, two months after it was cleared from his blood. Otherwise, people who have recovered are not infectious. The potential for widespread infections in countries with medical systems capable of observing correct medical isolation procedures is considered low. Usually when someone has symptoms of the disease, they are unable to travel without assistance. Dead bodies remain infectious; thus, people handling human remains in practices such as traditional burial rituals or more modern processes such as embalming are at risk. Of the cases of Ebola infections in Guinea during the 2014 outbreak, 69% are believed to have been contracted via unprotected (or unsuitably protected) contact with infected corpses during certain Guinean burial rituals. Health-care workers treating people with Ebola are at greatest risk of infection. The risk increases when they do not have appropriate protective clothing such as masks, gowns, gloves and eye protection; do not wear it properly; or handle contaminated clothing incorrectly. This risk is particularly common in parts of Africa where the disease mostly occurs and health systems function poorly. There has been transmission in hospitals in some African countries that reuse hypodermic needles. Some health-care centres caring for people with the disease do not have running water. In the United States the spread to two medical workers treating infected patients prompted criticism of inadequate training and procedures. Human-to-human transmission of EBOV through the air has not been reported to occur during EVD outbreaks, and airborne transmission has only been demonstrated in very strict laboratory conditions, and then only from pigs to primates , but not from primates to primates. Spread of EBOV by water, or food other than bushmeat, has not been observed. No spread by mosquitos or other insects has been reported. Other possible methods of transmission are being studied. Airborne transmission among humans is theoretically possible due to the presence of Ebola virus particles in saliva, which can be discharged into the air with a cough or sneeze, but observational data from previous epidemics suggests the actual risk of airborne transmission is low. A number of studies examining airborne transmission broadly concluded that transmission from pigs to primates could happen without direct contact because, unlike humans and primates, pigs with EVD get very high ebolavirus concentrations in their lungs, and not their bloodstream. Therefore, pigs with EVD can spread the disease through droplets in the air or on the ground when they sneeze or cough. By contrast, humans and other primates accumulate the virus throughout their body and specifically in their blood, but not very much in their lungs. It is believed that this is the reason researchers have observed pig to primate transmission without physical contact, but no evidence has been found of primates being infected without actual contact, even in experiments where infected and uninfected primates shared the same air. Although it is not entirely clear how Ebola initially spreads from animals to humans, the spread is believed to involve direct contact with an infected wild animal or fruit bat. Besides bats, other wild animals that are sometimes infected with EBOV include several species of monkeys such as baboons , great apes ( chimpanzees and gorillas ), and duikers (a species of antelope ). Animals may become infected when they eat fruit partially eaten by bats carrying the virus. Fruit production, animal behavior and other factors may trigger outbreaks among animal populations. Evidence indicates that both domestic dogs and pigs can also be infected with EBOV. Dogs do not appear to develop symptoms when they carry the virus, and pigs appear to be able to transmit the virus to at least some primates. Although some dogs in an area in which a human outbreak occurred had antibodies to EBOV, it is unclear whether they played a role in spreading the disease to people. The natural reservoir for Ebola has yet to be confirmed; however, bats are considered to be the most likely candidate. Three types of fruit bats ( Hypsignathus monstrosus , Epomops franqueti and Myonycteris torquata ) were found to possibly carry the virus without getting sick. As of 2013 [ update ] , whether other animals are involved in its spread is not known. Plants, arthropods , rodents , and birds have also been considered possible viral reservoirs. Bats were known to roost in the cotton factory in which the first cases of the 1976 and 1979 outbreaks were observed, and they have also been implicated in Marburg virus infections in 1975 and 1980. Of 24 plant and 19 vertebrate species experimentally inoculated with EBOV, only bats became infected. The bats displayed no clinical signs of disease, which is considered evidence that these bats are a reservoir species of EBOV. In a 2002–2003 survey of 1,030 animals including 679 bats from Gabon and the Republic of the Congo , immunoglobulin G (IgG) immune defense molecules indicative of Ebola infection were found in three bat species; at various periods of study, between 2.2 and 22.6% of bats were found to contain both RNA sequences and IgG molecules indicating Ebola infection. Antibodies against Zaire and Reston viruses have been found in fruit bats in Bangladesh , suggesting that these bats are also potential hosts of the virus and that the filoviruses are present in Asia. Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians and arthropods sampled from regions of EBOV outbreaks, no Ebola virus was detected apart from some genetic traces found in six rodents (belonging to the species Mus setulosus and Praomys ) and one shrew ( Sylvisorex ollula ) collected from the Central African Republic . However, further research efforts have not confirmed rodents as a reservoir. Traces of EBOV were detected in the carcasses of gorillas and chimpanzees during outbreaks in 2001 and 2003, which later became the source of human infections. However, the high rates of death in these species resulting from EBOV infection make it unlikely that these species represent a natural reservoir for the virus. Deforestation has been mentioned as a possible contributor to recent outbreaks, including the West African Ebola virus epidemic . Index cases of EVD have often been close to recently deforested lands. Like other filoviruses , EBOV replicates very efficiently in many cells , producing large amounts of virus in monocytes , macrophages , dendritic cells and other cells including liver cells , fibroblasts , and adrenal gland cells . Viral replication triggers high levels of inflammatory chemical signals and leads to a septic state . EBOV is thought to infect humans through contact with mucous membranes or skin breaks. After infection, endothelial cells (cells lining the inside of blood vessels), liver cells, and several types of immune cells such as macrophages, monocytes , and dendritic cells are the main targets of attack. Following infection, immune cells carry the virus to nearby lymph nodes where further reproduction of the virus takes place. From there the virus can enter the bloodstream and lymphatic system and spread throughout the body. Macrophages are the first cells infected with the virus, and this infection results in programmed cell death . Other types of white blood cells , such as lymphocytes , also undergo programmed cell death leading to an abnormally low concentration of lymphocytes in the blood. This contributes to the weakened immune response seen in those infected with EBOV. Endothelial cells may be infected within three days after exposure to the virus. The breakdown of endothelial cells leading to blood vessel injury can be attributed to EBOV glycoproteins . This damage occurs due to the synthesis of Ebola virus glycoprotein (GP), which reduces the availability of specific integrins responsible for cell adhesion to the intercellular structure and causes liver damage, leading to improper clotting . The widespread bleeding that occurs in affected people causes swelling and shock due to loss of blood volume . The dysfunctional bleeding and clotting commonly seen in EVD has been attributed to increased activation of the extrinsic pathway of the coagulation cascade due to excessive tissue factor production by macrophages and monocytes. After infection, a secreted glycoprotein , small soluble glycoprotein (sGP or GP) is synthesised. EBOV replication overwhelms protein synthesis of infected cells and the host immune defences. The GP forms a trimeric complex , which tethers the virus to the endothelial cells. The sGP forms a dimeric protein that interferes with the signalling of neutrophils , another type of white blood cell. This enables the virus to evade the immune system by inhibiting early steps of neutrophil activation. [ medical citation needed ] Furthermore, the virus is capable of hijacking cellular metabolism. Studies have shown that Ebola virus-like particles can reprogram metabolism in both vascular and immune cells. Filoviral infection also interferes with proper functioning of the innate immune system . EBOV proteins blunt the human immune system's response to viral infections by interfering with the cells' ability to produce and respond to interferon proteins such as interferon-alpha , interferon-beta , and interferon gamma . The VP24 and VP35 structural proteins of EBOV play a key role in this interference. When a cell is infected with EBOV, receptors located in the cell's cytosol (such as RIG-I and MDA5 ) or outside of the cytosol (such as Toll-like receptor 3 (TLR3) , TLR7 , TLR8 and TLR9 ) recognise infectious molecules associated with the virus. On TLR activation, proteins including interferon regulatory factor 3 and interferon regulatory factor 7 trigger a signalling cascade that leads to the expression of type 1 interferons . The type 1 interferons are then released and bind to the IFNAR1 and IFNAR2 receptors expressed on the surface of a neighbouring cell. Once interferon has bound to its receptors on the neighbouring cell, the signalling proteins STAT1 and STAT2 are activated and move to the cell's nucleus . This triggers the expression of interferon-stimulated genes , which code for proteins with antiviral properties. EBOV's V24 protein blocks the production of these antiviral proteins by preventing the STAT1 signalling protein in the neighbouring cell from entering the nucleus. The VP35 protein directly inhibits the production of interferon-beta. By inhibiting these immune responses, EBOV may quickly spread throughout the body. Filoviral infection also interferes with proper functioning of the innate immune system . EBOV proteins blunt the human immune system's response to viral infections by interfering with the cells' ability to produce and respond to interferon proteins such as interferon-alpha , interferon-beta , and interferon gamma . The VP24 and VP35 structural proteins of EBOV play a key role in this interference. When a cell is infected with EBOV, receptors located in the cell's cytosol (such as RIG-I and MDA5 ) or outside of the cytosol (such as Toll-like receptor 3 (TLR3) , TLR7 , TLR8 and TLR9 ) recognise infectious molecules associated with the virus. On TLR activation, proteins including interferon regulatory factor 3 and interferon regulatory factor 7 trigger a signalling cascade that leads to the expression of type 1 interferons . The type 1 interferons are then released and bind to the IFNAR1 and IFNAR2 receptors expressed on the surface of a neighbouring cell. Once interferon has bound to its receptors on the neighbouring cell, the signalling proteins STAT1 and STAT2 are activated and move to the cell's nucleus . This triggers the expression of interferon-stimulated genes , which code for proteins with antiviral properties. EBOV's V24 protein blocks the production of these antiviral proteins by preventing the STAT1 signalling protein in the neighbouring cell from entering the nucleus. The VP35 protein directly inhibits the production of interferon-beta. By inhibiting these immune responses, EBOV may quickly spread throughout the body. When EVD is suspected, travel, work history, and exposure to wildlife are important factors with respect to further diagnostic efforts. Possible non-specific laboratory indicators of EVD include a low platelet count ; an initially decreased white blood cell count followed by an increased white blood cell count ; elevated levels of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST); and abnormalities in blood clotting often consistent with disseminated intravascular coagulation (DIC) such as a prolonged prothrombin time , partial thromboplastin time , and bleeding time . Filovirions such as EBOV may be identified by their unique filamentous shapes in cell cultures examined with electron microscopy . The specific diagnosis of EVD is confirmed by isolating the virus, detecting its RNA or proteins, or detecting antibodies against the virus in a person's blood. Isolating the virus by cell culture , detecting the viral RNA by polymerase chain reaction (PCR) and detecting proteins by enzyme-linked immunosorbent assay (ELISA) are methods best used in the early stages of the disease and also for detecting the virus in human remains. Detecting antibodies against the virus is most reliable in the later stages of the disease and in those who recover. IgM antibodies are detectable two days after symptom onset and IgG antibodies can be detected six to 18 days after symptom onset. During an outbreak, isolation of the virus with cell culture methods is often not feasible. In field or mobile hospitals, the most common and sensitive diagnostic methods are real-time PCR and ELISA. In 2014, with new mobile testing facilities deployed in parts of Liberia, test results were obtained 3–5 hours after sample submission. In 2015, a rapid antigen test which gives results in 15 minutes was approved for use by WHO. It is able to confirm Ebola in 92% of those affected and rule it out in 85% of those not affected. Early symptoms of EVD may be similar to those of other diseases common in Africa, including malaria and dengue fever . The symptoms are also similar to those of other viral haemorrhagic fevers such as Marburg virus disease , Crimean–Congo haemorrhagic fever , and Lassa fever . The complete differential diagnosis is extensive and requires consideration of many other infectious diseases such as typhoid fever , shigellosis , rickettsial diseases , cholera , sepsis , borreliosis , EHEC enteritis , leptospirosis , scrub typhus , plague , Q fever , candidiasis , histoplasmosis , trypanosomiasis , visceral leishmaniasis , measles , and viral hepatitis among others. Non-infectious diseases that may result in symptoms similar to those of EVD include acute promyelocytic leukaemia , haemolytic uraemic syndrome , snake envenomation , clotting factor deficiencies/platelet disorders, thrombotic thrombocytopenic purpura , hereditary haemorrhagic telangiectasia , Kawasaki disease , and warfarin poisoning. Possible non-specific laboratory indicators of EVD include a low platelet count ; an initially decreased white blood cell count followed by an increased white blood cell count ; elevated levels of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST); and abnormalities in blood clotting often consistent with disseminated intravascular coagulation (DIC) such as a prolonged prothrombin time , partial thromboplastin time , and bleeding time . Filovirions such as EBOV may be identified by their unique filamentous shapes in cell cultures examined with electron microscopy . The specific diagnosis of EVD is confirmed by isolating the virus, detecting its RNA or proteins, or detecting antibodies against the virus in a person's blood. Isolating the virus by cell culture , detecting the viral RNA by polymerase chain reaction (PCR) and detecting proteins by enzyme-linked immunosorbent assay (ELISA) are methods best used in the early stages of the disease and also for detecting the virus in human remains. Detecting antibodies against the virus is most reliable in the later stages of the disease and in those who recover. IgM antibodies are detectable two days after symptom onset and IgG antibodies can be detected six to 18 days after symptom onset. During an outbreak, isolation of the virus with cell culture methods is often not feasible. In field or mobile hospitals, the most common and sensitive diagnostic methods are real-time PCR and ELISA. In 2014, with new mobile testing facilities deployed in parts of Liberia, test results were obtained 3–5 hours after sample submission. In 2015, a rapid antigen test which gives results in 15 minutes was approved for use by WHO. It is able to confirm Ebola in 92% of those affected and rule it out in 85% of those not affected. Early symptoms of EVD may be similar to those of other diseases common in Africa, including malaria and dengue fever . The symptoms are also similar to those of other viral haemorrhagic fevers such as Marburg virus disease , Crimean–Congo haemorrhagic fever , and Lassa fever . The complete differential diagnosis is extensive and requires consideration of many other infectious diseases such as typhoid fever , shigellosis , rickettsial diseases , cholera , sepsis , borreliosis , EHEC enteritis , leptospirosis , scrub typhus , plague , Q fever , candidiasis , histoplasmosis , trypanosomiasis , visceral leishmaniasis , measles , and viral hepatitis among others. Non-infectious diseases that may result in symptoms similar to those of EVD include acute promyelocytic leukaemia , haemolytic uraemic syndrome , snake envenomation , clotting factor deficiencies/platelet disorders, thrombotic thrombocytopenic purpura , hereditary haemorrhagic telangiectasia , Kawasaki disease , and warfarin poisoning. An Ebola vaccine , rVSV-ZEBOV , was approved in the United States in December 2019. It appears to be fully effective ten days after being given. It was studied in Guinea between 2014 and 2016. More than 100,000 people have been vaccinated against Ebola as of 2019 [ update ] . The WHO reported that approximately 345,000 people were given the vaccine during the Kivu Ebola epidemic from 2018 to 2020. Community awareness of the benefits on survival chances of admitting cases early is important for the infected and infection control People who care for those infected with Ebola should wear protective clothing including masks, gloves, gowns and goggles. The U.S. Centers for Disease Control (CDC) recommend that the protective gear leaves no skin exposed. These measures are also recommended for those who may handle objects contaminated by an infected person's body fluids. In 2014, the CDC began recommending that medical personnel receive training on the proper suit-up and removal of personal protective equipment (PPE); in addition, a designated person, appropriately trained in biosafety, should be watching each step of these procedures to ensure they are done correctly. In Sierra Leone, the typical training period for the use of such safety equipment lasts approximately 12 days. In 2022 in Uganda, lighter personal protection equipment has become available as well as possibilities to monitor and communicate with patients from windows in the treatment tents until it is necessary to enter if e.g. a patient's oxygen levels drop. The infected person should be in barrier-isolation from other people. All equipment, medical waste, patient waste and surfaces that may have come into contact with body fluids need to be disinfected . During the 2014 outbreak, kits were put together to help families treat Ebola disease in their homes, which included protective clothing as well as chlorine powder and other cleaning supplies. Education of caregivers in these techniques, and providing such barrier-separation supplies has been a priority of Doctors Without Borders . Ebolaviruses can be eliminated with heat (heating for 30 to 60 minutes at 60 °C or boiling for five minutes). To disinfect surfaces, some lipid solvents such as some alcohol-based products, detergents, sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder), and other suitable disinfectants may be used at appropriate concentrations. Education of the general public about the risk factors for Ebola infection and of the protective measures individuals may take to prevent infection is recommended by the World Health Organization . These measures include avoiding direct contact with infected people and regular hand washing using soap and water. Bushmeat , an important source of protein in the diet of some Africans, should be handled and prepared with appropriate protective clothing and thoroughly cooked before consumption. Some research suggests that an outbreak of Ebola disease in the wild animals used for consumption may result in a corresponding human outbreak. Since 2003, such animal outbreaks have been monitored to predict and prevent Ebola outbreaks in humans. If a person with Ebola disease dies, direct contact with the body should be avoided. Certain burial rituals , which may have included making various direct contacts with a dead body, require reformulation so that they consistently maintain a proper protective barrier between the dead body and the living. Social anthropologists may help find alternatives to traditional rules for burials. Transportation crews are instructed to follow a certain isolation procedure, should anyone exhibit symptoms resembling EVD. As of August 2014 [ update ] , the WHO does not consider travel bans to be useful in decreasing spread of the disease. In October 2014, the CDC defined four risk levels used to determine the level of 21-day monitoring for symptoms and restrictions on public activities. In the United States, the CDC recommends that restrictions on public activity, including travel restrictions, are not required for the following defined risk levels: having been in a country with widespread Ebola disease transmission and having no known exposure (low risk); or having been in that country more than 21 days ago (no risk) encounter with a person showing symptoms; but not within three feet of the person with Ebola without wearing PPE; and no direct contact with body fluids having had brief skin contact with a person showing symptoms of Ebola disease when the person was believed to be not very contagious (low risk) in countries without widespread Ebola disease transmission: direct contact with a person showing symptoms of the disease while wearing PPE (low risk) contact with a person with Ebola disease before the person was showing symptoms (no risk). The CDC recommends monitoring for the symptoms of Ebola disease for those both at "low risk" and at higher risk. In laboratories where diagnostic testing is carried out, biosafety level 4-equivalent containment is required. Laboratory researchers must be properly trained in BSL-4 practices and wear proper PPE. Isolation refers to separating those who are sick from those who are not. Quarantine refers to separating those who may have been exposed to a disease until they either show signs of the disease or are no longer at risk. Quarantine, also known as enforced isolation, is usually effective in decreasing spread. Governments often quarantine areas where the disease is occurring or individuals who may transmit the disease outside of an initial area. In the United States, the law allows quarantine of those infected with ebolaviruses. Contact tracing is considered important to contain an outbreak. It involves finding everyone who had close contact with infected individuals and monitoring them for signs of illness for 21 days. If any of these contacts comes down with the disease, they should be isolated, tested and treated. Then the process is repeated, tracing the contacts' contacts. An Ebola vaccine , rVSV-ZEBOV , was approved in the United States in December 2019. It appears to be fully effective ten days after being given. It was studied in Guinea between 2014 and 2016. More than 100,000 people have been vaccinated against Ebola as of 2019 [ update ] . The WHO reported that approximately 345,000 people were given the vaccine during the Kivu Ebola epidemic from 2018 to 2020. Community awareness of the benefits on survival chances of admitting cases early is important for the infected and infection control People who care for those infected with Ebola should wear protective clothing including masks, gloves, gowns and goggles. The U.S. Centers for Disease Control (CDC) recommend that the protective gear leaves no skin exposed. These measures are also recommended for those who may handle objects contaminated by an infected person's body fluids. In 2014, the CDC began recommending that medical personnel receive training on the proper suit-up and removal of personal protective equipment (PPE); in addition, a designated person, appropriately trained in biosafety, should be watching each step of these procedures to ensure they are done correctly. In Sierra Leone, the typical training period for the use of such safety equipment lasts approximately 12 days. In 2022 in Uganda, lighter personal protection equipment has become available as well as possibilities to monitor and communicate with patients from windows in the treatment tents until it is necessary to enter if e.g. a patient's oxygen levels drop. The infected person should be in barrier-isolation from other people. All equipment, medical waste, patient waste and surfaces that may have come into contact with body fluids need to be disinfected . During the 2014 outbreak, kits were put together to help families treat Ebola disease in their homes, which included protective clothing as well as chlorine powder and other cleaning supplies. Education of caregivers in these techniques, and providing such barrier-separation supplies has been a priority of Doctors Without Borders . Ebolaviruses can be eliminated with heat (heating for 30 to 60 minutes at 60 °C or boiling for five minutes). To disinfect surfaces, some lipid solvents such as some alcohol-based products, detergents, sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder), and other suitable disinfectants may be used at appropriate concentrations. Education of the general public about the risk factors for Ebola infection and of the protective measures individuals may take to prevent infection is recommended by the World Health Organization . These measures include avoiding direct contact with infected people and regular hand washing using soap and water. Bushmeat , an important source of protein in the diet of some Africans, should be handled and prepared with appropriate protective clothing and thoroughly cooked before consumption. Some research suggests that an outbreak of Ebola disease in the wild animals used for consumption may result in a corresponding human outbreak. Since 2003, such animal outbreaks have been monitored to predict and prevent Ebola outbreaks in humans. If a person with Ebola disease dies, direct contact with the body should be avoided. Certain burial rituals , which may have included making various direct contacts with a dead body, require reformulation so that they consistently maintain a proper protective barrier between the dead body and the living. Social anthropologists may help find alternatives to traditional rules for burials. Transportation crews are instructed to follow a certain isolation procedure, should anyone exhibit symptoms resembling EVD. As of August 2014 [ update ] , the WHO does not consider travel bans to be useful in decreasing spread of the disease. In October 2014, the CDC defined four risk levels used to determine the level of 21-day monitoring for symptoms and restrictions on public activities. In the United States, the CDC recommends that restrictions on public activity, including travel restrictions, are not required for the following defined risk levels: having been in a country with widespread Ebola disease transmission and having no known exposure (low risk); or having been in that country more than 21 days ago (no risk) encounter with a person showing symptoms; but not within three feet of the person with Ebola without wearing PPE; and no direct contact with body fluids having had brief skin contact with a person showing symptoms of Ebola disease when the person was believed to be not very contagious (low risk) in countries without widespread Ebola disease transmission: direct contact with a person showing symptoms of the disease while wearing PPE (low risk) contact with a person with Ebola disease before the person was showing symptoms (no risk). The CDC recommends monitoring for the symptoms of Ebola disease for those both at "low risk" and at higher risk. In laboratories where diagnostic testing is carried out, biosafety level 4-equivalent containment is required. Laboratory researchers must be properly trained in BSL-4 practices and wear proper PPE. People who care for those infected with Ebola should wear protective clothing including masks, gloves, gowns and goggles. The U.S. Centers for Disease Control (CDC) recommend that the protective gear leaves no skin exposed. These measures are also recommended for those who may handle objects contaminated by an infected person's body fluids. In 2014, the CDC began recommending that medical personnel receive training on the proper suit-up and removal of personal protective equipment (PPE); in addition, a designated person, appropriately trained in biosafety, should be watching each step of these procedures to ensure they are done correctly. In Sierra Leone, the typical training period for the use of such safety equipment lasts approximately 12 days. In 2022 in Uganda, lighter personal protection equipment has become available as well as possibilities to monitor and communicate with patients from windows in the treatment tents until it is necessary to enter if e.g. a patient's oxygen levels drop. The infected person should be in barrier-isolation from other people. All equipment, medical waste, patient waste and surfaces that may have come into contact with body fluids need to be disinfected . During the 2014 outbreak, kits were put together to help families treat Ebola disease in their homes, which included protective clothing as well as chlorine powder and other cleaning supplies. Education of caregivers in these techniques, and providing such barrier-separation supplies has been a priority of Doctors Without Borders . Ebolaviruses can be eliminated with heat (heating for 30 to 60 minutes at 60 °C or boiling for five minutes). To disinfect surfaces, some lipid solvents such as some alcohol-based products, detergents, sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder), and other suitable disinfectants may be used at appropriate concentrations. Education of the general public about the risk factors for Ebola infection and of the protective measures individuals may take to prevent infection is recommended by the World Health Organization . These measures include avoiding direct contact with infected people and regular hand washing using soap and water. Bushmeat , an important source of protein in the diet of some Africans, should be handled and prepared with appropriate protective clothing and thoroughly cooked before consumption. Some research suggests that an outbreak of Ebola disease in the wild animals used for consumption may result in a corresponding human outbreak. Since 2003, such animal outbreaks have been monitored to predict and prevent Ebola outbreaks in humans. If a person with Ebola disease dies, direct contact with the body should be avoided. Certain burial rituals , which may have included making various direct contacts with a dead body, require reformulation so that they consistently maintain a proper protective barrier between the dead body and the living. Social anthropologists may help find alternatives to traditional rules for burials. Transportation crews are instructed to follow a certain isolation procedure, should anyone exhibit symptoms resembling EVD. As of August 2014 [ update ] , the WHO does not consider travel bans to be useful in decreasing spread of the disease. In October 2014, the CDC defined four risk levels used to determine the level of 21-day monitoring for symptoms and restrictions on public activities. In the United States, the CDC recommends that restrictions on public activity, including travel restrictions, are not required for the following defined risk levels: having been in a country with widespread Ebola disease transmission and having no known exposure (low risk); or having been in that country more than 21 days ago (no risk) encounter with a person showing symptoms; but not within three feet of the person with Ebola without wearing PPE; and no direct contact with body fluids having had brief skin contact with a person showing symptoms of Ebola disease when the person was believed to be not very contagious (low risk) in countries without widespread Ebola disease transmission: direct contact with a person showing symptoms of the disease while wearing PPE (low risk) contact with a person with Ebola disease before the person was showing symptoms (no risk). The CDC recommends monitoring for the symptoms of Ebola disease for those both at "low risk" and at higher risk. In laboratories where diagnostic testing is carried out, biosafety level 4-equivalent containment is required. Laboratory researchers must be properly trained in BSL-4 practices and wear proper PPE. Isolation refers to separating those who are sick from those who are not. Quarantine refers to separating those who may have been exposed to a disease until they either show signs of the disease or are no longer at risk. Quarantine, also known as enforced isolation, is usually effective in decreasing spread. Governments often quarantine areas where the disease is occurring or individuals who may transmit the disease outside of an initial area. In the United States, the law allows quarantine of those infected with ebolaviruses. Contact tracing is considered important to contain an outbreak. It involves finding everyone who had close contact with infected individuals and monitoring them for signs of illness for 21 days. If any of these contacts comes down with the disease, they should be isolated, tested and treated. Then the process is repeated, tracing the contacts' contacts. As of 2019 [ update ] two treatments ( atoltivimab/maftivimab/odesivimab and ansuvimab ) are associated with improved outcomes. The U.S. Food and Drug Administration (FDA) advises people to be careful of advertisements making unverified or fraudulent claims of benefits supposedly gained from various anti-Ebola products. In October 2020, the U.S. Food and Drug Administration (FDA) approved atoltivimab/maftivimab/odesivimab with an indication for the treatment of infection caused by Zaire ebolavirus . Treatment is primarily supportive in nature. Early supportive care with rehydration and symptomatic treatment improves survival. Rehydration may be via the oral or intravenous route. These measures may include pain management , and treatment for nausea , fever , and anxiety . The World Health Organization (WHO) recommends avoiding aspirin or ibuprofen for pain management, due to the risk of bleeding associated with these medications. Blood products such as packed red blood cells , platelets , or fresh frozen plasma may also be used. Other regulators of coagulation have also been tried including heparin in an effort to prevent disseminated intravascular coagulation and clotting factors to decrease bleeding. Antimalarial medications and antibiotics are often used before the diagnosis is confirmed, though there is no evidence to suggest such treatment helps. Several experimental treatments are being studied . Where hospital care is not possible, the WHO's guidelines for home care have been relatively successful. Recommendations include using towels soaked in a bleach solution when moving infected people or bodies and also applying bleach on stains. It is also recommended that the caregivers wash hands with bleach solutions and cover their mouth and nose with a cloth. Intensive care is often used in the developed world. This may include maintaining blood volume and electrolytes (salts) balance as well as treating any bacterial infections that may develop. Dialysis may be needed for kidney failure , and extracorporeal membrane oxygenation may be used for lung dysfunction. Treatment is primarily supportive in nature. Early supportive care with rehydration and symptomatic treatment improves survival. Rehydration may be via the oral or intravenous route. These measures may include pain management , and treatment for nausea , fever , and anxiety . The World Health Organization (WHO) recommends avoiding aspirin or ibuprofen for pain management, due to the risk of bleeding associated with these medications. Blood products such as packed red blood cells , platelets , or fresh frozen plasma may also be used. Other regulators of coagulation have also been tried including heparin in an effort to prevent disseminated intravascular coagulation and clotting factors to decrease bleeding. Antimalarial medications and antibiotics are often used before the diagnosis is confirmed, though there is no evidence to suggest such treatment helps. Several experimental treatments are being studied . Where hospital care is not possible, the WHO's guidelines for home care have been relatively successful. Recommendations include using towels soaked in a bleach solution when moving infected people or bodies and also applying bleach on stains. It is also recommended that the caregivers wash hands with bleach solutions and cover their mouth and nose with a cloth. Intensive care is often used in the developed world. This may include maintaining blood volume and electrolytes (salts) balance as well as treating any bacterial infections that may develop. Dialysis may be needed for kidney failure , and extracorporeal membrane oxygenation may be used for lung dysfunction. EVD has a risk of death in those infected of between 25% and 90%. As of September 2014 [ update ] , the average risk of death among those infected is 50%. The highest risk of death was 90% in the 2002–2003 Republic of the Congo outbreak. Early admission significantly increases survival rates Death, if it occurs, follows typically six to sixteen days after symptoms appear and is often due to low blood pressure from fluid loss . Early supportive care to prevent dehydration may reduce the risk of death. If an infected person survives, recovery may be quick and complete. However, a large portion of survivors develop post-Ebola virus syndrome after the acute phase of the infection. Prolonged cases are often complicated by the occurrence of long-term problems, such as inflammation of the testicles , joint pains , fatigue, hearing loss, mood and sleep disturbances, muscular pain , abdominal pain, menstrual abnormalities , miscarriages , skin peeling , or hair loss . Inflammation and swelling of the uveal layer of the eye is the most common eye complication in survivors of Ebola virus disease. Eye symptoms, such as light sensitivity , excess tearing , and vision loss have been described. Ebola can stay in some body parts like the eyes, breasts, and testicles after infection. Sexual transmission after recovery has been suspected. If sexual transmission occurs following recovery it is believed to be a rare event. One case of a condition similar to meningitis has been reported many months after recovery, as of October 2015 [ update ] . If an infected person survives, recovery may be quick and complete. However, a large portion of survivors develop post-Ebola virus syndrome after the acute phase of the infection. Prolonged cases are often complicated by the occurrence of long-term problems, such as inflammation of the testicles , joint pains , fatigue, hearing loss, mood and sleep disturbances, muscular pain , abdominal pain, menstrual abnormalities , miscarriages , skin peeling , or hair loss . Inflammation and swelling of the uveal layer of the eye is the most common eye complication in survivors of Ebola virus disease. Eye symptoms, such as light sensitivity , excess tearing , and vision loss have been described. Ebola can stay in some body parts like the eyes, breasts, and testicles after infection. Sexual transmission after recovery has been suspected. If sexual transmission occurs following recovery it is believed to be a rare event. One case of a condition similar to meningitis has been reported many months after recovery, as of October 2015 [ update ] . The disease typically occurs in outbreaks in tropical regions of Sub-Saharan Africa . From 1976 (when it was first identified) through 2013, the WHO reported 2,387 confirmed cases with 1,590 overall fatalities. The largest outbreak to date was the Ebola virus epidemic in West Africa , which caused a large number of deaths in Guinea , Sierra Leone , and Liberia . The first known outbreak of EVD was identified only after the fact. It occurred between June and November 1976, in Nzara, South Sudan (then part of Sudan ), and was caused by Sudan virus (SUDV). The Sudan outbreak infected 284 people and killed 151. The first identifiable case in Sudan occurred on 27 June in a storekeeper in a cotton factory in Nzara , who was hospitalised on 30 June and died on 6 July. Although the WHO medical staff involved in the Sudan outbreak knew that they were dealing with a heretofore unknown disease, the actual "positive identification" process and the naming of the virus did not occur until some months later in Zaire . On 26 August 1976, the second outbreak of EVD began in Yambuku , a small rural village in Mongala District in northern Zaire (now known as the Democratic Republic of the Congo ). This outbreak was caused by EBOV, formerly designated Zaire ebolavirus , a different member of the genus Ebolavirus than in the first Sudan outbreak. The first person infected with the disease was the village school's headmaster Mabalo Lokela , who began displaying symptoms on 26 August 1976. Lokela had returned from a trip to Northern Zaire near the border of the Central African Republic , after visiting the Ebola River between 12 and 22 August. He was originally believed to have malaria and was given quinine . However, his symptoms continued to worsen, and he was admitted to Yambuku Mission Hospital on 5 September. Lokela died on 8 September 14 days after he began displaying symptoms. Soon after Lokela's death, others who had been in contact with him also died, and people in Yambuku began to panic. The country's Minister of Health and Zaire President Mobutu Sese Seko declared the entire region, including Yambuku and the country's capital, Kinshasa , a quarantine zone. No-one was permitted to enter or leave the area, and roads, waterways, and airfields were placed under martial law . Schools, businesses and social organisations were closed. The initial response was led by Congolese doctors, including Jean-Jacques Muyembe-Tamfum , one of the discoverers of Ebola. Muyembe took a blood sample from a Belgian nun; this sample would eventually be used by Peter Piot to identify the previously unknown Ebola virus. Muyembe was also the first scientist to come into direct contact with the disease and survive. Researchers from the Centers for Disease Control and Prevention (CDC), including Piot, co-discoverer of Ebola, later arrived to assess the effects of the outbreak, observing that "the whole region was in panic." Piot concluded that Belgian nuns had inadvertently started the epidemic by giving unnecessary vitamin injections to pregnant women without sterilizing the syringes and needles. The outbreak lasted 26 days and the quarantine lasted two weeks. Researchers speculated that the disease disappeared due to the precautions taken by locals, the quarantine of the area, and discontinuing of the injections. During this outbreak, Ngoy Mushola recorded the first clinical description of EVD in Yambuku , where he wrote the following in his daily log: "The illness is characterised with a high temperature of about 39 °C (102 °F) , haematemesis , diarrhoea with blood, retrosternal abdominal pain, prostration with 'heavy' articulations, and rapid evolution death after a mean of three days." The virus responsible for the initial outbreak, first thought to be the Marburg virus , was later identified as a new type of virus related to the genus Marburgvirus . Virus strain samples isolated from both outbreaks were named "Ebola virus" after the Ebola River , near the first-identified viral outbreak site in Zaire. Reports conflict about who initially coined the name: either Karl Johnson of the American CDC team or Belgian researchers. Subsequently, a number of other cases were reported, almost all centred on the Yambuku mission hospital or close contacts of another case. In all, 318 cases and 280 deaths (an 88% fatality rate) occurred in Zaire. Although the two outbreaks were at first believed connected, scientists later realised that they were caused by two distinct ebolaviruses, SUDV and EBOV. The second major outbreak occurred in Zaire (now the Democratic Republic of the Congo , DRC), in 1995, affecting 315 and killing 254. In 2000, Uganda had an outbreak infecting 425 and killing 224; in this case, the Sudan virus was found to be the Ebola species responsible for the outbreak. In 2003, an outbreak in the DRC infected 143 and killed 128, a 90% death rate, the highest of a genus Ebolavirus outbreak to date. In 2004, a Russian scientist died from Ebola after sticking herself with an infected needle. Between April and August 2007, a fever epidemic in a four-village region of the DRC was confirmed in September to have been cases of Ebola. Many people who attended the recent funeral of a local village chief died. The 2007 outbreak eventually infected 264 individuals and killed 187. On 30 November 2007, the Uganda Ministry of Health confirmed an outbreak of Ebola in the Bundibugyo District in Western Uganda. After confirming samples tested by the United States National Reference Laboratories and the Centers for Disease Control, the World Health Organization (WHO) confirmed the presence of a new species of genus Ebolavirus , which was tentatively named Bundibugyo. The WHO reported 149 cases of this new strain and 37 of those led to deaths. The WHO confirmed two small outbreaks in Uganda in 2012, both caused by the Sudan variant. The first outbreak affected seven people, killing four, and the second affected 24, killing 17. On 17 August 2012, the Ministry of Health of the DRC reported an outbreak of the Ebola-Bundibugyo variant in the eastern region. Other than its discovery in 2007, this was the only time that this variant has been identified as responsible for an outbreak. The WHO revealed that the virus had sickened 57 people and killed 29. The probable cause of the outbreak was tainted bush meat hunted by local villagers around the towns of Isiro and Viadana. In 2014, an outbreak occurred in the DRC. Genome-sequencing showed that this outbreak was not related to the 2014–15 West Africa Ebola virus outbreak , but was the same EBOV species, the Zaire species. It began in August 2014, and was declared over in November with 66 cases and 49 deaths. This was the 7th outbreak in the DRC, three of which occurred during the period when the country was known as Zaire . In March 2014, the World Health Organization (WHO) reported a major Ebola outbreak in Guinea , a West African nation. Researchers traced the outbreak to a one-year-old child who died in December 2013. The disease rapidly spread to the neighbouring countries of Liberia and Sierra Leone . It was the largest Ebola outbreak ever documented, and the first recorded in the region. On 8 August 2014, the WHO declared the epidemic an international public health emergency. Urging the world to offer aid to the affected regions, its Director-General said, "Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible." By mid-August 2014, Doctors Without Borders reported the situation in Liberia's capital, Monrovia , was "catastrophic" and "deteriorating daily". They reported that fears of Ebola among staff members and patients had shut down much of the city's health system, leaving many people without medical treatment for other conditions. In a 26 September statement, WHO said, "The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times. Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long." Intense contact tracing and strict isolation largely prevented further spread of the disease in the countries that had imported cases. It caused significant mortality, with a considerable case fatality rate . [note 1] By the end of the epidemic, 28,616 people had been infected; of these, 11,310 had died, for a case-fatality rate of 40%. As of 8 May 2016 [ update ] , 28,646 suspected cases and 11,323 deaths were reported; however, the WHO said that these numbers may be underestimated. Because they work closely with the body fluids of infected patients, healthcare workers were especially vulnerable to infection; in August 2014, the WHO reported that 10% of the dead were healthcare workers. In September 2014, it was estimated that the countries' capacity for treating Ebola patients was insufficient by the equivalent of 2,122 beds; by December there were a sufficient number of beds to treat and isolate all reported Ebola cases, although the uneven distribution of cases was causing serious shortfalls in some areas. On 28 January 2015, the WHO reported that for the first time since the week ending 29 June 2014, there had been fewer than 100 new confirmed cases reported in a week in the three most-affected countries. The response to the epidemic then moved to a second phase, as the focus shifted from slowing transmission to ending the epidemic. On 8 April 2015, the WHO reported only 30 confirmed cases, the lowest weekly total since the third week of May 2014. On 29 December 2015, 42 days after the last person tested negative for a second time, Guinea was declared free of Ebola transmission. At that time, a 90-day period of heightened surveillance was announced by that agency. "This is the first time that all three countries – Guinea, Liberia and Sierra Leone – have stopped the original chains of transmission ...", the organisation stated in a news release. A new case was detected in Sierra Leone on 14 January 2016. However, the outbreak was declared no longer an emergency on 29 March 2016. On 19 September, Eric Duncan flew from his native Liberia to Texas; five days later he began showing symptoms and visited a hospital but was sent home. His condition worsened and he returned to the hospital on 28 September, where he died on 8 October. Health officials confirmed a diagnosis of Ebola on 30 September – the first case in the United States. In early October, Teresa Romero, a 44-year-old Spanish nurse, contracted Ebola after caring for a priest who had been repatriated from West Africa. This was the first transmission of the virus to occur outside Africa. Romero tested negative for the disease on 20 October, suggesting that she may have recovered from Ebola infection. On 12 October, the Centers for Disease Control and Prevention (CDC) confirmed that a nurse in Texas, Nina Pham , who had treated Duncan tested positive for the Ebola virus, the first known case of transmission in the United States. On 15 October, a second Texas health-care worker who had treated Duncan was confirmed to have the virus. Both of these people recovered. An unrelated case involved a doctor in New York City, who returned to the United States from Guinea after working with Médecins Sans Frontières and tested positive for Ebola on 23 October. The person recovered and was discharged from Bellevue Hospital on 11 November. On 24 December 2014, a laboratory in Atlanta , Georgia reported that a technician had been exposed to Ebola. On 29 December 2014, Pauline Cafferkey , a British nurse who had just returned to Glasgow from Sierra Leone, was diagnosed with Ebola at Glasgow's Gartnavel General Hospital . After initial treatment in Glasgow, she was transferred by air to RAF Northolt , then to the specialist high-level isolation unit at the Royal Free Hospital in London for longer-term treatment. On 11 May 2017, the DRC Ministry of Public Health notified the WHO about an outbreak of Ebola. Four people died, and four people survived; five of these eight cases were laboratory-confirmed. A total of 583 contacts were monitored. On 2 July 2017, the WHO declared the end of the outbreak. On 14 May 2018, the World Health Organization reported that "the Democratic Republic of Congo reported 39 suspected, probable or confirmed cases of Ebola between 4 April and 13 May, including 19 deaths." Some 393 people identified as contacts of Ebola patients were being followed up. The outbreak centred on the Bikoro , Iboko, and Wangata areas in Equateur province, including in the large city of Mbandaka . The DRC Ministry of Public Health approved the use of an experimental vaccine. On 13 May 2018, WHO Director-General Tedros Adhanom Ghebreyesus visited Bikoro. Reports emerged that maps of the area were inaccurate, not so much hampering medical providers as epidemiologists and officials trying to assess the outbreak and containment efforts. The 2018 outbreak in the DRC was declared over on 24 July 2018. On 1 August 2018, the world's 10th Ebola outbreak was declared in North Kivu province of the Democratic Republic of the Congo. It was the first Ebola outbreak in a military conflict zone, with thousands of refugees in the area. By November 2018, nearly 200 Congolese had died of Ebola, about half of them from the city of Beni , where armed groups are fighting over the region's mineral wealth, impeding medical relief efforts. By March 2019, this became the second largest Ebola outbreak ever recorded, with more than 1,000 cases and insecurity continuing to be the major resistance to providing an adequate response. As of 4 June 2019 [ update ] , the WHO reported 2025 confirmed and probable cases with 1357 deaths. In June 2019, two people died of Ebola in neighbouring Uganda . In July 2019, an infected man travelled to Goma , home to more than two million people. One week later, on 17 July 2019, the WHO declared the Ebola outbreak a global health emergency , the fifth time such a declaration has been made by the organisation. A government spokesman said that half of the Ebola cases are unidentified, and he added that the current outbreak could last up to three years. On 25 June 2020, the second biggest EVD outbreak ever was declared over. On 1 June 2020, the Congolese health ministry announced a new DRC outbreak of Ebola in Mbandaka , Équateur Province , a region along the Congo River. Genome sequencing suggests that this outbreak, the 11th outbreak since the virus was first discovered in the country in 1976, is unrelated to the one in North Kivu Province or the previous outbreak in the same area in 2018. It was reported that six cases had been identified; four of the people had died. It is expected that more people will be identified as surveillance activities increase. By 15 June the case count had increased to 17 with 11 deaths, with more than 2,500 people having been vaccinated. The 11th EVD outbreak was officially declared over on 19 November 2020. By the time the Équateur outbreak ended, it had 130 confirmed cases with 75 recoveries and 55 deaths. On 7 February 2021, the Congolese health ministry announced a new case of Ebola near Butembo, North Kivu detected a day before. The case was a 42-year-old woman who had symptoms of Ebola in Biena on 1 February 2021. A few days after, she died in a hospital in Butembo. The WHO said that more than 70 people with contact with the woman had been tracked. On 11 February 2021, another woman who had contact with the previous woman died in the same town, and the number of traced contacts increased to 100. A day after, a third case was detected in Butembo. On 3 May 2021, the 12th EVD outbreak was declared over, resulting in 12 cases and six deaths. Heightened surveillance will continue for 90 days after the declaration, in case of resurgence. In February 2021, Sakoba Keita, head of Guinea's national health agency confirmed that three people had died of Ebola in the south-eastern region near the city of Nzérékoré. A further five people also tested positive. Keita also confirmed more testing was underway, and attempts to trace and isolate further cases had begun. On 14 February, the Guinean government declared an Ebola epidemic. The outbreak may have started following reactivation of a latent case in a survivor of an earlier outbreak. As of 4 May 2021, 23 cases were reported, with no new cases or deaths since 3 April 2021. A 42-day countdown period was started on 8 May 2021, and on 19 June, the outbreak was declared over. On 14 August 2021, The Ministry of Health of Cote d'Ivoire confirmed the country's first case of Ebola since 1994. This came after the Institut Pasteur in Cote d'Ivoire confirmed the Ebola Virus Disease in samples collected from a patient, who was hospitalized in the commercial capital of Abidjan , after arriving from Guinea. However, on 31 August 2021, the WHO found that, after further tests in a laboratory in Lyon , the patient did not have Ebola. The cause of her disease is still being analyzed. On 23 April 2022, a case of Ebola was confirmed in the DRC in the Equateur province. The case was a 31-year-old man whose symptoms began on 5 April, but did not seek treatment for over a week. On 21 April, he was admitted to an Ebola treatment centre and died later that day. By 24 May 2022, there were 5 recorded deaths in the DRC. On 15 August, the fifth case was buried, and the outbreak was declared over, 42 days after, on 4 July 2022. In September 2022, Uganda reported 7 cases infected with the Ebola Sudan strain , but by mid-October the count had increased to 63. In November 2022, the outbreak in Uganda continued - still without a vaccine. On 10 January 2023, the outbreak was considered over after no new cases had been reported for 42 days; the outbreak killed nearly 80 people. The first known outbreak of EVD was identified only after the fact. It occurred between June and November 1976, in Nzara, South Sudan (then part of Sudan ), and was caused by Sudan virus (SUDV). The Sudan outbreak infected 284 people and killed 151. The first identifiable case in Sudan occurred on 27 June in a storekeeper in a cotton factory in Nzara , who was hospitalised on 30 June and died on 6 July. Although the WHO medical staff involved in the Sudan outbreak knew that they were dealing with a heretofore unknown disease, the actual "positive identification" process and the naming of the virus did not occur until some months later in Zaire . On 26 August 1976, the second outbreak of EVD began in Yambuku , a small rural village in Mongala District in northern Zaire (now known as the Democratic Republic of the Congo ). This outbreak was caused by EBOV, formerly designated Zaire ebolavirus , a different member of the genus Ebolavirus than in the first Sudan outbreak. The first person infected with the disease was the village school's headmaster Mabalo Lokela , who began displaying symptoms on 26 August 1976. Lokela had returned from a trip to Northern Zaire near the border of the Central African Republic , after visiting the Ebola River between 12 and 22 August. He was originally believed to have malaria and was given quinine . However, his symptoms continued to worsen, and he was admitted to Yambuku Mission Hospital on 5 September. Lokela died on 8 September 14 days after he began displaying symptoms. Soon after Lokela's death, others who had been in contact with him also died, and people in Yambuku began to panic. The country's Minister of Health and Zaire President Mobutu Sese Seko declared the entire region, including Yambuku and the country's capital, Kinshasa , a quarantine zone. No-one was permitted to enter or leave the area, and roads, waterways, and airfields were placed under martial law . Schools, businesses and social organisations were closed. The initial response was led by Congolese doctors, including Jean-Jacques Muyembe-Tamfum , one of the discoverers of Ebola. Muyembe took a blood sample from a Belgian nun; this sample would eventually be used by Peter Piot to identify the previously unknown Ebola virus. Muyembe was also the first scientist to come into direct contact with the disease and survive. Researchers from the Centers for Disease Control and Prevention (CDC), including Piot, co-discoverer of Ebola, later arrived to assess the effects of the outbreak, observing that "the whole region was in panic." Piot concluded that Belgian nuns had inadvertently started the epidemic by giving unnecessary vitamin injections to pregnant women without sterilizing the syringes and needles. The outbreak lasted 26 days and the quarantine lasted two weeks. Researchers speculated that the disease disappeared due to the precautions taken by locals, the quarantine of the area, and discontinuing of the injections. During this outbreak, Ngoy Mushola recorded the first clinical description of EVD in Yambuku , where he wrote the following in his daily log: "The illness is characterised with a high temperature of about 39 °C (102 °F) , haematemesis , diarrhoea with blood, retrosternal abdominal pain, prostration with 'heavy' articulations, and rapid evolution death after a mean of three days." The virus responsible for the initial outbreak, first thought to be the Marburg virus , was later identified as a new type of virus related to the genus Marburgvirus . Virus strain samples isolated from both outbreaks were named "Ebola virus" after the Ebola River , near the first-identified viral outbreak site in Zaire. Reports conflict about who initially coined the name: either Karl Johnson of the American CDC team or Belgian researchers. Subsequently, a number of other cases were reported, almost all centred on the Yambuku mission hospital or close contacts of another case. In all, 318 cases and 280 deaths (an 88% fatality rate) occurred in Zaire. Although the two outbreaks were at first believed connected, scientists later realised that they were caused by two distinct ebolaviruses, SUDV and EBOV. The first known outbreak of EVD was identified only after the fact. It occurred between June and November 1976, in Nzara, South Sudan (then part of Sudan ), and was caused by Sudan virus (SUDV). The Sudan outbreak infected 284 people and killed 151. The first identifiable case in Sudan occurred on 27 June in a storekeeper in a cotton factory in Nzara , who was hospitalised on 30 June and died on 6 July. Although the WHO medical staff involved in the Sudan outbreak knew that they were dealing with a heretofore unknown disease, the actual "positive identification" process and the naming of the virus did not occur until some months later in Zaire . On 26 August 1976, the second outbreak of EVD began in Yambuku , a small rural village in Mongala District in northern Zaire (now known as the Democratic Republic of the Congo ). This outbreak was caused by EBOV, formerly designated Zaire ebolavirus , a different member of the genus Ebolavirus than in the first Sudan outbreak. The first person infected with the disease was the village school's headmaster Mabalo Lokela , who began displaying symptoms on 26 August 1976. Lokela had returned from a trip to Northern Zaire near the border of the Central African Republic , after visiting the Ebola River between 12 and 22 August. He was originally believed to have malaria and was given quinine . However, his symptoms continued to worsen, and he was admitted to Yambuku Mission Hospital on 5 September. Lokela died on 8 September 14 days after he began displaying symptoms. Soon after Lokela's death, others who had been in contact with him also died, and people in Yambuku began to panic. The country's Minister of Health and Zaire President Mobutu Sese Seko declared the entire region, including Yambuku and the country's capital, Kinshasa , a quarantine zone. No-one was permitted to enter or leave the area, and roads, waterways, and airfields were placed under martial law . Schools, businesses and social organisations were closed. The initial response was led by Congolese doctors, including Jean-Jacques Muyembe-Tamfum , one of the discoverers of Ebola. Muyembe took a blood sample from a Belgian nun; this sample would eventually be used by Peter Piot to identify the previously unknown Ebola virus. Muyembe was also the first scientist to come into direct contact with the disease and survive. Researchers from the Centers for Disease Control and Prevention (CDC), including Piot, co-discoverer of Ebola, later arrived to assess the effects of the outbreak, observing that "the whole region was in panic." Piot concluded that Belgian nuns had inadvertently started the epidemic by giving unnecessary vitamin injections to pregnant women without sterilizing the syringes and needles. The outbreak lasted 26 days and the quarantine lasted two weeks. Researchers speculated that the disease disappeared due to the precautions taken by locals, the quarantine of the area, and discontinuing of the injections. During this outbreak, Ngoy Mushola recorded the first clinical description of EVD in Yambuku , where he wrote the following in his daily log: "The illness is characterised with a high temperature of about 39 °C (102 °F) , haematemesis , diarrhoea with blood, retrosternal abdominal pain, prostration with 'heavy' articulations, and rapid evolution death after a mean of three days." The virus responsible for the initial outbreak, first thought to be the Marburg virus , was later identified as a new type of virus related to the genus Marburgvirus . Virus strain samples isolated from both outbreaks were named "Ebola virus" after the Ebola River , near the first-identified viral outbreak site in Zaire. Reports conflict about who initially coined the name: either Karl Johnson of the American CDC team or Belgian researchers. Subsequently, a number of other cases were reported, almost all centred on the Yambuku mission hospital or close contacts of another case. In all, 318 cases and 280 deaths (an 88% fatality rate) occurred in Zaire. Although the two outbreaks were at first believed connected, scientists later realised that they were caused by two distinct ebolaviruses, SUDV and EBOV. The second major outbreak occurred in Zaire (now the Democratic Republic of the Congo , DRC), in 1995, affecting 315 and killing 254. In 2000, Uganda had an outbreak infecting 425 and killing 224; in this case, the Sudan virus was found to be the Ebola species responsible for the outbreak. In 2003, an outbreak in the DRC infected 143 and killed 128, a 90% death rate, the highest of a genus Ebolavirus outbreak to date. In 2004, a Russian scientist died from Ebola after sticking herself with an infected needle. Between April and August 2007, a fever epidemic in a four-village region of the DRC was confirmed in September to have been cases of Ebola. Many people who attended the recent funeral of a local village chief died. The 2007 outbreak eventually infected 264 individuals and killed 187. On 30 November 2007, the Uganda Ministry of Health confirmed an outbreak of Ebola in the Bundibugyo District in Western Uganda. After confirming samples tested by the United States National Reference Laboratories and the Centers for Disease Control, the World Health Organization (WHO) confirmed the presence of a new species of genus Ebolavirus , which was tentatively named Bundibugyo. The WHO reported 149 cases of this new strain and 37 of those led to deaths. The WHO confirmed two small outbreaks in Uganda in 2012, both caused by the Sudan variant. The first outbreak affected seven people, killing four, and the second affected 24, killing 17. On 17 August 2012, the Ministry of Health of the DRC reported an outbreak of the Ebola-Bundibugyo variant in the eastern region. Other than its discovery in 2007, this was the only time that this variant has been identified as responsible for an outbreak. The WHO revealed that the virus had sickened 57 people and killed 29. The probable cause of the outbreak was tainted bush meat hunted by local villagers around the towns of Isiro and Viadana. In 2014, an outbreak occurred in the DRC. Genome-sequencing showed that this outbreak was not related to the 2014–15 West Africa Ebola virus outbreak , but was the same EBOV species, the Zaire species. It began in August 2014, and was declared over in November with 66 cases and 49 deaths. This was the 7th outbreak in the DRC, three of which occurred during the period when the country was known as Zaire . In March 2014, the World Health Organization (WHO) reported a major Ebola outbreak in Guinea , a West African nation. Researchers traced the outbreak to a one-year-old child who died in December 2013. The disease rapidly spread to the neighbouring countries of Liberia and Sierra Leone . It was the largest Ebola outbreak ever documented, and the first recorded in the region. On 8 August 2014, the WHO declared the epidemic an international public health emergency. Urging the world to offer aid to the affected regions, its Director-General said, "Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible." By mid-August 2014, Doctors Without Borders reported the situation in Liberia's capital, Monrovia , was "catastrophic" and "deteriorating daily". They reported that fears of Ebola among staff members and patients had shut down much of the city's health system, leaving many people without medical treatment for other conditions. In a 26 September statement, WHO said, "The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times. Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long." Intense contact tracing and strict isolation largely prevented further spread of the disease in the countries that had imported cases. It caused significant mortality, with a considerable case fatality rate . [note 1] By the end of the epidemic, 28,616 people had been infected; of these, 11,310 had died, for a case-fatality rate of 40%. As of 8 May 2016 [ update ] , 28,646 suspected cases and 11,323 deaths were reported; however, the WHO said that these numbers may be underestimated. Because they work closely with the body fluids of infected patients, healthcare workers were especially vulnerable to infection; in August 2014, the WHO reported that 10% of the dead were healthcare workers. In September 2014, it was estimated that the countries' capacity for treating Ebola patients was insufficient by the equivalent of 2,122 beds; by December there were a sufficient number of beds to treat and isolate all reported Ebola cases, although the uneven distribution of cases was causing serious shortfalls in some areas. On 28 January 2015, the WHO reported that for the first time since the week ending 29 June 2014, there had been fewer than 100 new confirmed cases reported in a week in the three most-affected countries. The response to the epidemic then moved to a second phase, as the focus shifted from slowing transmission to ending the epidemic. On 8 April 2015, the WHO reported only 30 confirmed cases, the lowest weekly total since the third week of May 2014. On 29 December 2015, 42 days after the last person tested negative for a second time, Guinea was declared free of Ebola transmission. At that time, a 90-day period of heightened surveillance was announced by that agency. "This is the first time that all three countries – Guinea, Liberia and Sierra Leone – have stopped the original chains of transmission ...", the organisation stated in a news release. A new case was detected in Sierra Leone on 14 January 2016. However, the outbreak was declared no longer an emergency on 29 March 2016. On 19 September, Eric Duncan flew from his native Liberia to Texas; five days later he began showing symptoms and visited a hospital but was sent home. His condition worsened and he returned to the hospital on 28 September, where he died on 8 October. Health officials confirmed a diagnosis of Ebola on 30 September – the first case in the United States. In early October, Teresa Romero, a 44-year-old Spanish nurse, contracted Ebola after caring for a priest who had been repatriated from West Africa. This was the first transmission of the virus to occur outside Africa. Romero tested negative for the disease on 20 October, suggesting that she may have recovered from Ebola infection. On 12 October, the Centers for Disease Control and Prevention (CDC) confirmed that a nurse in Texas, Nina Pham , who had treated Duncan tested positive for the Ebola virus, the first known case of transmission in the United States. On 15 October, a second Texas health-care worker who had treated Duncan was confirmed to have the virus. Both of these people recovered. An unrelated case involved a doctor in New York City, who returned to the United States from Guinea after working with Médecins Sans Frontières and tested positive for Ebola on 23 October. The person recovered and was discharged from Bellevue Hospital on 11 November. On 24 December 2014, a laboratory in Atlanta , Georgia reported that a technician had been exposed to Ebola. On 29 December 2014, Pauline Cafferkey , a British nurse who had just returned to Glasgow from Sierra Leone, was diagnosed with Ebola at Glasgow's Gartnavel General Hospital . After initial treatment in Glasgow, she was transferred by air to RAF Northolt , then to the specialist high-level isolation unit at the Royal Free Hospital in London for longer-term treatment. On 19 September, Eric Duncan flew from his native Liberia to Texas; five days later he began showing symptoms and visited a hospital but was sent home. His condition worsened and he returned to the hospital on 28 September, where he died on 8 October. Health officials confirmed a diagnosis of Ebola on 30 September – the first case in the United States. In early October, Teresa Romero, a 44-year-old Spanish nurse, contracted Ebola after caring for a priest who had been repatriated from West Africa. This was the first transmission of the virus to occur outside Africa. Romero tested negative for the disease on 20 October, suggesting that she may have recovered from Ebola infection. On 12 October, the Centers for Disease Control and Prevention (CDC) confirmed that a nurse in Texas, Nina Pham , who had treated Duncan tested positive for the Ebola virus, the first known case of transmission in the United States. On 15 October, a second Texas health-care worker who had treated Duncan was confirmed to have the virus. Both of these people recovered. An unrelated case involved a doctor in New York City, who returned to the United States from Guinea after working with Médecins Sans Frontières and tested positive for Ebola on 23 October. The person recovered and was discharged from Bellevue Hospital on 11 November. On 24 December 2014, a laboratory in Atlanta , Georgia reported that a technician had been exposed to Ebola. On 29 December 2014, Pauline Cafferkey , a British nurse who had just returned to Glasgow from Sierra Leone, was diagnosed with Ebola at Glasgow's Gartnavel General Hospital . After initial treatment in Glasgow, she was transferred by air to RAF Northolt , then to the specialist high-level isolation unit at the Royal Free Hospital in London for longer-term treatment. On 11 May 2017, the DRC Ministry of Public Health notified the WHO about an outbreak of Ebola. Four people died, and four people survived; five of these eight cases were laboratory-confirmed. A total of 583 contacts were monitored. On 2 July 2017, the WHO declared the end of the outbreak. On 14 May 2018, the World Health Organization reported that "the Democratic Republic of Congo reported 39 suspected, probable or confirmed cases of Ebola between 4 April and 13 May, including 19 deaths." Some 393 people identified as contacts of Ebola patients were being followed up. The outbreak centred on the Bikoro , Iboko, and Wangata areas in Equateur province, including in the large city of Mbandaka . The DRC Ministry of Public Health approved the use of an experimental vaccine. On 13 May 2018, WHO Director-General Tedros Adhanom Ghebreyesus visited Bikoro. Reports emerged that maps of the area were inaccurate, not so much hampering medical providers as epidemiologists and officials trying to assess the outbreak and containment efforts. The 2018 outbreak in the DRC was declared over on 24 July 2018. On 1 August 2018, the world's 10th Ebola outbreak was declared in North Kivu province of the Democratic Republic of the Congo. It was the first Ebola outbreak in a military conflict zone, with thousands of refugees in the area. By November 2018, nearly 200 Congolese had died of Ebola, about half of them from the city of Beni , where armed groups are fighting over the region's mineral wealth, impeding medical relief efforts. By March 2019, this became the second largest Ebola outbreak ever recorded, with more than 1,000 cases and insecurity continuing to be the major resistance to providing an adequate response. As of 4 June 2019 [ update ] , the WHO reported 2025 confirmed and probable cases with 1357 deaths. In June 2019, two people died of Ebola in neighbouring Uganda . In July 2019, an infected man travelled to Goma , home to more than two million people. One week later, on 17 July 2019, the WHO declared the Ebola outbreak a global health emergency , the fifth time such a declaration has been made by the organisation. A government spokesman said that half of the Ebola cases are unidentified, and he added that the current outbreak could last up to three years. On 25 June 2020, the second biggest EVD outbreak ever was declared over. On 1 June 2020, the Congolese health ministry announced a new DRC outbreak of Ebola in Mbandaka , Équateur Province , a region along the Congo River. Genome sequencing suggests that this outbreak, the 11th outbreak since the virus was first discovered in the country in 1976, is unrelated to the one in North Kivu Province or the previous outbreak in the same area in 2018. It was reported that six cases had been identified; four of the people had died. It is expected that more people will be identified as surveillance activities increase. By 15 June the case count had increased to 17 with 11 deaths, with more than 2,500 people having been vaccinated. The 11th EVD outbreak was officially declared over on 19 November 2020. By the time the Équateur outbreak ended, it had 130 confirmed cases with 75 recoveries and 55 deaths.On 7 February 2021, the Congolese health ministry announced a new case of Ebola near Butembo, North Kivu detected a day before. The case was a 42-year-old woman who had symptoms of Ebola in Biena on 1 February 2021. A few days after, she died in a hospital in Butembo. The WHO said that more than 70 people with contact with the woman had been tracked. On 11 February 2021, another woman who had contact with the previous woman died in the same town, and the number of traced contacts increased to 100. A day after, a third case was detected in Butembo. On 3 May 2021, the 12th EVD outbreak was declared over, resulting in 12 cases and six deaths. Heightened surveillance will continue for 90 days after the declaration, in case of resurgence. In February 2021, Sakoba Keita, head of Guinea's national health agency confirmed that three people had died of Ebola in the south-eastern region near the city of Nzérékoré. A further five people also tested positive. Keita also confirmed more testing was underway, and attempts to trace and isolate further cases had begun. On 14 February, the Guinean government declared an Ebola epidemic. The outbreak may have started following reactivation of a latent case in a survivor of an earlier outbreak. As of 4 May 2021, 23 cases were reported, with no new cases or deaths since 3 April 2021. A 42-day countdown period was started on 8 May 2021, and on 19 June, the outbreak was declared over. On 14 August 2021, The Ministry of Health of Cote d'Ivoire confirmed the country's first case of Ebola since 1994. This came after the Institut Pasteur in Cote d'Ivoire confirmed the Ebola Virus Disease in samples collected from a patient, who was hospitalized in the commercial capital of Abidjan , after arriving from Guinea. However, on 31 August 2021, the WHO found that, after further tests in a laboratory in Lyon , the patient did not have Ebola. The cause of her disease is still being analyzed. On 7 February 2021, the Congolese health ministry announced a new case of Ebola near Butembo, North Kivu detected a day before. The case was a 42-year-old woman who had symptoms of Ebola in Biena on 1 February 2021. A few days after, she died in a hospital in Butembo. The WHO said that more than 70 people with contact with the woman had been tracked. On 11 February 2021, another woman who had contact with the previous woman died in the same town, and the number of traced contacts increased to 100. A day after, a third case was detected in Butembo. On 3 May 2021, the 12th EVD outbreak was declared over, resulting in 12 cases and six deaths. Heightened surveillance will continue for 90 days after the declaration, in case of resurgence. In February 2021, Sakoba Keita, head of Guinea's national health agency confirmed that three people had died of Ebola in the south-eastern region near the city of Nzérékoré. A further five people also tested positive. Keita also confirmed more testing was underway, and attempts to trace and isolate further cases had begun. On 14 February, the Guinean government declared an Ebola epidemic. The outbreak may have started following reactivation of a latent case in a survivor of an earlier outbreak. As of 4 May 2021, 23 cases were reported, with no new cases or deaths since 3 April 2021. A 42-day countdown period was started on 8 May 2021, and on 19 June, the outbreak was declared over. On 14 August 2021, The Ministry of Health of Cote d'Ivoire confirmed the country's first case of Ebola since 1994. This came after the Institut Pasteur in Cote d'Ivoire confirmed the Ebola Virus Disease in samples collected from a patient, who was hospitalized in the commercial capital of Abidjan , after arriving from Guinea. However, on 31 August 2021, the WHO found that, after further tests in a laboratory in Lyon , the patient did not have Ebola. The cause of her disease is still being analyzed. On 23 April 2022, a case of Ebola was confirmed in the DRC in the Equateur province. The case was a 31-year-old man whose symptoms began on 5 April, but did not seek treatment for over a week. On 21 April, he was admitted to an Ebola treatment centre and died later that day. By 24 May 2022, there were 5 recorded deaths in the DRC. On 15 August, the fifth case was buried, and the outbreak was declared over, 42 days after, on 4 July 2022. In September 2022, Uganda reported 7 cases infected with the Ebola Sudan strain , but by mid-October the count had increased to 63. In November 2022, the outbreak in Uganda continued - still without a vaccine. On 10 January 2023, the outbreak was considered over after no new cases had been reported for 42 days; the outbreak killed nearly 80 people. Ebolavirus is classified as a biosafety level 4 agent, as well as a Category A bioterrorism agent by the Centers for Disease Control and Prevention. It has the potential to be weaponised for use in biological warfare , and was investigated by Biopreparat for such use, but might be difficult to prepare as a weapon of mass destruction because the virus becomes ineffective quickly in open air. Fake emails pretending to be Ebola information from the WHO or the Mexican government have, in 2014, been misused to spread computer malware. The BBC reported in 2015 that "North Korean state media has suggested the disease was created by the U.S. military as a biological weapon." Richard Preston 's 1995 best-selling book, The Hot Zone , dramatised the Ebola outbreak in Reston, Virginia. William Close 's 1995 Ebola: A Documentary Novel of Its First Explosion and 2002 Ebola: Through the Eyes of the People focused on individuals' reactions to the 1976 Ebola outbreak in Zaire. Tom Clancy 's 1996 novel, Executive Orders , involves a Middle Eastern terrorist attack on the United States using an airborne form of a deadly Ebola virus strain named "Ebola Mayinga" (see Mayinga N'Seka ). As the Ebola virus epidemic in West Africa developed in 2014, a number of popular self-published and well-reviewed books containing sensational and misleading information about the disease appeared in electronic and printed formats. The authors of some such books admitted that they lacked medical credentials and were not technically qualified to give medical advice. The World Health Organization and the United Nations stated that such misinformation had contributed to the spread of the disease. Ebolavirus is classified as a biosafety level 4 agent, as well as a Category A bioterrorism agent by the Centers for Disease Control and Prevention. It has the potential to be weaponised for use in biological warfare , and was investigated by Biopreparat for such use, but might be difficult to prepare as a weapon of mass destruction because the virus becomes ineffective quickly in open air. Fake emails pretending to be Ebola information from the WHO or the Mexican government have, in 2014, been misused to spread computer malware. The BBC reported in 2015 that "North Korean state media has suggested the disease was created by the U.S. military as a biological weapon." Richard Preston 's 1995 best-selling book, The Hot Zone , dramatised the Ebola outbreak in Reston, Virginia. William Close 's 1995 Ebola: A Documentary Novel of Its First Explosion and 2002 Ebola: Through the Eyes of the People focused on individuals' reactions to the 1976 Ebola outbreak in Zaire. Tom Clancy 's 1996 novel, Executive Orders , involves a Middle Eastern terrorist attack on the United States using an airborne form of a deadly Ebola virus strain named "Ebola Mayinga" (see Mayinga N'Seka ). As the Ebola virus epidemic in West Africa developed in 2014, a number of popular self-published and well-reviewed books containing sensational and misleading information about the disease appeared in electronic and printed formats. The authors of some such books admitted that they lacked medical credentials and were not technically qualified to give medical advice. The World Health Organization and the United Nations stated that such misinformation had contributed to the spread of the disease. Ebola has a high mortality rate among primates. Frequent outbreaks of Ebola may have resulted in the deaths of 5,000 gorillas. Outbreaks of Ebola may have been responsible for an 88% decline in tracking indices of observed chimpanzee populations in the 420 km 2 Lossi Sanctuary between 2002 and 2003. Transmission among chimpanzees through meat consumption constitutes a significant risk factor, whereas contact between the animals, such as touching dead bodies and grooming, is not. Recovered gorilla carcasses have contained multiple Ebola virus strains, suggesting multiple introductions of the virus. Bodies decompose quickly and carcasses are not infectious after three to four days. Contact between gorilla groups is rare, suggesting that transmission among gorilla groups is unlikely, and that outbreaks result from transmission between viral reservoirs and animal populations. In 2012, it was demonstrated that the virus can travel without contact from pigs to nonhuman primates, although the same study failed to achieve transmission in that manner between primates. Dogs may become infected with EBOV but not develop symptoms. Dogs in some parts of Africa scavenge for food, and they sometimes eat EBOV-infected animals and also the corpses of humans. A 2005 survey of dogs during an EBOV outbreak found that although they remain asymptomatic, about 32 percent of dogs closest to an outbreak showed a seroprevalence for EBOV versus nine percent of those farther away. The authors concluded that there were "potential implications for preventing and controlling human outbreaks." In late 1989, Hazelton Research Products' Reston Quarantine Unit in Reston, Virginia , had an outbreak of fatal illness amongst certain lab monkeys. This lab outbreak was initially diagnosed as simian haemorrhagic fever virus (SHFV) and occurred amongst a shipment of crab-eating macaque monkeys imported from the Philippines. Hazelton's veterinary pathologist in Reston sent tissue samples from dead animals to the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, Maryland , where an ELISA test indicated the antibodies present in the tissue were a response to Ebola virus and not SHFV. An electron microscopist from USAMRIID discovered filoviruses similar in appearance, in crystalloid aggregates and as single filaments with a shepherd's hook, to Ebola in the tissue samples sent from Hazelton Research Products' Reston Quarantine Unit. A US Army team headquartered at USAMRIID euthanised the surviving monkeys, and brought all the dead monkeys to Fort Detrick for study by the Army's veterinary pathologists and virologists, and eventual disposal under safe conditions. Blood samples were taken from 178 animal handlers during the incident. Of those, six animal handlers eventually seroconverted , including one who had cut himself with a bloody scalpel. Despite its status as a Level‑4 organism and its apparent pathogenicity in monkeys, when the handlers did not become ill, the CDC concluded that the virus had a very low pathogenicity to humans. The Philippines and the United States had no previous cases of Ebola infection, and upon further isolation, researchers concluded it was another strain of Ebola, or a new filovirus of Asian origin, which they named Reston ebolavirus (RESTV) after the location of the incident. Reston virus (RESTV) can be transmitted to pigs. Since the initial outbreak it has since been found in nonhuman primates in Pennsylvania, Texas, and Italy, where the virus had infected pigs. According to the WHO, routine cleaning and disinfection of pig (or monkey) farms with sodium hypochlorite or detergents should be effective in inactivating the Reston ebolavirus . Pigs that have been infected with RESTV tend to show symptoms of the disease. Ebola has a high mortality rate among primates. Frequent outbreaks of Ebola may have resulted in the deaths of 5,000 gorillas. Outbreaks of Ebola may have been responsible for an 88% decline in tracking indices of observed chimpanzee populations in the 420 km 2 Lossi Sanctuary between 2002 and 2003. Transmission among chimpanzees through meat consumption constitutes a significant risk factor, whereas contact between the animals, such as touching dead bodies and grooming, is not. Recovered gorilla carcasses have contained multiple Ebola virus strains, suggesting multiple introductions of the virus. Bodies decompose quickly and carcasses are not infectious after three to four days. Contact between gorilla groups is rare, suggesting that transmission among gorilla groups is unlikely, and that outbreaks result from transmission between viral reservoirs and animal populations. In 2012, it was demonstrated that the virus can travel without contact from pigs to nonhuman primates, although the same study failed to achieve transmission in that manner between primates. Dogs may become infected with EBOV but not develop symptoms. Dogs in some parts of Africa scavenge for food, and they sometimes eat EBOV-infected animals and also the corpses of humans. A 2005 survey of dogs during an EBOV outbreak found that although they remain asymptomatic, about 32 percent of dogs closest to an outbreak showed a seroprevalence for EBOV versus nine percent of those farther away. The authors concluded that there were "potential implications for preventing and controlling human outbreaks."In late 1989, Hazelton Research Products' Reston Quarantine Unit in Reston, Virginia , had an outbreak of fatal illness amongst certain lab monkeys. This lab outbreak was initially diagnosed as simian haemorrhagic fever virus (SHFV) and occurred amongst a shipment of crab-eating macaque monkeys imported from the Philippines. Hazelton's veterinary pathologist in Reston sent tissue samples from dead animals to the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, Maryland , where an ELISA test indicated the antibodies present in the tissue were a response to Ebola virus and not SHFV. An electron microscopist from USAMRIID discovered filoviruses similar in appearance, in crystalloid aggregates and as single filaments with a shepherd's hook, to Ebola in the tissue samples sent from Hazelton Research Products' Reston Quarantine Unit. A US Army team headquartered at USAMRIID euthanised the surviving monkeys, and brought all the dead monkeys to Fort Detrick for study by the Army's veterinary pathologists and virologists, and eventual disposal under safe conditions. Blood samples were taken from 178 animal handlers during the incident. Of those, six animal handlers eventually seroconverted , including one who had cut himself with a bloody scalpel. Despite its status as a Level‑4 organism and its apparent pathogenicity in monkeys, when the handlers did not become ill, the CDC concluded that the virus had a very low pathogenicity to humans. The Philippines and the United States had no previous cases of Ebola infection, and upon further isolation, researchers concluded it was another strain of Ebola, or a new filovirus of Asian origin, which they named Reston ebolavirus (RESTV) after the location of the incident. Reston virus (RESTV) can be transmitted to pigs. Since the initial outbreak it has since been found in nonhuman primates in Pennsylvania, Texas, and Italy, where the virus had infected pigs. According to the WHO, routine cleaning and disinfection of pig (or monkey) farms with sodium hypochlorite or detergents should be effective in inactivating the Reston ebolavirus . Pigs that have been infected with RESTV tend to show symptoms of the disease. As of July 2015 [ update ] , no medication has been proven safe and effective for treating Ebola. By the time the Ebola virus epidemic in West Africa began in 2013, there were at least nine different candidate treatments. Several trials were conducted in late 2014, and early 2015, but some were abandoned due to lack of efficacy or lack of people to study. As of August 2019 [ update ] , two experimental treatments known as atoltivimab/maftivimab/odesivimab and ansuvimab were found to be 90% effective. The diagnostic tests currently available require specialised equipment and highly trained personnel. Since there are few suitable testing centres in West Africa, this leads to delay in diagnosis. On 29 November 2014, a new 15-minute Ebola test was reported that if successful, "not only gives patients a better chance of survival, but it prevents transmission of the virus to other people." The new equipment, about the size of a laptop and solar-powered, allows testing to be done in remote areas. On 29 December 2014, the U.S. Food and Drug Administration (FDA) approved the LightMix Ebola Zaire rRT-PCR test for patients with symptoms of Ebola. Animal models and in particular non-human primates are being used to study different aspects of Ebola virus disease. Developments in organ-on-a-chip technology have led to a chip-based model for Ebola haemorrhagic syndrome. As of July 2015 [ update ] , no medication has been proven safe and effective for treating Ebola. By the time the Ebola virus epidemic in West Africa began in 2013, there were at least nine different candidate treatments. Several trials were conducted in late 2014, and early 2015, but some were abandoned due to lack of efficacy or lack of people to study. As of August 2019 [ update ] , two experimental treatments known as atoltivimab/maftivimab/odesivimab and ansuvimab were found to be 90% effective. The diagnostic tests currently available require specialised equipment and highly trained personnel. Since there are few suitable testing centres in West Africa, this leads to delay in diagnosis. On 29 November 2014, a new 15-minute Ebola test was reported that if successful, "not only gives patients a better chance of survival, but it prevents transmission of the virus to other people." The new equipment, about the size of a laptop and solar-powered, allows testing to be done in remote areas. On 29 December 2014, the U.S. Food and Drug Administration (FDA) approved the LightMix Ebola Zaire rRT-PCR test for patients with symptoms of Ebola. Animal models and in particular non-human primates are being used to study different aspects of Ebola virus disease. Developments in organ-on-a-chip technology have led to a chip-based model for Ebola haemorrhagic syndrome.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Jordi_Casals_i_Ariet/html

Jordi Casals i Ariet

Jordi Casals i Ariet (born 15 May 1911, Viladrau , Osona , Spain; died 10 February 2004) was a Catalan physician and epidemiologist . Casals' major legacies include his work on viral taxonomy , especially for insect-borne viruses , and significant improvements in safety in the handling of dangerous pathogens in laboratory settings. The latter stem in part from an incident in 1969 at Yale where Casals barely survived the Lassa fever he contracted while studying the virus in the laboratory, and another staff member, Juan Roman, died.Casals served in the Spanish Army before studying medicine in Barcelona, where he graduated in 1934. He remained as an intern at Hospital Clínic de Barcelona until 1936, when he emigrated to the United States during the Spanish Civil War . [ citation needed ]After graduating from medical school in Barcelona, Casals moved to New York in 1936, and first worked in the Department of Pathology at Cornell University Medical College in New York. In 1938, he moved to the Rockefeller Institute of Medical Research (now Rockefeller University) in Manhattan. There he began his research on classifying viruses which later became one of his most important legacies. In 1952, Casals joined the Rockefeller Foundation , where he worked on analysis of samples collected in the field. His collection of viral disease agents gathered during this period was the germ of the future reference collection at the World Health Organization . In 1964, the Rockefeller Foundation moved its insect-borne disease group to Yale University, and in 1965 Casals therefore moved to New Haven and was appointed professor of epidemiology at Yale University (within the Rockefeller Foundation). In 1969 he became deathly ill while investigating Lassa virus, and barely survived; a technician fell ill several months later and died. [ citation needed ] Casals went on to investigate the Lassa outbreaks in West Africa. In 1973, biologists in Sierra Leone , with the help of teams from Yale and the CDC, determined that the Lassa virus was being passed to humans from wild rats. Casals also continued his sample collection, collaborating with the CDC to establish what eventually became the World Health Organization's reference collection of arboviruses . Casals left Yale in 1981 for Mount Sinai School of Medicine . and remained there until his death. His last paper was published in 1998. Jordi Casals carried out noted studies on multiple diseases, including Lassa fever . He identified Lassa virus and a large number of other pathogens; among them, the Zika virus . Casals was a consultant for numerous health institutions and organizations, and was awarded the Kimble Methodology Award by the American Public Health Association for his scientific curriculum. He was considered a world authority in the field of viruses, especially arboviruses . [ citation needed ] Casals collaborated with many institutions during his career, such as the WHO , the United States National Institute of Mental Health , and was elected to many U.S. and international societies. He worked with hundreds of scientists worldwide during his career, and was known for his scientific accuracy and professional ethics. In January 1969, missionary nurse Laura Wine fell ill with a mysterious disease she contracted from an obstetrical patient in the Lassa Mission Hospital where she worked in Lassa, Nigeria a village in Borno State . She was then airlifted to a better-equipped hospital Jos , Nigeria where she died the next day. Subsequently, two other nurses at the Jos hospital became infected, Charlotte Shaw, who died, and fifty-two-year-old nurse Lily Pinneo, commonly known as Penny, who had cared for Wine. Pinneo was flown to New York, along with tissues from other patients and victims, and treated for nine weeks at Columbia Presbyterian Hospital, and survived. A specialist in tropical diseases at the Columbia Presbyterian provided samples from Pinneo to the Yale Arbovirus Research Unit. While at Yale, Casals and his team studied new viruses from Africa, and he identified an unknown virus in the blood of three American nurses who had been missionaries in Nigeria, in the village of Lassa in the Borno State in the northeastern part of the country. The newly isolated virus was named after the village. In June 1969, three months after Lassa fever reached Yale University, Casals fell ill with a fever and cold-like symptoms, with chills and severe muscle pain. On 15 June, he was placed in an isolation unit. He had been tested for Lassa, but the results wouldn't be known for four days, and it was uncertain that he would survive that long. The decision was made for him to be inoculated with antibodies from nurse Lily Pinneo (convalescing at home in Rochester, New York), a decision researchers made according to Robert W. McCollum, chief of epidemiology. Casals recovered, and resumed his research. [ citation needed ] In December 1969, a technician at the laboratory was admitted to a hospital in Pennsylvania where he was visiting his family, with a fever of 105 °F (41 °C) and in acute distress. Antibiotics and other courses of treatment were prescribed, but he died five days later. A blood test confirmed the presence of Lassa virus . Although he worked at the Yale Arbovirus Research Unit where researchers were investigating the Lassa virus, he did not work in the actual facility where the virus was present, and he had no known contact with the virus. After his death, forty-one hospital personnel who had been in contact with him and seven family members were put under intense surveillance for two weeks in Pennsylvania, and in Puerto Rico where he was buried, but all managed to escape the infection. Casals confirmed that Ramon had succumbed to Lassa Fever . This chilling information caused the group investigating the live virus to stop their investigation, and all samples were sent to a maximum security laboratory at the Center for Disease Control (CDC). In January 1969, missionary nurse Laura Wine fell ill with a mysterious disease she contracted from an obstetrical patient in the Lassa Mission Hospital where she worked in Lassa, Nigeria a village in Borno State . She was then airlifted to a better-equipped hospital Jos , Nigeria where she died the next day. Subsequently, two other nurses at the Jos hospital became infected, Charlotte Shaw, who died, and fifty-two-year-old nurse Lily Pinneo, commonly known as Penny, who had cared for Wine. Pinneo was flown to New York, along with tissues from other patients and victims, and treated for nine weeks at Columbia Presbyterian Hospital, and survived. A specialist in tropical diseases at the Columbia Presbyterian provided samples from Pinneo to the Yale Arbovirus Research Unit. While at Yale, Casals and his team studied new viruses from Africa, and he identified an unknown virus in the blood of three American nurses who had been missionaries in Nigeria, in the village of Lassa in the Borno State in the northeastern part of the country. The newly isolated virus was named after the village. In June 1969, three months after Lassa fever reached Yale University, Casals fell ill with a fever and cold-like symptoms, with chills and severe muscle pain. On 15 June, he was placed in an isolation unit. He had been tested for Lassa, but the results wouldn't be known for four days, and it was uncertain that he would survive that long. The decision was made for him to be inoculated with antibodies from nurse Lily Pinneo (convalescing at home in Rochester, New York), a decision researchers made according to Robert W. McCollum, chief of epidemiology. Casals recovered, and resumed his research. [ citation needed ] In December 1969, a technician at the laboratory was admitted to a hospital in Pennsylvania where he was visiting his family, with a fever of 105 °F (41 °C) and in acute distress. Antibiotics and other courses of treatment were prescribed, but he died five days later. A blood test confirmed the presence of Lassa virus . Although he worked at the Yale Arbovirus Research Unit where researchers were investigating the Lassa virus, he did not work in the actual facility where the virus was present, and he had no known contact with the virus. After his death, forty-one hospital personnel who had been in contact with him and seven family members were put under intense surveillance for two weeks in Pennsylvania, and in Puerto Rico where he was buried, but all managed to escape the infection. Casals confirmed that Ramon had succumbed to Lassa Fever . This chilling information caused the group investigating the live virus to stop their investigation, and all samples were sent to a maximum security laboratory at the Center for Disease Control (CDC). Although Casals and his coworkers recognized the dangerous nature of Lassa virus, and had implemented special safety protocols, Casals contracted Lassa fever in June 1969 nevertheless, and nearly died from it. A few months later, technician Juan Roman became ill and died, even though he never worked directly in the laboratory or dealt with the virus. It was never determined how the two of them contracted the virus, although one theory was dust kicked up by lab mice. The chilling effect of this caused the laboratory to halt work on the virus, and transfer the samples to the CDC maximum-security lab. According to Dr. Gregory Tignor, a retired Yale professor who worked with Dr. Casals, "It took great courage to work with viruses in those days because every worker knew that his or her life was in danger." The events at the Yale laboratory had a major impact in the handling of dangerous viruses. Yale biological safety officer Ben Fontes gave credit to the "extremely careful" protocols Casals had designed for preventing a more serious outbreak, and said that "The incident forced changes to biosafety nationally, and was one of the seminal events in [bringing about modern] biosafety. Following the incidents at the Yale lab and other labs nationally, a classification system was developed to label the danger level of handling different viruses or other biological agents. As a result, pathogens like Lassa and unidentified new ones were sent to the most secure facilities. Casals helped identify and classify a thousand viruses. Lassa is one of many he discovered. He is considered an authority on viral taxonomy because of his landmark classification of pathogenic viruses, especially mosquito- and other insect-borne viruses, among which is the Zika virus . He also was the first to establish the fact that some viruses that cause infections in the same organ, such as polio, encephalitis, or rabies viruses in the central nervous system, are not from the same family but belong to different families. Casals had polio as a child, and as a result walked with a limp in adulthood. He was married to Ellen Casals.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Emerging_infectious_disease/html

Emerging infectious disease

An emerging infectious disease ( EID ) is an infectious disease whose incidence has increased recently (in the past 20 years), and could increase in the near future. The minority that are capable of developing efficient transmission between humans can become major public and global concerns as potential causes of epidemics or pandemics . Their many impacts can be economic and societal , as well as clinical. EIDs have been increasing steadily since at least 1940. For every decade since 1940, there has been a consistent increase in the number of EID events from wildlife-related zoonosis . Human activity is the primary driver of this increase, with loss of biodiversity a leading mechanism. Emerging infections account for at least 12% of all human pathogens . EIDs can be caused by newly identified microbes , including novel species or strains of virus (e.g. novel coronaviruses , ebolaviruses , HIV ). Some EIDs evolve from a known pathogen, as occurs with new strains of influenza . EIDs may also result from spread of an existing disease to a new population in a different geographic region, as occurs with West Nile fever outbreaks . Some known diseases can also emerge in areas undergoing ecologic transformation (as in the case of Lyme disease ). Others can experience a resurgence as a re-emerging infectious disease , like tuberculosis (following drug resistance ) or measles . Nosocomial (hospital-acquired) infections, such as methicillin-resistant Staphylococcus aureus are emerging in hospitals, and are extremely problematic in that they are resistant to many antibiotics. Of growing concern are adverse synergistic interactions between emerging diseases and other infectious and non-infectious conditions leading to the development of novel syndemics . Many EID are zoonotic , deriving from pathogens present in animals, with only occasional cross-species transmission into human populations. For instance, most emergent viruses are zoonotic (whereas other novel viruses may have been circulating in the species without being recognized, as occurred with hepatitis C ).The French doctor Charles Anglada (1809–1878) wrote a book in 1869 on extinct and new diseases. He did not distinguish infectious diseases from others (he uses the terms reactive and affective diseases, to mean diseases with an external or internal cause, more or less meaning diseases with or without an observable external cause). He writes in the introduction: A widely held opinion among physicians admits the invariability of pathologies. All the illnesses which have existed or which have an outbreak around us are categorized according to arrested and preconceived types, and must enter one way or the other into the frameworks established by the nosologists. History and observation protest wildly against this prejudice, and this is what they teach: Diseases which have disappeared and whose traces are confined to the archives of science, are followed by other diseases, unknown to the contemporary generation, and which come for the first time to assert their rights. In other words, there are extinct and new diseases. Charles Nicolle , laureate of the Nobel Prize in Physiology or Medicine elaborated the concept of emergence of diseases in his 1930 book Naissance, vie et mort des maladies infectieuses (Birth, Life and Death of Infectious Diseases), and later in Destin des maladies infectieuses (Fate of Infectious Diseases) published in 1933 which served as lecture notes for his teaching of a second year course at the Collège de France . In the introduction of the book he sets out the program of the lectures: It is this historical existence, this destiny that will be the subject of our talks. I will have to answer, to the extent that our current knowledge allows, questions that you have asked yourself, that every thoughtful or simply curious mind asks: have the infectious diseases that we observe today always existed? Or have some of them appeared in the course of history? Can we assume that new ones will appear? Can we assume that some of these diseases will disappear? Have some of them already disappeared? Finally, what will become of humanity and domestic animals if, as a result of more and more frequent contacts between people, the number of infectious diseases continues to increase? The term emerging disease has been in use in scientific publications since the beginning of the 1960s at least and is used in the modern sense by David Sencer in his 1971 article "Emerging Diseases of Man and Animals" where in the first sentence of the introduction he implicitly defines emerging diseases as "infectious diseases of man and animals currently emerging as public health problems" and as a consequence also includes re-emerging diseases: Infectious diseases of man and animals currently emerging as public health problems include some old acquaintances and some that are new in respect to identity or concept. He also notes that some infectious agents are newly considered as diseases because of changing medical technologies: But there are also many familiar organisms formerly considered nonpathogenic that are now associated with nosocomial infections, use of artificial kidneys, and the acceptance or rejection of organ transplants, for example. He concludes the introduction with a word of caution: And so infectious disease, one of man's oldest enemies, survives as an adversary that calls forth our best efforts. However, to many people in the 1960s and 1970s the emergence of new diseases appeared as a marginal problem, as illustrated by the introduction to the 1962 edition of Natural History of Infectious Disease by Macfarlane Burnet : to write about infectious disease is almost to write of something that has passed into history as well as the epilogue of the 1972 edition: On the basis of what has happened in the last thirty years, can we forecast any likely developments for the 1970s? If for the present we retain a basic optimism and assume no major catastrophes occur [...] the most likely forecast about the future of infectious disease is that it will be very dull. There may be some wholly unexpected emergence of a new and dangerous infectious disease, but nothing of the sort has marked the past fifty years. The concept gained more interest at the end of the 1980s as a reaction to the AIDS epidemic . On the side of epistemology, Mirko Grmek worked on the concept of emerging diseases while writing his book on the history of AIDS and later in 1993 published an article about the concept of emerging disease as a more precise notion than the term "new disease" that was mostly used in France at that time to qualify AIDS among others. Also under the shock of the emergence of AIDS, epidemiologists wanted to take a more active approach to anticipate and prevent the emergence of new diseases. Stephen S. Morse from The Rockefeller University in New York was chair and principal organizer of the NIAID / NIH Conference "Emerging Viruses: The Evolution of Viruses and Viral Diseases" held 1–3 May 1989 in Washington, DC. In the article summarizing the conference the authors write: Challenged by the sudden appearance of AIDS as a major public health crisis [...] jointly sponsored the conference "Emerging Viruses: The Evolution of Viruses and Viral Diseases" [...] It was convened to consider the mechanisms of viral emergence and possible strategies for anticipating, detecting, and preventing the emergence of new viral diseases in the future. They further note: Surprisingly, most emergent viruses are zoonotic, with natural animal reservoirs a more frequent source of new viruses than is the sudden evolution of a new entity. The most frequent factor in emergence is human behavior that increases the probability of transfer of viruses from their endogenous animal hosts to man. In a 1991 paper Morse underlines how the emergence of new infectious diseases (of which the public became aware through the AIDS epidemic) is the opposite of the then generally expected retreat of these diseases: The striking successes achieved with antibiotics, together with widespread application of vaccines for many previously feared viral diseases, made it appear to many physicians and the public that infectious diseases were retreating and would in time be fully conquered. Although this view was disputed by virologists and many specialists in infectious diseases, it had become a commonplace to suggest that infectious diseases were about to become a thing of the past [...]. As a direct consequence of the 1989 conference on emerging viruses, the Institute Of Medicine convened in February 1991 the 19-member multidisciplinary Committee on Emerging Microbial Threats to Health, co-chaired by Joshua Lederberg and Robert Shope , to conduct an 18-month study. According to the report produced by the committee in 1992, its charge "was to identify significant emerging infectious diseases, determine what might be done to deal with them, and recommend how similar future threats might be confronted to lessen their impact on public health." The report recommended setting up a surveillance program to recognize emerging diseases and proposed methods of intervention in case an emergent disease was discovered. A well-designed, well-implemented surveillance program can detect unusual clusters of disease, document the geographic and demographic spread of an outbreak, and estimate the magnitude of the problem. It can also help to describe the natural history of a disease, identify factors responsible for emergence, facilitate laboratory and epidemiological research, and assess the success of specific intervention efforts. The proposed interventions were based on the following: the U.S. public health system, research and training, vaccine and drug development, vector control, public education and behavioral change. A few years after the 1989 Emerging Viruses conference and the 1992 IOM report, the Program for Monitoring Emerging Diseases (ProMED) was formed by a group of scientists as a follow-up in 1994 and the Centres for Disease Control (CDC) launched the Emerging Infectious Diseases journal in 1995. A decade later the IOM convened the Committee on Emerging Microbial Threats to Health in the 21st Century which published its conclusions in 2003. In April 2000 the WHO organized a meeting on Global Outbreak Alert and Response, which was the founding act of the Global Outbreak Alert and Response Network . In 2014, the Western African Ebola virus epidemic demonstrated how ill-prepared the world was to handle such an epidemic. In response, the Coalition for Epidemic Preparedness Innovation was launched at the World Economic Forum in 2017 with the objective of accelerating the development of vaccines against emerging infectious diseases to be able to offer them to affected populations during outbreaks. CEPI promotes the idea that a proactive approach is required to "create a world in which epidemics are no longer a threat to humanity". One way to classify emerging infections diseases is by time and how humans were involved in the emergence: The 1992 IOM report distinguished 6 factors contributing to emergence of new diseases (Microbial adaptation and change; Economic development and land use; Human demographics and behavior; International travel and commerce; Technology and industry; Breakdown of public health measures) which were extended to 13 factors in the 2003 report (Chapter 3 of the report detailing each of them) Microbial adaptation and change Human susceptibility to infection Climate and weather Changing ecosystems Human demographics and behavior Economic development and land use International travel and commerce Technology and industry Breakdown of public health measures Poverty and social inequality War and famine Lack of political will Intent to harm Their classification serves as a basis for many others. The following table gives examples for different factors:Emerging infectious diseases between human, animal have become a significant concern in recent years, playing a crucial role in the occurrence and spread of diseases. Human population growth, increased proximity to wildlife, and climate change have created favorable conditions for the transmission of zoonotic diseases, leading to outbreaks such as Zika, Ebola, and COVID-19. The One Health approach, which integrates animal, human, and environmental health, has emerged as a crucial tool for monitoring and mitigating the spread of infectious diseases. Zoonotic diseases , originating from animal sources, pose a significant threat to human health. Up to 75% of emerging infectious diseases are zoonotic, originating from viruses and other pathogens that are transmitted from animals to humans. Understanding the mechanisms of transmission, the role of wildlife trade, and the importance of surveillance and early detection is crucial for mitigating the impact of zoonotic diseases on human health. Surveillance efforts involving wastewater have been identified as valuable tools for detecting early warning signs of disease emergence and providing timely interventions. The U.S. National Institute of Allergy and Infectious Diseases (NIAID) maintains a list of Biodefense and Emerging Infectious Diseases. The list is categorized by biodefense risk, which is mostly based on biological warfare and bioterrorism considerations. As of 2004, it recognized the following emerging and re-emerging diseases. Re-emerging: Diseases with bioterrorism potential, CDC category A (most dangerous): Diseases with bioterrorism potential, CDC category B: Diseases with bioterrorism potential, CDC category C (least dangerous): Since 2004, NIAID has added to its biodefense emerging pathogen list: In December 2015, the World Health Organization held a workshop on prioritization of pathogens "for accelerated R&D for severe emerging diseases with potential to generate a public health emergency, and for which no, or insufficient, preventive and curative solutions exist." The result was a list containing the following six diseases: These were selected based on the following measures: Human transmissibility (including population immunity, behavioural factors, etc.) Severity or case fatality rate Spillover potential Evolutionary potential Available countermeasures Difficulty of detection or control Public health context of the affected area(s) Potential scope of outbreak (risk of international spread) Potential societal impacts In 2007 Mark Woolhouse and Eleanor Gaunt established a list of 87 human pathogens first reported in the period between 1980 and 2005. These were classified according to their types. known in 2005 reported from 1980 to 2005 The following table summarizes the major outbreaks since 1998 caused by emerging or re-emerging infectious diseases. The U.S. National Institute of Allergy and Infectious Diseases (NIAID) maintains a list of Biodefense and Emerging Infectious Diseases. The list is categorized by biodefense risk, which is mostly based on biological warfare and bioterrorism considerations. As of 2004, it recognized the following emerging and re-emerging diseases. Re-emerging: Diseases with bioterrorism potential, CDC category A (most dangerous): Diseases with bioterrorism potential, CDC category B: Diseases with bioterrorism potential, CDC category C (least dangerous): Since 2004, NIAID has added to its biodefense emerging pathogen list: In December 2015, the World Health Organization held a workshop on prioritization of pathogens "for accelerated R&D for severe emerging diseases with potential to generate a public health emergency, and for which no, or insufficient, preventive and curative solutions exist." The result was a list containing the following six diseases: These were selected based on the following measures: Human transmissibility (including population immunity, behavioural factors, etc.) Severity or case fatality rate Spillover potential Evolutionary potential Available countermeasures Difficulty of detection or control Public health context of the affected area(s) Potential scope of outbreak (risk of international spread) Potential societal impactsIn 2007 Mark Woolhouse and Eleanor Gaunt established a list of 87 human pathogens first reported in the period between 1980 and 2005. These were classified according to their types. known in 2005 reported from 1980 to 2005The following table summarizes the major outbreaks since 1998 caused by emerging or re-emerging infectious diseases. Methicillin-resistant Staphylococcus aureus (MRSA) evolved from methicillin-susceptible Staphylococcus aureus (MSSA), otherwise known as common S. aureus . Many people are natural carriers of S. aureus , without being affected in any way. MSSA was treatable with the antibiotic methicillin until it acquired the gene for antibiotic resistance. Through genetic mapping of various strains of MRSA, scientists have found that MSSA acquired the mecA gene in the 1960s, which accounts for its pathogenicity, before this it had a predominantly commensal relationship with humans. It is theorized that when this S. aureus strain that had acquired the mecA gene was introduced into hospitals, it came into contact with other hospital bacteria that had already been exposed to high levels of antibiotics. When exposed to such high levels of antibiotics, the hospital bacteria suddenly found themselves in an environment that had a high level of selection for antibiotic resistance, and thus resistance to multiple antibiotics formed within these hospital populations. When S. aureus came into contact with these populations, the multiple genes that code for antibiotic resistance to different drugs were then acquired by MRSA, making it nearly impossible to control. It is thought that MSSA acquired the resistance gene through the horizontal gene transfer , a method in which genetic information can be passed within a generation, and spread rapidly through its own population as was illustrated in multiple studies. Horizontal gene transfer speeds the process of genetic transfer since there is no need to wait an entire generation time for gene to be passed on. Since most antibiotics do not work on MRSA, physicians have to turn to alternative methods based in Darwinian medicine . However, prevention is the most preferred method of avoiding antibiotic resistance. By reducing unnecessary antibiotic use in human and animal populations, antibiotics resistance can be slowed. On 16 July 2021, the Director-General of WHO announced the formation of the Scientific Advisory Group for Origins of Novel Pathogens (SAGO), which is to be a permanent advisory body of the organisation. The Group was formed with a broad objective to examine emerging infectious diseases, including COVID-19 . According to the WHO Director-General, "SAGO will play a vital role in the next phase of studies into the origins of SARS-CoV-2, as well as the origins of future new pathogens." Methicillin-resistant Staphylococcus aureus (MRSA) evolved from methicillin-susceptible Staphylococcus aureus (MSSA), otherwise known as common S. aureus . Many people are natural carriers of S. aureus , without being affected in any way. MSSA was treatable with the antibiotic methicillin until it acquired the gene for antibiotic resistance. Through genetic mapping of various strains of MRSA, scientists have found that MSSA acquired the mecA gene in the 1960s, which accounts for its pathogenicity, before this it had a predominantly commensal relationship with humans. It is theorized that when this S. aureus strain that had acquired the mecA gene was introduced into hospitals, it came into contact with other hospital bacteria that had already been exposed to high levels of antibiotics. When exposed to such high levels of antibiotics, the hospital bacteria suddenly found themselves in an environment that had a high level of selection for antibiotic resistance, and thus resistance to multiple antibiotics formed within these hospital populations. When S. aureus came into contact with these populations, the multiple genes that code for antibiotic resistance to different drugs were then acquired by MRSA, making it nearly impossible to control. It is thought that MSSA acquired the resistance gene through the horizontal gene transfer , a method in which genetic information can be passed within a generation, and spread rapidly through its own population as was illustrated in multiple studies. Horizontal gene transfer speeds the process of genetic transfer since there is no need to wait an entire generation time for gene to be passed on. Since most antibiotics do not work on MRSA, physicians have to turn to alternative methods based in Darwinian medicine . However, prevention is the most preferred method of avoiding antibiotic resistance. By reducing unnecessary antibiotic use in human and animal populations, antibiotics resistance can be slowed.On 16 July 2021, the Director-General of WHO announced the formation of the Scientific Advisory Group for Origins of Novel Pathogens (SAGO), which is to be a permanent advisory body of the organisation. The Group was formed with a broad objective to examine emerging infectious diseases, including COVID-19 . According to the WHO Director-General, "SAGO will play a vital role in the next phase of studies into the origins of SARS-CoV-2, as well as the origins of future new pathogens."

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Venezuelan_hemorrhagic_fever/html

Venezuelan hemorrhagic fever

Guanarito virus Venezuelan hemorrhagic fever ( VHF ) is a zoonotic human illness first identified in 1989. The disease is most prevalent in several rural areas of central Venezuela and is caused by Guanarito mammarenavirus ( GTOV ) which belongs to the Arenaviridae family. The short-tailed cane mouse ( Zygodontomys brevicauda ) is the main host for GTOV which is spread mostly by inhalation of aerosolized droplets of saliva, respiratory secretions, urine, or blood from infected rodents. Person-to-person spread is possible, but uncommon.VHF has many similarities to Lassa fever and to the arenavirus hemorrhagic fevers that occur in Argentina and Bolivia. It causes fever and malaise followed by hemorrhagic manifestations and convulsions. Some presentations of the virus are also characterized by vascular damage, bleeding diathesis, fever, and multiple organ involvement. Clinical diagnosis of VHF has proven to be difficult based on the nonspecific symptoms . The disease is fatal in 30% of cases and is endemic to Portuguesa state and Barinas state in Venezuela . Treatment and prevention for the VHF virus are limited and there are currently no licensed vaccines available that can act to prevent the disease. However, once infected, ribavirin , an anti-viral drug given intravenously, is one way to treat VHF.Arenaviruses are enveloped, single-stranded, bisegmented RNA viruses with antisense genomes. Based on their antigenic properties, arenaviruses have been classified into two major groups: the Old World arenaviruses, and the New World arenaviruses. Old World arenaviruses include lymphocytic choriomeningitis virus and Lassa virus . New world arena viruses are further broken down into three clades, A, B, and C. The Guanarito arena virus belongs to clade B and is the cause of VHF. On the biosafety level scale of one to four, with four causing the most risk, the viruses causing hemorrhagic fevers have been assigned a four by the CDC. The short-tailed cane mouse, the main host of GTOV, is native to western Venezuela and resides in large numbers in tall grass, cultivated agricultural fields, human homes, and outbuildings. It is speculated that demographic and ecological changes in the rural areas increased the frequency of contact between humans and infected rodents such that VHF emerged. From September 1989 through December 2006, the State of Portuguesa recorded 618 cases of VHF. Nearly all of the cases were individuals who worked or lived in Guanarito during the time they became infected. The case fatality rate was 23.1%. Because the virus is contracted by aerosol dissemination, concern arose shortly after the first cases emerged in 1989 due to fear of biological warfare . Potential biological terrorism agents were identified and categorized in 1999 by the Centers for Disease Control and Prevention (CDC) as part of the Congressional initiative to further response capabilities to biological weapons. Arenaviruses causing hemorrhagic fevers , along with a genus of virus called filoviruses, were categorized in Category A; these are pathogens with the highest potential impact on public health safety. A notable event in the timeline of this virus' scientific knowledge was the unexplained disappearance of a vial of the virus at the University of Texas Medical Branch Galveston National Laboratory, announced 2013 March 24.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Rift_Valley_fever/html

Rift Valley fever

Rift Valley fever ( RVF ) is a viral disease of humans and livestock that can cause mild to severe symptoms. The mild symptoms may include: fever , muscle pains , and headaches which often last for up to a week. The severe symptoms may include: loss of sight beginning three weeks after the infection, infections of the brain causing severe headaches and confusion , and bleeding together with liver problems which may occur within the first few days. Those who have bleeding have a chance of death as high as 50%. The disease is caused by the RVF virus . It is spread by either touching infected animal blood, breathing in the air around an infected animal being butchered , drinking raw milk from an infected animal, or the bite of infected mosquitoes . Animals such as cows, sheep, goats, and camels may be affected. In these animals it is spread mostly by mosquitoes. It does not appear that one person can infect another person. The disease is diagnosed by finding antibodies against the virus or the virus itself in the blood. Prevention of the disease in humans is accomplished by vaccinating animals against the disease. This must be done before an outbreak occurs because if it is done during an outbreak it may worsen the situation. Stopping the movement of animals during an outbreak may also be useful, as may decreasing mosquito numbers and avoiding their bites. There is a human vaccine ; however, as of 2010 it is not widely available. There is no specific treatment and medical efforts are supportive. Outbreaks of the disease have only occurred in Africa and Arabia . Outbreaks usually occur during periods of increased rain which increase the number of mosquitoes. The disease was first reported among livestock in Rift Valley of Kenya in the early 1900s, and the virus was first isolated in 1931. In humans, the virus can cause several syndromes. Usually, they have either no symptoms or only a mild illness with fever, headache , muscle pains , and liver abnormalities. In a small percentage of cases (< 2%), the illness can progress to hemorrhagic fever syndrome, meningoencephalitis (inflammation of the brain and tissues lining the brain ), or affect the eye. Patients who become ill usually experience fever, generalised weakness, back pain, dizziness, and weight loss at the onset of the illness. Typically, people recover within two to seven days after onset. About 1% of people with the disease die of it. In livestock, the fatality level is significantly higher. Pregnant livestock infected with RVF abort virtually 100% of foetuses. An epizootic (animal disease epidemic) of RVF is usually first indicated by a wave of unexplained abortions. [ citation needed ] Other signs in livestock include vomiting and diarrhea, respiratory disease, fever, lethargy, anorexia and sudden death in young animals. The virus belongs to the Bunyavirales order. This is an order of enveloped negative single stranded RNA viruses. All Bunyaviruses have an outer lipid envelope with two glycoproteins —G(N) and G(C)—required for cell entry. They deliver their genome into the host-cell cytoplasm by fusing their envelope with an endosomal membrane . [ citation needed ] The virus' G(C) protein has a class II membrane fusion protein architecture similar to that found in flaviviruses and alphaviruses . This structural similarity suggests that there may be a common origin for these viral families. [ citation needed ] The virus' 11.5 kb tripartite genome is composed of single-stranded RNA . As a Phlebovirus , it has an ambisense genome. Its L and M segments are negative-sense, but its S segment is ambisense. These three genome segments code for six major proteins: L protein ( viral polymerase ), the two glycoproteins G(N) and G(C), the nucleocapsid N protein, and the nonstructural NSs and NSm proteins. The virus is transmitted through mosquito vectors , as well as through contact with the tissue of infected animals. Two species— Culex tritaeniorhynchus and Aedes vexans —are known to transmit the virus. Other potential vectors include Aedes caspius , Aedes mcintosh , Aedes ochraceus , Culex pipiens , Culex antennatus , Culex perexiguus , Culex zombaensis and Culex quinquefasciatus . Contact with infected tissue is considered to be the main source of human infections. The virus has been isolated from two bat species: the Peter's epauletted fruit bat ( Micropteropus pusillus ) and the aba roundleaf bat ( Hipposideros abae ), which are believed to be reservoirs for the virus. The virus belongs to the Bunyavirales order. This is an order of enveloped negative single stranded RNA viruses. All Bunyaviruses have an outer lipid envelope with two glycoproteins —G(N) and G(C)—required for cell entry. They deliver their genome into the host-cell cytoplasm by fusing their envelope with an endosomal membrane . [ citation needed ] The virus' G(C) protein has a class II membrane fusion protein architecture similar to that found in flaviviruses and alphaviruses . This structural similarity suggests that there may be a common origin for these viral families. [ citation needed ] The virus' 11.5 kb tripartite genome is composed of single-stranded RNA . As a Phlebovirus , it has an ambisense genome. Its L and M segments are negative-sense, but its S segment is ambisense. These three genome segments code for six major proteins: L protein ( viral polymerase ), the two glycoproteins G(N) and G(C), the nucleocapsid N protein, and the nonstructural NSs and NSm proteins. The virus is transmitted through mosquito vectors , as well as through contact with the tissue of infected animals. Two species— Culex tritaeniorhynchus and Aedes vexans —are known to transmit the virus. Other potential vectors include Aedes caspius , Aedes mcintosh , Aedes ochraceus , Culex pipiens , Culex antennatus , Culex perexiguus , Culex zombaensis and Culex quinquefasciatus . Contact with infected tissue is considered to be the main source of human infections. The virus has been isolated from two bat species: the Peter's epauletted fruit bat ( Micropteropus pusillus ) and the aba roundleaf bat ( Hipposideros abae ), which are believed to be reservoirs for the virus. Although many components of the RVFV's RNA play an important role in the virus' pathology, the nonstructural protein encoded on the S segment (NSs) is the only component that has been found to directly affect the host. NSs is hostile and combative against the host interferon (IFNs) antiviral response. IFNs are essential in order for the immune system to fight off viral infections in a host. This inhibitory mechanism is believed to be due to a number of reasons, the first being, competitive inhibition of the formation of the transcription factor. On this transcription factor, NSs interacts with and binds to a subunit that is needed for RNA polymerase I and II. This interaction cause competitive inhibition with another transcription factor component and prevents the assembly process of the transcription factor complex, which results in the suppression of the host antiviral response. Transcription suppression is believed to be another mechanism of this inhibitory process. This occurs when an area of NSs interacts with and binds to the host's protein, SAP30 and forms a complex. This complex causes histone acetylation to regress, which is needed for transcriptional activation of the IFN promoter. This causes IFN expression to be obstructed. Lastly, NSs has also been known to affect regular activity of double-stranded RNA-dependent protein kinase R. This protein is involved in cellular antiviral responses in the host. When RVFV is able to enter the host's DNA, NSs forms a filamentous structure in the nucleus. This allows the virus to interact with specific areas of the host's DNA that relates to segregation defects and induction of chromosome continuity. This increases host infectivity and decreases the host's antiviral response. Diagnosis relies on viral isolation from tissues, or serological testing with an ELISA . Other methods of diagnosis include Nucleic Acid Testing (NAT), cell culture , and IgM antibody assays. As of September 2016, the Kenya Medical Research Institute (KEMRI) has developed a product called Immunoline, designed to diagnose the disease in humans much faster than in previous methods. A person's chances of becoming infected can be reduced by taking measures to decrease contact with blood, body fluids, or tissues of infected animals and protection against mosquitoes and other bloodsucking insects. Use of mosquito repellents and bed nets are two effective methods. For persons working with animals in RVF-endemic areas, wearing protective equipment to avoid any exposure to blood or tissues of animals that may potentially be infected is an important protective measure. Potentially, establishing environmental monitoring and case surveillance systems may aid in the prediction and control of future RVF outbreaks. No vaccines are currently available for humans. While a vaccines have been developed for humans, it has only been used experimentally for scientific personnel in high-risk environments. Trials of a number of vaccines, such as NDBR-103 and TSI-GSD 200, are ongoing. Different types of vaccines for veterinary use are available. The killed vaccines are not practical in routine animal field vaccination because of the need of multiple injections. Live vaccines require a single injection but are known to cause birth defects and abortions in sheep and induce only low-level protection in cattle. The live-attenuated vaccine, MP-12, has demonstrated promising results in laboratory trials in domesticated animals, but more research is needed before the vaccine can be used in the field. The live-attenuated clone 13 vaccine was recently registered and used in South Africa. Alternative vaccines using molecular recombinant constructs are in development and show promising results. A vaccine has been conditionally approved for use in animals in the US. It has been shown that knockout of the NSs and NSm nonstructural proteins of this virus produces an effective vaccine in sheep as well. RVF outbreaks occur across sub-Saharan Africa , with outbreaks occurring elsewhere infrequently. Outbreaks of this disease usually correspond with the warm phases of the EI Niño/Southern Oscillation. During this time there is an increase in rainfall, flooding and greenness of vegetation index , which leads to an increase in mosquito vectors. RVFV can be transmitted vertically in mosquitos, meaning that the virus can be passed from the mother to her offspring. During dry conditions, the virus can remain viable for a number of years in the egg. Mosquitos lay their eggs in water, where they eventually hatch. As water is essential for mosquito eggs to hatch, rainfall and flooding cause an increase in the mosquito population and an increased potential for the virus. The first documented outbreak was identified in Kenya in 1931, in sheep, cattle and humans; another severe outbreak in the country in 1950–1951 involved 100,000 deaths in livestock and an unrecorded number of humans with fever. An outbreak occurred in South Africa in 1974–1976, with more than 500,000 infected animals and the first deaths in humans. In Egypt in 1977–78, an estimated 200,000 people were infected and there were at least 594 deaths. In Kenya in 1998, the virus killed more than 400 people. [ citation needed ] Since then, there have been outbreaks in Saudi Arabia and Yemen (2000), [ citation needed ] East Africa (2006–2007) , Sudan (2007), South Africa (2010), Uganda (2016), Kenya (2018), and Mayotte (2018–2019). 2020–2021 in Kenya, in 2022 an outbreak is ongoing in Burundi.Rift Valley fever was one of more than a dozen agents that the United States researched as potential biological weapons before the nation suspended its biological weapons program in 1969. The disease is one of several identified by WHO as a likely cause of a future epidemic in a new plan developed after the Ebola epidemic for urgent research and development toward new diagnostic tests, vaccines and medicines.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/List_of_epidemics_and_pandemics/html

List of epidemics and pandemics

This is a list of the largest known epidemics and pandemics caused by an infectious disease . Widespread non-communicable diseases such as cardiovascular disease and cancer are not included. An epidemic is the rapid spread of disease to a large number of people in a given population within a short period of time; in meningococcal infections , an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic. Due to the long time spans, the first plague pandemic (6th century – 8th century) and the second plague pandemic (14th century – early 19th century) are shown by individual outbreaks, such as the Plague of Justinian (first pandemic) and the Black Death (second pandemic). Infectious diseases with high prevalence are listed separately (sometimes in addition to their epidemics), such as malaria , which may have killed 50–60 billion people throughout history, or about half of all humans that have ever lived. Ongoing epidemics and pandemics are in boldface . For a given epidemic or pandemic, the average of its estimated death toll range is used for ranking. If the death toll averages of two or more epidemics or pandemics are equal, then the smaller the range, the higher the rank. For the historical records of major changes in the world population, see world population . Not included in the above table are many waves of deadly diseases brought by Europeans to the Americas and Caribbean. Western Hemisphere populations were ravaged mostly by smallpox , but also typhus , measles , influenza , bubonic plague , cholera , malaria , tuberculosis , mumps , yellow fever , and pertussis . The lack of written records in many places and the destruction of many native societies by disease, war, and colonization make estimates uncertain. Deaths probably numbered in the tens or perhaps over a hundred million, with perhaps 90% of the population dead in the worst-hit areas. Lack of scientific knowledge about microorganisms and lack of surviving medical records for many areas makes attribution of specific numbers to specific diseases uncertain. There have been various major infectious diseases with high prevalence worldwide, but they are currently not listed in the above table as epidemics/pandemics due to the lack of definite data, such as time span and death toll.Ongoing epidemics and pandemics are in boldface . For a given epidemic or pandemic, the average of its estimated death toll range is used for ranking. If the death toll averages of two or more epidemics or pandemics are equal, then the smaller the range, the higher the rank. For the historical records of major changes in the world population, see world population . Not included in the above table are many waves of deadly diseases brought by Europeans to the Americas and Caribbean. Western Hemisphere populations were ravaged mostly by smallpox , but also typhus , measles , influenza , bubonic plague , cholera , malaria , tuberculosis , mumps , yellow fever , and pertussis . The lack of written records in many places and the destruction of many native societies by disease, war, and colonization make estimates uncertain. Deaths probably numbered in the tens or perhaps over a hundred million, with perhaps 90% of the population dead in the worst-hit areas. Lack of scientific knowledge about microorganisms and lack of surviving medical records for many areas makes attribution of specific numbers to specific diseases uncertain.There have been various major infectious diseases with high prevalence worldwide, but they are currently not listed in the above table as epidemics/pandemics due to the lack of definite data, such as time span and death toll.Events in boldface are ongoing.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Yellow_fever/html

Yellow fever

Yellow fever is a viral disease of typically short duration . In most cases, symptoms include fever , chills , loss of appetite , nausea , muscle pains—particularly in the back—and headaches . Symptoms typically improve within five days. In about 15% of people, within a day of improving the fever comes back, abdominal pain occurs, and liver damage begins causing yellow skin . If this occurs, the risk of bleeding and kidney problems is increased. The disease is caused by the yellow fever virus and is spread by the bite of an infected mosquito . It infects humans, other primates , and several types of mosquitoes. In cities, it is spread primarily by Aedes aegypti , a type of mosquito found throughout the tropics and subtropics . The virus is an RNA virus of the genus Flavivirus . The disease may be difficult to tell apart from other illnesses, especially in the early stages. To confirm a suspected case, blood-sample testing with a polymerase chain reaction is required. A safe and effective vaccine against yellow fever exists, and some countries require vaccinations for travelers. Other efforts to prevent infection include reducing the population of the transmitting mosquitoes. In areas where yellow fever is common, early diagnosis of cases and immunization of large parts of the population are important to prevent outbreaks . Once a person is infected, management is symptomatic; no specific measures are effective against the virus. Death occurs in up to half of those who get severe disease. In 2013, yellow fever was estimated to have caused 130,000 severe infections and 78,000 deaths in Africa. Approximately 90 percent of an estimated 200,000 cases of yellow fever per year occur in Africa. Nearly a billion people live in an area of the world where the disease is common. It is common in tropical areas of the continents of South America and Africa, but not in Asia. Since the 1980s, the number of cases of yellow fever has been increasing. This is believed to be due to fewer people being immune, more people living in cities, people moving frequently, and changing climate increasing the habitat for mosquitoes. The disease originated in Africa and spread to the Americas starting in the 17th century with the European trafficking of enslaved Africans from sub-Saharan Africa. Since the 17th century, several major outbreaks of the disease have occurred in the Americas, Africa, and Europe. In the 18th and 19th centuries, yellow fever was considered one of the most dangerous infectious diseases ; numerous epidemics swept through major cities of the US and in other parts of the world. In 1927, yellow fever virus became the first human virus to be isolated. Yellow fever begins after an incubation period of three to six days. Most cases cause only mild infection with fever, headache, chills, back pain, fatigue, loss of appetite, muscle pain, nausea, and vomiting. In these cases, the infection lasts only three to six days. But in 15% of cases, people enter a second, toxic phase of the disease characterized by recurring fever, this time accompanied by jaundice due to liver damage , as well as abdominal pain . Bleeding in the mouth, nose, eyes, and the gastrointestinal tract cause vomit containing blood , hence one of the names in Spanish for yellow fever, vómito negro ("black vomit"). There may also be kidney failure, hiccups, and delirium. Among those who develop jaundice, the fatality rate is 20 to 50%, while the overall fatality rate is about 3 to 7.5%. Severe cases may have a mortality rate greater than 50%. Surviving the infection provides lifelong immunity , and normally results in no permanent organ damage. Yellow fever can lead to death for 20% to 50% of those who develop severe disease. Jaundice, fatigue, heart rhythm problems, seizures and internal bleeding may also appear as complications of yellow fever during recovery time. Yellow fever can lead to death for 20% to 50% of those who develop severe disease. Jaundice, fatigue, heart rhythm problems, seizures and internal bleeding may also appear as complications of yellow fever during recovery time. {| class="infobox biota" style="text-align: left; width: 200px; font-size: 100%" |- ! Yellow fever virus |- | |- | Flavivirus structure and genome |- |- |- |- ! Virus classification |- |(unranked): | Virus |- | Realm : | Riboviria |- |Kingdom: | Orthornavirae |- |Phylum: | Kitrinoviricota |- |Class: | Flasuviricetes |- |Order: | Amarillovirales |- |Family: | Flaviviridae |- |Genus: | Flavivirus |- | Species: | |- |- |- |- |- |- |- |- |- |- |- |- |- |- |- |} Yellow fever is caused by Yellow fever virus (YFV), an enveloped RNA virus 40–50 nm in width, the type species and namesake of the family Flaviviridae . It was the first illness shown to be transmissible by filtered human serum and transmitted by mosquitoes, by American doctor Walter Reed around 1900. The positive- sense , single-stranded RNA is around 10,862 nucleotides long and has a single open reading frame encoding a polyprotein . Host proteases cut this polyprotein into three structural (C, prM, E) and seven nonstructural proteins (NS1, NS2A, NS2B, NS3, NS4A, NS4B, NS5); the enumeration corresponds to the arrangement of the protein coding genes in the genome . Minimal YFV 3 ′ UTR region is required for stalling of the host 5 ′ -3 ′ exonuclease XRN1. The UTR contains PKS3 pseudoknot structure, which serves as a molecular signal to stall the exonuclease and is the only viral requirement for subgenomic flavivirus RNA (sfRNA) production. The sfRNAs are a result of incomplete degradation of the viral genome by the exonuclease and are important for viral pathogenicity. Yellow fever belongs to the group of hemorrhagic fevers . The viruses infect, amongst others, monocytes , macrophages , Schwann cells , and dendritic cells . They attach to the cell surfaces via specific receptors and are taken up by an endosomal vesicle . Inside the endosome , the decreased pH induces the fusion of the endosomal membrane with the virus envelope . The capsid enters the cytosol , decays, and releases the genome. Receptor binding, as well as membrane fusion, are catalyzed by the protein E, which changes its conformation at low pH, causing a rearrangement of the 90 homo dimers to 60 homo trimers . After entering the host cell, the viral genome is replicated in the rough endoplasmic reticulum (ER) and in the so-called vesicle packets. At first, an immature form of the virus particle is produced inside the ER, whose M-protein is not yet cleaved to its mature form, so is denoted as precursor M (prM) and forms a complex with protein E. The immature particles are processed in the Golgi apparatus by the host protein furin , which cleaves prM to M. This releases E from the complex, which can now take its place in the mature, infectious virion . Yellow fever virus is mainly transmitted through the bite of the yellow fever mosquito Aedes aegypti , but other mostly Aedes mosquitoes such as the tiger mosquito ( Aedes albopictus ) can also serve as a vector for this virus. Like other arboviruses , which are transmitted by mosquitoes, yellow fever virus is taken up by a female mosquito when it ingests the blood of an infected human or another primate. Viruses reach the stomach of the mosquito, and if the virus concentration is high enough, the virions can infect epithelial cells and replicate there. From there, they reach the haemocoel (the blood system of mosquitoes) and from there the salivary glands . When the mosquito next sucks blood, it injects its saliva into the wound, and the virus reaches the bloodstream of the bitten person. Transovarial transmissionial and transstadial transmission of yellow fever virus within A. aegypti , that is, the transmission from a female mosquito to its eggs and then larvae, are indicated. This infection of vectors without a previous blood meal seems to play a role in single, sudden breakouts of the disease. Three epidemiologically different infectious cycles occur in which the virus is transmitted from mosquitoes to humans or other primates. In the "urban cycle", only the yellow fever mosquito A. aegypti is involved. It is well adapted to urban areas, and can also transmit other diseases, including Zika fever , dengue fever , and chikungunya . The urban cycle is responsible for the major outbreaks of yellow fever that occur in Africa. Except for an outbreak in Bolivia in 1999, this urban cycle no longer exists in South America. Besides the urban cycle, both in Africa and South America, a sylvatic cycle (forest or jungle cycle) is present, where Aedes africanus (in Africa) or mosquitoes of the genus Haemagogus and Sabethes (in South America) serve as vectors. In the jungle, the mosquitoes infect mainly nonhuman primates; the disease is mostly asymptomatic in African primates. In South America, the sylvatic cycle is currently the only way unvaccinated humans can become infected, which explains the low incidence of yellow fever cases on the continent. People who become infected in the jungle can carry the virus to urban areas, where A. aegypti acts as a vector. Because of this sylvatic cycle, yellow fever cannot be eradicated except by eradicating the mosquitoes that serve as vectors. In Africa, a third infectious cycle known as "savannah cycle" or intermediate cycle, occurs between the jungle and urban cycles. Different mosquitoes of the genus Aedes are involved. In recent years, this has been the most common form of transmission of yellow fever in Africa. Concern exists about yellow fever spreading to southeast Asia, where its vector A. aegypti already occurs. Yellow fever virus is mainly transmitted through the bite of the yellow fever mosquito Aedes aegypti , but other mostly Aedes mosquitoes such as the tiger mosquito ( Aedes albopictus ) can also serve as a vector for this virus. Like other arboviruses , which are transmitted by mosquitoes, yellow fever virus is taken up by a female mosquito when it ingests the blood of an infected human or another primate. Viruses reach the stomach of the mosquito, and if the virus concentration is high enough, the virions can infect epithelial cells and replicate there. From there, they reach the haemocoel (the blood system of mosquitoes) and from there the salivary glands . When the mosquito next sucks blood, it injects its saliva into the wound, and the virus reaches the bloodstream of the bitten person. Transovarial transmissionial and transstadial transmission of yellow fever virus within A. aegypti , that is, the transmission from a female mosquito to its eggs and then larvae, are indicated. This infection of vectors without a previous blood meal seems to play a role in single, sudden breakouts of the disease. Three epidemiologically different infectious cycles occur in which the virus is transmitted from mosquitoes to humans or other primates. In the "urban cycle", only the yellow fever mosquito A. aegypti is involved. It is well adapted to urban areas, and can also transmit other diseases, including Zika fever , dengue fever , and chikungunya . The urban cycle is responsible for the major outbreaks of yellow fever that occur in Africa. Except for an outbreak in Bolivia in 1999, this urban cycle no longer exists in South America. Besides the urban cycle, both in Africa and South America, a sylvatic cycle (forest or jungle cycle) is present, where Aedes africanus (in Africa) or mosquitoes of the genus Haemagogus and Sabethes (in South America) serve as vectors. In the jungle, the mosquitoes infect mainly nonhuman primates; the disease is mostly asymptomatic in African primates. In South America, the sylvatic cycle is currently the only way unvaccinated humans can become infected, which explains the low incidence of yellow fever cases on the continent. People who become infected in the jungle can carry the virus to urban areas, where A. aegypti acts as a vector. Because of this sylvatic cycle, yellow fever cannot be eradicated except by eradicating the mosquitoes that serve as vectors. In Africa, a third infectious cycle known as "savannah cycle" or intermediate cycle, occurs between the jungle and urban cycles. Different mosquitoes of the genus Aedes are involved. In recent years, this has been the most common form of transmission of yellow fever in Africa. Concern exists about yellow fever spreading to southeast Asia, where its vector A. aegypti already occurs. After transmission from a mosquito, the viruses replicate in the lymph nodes and infect dendritic cells in particular. From there, they reach the liver and infect hepatocytes (probably indirectly via Kupffer cells ), which leads to eosinophilic degradation of these cells and to the release of cytokines . Apoptotic masses known as Councilman bodies appear in the cytoplasm of hepatocytes. Fatality may occur when cytokine storm , shock , and multiple organ failure follow. Yellow fever is most frequently a clinical diagnosis , based on symptomatology and travel history. Mild cases of the disease can only be confirmed virologically. Since mild cases of yellow fever can also contribute significantly to regional outbreaks, every suspected case of yellow fever (involving symptoms of fever, pain, nausea, and vomiting 6–10 days after leaving the affected area) is treated seriously. If yellow fever is suspected, the virus cannot be confirmed until 6–10 days following the illness. A direct confirmation can be obtained by reverse transcription polymerase chain reaction , where the genome of the virus is amplified. Another direct approach is the isolation of the virus and its growth in cell culture using blood plasma ; this can take 1–4 weeks. Serologically, an enzyme-linked immunosorbent assay during the acute phase of the disease using specific IgM against yellow fever or an increase in specific IgG titer (compared to an earlier sample) can confirm yellow fever. Together with clinical symptoms, the detection of IgM or a four-fold increase in IgG titer is considered sufficient indication for yellow fever. As these tests can cross-react with other flaviviruses, such as dengue virus , these indirect methods cannot conclusively prove yellow fever infection. Liver biopsy can verify inflammation and necrosis of hepatocytes and detect viral antigens . Because of the bleeding tendency of yellow fever patients, a biopsy is only advisable post mortem to confirm the cause of death. In a differential diagnosis , infections with yellow fever must be distinguished from other feverish illnesses such as malaria . Other viral hemorrhagic fevers , such as Ebola virus , Lassa virus , Marburg virus , and Junin virus , must be excluded as the cause. Personal prevention of yellow fever includes vaccination and avoidance of mosquito bites in areas where yellow fever is endemic. Institutional measures for prevention of yellow fever include vaccination programmes and measures to control mosquitoes. Programmes for distribution of mosquito nets for use in homes produce reductions in cases of both malaria and yellow fever. Use of EPA-registered insect repellent is recommended when outdoors. Exposure for even a short time is enough for a potential mosquito bite. Long-sleeved clothing, long pants, and socks are useful for prevention. The application of larvicides to water-storage containers can help eliminate potential mosquito breeding sites. EPA-registered insecticide spray decreases the transmission of yellow fever. Vaccination is recommended for those traveling to affected areas, because non-native people tend to develop more severe illness when infected. Protection begins by the 10th day after vaccine administration in 95% of people, and had been reported to last for at least 10 years. The World Health Organization (WHO) now states that a single dose of vaccine is sufficient to confer lifelong immunity against yellow fever disease. The attenuated live vaccine stem 17D was developed in 1937 by Max Theiler . The WHO recommends routine vaccination for people living in affected areas between the 9th and 12th month after birth. Up to one in four people experience fever, aches, and local soreness and redness at the site of injection. In rare cases (less than one in 200,000 to 300,000), the vaccination can cause yellow fever vaccine-associated viscerotropic disease, which is fatal in 60% of cases. It is probably due to the genetic morphology of the immune system. Another possible side effect is an infection of the nervous system, which occurs in one in 200,000 to 300,000 cases, causing yellow fever vaccine-associated neurotropic disease, which can lead to meningoencephalitis and is fatal in less than 5% of cases. The Yellow Fever Initiative, launched by the WHO in 2006, vaccinated more than 105 million people in 14 countries in West Africa. No outbreaks were reported during 2015. The campaign was supported by the GAVI alliance and governmental organizations in Europe and Africa. According to the WHO, mass vaccination cannot eliminate yellow fever because of the vast number of infected mosquitoes in urban areas of the target countries, but it will significantly reduce the number of people infected. Demand for yellow fever vaccine has continued to increase due to the growing number of countries implementing yellow fever vaccination as part of their routine immunization programmes. Recent upsurges in yellow fever outbreaks in Angola (2015), the Democratic Republic of Congo (2016), Uganda (2016), and more recently in Nigeria and Brazil in 2017 have further increased demand, while straining global vaccine supply. Therefore, to vaccinate susceptible populations in preventive mass immunization campaigns during outbreaks, fractional dosing of the vaccine is being considered as a dose-sparing strategy to maximize limited vaccine supplies. Fractional dose yellow fever vaccination refers to administration of a reduced volume of vaccine dose, which has been reconstituted as per manufacturer recommendations. The first practical use of fractional dose yellow fever vaccination was in response to a large yellow fever outbreak in the Democratic Republic of the Congo in mid-2016. Available evidence shows that fractional dose yellow fever vaccination induces a level of immune response similar to that of the standard full dose. In March 2017, the WHO launched a vaccination campaign in Brazil with 3.5 million doses from an emergency stockpile. In March 2017 the WHO recommended vaccination for travellers to certain parts of Brazil. In March 2018, Brazil shifted its policy and announced it planned to vaccinate all 77.5 million currently unvaccinated citizens by April 2019. Some countries in Asia are considered to be potentially in danger of yellow fever epidemics, as both mosquitoes with the capability to transmit yellow fever as well as susceptible monkeys are present. The disease does not yet occur in Asia. To prevent introduction of the virus, some countries demand previous vaccination of foreign visitors who have passed through yellow fever areas. Vaccination has to be proved by a vaccination certificate, which is valid 10 days after the vaccination and lasts for 10 years. Although the WHO on 17 May 2013 advised that subsequent booster vaccinations are unnecessary, an older (than 10 years) certificate may not be acceptable at all border posts in all affected countries. A list of the countries that require yellow fever vaccination is published by the WHO. If the vaccination cannot be given for some reason, dispensation may be possible. In this case, an exemption certificate issued by a WHO-approved vaccination center is required. Although 32 of 44 countries where yellow fever occurs endemically do have vaccination programmes, in many of these countries, less than 50% of their population is vaccinated. Control of the yellow fever mosquito A. aegypti is of major importance, especially because the same mosquito can also transmit dengue fever and chikungunya disease. A. aegypti breeds preferentially in water, for example, in installations by inhabitants of areas with precarious drinking water supplies, or in domestic refuse, especially tires, cans, and plastic bottles. These conditions are common in urban areas in developing countries. Two main strategies are employed to reduce A. aegypti populations. One approach is to kill the developing larvae. Measures are taken to reduce the water accumulations in which the larvae develop. Larvicides are used, along with larvae-eating fish and copepods , which reduce the number of larvae. For many years, copepods of the genus Mesocyclops have been used in Vietnam for preventing dengue fever. This eradicated the mosquito vector in several areas. Similar efforts may prove effective against yellow fever. Pyriproxyfen is recommended as a chemical larvicide, mainly because it is safe for humans and effective in small doses. The second strategy is to reduce populations of the adult yellow fever mosquito. Lethal ovitraps can reduce Aedes populations, using lesser amounts of pesticide because it targets the pest directly. Curtains and lids of water tanks can be sprayed with insecticides, but application inside houses is not recommended by the WHO. Insecticide-treated mosquito nets are effective, just as they are against the Anopheles mosquito that carries malaria. Vaccination is recommended for those traveling to affected areas, because non-native people tend to develop more severe illness when infected. Protection begins by the 10th day after vaccine administration in 95% of people, and had been reported to last for at least 10 years. The World Health Organization (WHO) now states that a single dose of vaccine is sufficient to confer lifelong immunity against yellow fever disease. The attenuated live vaccine stem 17D was developed in 1937 by Max Theiler . The WHO recommends routine vaccination for people living in affected areas between the 9th and 12th month after birth. Up to one in four people experience fever, aches, and local soreness and redness at the site of injection. In rare cases (less than one in 200,000 to 300,000), the vaccination can cause yellow fever vaccine-associated viscerotropic disease, which is fatal in 60% of cases. It is probably due to the genetic morphology of the immune system. Another possible side effect is an infection of the nervous system, which occurs in one in 200,000 to 300,000 cases, causing yellow fever vaccine-associated neurotropic disease, which can lead to meningoencephalitis and is fatal in less than 5% of cases. The Yellow Fever Initiative, launched by the WHO in 2006, vaccinated more than 105 million people in 14 countries in West Africa. No outbreaks were reported during 2015. The campaign was supported by the GAVI alliance and governmental organizations in Europe and Africa. According to the WHO, mass vaccination cannot eliminate yellow fever because of the vast number of infected mosquitoes in urban areas of the target countries, but it will significantly reduce the number of people infected. Demand for yellow fever vaccine has continued to increase due to the growing number of countries implementing yellow fever vaccination as part of their routine immunization programmes. Recent upsurges in yellow fever outbreaks in Angola (2015), the Democratic Republic of Congo (2016), Uganda (2016), and more recently in Nigeria and Brazil in 2017 have further increased demand, while straining global vaccine supply. Therefore, to vaccinate susceptible populations in preventive mass immunization campaigns during outbreaks, fractional dosing of the vaccine is being considered as a dose-sparing strategy to maximize limited vaccine supplies. Fractional dose yellow fever vaccination refers to administration of a reduced volume of vaccine dose, which has been reconstituted as per manufacturer recommendations. The first practical use of fractional dose yellow fever vaccination was in response to a large yellow fever outbreak in the Democratic Republic of the Congo in mid-2016. Available evidence shows that fractional dose yellow fever vaccination induces a level of immune response similar to that of the standard full dose. In March 2017, the WHO launched a vaccination campaign in Brazil with 3.5 million doses from an emergency stockpile. In March 2017 the WHO recommended vaccination for travellers to certain parts of Brazil. In March 2018, Brazil shifted its policy and announced it planned to vaccinate all 77.5 million currently unvaccinated citizens by April 2019. Some countries in Asia are considered to be potentially in danger of yellow fever epidemics, as both mosquitoes with the capability to transmit yellow fever as well as susceptible monkeys are present. The disease does not yet occur in Asia. To prevent introduction of the virus, some countries demand previous vaccination of foreign visitors who have passed through yellow fever areas. Vaccination has to be proved by a vaccination certificate, which is valid 10 days after the vaccination and lasts for 10 years. Although the WHO on 17 May 2013 advised that subsequent booster vaccinations are unnecessary, an older (than 10 years) certificate may not be acceptable at all border posts in all affected countries. A list of the countries that require yellow fever vaccination is published by the WHO. If the vaccination cannot be given for some reason, dispensation may be possible. In this case, an exemption certificate issued by a WHO-approved vaccination center is required. Although 32 of 44 countries where yellow fever occurs endemically do have vaccination programmes, in many of these countries, less than 50% of their population is vaccinated. Some countries in Asia are considered to be potentially in danger of yellow fever epidemics, as both mosquitoes with the capability to transmit yellow fever as well as susceptible monkeys are present. The disease does not yet occur in Asia. To prevent introduction of the virus, some countries demand previous vaccination of foreign visitors who have passed through yellow fever areas. Vaccination has to be proved by a vaccination certificate, which is valid 10 days after the vaccination and lasts for 10 years. Although the WHO on 17 May 2013 advised that subsequent booster vaccinations are unnecessary, an older (than 10 years) certificate may not be acceptable at all border posts in all affected countries. A list of the countries that require yellow fever vaccination is published by the WHO. If the vaccination cannot be given for some reason, dispensation may be possible. In this case, an exemption certificate issued by a WHO-approved vaccination center is required. Although 32 of 44 countries where yellow fever occurs endemically do have vaccination programmes, in many of these countries, less than 50% of their population is vaccinated. Control of the yellow fever mosquito A. aegypti is of major importance, especially because the same mosquito can also transmit dengue fever and chikungunya disease. A. aegypti breeds preferentially in water, for example, in installations by inhabitants of areas with precarious drinking water supplies, or in domestic refuse, especially tires, cans, and plastic bottles. These conditions are common in urban areas in developing countries. Two main strategies are employed to reduce A. aegypti populations. One approach is to kill the developing larvae. Measures are taken to reduce the water accumulations in which the larvae develop. Larvicides are used, along with larvae-eating fish and copepods , which reduce the number of larvae. For many years, copepods of the genus Mesocyclops have been used in Vietnam for preventing dengue fever. This eradicated the mosquito vector in several areas. Similar efforts may prove effective against yellow fever. Pyriproxyfen is recommended as a chemical larvicide, mainly because it is safe for humans and effective in small doses. The second strategy is to reduce populations of the adult yellow fever mosquito. Lethal ovitraps can reduce Aedes populations, using lesser amounts of pesticide because it targets the pest directly. Curtains and lids of water tanks can be sprayed with insecticides, but application inside houses is not recommended by the WHO. Insecticide-treated mosquito nets are effective, just as they are against the Anopheles mosquito that carries malaria. As with other Flavivirus infections, no cure is known for yellow fever. Hospitalization is advisable and intensive care may be necessary because of rapid deterioration in some cases. Certain acute treatment methods lack efficacy: passive immunization after the emergence of symptoms is probably without effect; ribavirin and other antiviral drugs , as well as treatment with interferons , are ineffective in yellow fever patients. Symptomatic treatment includes rehydration and pain relief with drugs such as paracetamol (acetaminophen). However, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are often avoided because of an increased risk of gastrointestinal bleeding due to their anticoagulant effects. Yellow fever is common in tropical and subtropical areas of South America and Africa. Worldwide, about 600 million people live in endemic areas. The WHO estimates 200,000 cases of yellow fever worldwide each year. About 15% of people infected with yellow fever progress to a severe form of the illness, and up to half of those will die, as there is no cure for yellow fever. An estimated 90% of yellow fever infections occur on the African continent. In 2016, a large outbreak originated in Angola and spread to neighboring countries before being contained by a massive vaccination campaign. In March and April 2016, 11 imported cases of the Angola genotype in unvaccinated Chinese nationals were reported in China, the first appearance of the disease in Asia in recorded history. Phylogenetic analysis has identified seven genotypes of yellow fever viruses, and they are assumed to be differently adapted to humans and to the vector A. aegypti . Five genotypes (Angola, Central/East Africa, East Africa, West Africa I, and West Africa II) occur only in Africa. West Africa genotype I is found in Nigeria and the surrounding region. West Africa genotype I appears to be especially infectious, as it is often associated with major outbreaks. The three genotypes found outside of Nigeria and Angola occur in areas where outbreaks are rare. Two outbreaks, in Kenya (1992–1993) and Sudan (2003 and 2005), involved the East African genotype, which had remained undetected in the previous 40 years. In South America, two genotypes have been identified (South American genotypes I and II). Based on phylogenetic analysis these two genotypes appear to have originated in West Africa and were first introduced into Brazil. The date of introduction of the predecessor African genotype which gave rise to the South American genotypes appears to be 1822 (95% confidence interval 1701 to 1911). The historical record shows an outbreak of yellow fever occurred in Recife, Brazil, between 1685 and 1690. The disease seems to have disappeared, with the next outbreak occurring in 1849. It was likely introduced with the trafficking of slaves through the slave trade from Africa. Genotype I has been divided into five subclades, A through E. In late 2016, a large outbreak began in Minas Gerais state of Brazil that was characterized as a sylvatic or jungle epizootic . Real-time phylogenetic investigations at the epicentre of the outbreak revealed that the outbreak was caused by the introduction of a virus lineage from the Amazon region into the southeast region around July 2016, spreading rapidly across several neotropical monkey species, including brown howler monkeys, which serve as a sentinel species for yellow fever. No cases had been transmitted between humans by the A. aegypti mosquito, which can sustain urban outbreaks that can spread rapidly. In April 2017, the sylvatic outbreak continued moving toward the Brazilian coast, where most people were unvaccinated. By the end of May the outbreak appeared to be declining after more than 3,000 suspected cases, 758 confirmed and 264 deaths confirmed to be yellow fever. The Health Ministry launched a vaccination campaign and was concerned about spread during the Carnival season in February and March. The CDC issued a Level 2 alert (practice enhanced precautions.) A Bayesian analysis of genotypes I and II has shown that genotype I accounts for virtually all the current infections in Brazil , Colombia , Venezuela , and Trinidad and Tobago , while genotype II accounted for all cases in Peru . Genotype I originated in the northern Brazilian region around 1908 (95% highest posterior density interval [HPD]: 1870–1936). Genotype II originated in Peru in 1920 (95% HPD: 1867–1958). The estimated rate of mutation for both genotypes was about 5 × 10 −4 substitutions/site/year, similar to that of other RNA viruses. The main vector ( A. aegypti ) also occurs in tropical and subtropical regions of Asia, the Pacific, and Australia, but yellow fever had never occurred there until jet travel introduced 11 cases from the 2016 Angola and DR Congo yellow fever outbreak in Africa. Proposed explanations include: But none is considered satisfactory. Another proposal is the absence of a slave trade to Asia on the scale of that to the Americas. The trans-Atlantic slave trade probably introduced yellow fever into the Western Hemisphere from Africa. An estimated 90% of yellow fever infections occur on the African continent. In 2016, a large outbreak originated in Angola and spread to neighboring countries before being contained by a massive vaccination campaign. In March and April 2016, 11 imported cases of the Angola genotype in unvaccinated Chinese nationals were reported in China, the first appearance of the disease in Asia in recorded history. Phylogenetic analysis has identified seven genotypes of yellow fever viruses, and they are assumed to be differently adapted to humans and to the vector A. aegypti . Five genotypes (Angola, Central/East Africa, East Africa, West Africa I, and West Africa II) occur only in Africa. West Africa genotype I is found in Nigeria and the surrounding region. West Africa genotype I appears to be especially infectious, as it is often associated with major outbreaks. The three genotypes found outside of Nigeria and Angola occur in areas where outbreaks are rare. Two outbreaks, in Kenya (1992–1993) and Sudan (2003 and 2005), involved the East African genotype, which had remained undetected in the previous 40 years. In South America, two genotypes have been identified (South American genotypes I and II). Based on phylogenetic analysis these two genotypes appear to have originated in West Africa and were first introduced into Brazil. The date of introduction of the predecessor African genotype which gave rise to the South American genotypes appears to be 1822 (95% confidence interval 1701 to 1911). The historical record shows an outbreak of yellow fever occurred in Recife, Brazil, between 1685 and 1690. The disease seems to have disappeared, with the next outbreak occurring in 1849. It was likely introduced with the trafficking of slaves through the slave trade from Africa. Genotype I has been divided into five subclades, A through E. In late 2016, a large outbreak began in Minas Gerais state of Brazil that was characterized as a sylvatic or jungle epizootic . Real-time phylogenetic investigations at the epicentre of the outbreak revealed that the outbreak was caused by the introduction of a virus lineage from the Amazon region into the southeast region around July 2016, spreading rapidly across several neotropical monkey species, including brown howler monkeys, which serve as a sentinel species for yellow fever. No cases had been transmitted between humans by the A. aegypti mosquito, which can sustain urban outbreaks that can spread rapidly. In April 2017, the sylvatic outbreak continued moving toward the Brazilian coast, where most people were unvaccinated. By the end of May the outbreak appeared to be declining after more than 3,000 suspected cases, 758 confirmed and 264 deaths confirmed to be yellow fever. The Health Ministry launched a vaccination campaign and was concerned about spread during the Carnival season in February and March. The CDC issued a Level 2 alert (practice enhanced precautions.) A Bayesian analysis of genotypes I and II has shown that genotype I accounts for virtually all the current infections in Brazil , Colombia , Venezuela , and Trinidad and Tobago , while genotype II accounted for all cases in Peru . Genotype I originated in the northern Brazilian region around 1908 (95% highest posterior density interval [HPD]: 1870–1936). Genotype II originated in Peru in 1920 (95% HPD: 1867–1958). The estimated rate of mutation for both genotypes was about 5 × 10 −4 substitutions/site/year, similar to that of other RNA viruses. The main vector ( A. aegypti ) also occurs in tropical and subtropical regions of Asia, the Pacific, and Australia, but yellow fever had never occurred there until jet travel introduced 11 cases from the 2016 Angola and DR Congo yellow fever outbreak in Africa. Proposed explanations include: But none is considered satisfactory. Another proposal is the absence of a slave trade to Asia on the scale of that to the Americas. The trans-Atlantic slave trade probably introduced yellow fever into the Western Hemisphere from Africa. The evolutionary origins of yellow fever most likely lie in Africa, with transmission of the disease from nonhuman primates to humans. The virus is thought to have originated in East or Central Africa and spread from there to West Africa. As it was endemic in Africa, local populations had developed some immunity to it. When an outbreak of yellow fever would occur in an African community where colonists resided, most Europeans died, while the indigenous Africans usually developed nonlethal symptoms resembling influenza . This phenomenon, in which certain populations develop immunity to yellow fever due to prolonged exposure in their childhood, is known as acquired immunity . The virus, as well as the vector A. aegypti, were probably transferred to North and South America with the trafficking of slaves from Africa, part of the Columbian exchange following European exploration and colonization. However, some researchers have argued that yellow fever might have existed in the Americas during the pre-Columbian period as mosquitoes of the genus Haemagogus , which is indigenous to the Americas, have been known to carry the disease. The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados . An outbreak was recorded by Spanish colonists in 1648 in the Yucatán Peninsula , where the indigenous Mayan people called the illness xekik ("blood vomit"). In 1685, Brazil suffered its first epidemic in Recife . The first mention of the disease by the name "yellow fever" occurred in 1744. However, Dr. Mitchell misdiagnosed the disease that he observed and treated, and the disease was probably Weil's disease or hepatitis. McNeill argues that the environmental and ecological disruption caused by the introduction of sugar plantations created the conditions for mosquito and viral reproduction, and subsequent outbreaks of yellow fever. Deforestation reduced populations of insectivorous birds and other creatures that fed on mosquitoes and their eggs. In Colonial times and during the Napoleonic Wars , the West Indies were known as a particularly dangerous posting for soldiers due to yellow fever being endemic in the area. The mortality rate in British garrisons in Jamaica was seven times that of garrisons in Canada, mostly because of yellow fever and other tropical diseases. Both English and French forces posted there were seriously affected by the "yellow jack" . Wanting to regain control of the lucrative sugar trade in Saint-Domingue (Hispaniola), and with an eye on regaining France's New World empire, Napoleon sent an army under the command of his brother-in-law General Charles Leclerc to Saint-Domingue to seize control after a slave revolt. The historian J. R. McNeill asserts that yellow fever accounted for about 35,000 to 45,000 casualties of these forces during the fighting. Only one third of the French troops survived for withdrawal and return to France. Napoleon gave up on the island and his plans for North America, selling the Louisiana Purchase to the US in 1803. In 1804, Haiti proclaimed its independence as the second republic in the Western Hemisphere. Considerable debate exists over whether the number of deaths caused by disease in the Haitian Revolution was exaggerated. Although yellow fever is most prevalent in tropical-like climates, the northern United States were not exempted from the fever. The first outbreak in English-speaking North America occurred in New York City in 1668. English colonists in Philadelphia and the French in the Mississippi River Valley recorded major outbreaks in 1669, as well as additional yellow fever epidemics in Philadelphia, Baltimore , and New York City in the 18th and 19th centuries. The disease traveled along steamboat routes from New Orleans, causing some 100,000–150,000 deaths in total. The yellow fever epidemic of 1793 in Philadelphia, which was then the capital of the United States, resulted in the deaths of several thousand people, more than 9% of the population. One of these deaths was James Hutchinson , a physician helping to treat the population of the city. The national government fled the city to Trenton, New Jersey, including President George Washington . The southern city of New Orleans was plagued with major epidemics during the 19th century, most notably in 1833 and 1853. A major epidemic occurred in both New Orleans and Shreveport, Louisiana in 1873. Its residents called the disease "yellow jack". Urban epidemics continued in the United States until 1905, with the last outbreak affecting New Orleans. At least 25 major outbreaks took place in the Americas during the 18th and 19th centuries, including particularly serious ones in Cartagena, Chile , in 1741; Cuba in 1762 and 1900; Santo Domingo in 1803; and Memphis, Tennessee , in 1878. In the early 19th century, the prevalence of yellow fever in the Caribbean "led to serious health problems" and alarmed the United States Navy as numerous deaths and sickness curtailed naval operations and destroyed morale. One episode began in April 1822 when the frigate USS Macedonian left Boston and became part of Commodore James Biddle's West India Squadron. Unbeknownst to all, they were about to embark on a cruise to disaster and their assignment "would prove a cruise through hell". Secretary of the Navy Smith Thompson had assigned the squadron to guard United States merchant shipping and suppress piracy. During their time on deployment from 26 May to 3 August 1822, 76 of the Macedonian's officers and men died, including John Cadle, surgeon USN. Seventy-four of these deaths were attributed to yellow fever. Biddle reported that another 52 of his crew were on sick-list. In their report to the secretary of the Navy, Biddle and Surgeon's Mate Charles Chase stated the cause as "fever". As a consequence of this loss, Biddle noted that his squadron was forced to return to Norfolk Navy Yard early. Upon arrival, the Macedonian's crew were provided medical care and quarantined at Craney Island, Virginia. In 1853, Cloutierville, Louisiana , had a late-summer outbreak of yellow fever that quickly killed 68 of the 91 inhabitants. A local doctor concluded that some unspecified infectious agent had arrived in a package from New Orleans. In 1854, 650 residents of Savannah, Georgia , died from yellow fever. In 1858, St. Matthew's German Evangelical Lutheran Church in Charleston, South Carolina , had 308 yellow fever deaths, reducing the congregation by half. A ship carrying persons infected with the virus arrived in Hampton Roads in southeastern Virginia in June 1855. The disease spread quickly through the community, eventually killing over 3,000 people, mostly residents of Norfolk and Portsmouth . In 1873, Shreveport, Louisiana , lost 759 citizens in an 80-day period to a yellow fever epidemic, with over 400 additional victims eventually succumbing. The total death toll from August through November was approximately 1,200. In 1878, about 20,000 people died in a widespread epidemic in the Mississippi River Valley. That year, Memphis had an unusually large amount of rain, which led to an increase in the mosquito population. The result was a huge epidemic of yellow fever. The steamship John D. Porter took people fleeing Memphis northward in hopes of escaping the disease, but passengers were not allowed to disembark due to concerns of spreading yellow fever. The ship roamed the Mississippi River for the next two months before unloading her passengers. Major outbreaks have also occurred in southern Europe. Gibraltar lost many lives to outbreaks in 1804, 1814, and 1828. Barcelona suffered the loss of several thousand citizens during an outbreak in 1821. The Duke de Richelieu deployed 30,000 French troops to the border between France and Spain in the Pyrenees Mountains , to establish a cordon sanitaire in order to prevent the epidemic from spreading from Spain into France. Ezekiel Stone Wiggins , known as the Ottawa Prophet, proposed that the cause of a yellow fever epidemic in Jacksonville, Florida , in 1888, was astrological. The planets were in the same line as the sun and earth and this produced, besides Cyclones, Earthquakes, etc., a denser atmosphere holding more carbon and creating microbes. Mars had an uncommonly dense atmosphere, but its inhabitants were probably protected from the fever by their newly discovered canals , which were perhaps made to absorb carbon and prevent the disease. In 1848, Josiah C. Nott suggested that yellow fever was spread by insects such as moths or mosquitoes, basing his ideas on the pattern of transmission of the disease. Carlos Finlay , a Cuban-Spanish doctor and scientist, proposed in 1881 that yellow fever might be transmitted by previously infected mosquitoes rather than by direct contact from person to person, as had long been believed. Since the losses from yellow fever in the Spanish–American War in the 1890s were extremely high, U.S. Army doctors began research experiments with a team led by Walter Reed , and composed of doctors James Carroll , Aristides Agramonte , and Jesse William Lazear . They successfully proved Finlay's "mosquito hypothesis". Yellow fever was the first virus shown to be transmitted by mosquitoes. The physician William Gorgas applied these insights and eradicated yellow fever from Havana . He also campaigned against yellow fever during the construction of the Panama Canal . A previous effort of canal building by the French had failed in part due to mortality from the high incidence of yellow fever and malaria, which killed many workers. Although Reed has received much of the credit in United States history books for "beating" yellow fever, he had fully credited Finlay with the discovery of the yellow fever vector, and how it might be controlled. Reed often cited Finlay's papers in his own articles, and also credited him for the discovery in his personal correspondence. The acceptance of Finlay's work was one of the most important and far-reaching effects of the U.S. Army Yellow Fever Commission of 1900. Applying methods first suggested by Finlay, the United States government and Army eradicated yellow fever in Cuba and later in Panama, allowing completion of the Panama Canal. While Reed built on the research of Finlay, historian François Delaporte notes that yellow fever research was a contentious issue. Scientists, including Finlay and Reed, became successful by building on the work of less prominent scientists, without always giving them the credit they were due. Reed's research was essential in the fight against yellow fever. He is also credited for using the first type of medical consent form during his experiments in Cuba, an attempt to ensure that participants knew they were taking a risk by being part of testing. Like Cuba and Panama, Brazil also led a highly successful sanitation campaign against mosquitoes and yellow fever. Beginning in 1903, the campaign led by Oswaldo Cruz , then director general of public health, resulted not only in eradicating the disease but also in reshaping the physical landscape of Brazilian cities such as Rio de Janeiro. During rainy seasons, Rio de Janeiro had regularly suffered floods, as water from the bay surrounding the city overflowed into Rio's narrow streets. Coupled with the poor drainage systems found throughout Rio, this created swampy conditions in the city's neighborhoods. Pools of stagnant water stood year-long in city streets and proved to be a fertile ground for disease-carrying mosquitoes. Thus, under Cruz's direction, public health units known as "mosquito inspectors" fiercely worked to combat yellow fever throughout Rio by spraying, exterminating rats, improving drainage, and destroying unsanitary housing. Ultimately, the city's sanitation and renovation campaigns reshaped Rio de Janeiro's neighborhoods. Its poor residents were pushed from city centers to Rio's suburbs, or to towns found in the outskirts of the city. In later years, Rio's most impoverished inhabitants would come to reside in favelas . During 1920–1923, the Rockefeller Foundation 's International Health Board undertook an expensive and successful yellow fever eradication campaign in Mexico. The IHB gained the respect of Mexico's federal government because of the success. The eradication of yellow fever strengthened the relationship between the US and Mexico, which had not been very good in the years prior. The eradication of yellow fever was also a major step toward better global health. In 1927, scientists isolated the yellow fever virus in West Africa. Following this, two vaccines were developed in the 1930s. Max Theiler led the completion of the 17D yellow fever vaccine in 1937, for which he was subsequently awarded the Nobel Prize in Physiology or Medicine . That vaccine, 17D, is still in use, although newer vaccines, based on vero cells , are in development (as of 2018). Using vector control and strict vaccination programs, the urban cycle of yellow fever was nearly eradicated from South America. Since 1943, only a single urban outbreak in Santa Cruz de la Sierra , Bolivia, has occurred. Since the 1980s, however, the number of yellow fever cases has been increasing again, and A. aegypti has returned to the urban centers of South America. This is partly due to limitations on available insecticides, as well as habitat dislocations caused by climate change. It is also because the vector control program was abandoned. Although no new urban cycle has yet been established, scientists believe this could happen again at any point. An outbreak in Paraguay in 2008 was thought to be urban in nature, but this ultimately proved not to be the case. In Africa, virus eradication programs have mostly relied upon vaccination. These programs have largely been unsuccessful because they were unable to break the sylvatic cycle involving wild primates. With few countries establishing regular vaccination programs, measures to fight yellow fever have been neglected, making the future spread of the virus more likely. The evolutionary origins of yellow fever most likely lie in Africa, with transmission of the disease from nonhuman primates to humans. The virus is thought to have originated in East or Central Africa and spread from there to West Africa. As it was endemic in Africa, local populations had developed some immunity to it. When an outbreak of yellow fever would occur in an African community where colonists resided, most Europeans died, while the indigenous Africans usually developed nonlethal symptoms resembling influenza . This phenomenon, in which certain populations develop immunity to yellow fever due to prolonged exposure in their childhood, is known as acquired immunity . The virus, as well as the vector A. aegypti, were probably transferred to North and South America with the trafficking of slaves from Africa, part of the Columbian exchange following European exploration and colonization. However, some researchers have argued that yellow fever might have existed in the Americas during the pre-Columbian period as mosquitoes of the genus Haemagogus , which is indigenous to the Americas, have been known to carry the disease. The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados . An outbreak was recorded by Spanish colonists in 1648 in the Yucatán Peninsula , where the indigenous Mayan people called the illness xekik ("blood vomit"). In 1685, Brazil suffered its first epidemic in Recife . The first mention of the disease by the name "yellow fever" occurred in 1744. However, Dr. Mitchell misdiagnosed the disease that he observed and treated, and the disease was probably Weil's disease or hepatitis. McNeill argues that the environmental and ecological disruption caused by the introduction of sugar plantations created the conditions for mosquito and viral reproduction, and subsequent outbreaks of yellow fever. Deforestation reduced populations of insectivorous birds and other creatures that fed on mosquitoes and their eggs. In Colonial times and during the Napoleonic Wars , the West Indies were known as a particularly dangerous posting for soldiers due to yellow fever being endemic in the area. The mortality rate in British garrisons in Jamaica was seven times that of garrisons in Canada, mostly because of yellow fever and other tropical diseases. Both English and French forces posted there were seriously affected by the "yellow jack" . Wanting to regain control of the lucrative sugar trade in Saint-Domingue (Hispaniola), and with an eye on regaining France's New World empire, Napoleon sent an army under the command of his brother-in-law General Charles Leclerc to Saint-Domingue to seize control after a slave revolt. The historian J. R. McNeill asserts that yellow fever accounted for about 35,000 to 45,000 casualties of these forces during the fighting. Only one third of the French troops survived for withdrawal and return to France. Napoleon gave up on the island and his plans for North America, selling the Louisiana Purchase to the US in 1803. In 1804, Haiti proclaimed its independence as the second republic in the Western Hemisphere. Considerable debate exists over whether the number of deaths caused by disease in the Haitian Revolution was exaggerated. Although yellow fever is most prevalent in tropical-like climates, the northern United States were not exempted from the fever. The first outbreak in English-speaking North America occurred in New York City in 1668. English colonists in Philadelphia and the French in the Mississippi River Valley recorded major outbreaks in 1669, as well as additional yellow fever epidemics in Philadelphia, Baltimore , and New York City in the 18th and 19th centuries. The disease traveled along steamboat routes from New Orleans, causing some 100,000–150,000 deaths in total. The yellow fever epidemic of 1793 in Philadelphia, which was then the capital of the United States, resulted in the deaths of several thousand people, more than 9% of the population. One of these deaths was James Hutchinson , a physician helping to treat the population of the city. The national government fled the city to Trenton, New Jersey, including President George Washington . The southern city of New Orleans was plagued with major epidemics during the 19th century, most notably in 1833 and 1853. A major epidemic occurred in both New Orleans and Shreveport, Louisiana in 1873. Its residents called the disease "yellow jack". Urban epidemics continued in the United States until 1905, with the last outbreak affecting New Orleans. At least 25 major outbreaks took place in the Americas during the 18th and 19th centuries, including particularly serious ones in Cartagena, Chile , in 1741; Cuba in 1762 and 1900; Santo Domingo in 1803; and Memphis, Tennessee , in 1878. In the early 19th century, the prevalence of yellow fever in the Caribbean "led to serious health problems" and alarmed the United States Navy as numerous deaths and sickness curtailed naval operations and destroyed morale. One episode began in April 1822 when the frigate USS Macedonian left Boston and became part of Commodore James Biddle's West India Squadron. Unbeknownst to all, they were about to embark on a cruise to disaster and their assignment "would prove a cruise through hell". Secretary of the Navy Smith Thompson had assigned the squadron to guard United States merchant shipping and suppress piracy. During their time on deployment from 26 May to 3 August 1822, 76 of the Macedonian's officers and men died, including John Cadle, surgeon USN. Seventy-four of these deaths were attributed to yellow fever. Biddle reported that another 52 of his crew were on sick-list. In their report to the secretary of the Navy, Biddle and Surgeon's Mate Charles Chase stated the cause as "fever". As a consequence of this loss, Biddle noted that his squadron was forced to return to Norfolk Navy Yard early. Upon arrival, the Macedonian's crew were provided medical care and quarantined at Craney Island, Virginia. In 1853, Cloutierville, Louisiana , had a late-summer outbreak of yellow fever that quickly killed 68 of the 91 inhabitants. A local doctor concluded that some unspecified infectious agent had arrived in a package from New Orleans. In 1854, 650 residents of Savannah, Georgia , died from yellow fever. In 1858, St. Matthew's German Evangelical Lutheran Church in Charleston, South Carolina , had 308 yellow fever deaths, reducing the congregation by half. A ship carrying persons infected with the virus arrived in Hampton Roads in southeastern Virginia in June 1855. The disease spread quickly through the community, eventually killing over 3,000 people, mostly residents of Norfolk and Portsmouth . In 1873, Shreveport, Louisiana , lost 759 citizens in an 80-day period to a yellow fever epidemic, with over 400 additional victims eventually succumbing. The total death toll from August through November was approximately 1,200. In 1878, about 20,000 people died in a widespread epidemic in the Mississippi River Valley. That year, Memphis had an unusually large amount of rain, which led to an increase in the mosquito population. The result was a huge epidemic of yellow fever. The steamship John D. Porter took people fleeing Memphis northward in hopes of escaping the disease, but passengers were not allowed to disembark due to concerns of spreading yellow fever. The ship roamed the Mississippi River for the next two months before unloading her passengers. Major outbreaks have also occurred in southern Europe. Gibraltar lost many lives to outbreaks in 1804, 1814, and 1828. Barcelona suffered the loss of several thousand citizens during an outbreak in 1821. The Duke de Richelieu deployed 30,000 French troops to the border between France and Spain in the Pyrenees Mountains , to establish a cordon sanitaire in order to prevent the epidemic from spreading from Spain into France. Ezekiel Stone Wiggins , known as the Ottawa Prophet, proposed that the cause of a yellow fever epidemic in Jacksonville, Florida , in 1888, was astrological. The planets were in the same line as the sun and earth and this produced, besides Cyclones, Earthquakes, etc., a denser atmosphere holding more carbon and creating microbes. Mars had an uncommonly dense atmosphere, but its inhabitants were probably protected from the fever by their newly discovered canals , which were perhaps made to absorb carbon and prevent the disease. In 1848, Josiah C. Nott suggested that yellow fever was spread by insects such as moths or mosquitoes, basing his ideas on the pattern of transmission of the disease. Carlos Finlay , a Cuban-Spanish doctor and scientist, proposed in 1881 that yellow fever might be transmitted by previously infected mosquitoes rather than by direct contact from person to person, as had long been believed. Since the losses from yellow fever in the Spanish–American War in the 1890s were extremely high, U.S. Army doctors began research experiments with a team led by Walter Reed , and composed of doctors James Carroll , Aristides Agramonte , and Jesse William Lazear . They successfully proved Finlay's "mosquito hypothesis". Yellow fever was the first virus shown to be transmitted by mosquitoes. The physician William Gorgas applied these insights and eradicated yellow fever from Havana . He also campaigned against yellow fever during the construction of the Panama Canal . A previous effort of canal building by the French had failed in part due to mortality from the high incidence of yellow fever and malaria, which killed many workers. Although Reed has received much of the credit in United States history books for "beating" yellow fever, he had fully credited Finlay with the discovery of the yellow fever vector, and how it might be controlled. Reed often cited Finlay's papers in his own articles, and also credited him for the discovery in his personal correspondence. The acceptance of Finlay's work was one of the most important and far-reaching effects of the U.S. Army Yellow Fever Commission of 1900. Applying methods first suggested by Finlay, the United States government and Army eradicated yellow fever in Cuba and later in Panama, allowing completion of the Panama Canal. While Reed built on the research of Finlay, historian François Delaporte notes that yellow fever research was a contentious issue. Scientists, including Finlay and Reed, became successful by building on the work of less prominent scientists, without always giving them the credit they were due. Reed's research was essential in the fight against yellow fever. He is also credited for using the first type of medical consent form during his experiments in Cuba, an attempt to ensure that participants knew they were taking a risk by being part of testing. Like Cuba and Panama, Brazil also led a highly successful sanitation campaign against mosquitoes and yellow fever. Beginning in 1903, the campaign led by Oswaldo Cruz , then director general of public health, resulted not only in eradicating the disease but also in reshaping the physical landscape of Brazilian cities such as Rio de Janeiro. During rainy seasons, Rio de Janeiro had regularly suffered floods, as water from the bay surrounding the city overflowed into Rio's narrow streets. Coupled with the poor drainage systems found throughout Rio, this created swampy conditions in the city's neighborhoods. Pools of stagnant water stood year-long in city streets and proved to be a fertile ground for disease-carrying mosquitoes. Thus, under Cruz's direction, public health units known as "mosquito inspectors" fiercely worked to combat yellow fever throughout Rio by spraying, exterminating rats, improving drainage, and destroying unsanitary housing. Ultimately, the city's sanitation and renovation campaigns reshaped Rio de Janeiro's neighborhoods. Its poor residents were pushed from city centers to Rio's suburbs, or to towns found in the outskirts of the city. In later years, Rio's most impoverished inhabitants would come to reside in favelas . During 1920–1923, the Rockefeller Foundation 's International Health Board undertook an expensive and successful yellow fever eradication campaign in Mexico. The IHB gained the respect of Mexico's federal government because of the success. The eradication of yellow fever strengthened the relationship between the US and Mexico, which had not been very good in the years prior. The eradication of yellow fever was also a major step toward better global health. In 1927, scientists isolated the yellow fever virus in West Africa. Following this, two vaccines were developed in the 1930s. Max Theiler led the completion of the 17D yellow fever vaccine in 1937, for which he was subsequently awarded the Nobel Prize in Physiology or Medicine . That vaccine, 17D, is still in use, although newer vaccines, based on vero cells , are in development (as of 2018). Using vector control and strict vaccination programs, the urban cycle of yellow fever was nearly eradicated from South America. Since 1943, only a single urban outbreak in Santa Cruz de la Sierra , Bolivia, has occurred. Since the 1980s, however, the number of yellow fever cases has been increasing again, and A. aegypti has returned to the urban centers of South America. This is partly due to limitations on available insecticides, as well as habitat dislocations caused by climate change. It is also because the vector control program was abandoned. Although no new urban cycle has yet been established, scientists believe this could happen again at any point. An outbreak in Paraguay in 2008 was thought to be urban in nature, but this ultimately proved not to be the case. In Africa, virus eradication programs have mostly relied upon vaccination. These programs have largely been unsuccessful because they were unable to break the sylvatic cycle involving wild primates. With few countries establishing regular vaccination programs, measures to fight yellow fever have been neglected, making the future spread of the virus more likely. In the hamster model of yellow fever, early administration of the antiviral ribavirin is an effective treatment of many pathological features of the disease. Ribavirin treatment during the first five days after virus infection improved survival rates, reduced tissue damage in the liver and spleen , prevented hepatocellular steatosis , and normalised levels of alanine aminotransferase, a liver damage marker. The mechanism of action of ribavirin in reducing liver pathology in yellow fever virus infection may be similar to its activity in treatment of hepatitis C , a related virus. Because ribavirin had failed to improve survival in a virulent rhesus model of yellow fever infection, it had been previously discounted as a possible therapy. Infection was reduced in mosquitoes with the wMel strain of Wolbachia . Yellow fever has been researched by several countries as a potential biological weapon .

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Aniru_Conteh/html

Aniru Conteh

Kenema Government Hospital Merlin Nixon Memorial Hospital Centers for Disease Control and Prevention Aniru Sahib Sahib Conteh (6 August 1942 – 4 April 2004) was a Sierra Leonean physician and expert on the clinical treatment of Lassa fever , a viral hemorrhagic fever endemic to West Africa caused by the Lassa virus . Conteh studied medicine at the University of Ibadan in Nigeria and taught at Ibadan Teaching Hospital. He later returned to Sierra Leone where he joined the Centers for Disease Control and Prevention (CDC) Lassa fever program at Nixon Methodist Hospital in Segbwema , first as superintendent and then as clinical director. After the Sierra Leone Civil War began in 1991, the CDC closed their program in Segbwema. Conteh and his medical team moved from Segbwema to the Kenema Government Hospital (KGH), where he spent the next two decades running the only dedicated Lassa fever ward in the world. Conteh collaborated with the British charity Merlin to promote public health in Sierra Leone through education and awareness campaigns intended to prevent Lassa fever. With little funding and few supplies, Conteh successfully reduced mortality rates and saved many lives until an accidental needlestick injury led to his own death from the disease in 2004. Conteh received renewed public attention in 2009 as the hero of Ross I. Donaldson's memoir, The Lassa Ward .Aniru Sahib Sahib Conteh was born on 6 August 1942, in the town of Jawi Folu, Eastern Province , British Sierra Leone , the son of a farmer and chief of the village. He moved to Freetown , the capital of Sierra Leone, after his mother died while he was in his teens. Conteh studied chemistry and biology at Fourah Bay College and began teaching after receiving his BSc. In 1968, he began studying medicine in Nigeria at the modern University of Ibadan , graduating in 1974. Conteh spent the next four years employed by the Ibadan Teaching Hospital. He returned home to Sierra Leone in 1979. Conteh married and raised a family with his wife Sarah, producing several sons and daughters. Conteh spent his professional career working with people with Lassa fever , a viral hemorrhagic fever endemic to West Africa. Lassa fever was first brought to the attention of the public in 1969 during an outbreak in Nigeria. Identified in 1972, the disease is known to spread through its host, the Natal multimammate mouse ( Mastomys natalensis ), and infects an estimated 300,000 people and results in 5000 deaths annually in Sierra Leone, Liberia , and Guinea . In 1976, a hospital-acquired infection outbreak in the Panguma Catholic Hospital attracted attention in the United States. In response, the Centers for Disease Control and Prevention (CDC) established research programs in Segbwema, Kenema, and Panguma to study the disease. In 1979, Conteh began working with the CDC and team leader Joseph B. McCormick at the Nixon Methodist Hospital in Segbwema . Conteh became Medical Superintendent of the hospital in 1980. The Sierra Leone Civil War broke out in 1991, forcing the CDC to close their program and move to Guinea. The hospital was destroyed in the conflict and the spread of Lassa fever grew worse. During the civil war, the Natal multimammate mouse infested abandoned houses, increasing the likelihood of infection. Conteh now found himself in the middle of a war zone, starving and homeless. He wandered about for several months and finally came to Kenema where he began treating the sick in the midst of the fighting. Although he had friends overseas, and could have procured a job outside Sierra Leone, he chose to stay and help his people because "they had no one to help them". Due to the war, most experts familiar with Lassa fever had left the country, and patients suspected of having the disease began to be brought to Conteh for treatment. The Lassa team moved from Segbwema to the Kenema Government Hospital (KGH). In Kenema, Conteh became director of the only Lassa fever isolation ward in the world. Rebels from the Revolutionary United Front took over the town of Kenema in 1997 and 1999, but Conteh never left his post. It is thought that the rebels spared the hospital from destruction because they were afraid of catching Lassa fever. When the civil war ended in 2002 , the government of Sierra Leone began the process of rebuilding the country. During the civil war, Conteh was the only clinician in Sierra Leone who had the skills and qualifications to manage patients with Lassa fever. In the absence of the CDC, the Lassa ward was supported by Merlin , a medical relief agency based in the UK. According to Nicholas Mellor, co-founder of Merlin, "Conteh worked with Merlin to get a new laboratory built that would enable collaboration with international research centres with an interest in haemorrhagic diseases. He also worked on training and Lassa fever awareness campaigns." Conteh's Lassa fever program "provided the blueprint for many experts". In 1996, Daniel Bausch at the Tulane University School of Public Health and Tropical Medicine began working with Conteh and the CDC on research related to Lassa fever. In 2000, Conteh coauthored a study published in the Journal of Clinical Microbiology comparing the efficacy and outcome of diagnosing Lassa fever patients with the indirect fluorescent-antibody (IFA) test and the enzyme-linked immunosorbent assay (ELISA). According to Iruka N. Okeke , the study "focused specifically on the development of a diagnostic test for Lassa fever". In 2001, Conteh travelled to London, England to attend an international conference on Lassa fever where he presented a paper on managing the disease. Conteh returned to London in September 2003 to receive the "Spirit of Merlin" award for his outstanding role in "saving lives and alleviating suffering". In 1979, Conteh began working with the CDC and team leader Joseph B. McCormick at the Nixon Methodist Hospital in Segbwema . Conteh became Medical Superintendent of the hospital in 1980. The Sierra Leone Civil War broke out in 1991, forcing the CDC to close their program and move to Guinea. The hospital was destroyed in the conflict and the spread of Lassa fever grew worse. During the civil war, the Natal multimammate mouse infested abandoned houses, increasing the likelihood of infection. Conteh now found himself in the middle of a war zone, starving and homeless. He wandered about for several months and finally came to Kenema where he began treating the sick in the midst of the fighting. Although he had friends overseas, and could have procured a job outside Sierra Leone, he chose to stay and help his people because "they had no one to help them". Due to the war, most experts familiar with Lassa fever had left the country, and patients suspected of having the disease began to be brought to Conteh for treatment. The Lassa team moved from Segbwema to the Kenema Government Hospital (KGH). In Kenema, Conteh became director of the only Lassa fever isolation ward in the world. Rebels from the Revolutionary United Front took over the town of Kenema in 1997 and 1999, but Conteh never left his post. It is thought that the rebels spared the hospital from destruction because they were afraid of catching Lassa fever. When the civil war ended in 2002 , the government of Sierra Leone began the process of rebuilding the country. During the civil war, Conteh was the only clinician in Sierra Leone who had the skills and qualifications to manage patients with Lassa fever. In the absence of the CDC, the Lassa ward was supported by Merlin , a medical relief agency based in the UK. According to Nicholas Mellor, co-founder of Merlin, "Conteh worked with Merlin to get a new laboratory built that would enable collaboration with international research centres with an interest in haemorrhagic diseases. He also worked on training and Lassa fever awareness campaigns." Conteh's Lassa fever program "provided the blueprint for many experts". In 1996, Daniel Bausch at the Tulane University School of Public Health and Tropical Medicine began working with Conteh and the CDC on research related to Lassa fever. In 2000, Conteh coauthored a study published in the Journal of Clinical Microbiology comparing the efficacy and outcome of diagnosing Lassa fever patients with the indirect fluorescent-antibody (IFA) test and the enzyme-linked immunosorbent assay (ELISA). According to Iruka N. Okeke , the study "focused specifically on the development of a diagnostic test for Lassa fever". In 2001, Conteh travelled to London, England to attend an international conference on Lassa fever where he presented a paper on managing the disease. Conteh returned to London in September 2003 to receive the "Spirit of Merlin" award for his outstanding role in "saving lives and alleviating suffering". The Lassa ward was short-staffed, and Conteh would often draw blood from people himself. On 17 March 2004, Conteh was infected with the Lassa virus when he received a needlestick injury while drawing blood from a young pregnant nurse with the disease. The nurse died the next day, and Conteh himself became ill on 23 March. As his condition worsened, he was treated with intravenous ribavirin . Conteh initially survived the critical stage of Lassa fever, but died on 4 April from renal failure —18 days after first becoming infected with the Lassa virus. Reporter Sulaiman Momodu described the outpouring of grief in the wake of Conteh's death: News of his death spread in Kenema and its environs like a bush fire in the harmattan . Most people were devastated to learn that the only Lassa Fever specialist in Sierra Leone was gone, gone forever. Nurses cried, patients wept. Kenema was thrown into a state of shock and mourning. Conteh's funeral was held in the town of Daru . Conteh's work in the Lassa ward spanned 25 years and saved thousands of lives. He played a key role in helping Merlin implement a program to support the Lassa ward and fever control measures in Sierra Leone. Because of his skill and dedication, deaths due to cases of suspected Lassa fever declined by 20%. After Conteh's death, Merlin and the peacekeepers in the United Nations Mission in Sierra Leone (UNAMSIL) left Sierra Leone and the Lassa ward in Kenema was barely functioning. In 2004, Tulane University , in co-ordination with the World Health Organization , began monitoring Lassa fever patients in Sierra Leone, Liberia, and Guinea through the Mano River Union Lassa Fever Network (MRU-LFN). Today, the Lassa Fever Program is fully operational at Kenema Government Hospital, and focuses on "treatment, containment, prevention and research". Conteh was the mentor for UCLA medical professor Ross I. Donaldson in the summer of 2003, and is the hero of Donaldson's 2009 memoir, The Lassa Ward .

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/List_of_human_disease_case_fatality_rates/html

List of human disease case fatality rates

Human infectious diseases may be characterized by their case fatality rate (CFR), the proportion of people diagnosed with a disease who die from it ( cf. mortality rate ). It should not be confused with the infection fatality rate (IFR), the estimated proportion of people infected by a disease-causing agent, including asymptomatic and undiagnosed infections, who die from the disease. IFR cannot be higher than the CFR and is often much lower, but is also much harder to calculate. This data is based on optimally treated patients and exclude isolated cases or minor outbreaks, unless otherwise indicated.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Oropouche_fever/html

Oropouche fever

Oropouche fever is a tropical viral infection transmitted by biting midges and mosquitoes from the blood of sloths to humans . This disease is named after the region where it was first discovered and isolated at the Trinidad Regional Virus Laboratory in 1955 by the Oropouche River in Trinidad and Tobago . Oropouche fever is caused by a specific arbovirus , the Oropouche virus (OROV), of the Bunyaviridae family. Large epidemics are common and very swift, one of the earliest largest having occurred at the city of Belém , in the Brazilian Amazon state of Pará , with 11,000 recorded cases. In the Brazilian Amazon, oropouche is the second most frequent viral disease, after dengue fever. Several epidemics have generated more than 263,000 cases, of which 130,000 alone occurred in the period from 1978 to 1980. Presently, in Brazil alone it is estimated that more than half a million cases have occurred. Nevertheless, clinics in Brazil may not have adequate testing reliability as they rely on symptoms rather than PCR viral sequencing, which is expensive and time consuming, in many cases there may be co-infection with other similar mosquito-borne viruses. Oropouche fever is characterized as an acute febrile illness, meaning that it begins with a sudden onset of a fever followed by severe clinical symptoms. It typically takes 4 to 8 days from the incubation period to first start noticing signs of infection , beginning from the bite of the infected mosquito or midge. Fevers are the most common symptom with temperatures as high as 40 °C (104 °F) . Clinical symptoms include chills, headache, myalgia, arthralgia, dizziness, photophobia, vomiting, joint pains, epigastric pain , and rashes. There also have been some cases where rashes resembles rubella and patients presented systematic symptoms including nausea , vomiting , diarrhea , conjunctive congestion , epigastric pain, and retro-orbitial pain. The initial febrile episode typically passes after a few days, but it is very common to have a reoccurrence of these symptoms with a lesser intensity. Studies have shown this typically happens in about 60% of cases. The oropouche virus is an emerging infectious agent that causes the illness oropouche fever. This virus is an arbovirus and is transmitted among sloths, marsupials, primates, and birds through the mosquitoes Aedes serratus and Culex quinquefaciatus . The oropouche virus has evolved to an urban cycle infecting humans though midges as its main transporting vector. OROV was first described in Trinidad in 1955 when the prototype strain was isolated from the blood of a febrile human patient and from Coquillettidia venezuelensis mosquitoes . In Brazil, OROV was first described in 1960 when it was isolated from a three-toed sloth ( Bradypus tridactylus ) and Ochlerotatus serratus mosquitoes captured nearby during the construction of the Belém-Brasilia Highway . The oropouche virus is responsible for causing massive, explosive outbreaks in Latin American countries, making oropouche fever the second most common arboviral infection seen in Brazil. So far the only reported cases of Oropouche fever have been in Brazil, Panama, Peru, and Trinidad and Tobago. ORO fever occurs mainly during the rainy seasons because there is an increase in breeding sites in the vector populations. There has also been reports of the oropouche epidemics during the dry season but this is most likely due to the high population density of mosquitoes from the past rainy season. Moreover, during the dry season there is a deceased chance of outbreaks which decreases the amount of midges this is because the amount of outbreaks is related to the number of human population that has not yet been exposed to this virus. Oropouche fever is caused by the oropouche virus (OROV) that belongs to the Peribunyaviridae family of arboviruses. This virus is a single-stranded, negative sense RNA virus which is the cause of this disease. There are no specific ultrastructural studies of the oropouche virus in human tissues that have been recorded to this date. It is likely that this viral agent shares similar morphological characteristics with other members of the Orthobunyavirus genus. Members of the Orthobunyavirus genus have a three part, single-stranded, negative sense RNA genome of small (S), medium (M) and large (L) RNA segments. These segments function to encode nucleocapsids , glycoproteins and the RNA polymerase in that sequential order. Through phylogenetic analysis of nucleocapsid genes in different oropouche virus strains, it has been revealed that there are three unique genotypes (I, II, III) that are currently spreading through Central and South America. Genetic reassortment is said to be one of the most important mechanisms in explaining the viral biodiversity in orthobunyaviruses. This occurs when two genetically related viruses infect the same cell at the same time forming a progeny virus and this virus holds various components of genetic L, M and S segments from the two parental viruses. In reassortment, the S and L segments are the ones that are usually exchanged between species further, the S segment, that is coded by the nucleocapsid protein, and the L polymerase function together to create a replication of the viral genome. Due to this, one segment will restrict the molecular evolution of another segment and this is said to be inherited as a pair. On the contrary, the M segment codes for viral glycoproteins and these could be more prone to mutations due to a higher selective pressure in their coding region because these proteins are major host range determinants. There is not a significant amount of information about regarding the natural pathogenesis of OROV infections because there have been no recorded fatalities to date. It is known that within 2–4 days from the initial onset of systematic symptoms in humans, the presence of this virus is detected in the blood. In some cases this virus has also been recovered from the cerebrospinal fluid, but the route of invasion to the central nervous system remains unclear. To further understand the pathogenesis of how this virus manifests in the body experimental studies using murine models have been performed. BALB/c neonate mice were treated with this virus subcutaneously and presented clinical symptoms five days after inoculation . The mice revealed a high concentration of the replicating virus in the brain along with inflammation of the meninges and apoptosis of neurons without encephalitis, which is inflammation of the brain due to an infection. These findings confirmed the neurotropism of this virus, which means that this virus is capable of infecting nerve cells. Immunohistochemistry was used to reveal how this virus had access to the central nervous system. The findings indicated that the OROV infection starts from the posterior parts of the brain and progresses toward the forebrain. The oropouche virus spreads through the neural routes during early stages of the infection, reaching the spinal cord and traveling upward to the brain through brainstem with little inflammation. As the infection progresses, the virus crosses the blood-brain barrier and spreads to the brain parenchyma leading to severe manifestations of encephalitis . Damage to the brain parenchyma can result in the loss of cognitive ability or death. Genetic reassortment is said to be one of the most important mechanisms in explaining the viral biodiversity in orthobunyaviruses. This occurs when two genetically related viruses infect the same cell at the same time forming a progeny virus and this virus holds various components of genetic L, M and S segments from the two parental viruses. In reassortment, the S and L segments are the ones that are usually exchanged between species further, the S segment, that is coded by the nucleocapsid protein, and the L polymerase function together to create a replication of the viral genome. Due to this, one segment will restrict the molecular evolution of another segment and this is said to be inherited as a pair. On the contrary, the M segment codes for viral glycoproteins and these could be more prone to mutations due to a higher selective pressure in their coding region because these proteins are major host range determinants. There is not a significant amount of information about regarding the natural pathogenesis of OROV infections because there have been no recorded fatalities to date. It is known that within 2–4 days from the initial onset of systematic symptoms in humans, the presence of this virus is detected in the blood. In some cases this virus has also been recovered from the cerebrospinal fluid, but the route of invasion to the central nervous system remains unclear. To further understand the pathogenesis of how this virus manifests in the body experimental studies using murine models have been performed. BALB/c neonate mice were treated with this virus subcutaneously and presented clinical symptoms five days after inoculation . The mice revealed a high concentration of the replicating virus in the brain along with inflammation of the meninges and apoptosis of neurons without encephalitis, which is inflammation of the brain due to an infection. These findings confirmed the neurotropism of this virus, which means that this virus is capable of infecting nerve cells. Immunohistochemistry was used to reveal how this virus had access to the central nervous system. The findings indicated that the OROV infection starts from the posterior parts of the brain and progresses toward the forebrain. The oropouche virus spreads through the neural routes during early stages of the infection, reaching the spinal cord and traveling upward to the brain through brainstem with little inflammation. As the infection progresses, the virus crosses the blood-brain barrier and spreads to the brain parenchyma leading to severe manifestations of encephalitis . Damage to the brain parenchyma can result in the loss of cognitive ability or death. BALB/c neonate mice were treated with this virus subcutaneously and presented clinical symptoms five days after inoculation . The mice revealed a high concentration of the replicating virus in the brain along with inflammation of the meninges and apoptosis of neurons without encephalitis, which is inflammation of the brain due to an infection. These findings confirmed the neurotropism of this virus, which means that this virus is capable of infecting nerve cells. Immunohistochemistry was used to reveal how this virus had access to the central nervous system. The findings indicated that the OROV infection starts from the posterior parts of the brain and progresses toward the forebrain. The oropouche virus spreads through the neural routes during early stages of the infection, reaching the spinal cord and traveling upward to the brain through brainstem with little inflammation. As the infection progresses, the virus crosses the blood-brain barrier and spreads to the brain parenchyma leading to severe manifestations of encephalitis . Damage to the brain parenchyma can result in the loss of cognitive ability or death. Diagnosis of the oropouche infection is done through classic and molecular virology techniques. These include: Clinical diagnosis of oropouche fever is hard to perform due to the nonspecific nature of the disease, in many causes it can be confused with dengue fever or other arbovirus illness. Prevention strategies include reducing the breeding of midges through source reduction (removal and modification of breeding sites) and reducing contact between midges and people. This can be accomplished by reducing the number of natural and artificial water-filled habitats and encourage the midge larvae to grow. Oropouche fever is present in epidemics so the chances of one contracting it after being exposed to areas of midgets or mosquitoes is rare. Oropouche Fever has no cure or specific therapy so treatment is done by relieving the pain of the symptoms through symptomatic treatment . Certain oral analgesic and anti-inflammatory agents can help treat headaches and body pains. In extreme cases of oropouche fever the drug Ribavirin is recommended to help against the virus. This is called antiviral therapy . Treatments also consist of drinking plenty of fluids to prevent dehydration. Aspirin is not a recommended choice of drug because it can reduce blood clotting and may aggravate the hemorrhagic effects and prolong recovery time. [ citation needed ]The infection is usually self-limiting and complications are rare. This illness usually lasts for about a week but in extreme cases can be prolonged. Patients usually recover fully with no long term ill effects. There have been no recorded fatalities resulting from oropouche fever. One study has focused on identifying OROV through the use of RNA extraction from reverse transcription-polymerase chain reaction. This study revealed that OROV caused central nervous system infections in three patients. The three patients all had meningoencephalitis and also showed signs of clear lympho-monocytic cellular pattern in CSF , high protein, and normal to slightly decreased glucose levels indicating they had viral infections. Two of the patients already had underlying infections that can effect the CNS and immune system and in particular one of these patients has HIV/AIDS and the third patient has neurocysticercosis . Two patients were infected with OROV developed meningitis and it was theorized that this is due to them being immunocompromised. Through this it was revealed that it's possible that the invasion of the central nervous system by the oropouche virus can be performed by a previous blood-brain barrier damage.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Negative-strand_RNA_virus/html

Negative-strand RNA virus

See text Negative-strand RNA viruses ( −ssRNA viruses ) are a group of related viruses that have negative-sense , single-stranded genomes made of ribonucleic acid (RNA). They have genomes that act as complementary strands from which messenger RNA (mRNA) is synthesized by the viral enzyme RNA-dependent RNA polymerase (RdRp). During replication of the viral genome, RdRp synthesizes a positive-sense antigenome that it uses as a template to create genomic negative-sense RNA. Negative-strand RNA viruses also share a number of other characteristics: most contain a viral envelope that surrounds the capsid, which encases the viral genome, −ssRNA virus genomes are usually linear, and it is common for their genome to be segmented. Negative-strand RNA viruses constitute the phylum Negarnaviricota , in the kingdom Orthornavirae and realm Riboviria . They are descended from a common ancestor that was a double-stranded RNA (dsRNA) virus , and they are considered to be a sister clade of reoviruses , which are dsRNA viruses. Within the phylum, there are two major branches that form two subphyla: Haploviricotina , whose members are mostly non-segmented and which encode an RdRp that synthesizes caps on mRNA, and Polyploviricotina , whose members are segmented and which encode an RdRp that snatches caps from host mRNAs. A total of six classes in the phylum are recognized. Negative-strand RNA viruses are closely associated with arthropods and can be informally divided between those that are reliant on arthropods for transmission and those that are descended from arthropod viruses but can now replicate in vertebrates without the aid of arthropods. Prominent arthropod-borne −ssRNA viruses include the Rift Valley fever virus and the tomato spotted wilt virus . Notable vertebrate −ssRNA viruses include the Ebola virus , hantaviruses , influenza viruses , the Lassa fever virus , and the rabies virus .Negarnaviricota takes the first part of its name from Latin nega , meaning negative, the middle part rna refers to RNA, and the final part, - viricota , is the suffix used for virus phyla. The subphylum Haploviricotina takes the first part of its name, Haplo , from Ancient Greek ἁπλός, meaning simple, and - viricotina is the suffix used for virus subphyla. The subphylum Polyploviricotina follows the same pattern, Polyplo being taken from Ancient Greek πολύπλοκος, meaning complex. All viruses in Negarnaviricota are negative-sense, single-stranded RNA (−ssRNA) viruses. They have genomes made of RNA, which are single instead of double-stranded. Their genomes are negative sense, meaning that messenger RNA (mRNA) can be synthesized directly from the genome by the viral enzyme RNA-dependent RNA polymerase (RdRp), also called RNA replicase, which is encoded by all −ssRNA viruses. Excluding viruses in the genus Tenuivirus and some in the family Chuviridae , all −ssRNA viruses have linear rather than circular genomes, and the genomes may be segmented or non-segmented. All −ssRNA genomes contain terminal inverted repeats , which are palindromic nucleotide sequences at each end of the genome. Replication of −ssRNA genomes is executed by RdRp, which initiates replication by binding to a leader sequence on the 3'-end (usually pronounced "three prime end") of the genome. RdRp then uses the negative sense genome as a template to synthesize a positive-sense antigenome. When replicating the antigenome, RdRp first binds to the trailer sequence on the 3'-end of the antigenome. Thereafter, RdRp ignores all transcription signals on the antigenome and synthesizes a copy of the genome while using the antigenome as a template. Replication is executed while the genome is inside the nucleocapsid, and RdRp unveils the capsid and translocates along the genome during replication. As new nucleotide sequences are synthesized by RdRp, capsid proteins are assembled and encapsidate the newly replicate viral RNA. Transcribing mRNA from the genome follows the same directional pattern as producing the antigenome. At the leader sequence, RdRp synthesizes a 5-'end (usually pronounced "five prime end") triphosphate-leader RNA and either, in the case of the subphylum Haploviricotina , caps the 5'-end or, in the case of the subphylum Polyploviricotina , snatches a cap from a host mRNA and attaches it to the viral mRNA so that the mRNA can be translated by the host cell's ribosomes . After capping the mRNA, RdRp initiates transcription at a gene start signal and later terminates transcription upon reaching a gene end signal. At the end of transcription, RdRp synthesizes a polyadenylated tail (poly (A) tail) consisting of hundreds of adenines in the mRNA's 3-end, which may be done by stuttering on a sequence of uracils . After the poly (A) tail is constructed, the mRNA is released by RdRp. In genomes that encode more than one transcribable portion, RdRp can continue scanning to the next start sequence to continue with transcription. Some −ssRNA viruses are ambisense , meaning that both the negative genomic strand and positive antigenome separately encode different proteins. In order to transcribe ambisense viruses, two rounds of transcription are performed: first, mRNA is produced directly from the genome; second, mRNA is created from the antigenome. All ambisense viruses contain a hairpin loop structure to stop transcription after the protein's mRNA has been transcribed. Negative-strand RNA viruses contain a ribonucleoprotein complex composed of the genome and an RdRp attached to each segment of the genome surrounded by a capsid. The capsid is composed of proteins whose folded structure contains five alpha-helices in the N-terminal lobe (5-H motif) and three alpha-helices in the C-terminal lobe (3-H motif). Inside the capsid, the genome is sandwiched between these two motifs. Excluding the family Aspiviridae , −ssRNA viruses contain an outer viral envelope , a type of a lipid membrane that surrounds the capsid. The shape of the virus particle, called a virion, of −ssRNA viruses varies and may be filamentous, pleomorphic, spherical, or tubular. Genome segmentation is a prominent trait among many −ssRNA viruses, and −ssRNA viruses range from having genomes with one segment, typical for members of the order Mononegavirales , to genomes with ten segments, as is the case for Tilapia tilapinevirus . There is no clear trend over time that determines the number of segments, and genome segmentation among −ssRNA viruses appears to be a flexible trait since it has evolved independently on multiple occasions. Most members of the subphylum Haploviricotina are nonsegmented, whereas segmentation is universal in Polyploviricotina . All viruses in Negarnaviricota are negative-sense, single-stranded RNA (−ssRNA) viruses. They have genomes made of RNA, which are single instead of double-stranded. Their genomes are negative sense, meaning that messenger RNA (mRNA) can be synthesized directly from the genome by the viral enzyme RNA-dependent RNA polymerase (RdRp), also called RNA replicase, which is encoded by all −ssRNA viruses. Excluding viruses in the genus Tenuivirus and some in the family Chuviridae , all −ssRNA viruses have linear rather than circular genomes, and the genomes may be segmented or non-segmented. All −ssRNA genomes contain terminal inverted repeats , which are palindromic nucleotide sequences at each end of the genome. Replication of −ssRNA genomes is executed by RdRp, which initiates replication by binding to a leader sequence on the 3'-end (usually pronounced "three prime end") of the genome. RdRp then uses the negative sense genome as a template to synthesize a positive-sense antigenome. When replicating the antigenome, RdRp first binds to the trailer sequence on the 3'-end of the antigenome. Thereafter, RdRp ignores all transcription signals on the antigenome and synthesizes a copy of the genome while using the antigenome as a template. Replication is executed while the genome is inside the nucleocapsid, and RdRp unveils the capsid and translocates along the genome during replication. As new nucleotide sequences are synthesized by RdRp, capsid proteins are assembled and encapsidate the newly replicate viral RNA. Transcribing mRNA from the genome follows the same directional pattern as producing the antigenome. At the leader sequence, RdRp synthesizes a 5-'end (usually pronounced "five prime end") triphosphate-leader RNA and either, in the case of the subphylum Haploviricotina , caps the 5'-end or, in the case of the subphylum Polyploviricotina , snatches a cap from a host mRNA and attaches it to the viral mRNA so that the mRNA can be translated by the host cell's ribosomes . After capping the mRNA, RdRp initiates transcription at a gene start signal and later terminates transcription upon reaching a gene end signal. At the end of transcription, RdRp synthesizes a polyadenylated tail (poly (A) tail) consisting of hundreds of adenines in the mRNA's 3-end, which may be done by stuttering on a sequence of uracils . After the poly (A) tail is constructed, the mRNA is released by RdRp. In genomes that encode more than one transcribable portion, RdRp can continue scanning to the next start sequence to continue with transcription. Some −ssRNA viruses are ambisense , meaning that both the negative genomic strand and positive antigenome separately encode different proteins. In order to transcribe ambisense viruses, two rounds of transcription are performed: first, mRNA is produced directly from the genome; second, mRNA is created from the antigenome. All ambisense viruses contain a hairpin loop structure to stop transcription after the protein's mRNA has been transcribed. Negative-strand RNA viruses contain a ribonucleoprotein complex composed of the genome and an RdRp attached to each segment of the genome surrounded by a capsid. The capsid is composed of proteins whose folded structure contains five alpha-helices in the N-terminal lobe (5-H motif) and three alpha-helices in the C-terminal lobe (3-H motif). Inside the capsid, the genome is sandwiched between these two motifs. Excluding the family Aspiviridae , −ssRNA viruses contain an outer viral envelope , a type of a lipid membrane that surrounds the capsid. The shape of the virus particle, called a virion, of −ssRNA viruses varies and may be filamentous, pleomorphic, spherical, or tubular. Genome segmentation is a prominent trait among many −ssRNA viruses, and −ssRNA viruses range from having genomes with one segment, typical for members of the order Mononegavirales , to genomes with ten segments, as is the case for Tilapia tilapinevirus . There is no clear trend over time that determines the number of segments, and genome segmentation among −ssRNA viruses appears to be a flexible trait since it has evolved independently on multiple occasions. Most members of the subphylum Haploviricotina are nonsegmented, whereas segmentation is universal in Polyploviricotina . Phylogenetic analysis based on RdRp shows that −ssRNA viruses are descended from a common ancestor and that they are likely a sister clade of reoviruses , which are dsRNA viruses. Within the phylum, there are two clear branches, assigned to two subphyla, based on whether RdRp synthesizes a cap on viral mRNA or snatches a cap from host mRNA and attaches that cap to viral mRNA. Within the phylum, −ssRNA viruses that infect arthropods appear to be basal and the ancestors of all other −ssRNA viruses. Arthropods frequently live together in large groups, which allows for viruses to be transmitted easily. Over time, this has led to arthropod −ssRNA viruses gaining a high level of diversity. While arthropods host large quantities of viruses, there is disagreement about the degree to which cross-species transmission of arthropod −ssRNA viruses occurs among arthropods. Plant and vertebrate −ssRNA viruses tend to be genetically related to arthropod-infected viruses. Furthermore, most −ssRNA viruses outside of arthropods are found in species that interact with arthropods. Arthropods therefore serve as both key hosts and vectors of transmission of −ssRNA viruses. In terms of transmission, non-arthropod −ssRNA viruses can be distinguished between those that are reliant on arthropods for transmission and those that can circulate among vertebrates without the aid of arthropods. The latter group is likely to have originated from the former, adapting to vertebrate-only transmission. Negarnaviricota belongs to the kingdom Orthornavirae , which encompasses all RNA viruses that encode RdRp, and the realm Riboviria , which includes Orthornavirae as well as all viruses that encode reverse transcriptase in the kingdom Pararnavirae . Negarnaviricota contains two subphyla, which contain a combined six classes, five of which are monotypic down to lower taxa: Subphylum: Haploviricotina , which contains −ssRNA viruses that encode an RdRp that synthesizes a cap structure on viral mRNA and which usually have nonsegmented genomes Class: Chunquiviricetes Order: Muvirales Family: Qinviridae Genus: Yingvirus Class: Milneviricetes Order: Serpentovirales Family: Aspviridae Genus: Ophiovirus Class: Monjiviricetes Class: Yunchangviricetes Order: Goujianvirales Family: Yueviridae Genus: Yuyuevirus Subphylum: Polyploviricotina , which contains −ssRNA viruses that encode an RdRp that takes a cap from host mRNA to use as the cap on viral mRNA and which have segmented genomes Class: Ellioviricetes Order: Bunyavirales Class: Insthoviricetes Order: Articulavirales Class: Chunquiviricetes Order: Muvirales Family: Qinviridae Genus: Yingvirus Class: Milneviricetes Order: Serpentovirales Family: Aspviridae Genus: Ophiovirus Class: Monjiviricetes Class: Yunchangviricetes Order: Goujianvirales Family: Yueviridae Genus: Yuyuevirus Order: Muvirales Family: Qinviridae Genus: Yingvirus Family: Qinviridae Genus: Yingvirus Order: Serpentovirales Family: Aspviridae Genus: Ophiovirus Family: Aspviridae Genus: Ophiovirus Order: Goujianvirales Family: Yueviridae Genus: Yuyuevirus Family: Yueviridae Genus: Yuyuevirus Class: Ellioviricetes Order: Bunyavirales Class: Insthoviricetes Order: Articulavirales Negative-strand RNA viruses are classified as Group V in the Baltimore classification system, which groups viruses together based on their manner of mRNA production and which is often used alongside standard virus taxonomy, which is based on evolutionary history. Therefore, Group V and Negarnaviricota are synonymous. Negative-strand RNA viruses caused many widely known diseases. Many of these are transmitted by arthropods, including the Rift Valley fever virus and the tomato spotted wilt virus . Among vertebrates, bats and rodents are common vectors for many viruses, including the Ebola virus and the rabies virus , transmitted by bats and other vertebrates, and the Lassa fever virus and hantaviruses , transmitted by rodents. Influenza viruses are common among birds and mammals. Human-specific −ssRNA viruses include the measles virus and the mumps virus . Many diseases caused by −ssRNA viruses have been known throughout history, including hantavirus infection, measles, and rabies. In modern history, some such as Ebola and influenza have caused deadly disease outbreaks. The vesicular stomatitis virus , first isolated in 1925 and one of the first animal viruses to be studied because it could be studied well in cell cultures , was identified as an −ssRNA virus, which was unique at the time because other RNA viruses that had been discovered were positive sense. In the early 21st century, the bovine disease rinderpest , caused by −ssRNA rinderpest virus, became the second disease to be eradicated, after smallpox , caused by a DNA virus. In the 21st century, viral metagenomics has become common to identify viruses in the environment. For −ssRNA viruses, this allowed for a large number of invertebrate, and especially arthropod, viruses to be identified, which helped to provide insight into the evolutionary history of −ssRNA viruses. Based on phylogenetic analysis of RdRp showing that −ssRNA viruses were descended from a common ancestor, Negarnaviricota and its two subphyla were established in 2018, and it was placed into the then newly established realm Riboviria .

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Fulminant/html

Fulminant

Fulminant ( / ˈ f ʊ l m ɪ n ən t / ) is a medical descriptor for any event or process that occurs suddenly and escalates quickly, and is intense and severe to the point of lethality, i.e., it has an explosive character. The word comes from Latin fulmināre , to strike with lightning . There are several diseases described by this adjective: Beyond these particular uses, the term is used more generally as a descriptor for sudden-onset medical conditions that are immediately threatening to life or limb. Some viral hemorrhagic fevers , such as Ebola , Lassa fever , and Lábrea fever , may kill in as little as two to five days. Diseases that cause rapidly developing lung edema , such as some kinds of pneumonia , may kill in a few hours. It was said of the " black death " (pneumonic bubonic plague ) that some of its victims would die in a matter of hours after the initial symptoms appeared. Other pathologic conditions that may be fulminating in character are acute respiratory distress syndrome , asthma , acute anaphylaxis , septic shock , and disseminated intravascular coagulation . The term is generally not used to refer to immediate death by trauma, such as gunshot wound, but can refer to trauma-induced secondary conditions, such as commotio cordis , a sudden cardiac arrest caused by a blunt, non-penetrating trauma to the precordium , which causes ventricular fibrillation of the heart. Cardiac arrest and stroke in certain parts of the brain , such as in the brainstem (which controls cardiovascular and respiratory system functions), and massive hemorrhage of the great arteries (such as in perforation of the walls by trauma or by sudden opening of an aneurysm of the aorta ) may be very quick, causing "fulminant death". Sudden infant death syndrome (SIDS) is still a mysterious cause of respiratory arrest in infants. Certain infections of the brain, such as rabies , meningococcal meningitis , or primary amebic meningoencephalitis can kill within hours to days after symptoms appear. Some toxins , such as cyanide , may also provoke fulminant death. Abrupt hyperkalemia provoked by intravenous injection of potassium chloride leads to fulminant death by cardiac arrest.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Natal_multimammate_mouse/html

Natal multimammate mouse

Mastomys hildebrandtii (Peters, 1878) Myomys fumatus (Peters, 1878) The Natal multimammate mouse ( Mastomys natalensis ) is a species of rodent in the family Muridae . It is also known as the Natal multimammate rat , the common African rat, or the African soft-furred mouse . The Natal multimammate rat is the natural host of the Lassa fever virus .It is found in Africa south of the Sahara . Six different genetic groups can be distinguished in different regions: one in western Africa, one in central Africa, one in southern Africa and three in eastern Africa. Its natural habitats are subtropical or tropical dry forest , subtropical or tropical moist lowland forest , dry savanna , moist savanna, subtropical or tropical dry shrubland , subtropical or tropical moist shrubland , arable land , pastureland, rural gardens, urban areas , irrigated land, and seasonally flooded agricultural land. These rats associate closely with humans, and are commonly found in and around African villages.The species has been used as a laboratory animal since 1939. It has great value for researchers who focused on stomach cancer and spontaneous tumors. It is also the most important reservoir of Lassa fever virus .

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Endemic_(epidemiology)/html

Endemic (epidemiology)

In epidemiology , an infection is said to be endemic in a specific population or populated place when that infection is constantly present, or maintained at a baseline level, without extra infections being brought into the group as a result of travel or similar means. The term describes the distribution (spread) of an infectious disease among a group of people or within a populated area. An endemic disease always has a steady, predictable number of people getting sick, but that number can be high ( hyperendemic ) or low ( hypoendemic ), and the disease can be severe or mild. Also, a disease that is usually endemic can become epidemic . For example, chickenpox is endemic (steady state) in the United Kingdom, but malaria is not. Every year, there are a few cases of malaria reported in the UK, but these do not lead to sustained transmission in the population due to the lack of a suitable vector (mosquitoes of the genus Anopheles ). Consequently, the number of people infected by malaria in the UK is too variable to be called endemic. However, the number of people who get chickenpox in the UK varies little from year to year, so chickenpox is considered endemic in the UK.For an infection that relies on person-to-person transmission, to be endemic, each person who becomes infected with the disease must pass it on to one other person on average. Assuming a completely susceptible population, that means that the basic reproduction number (R 0 ) of the infection must equal one. In a population with some immune individuals, the basic reproduction number multiplied by the proportion of susceptible individuals in the population ( S ) must be one. This takes account of the probability of each individual to whom the disease may be transmitted being susceptible to it, effectively discounting the immune sector of the population. So, for a disease to be in an endemic steady state or endemic equilibrium , it holds that In this way, the infection neither dies out nor does the number of infected people increase exponentially but the infection is said to be in an endemic steady state. An infection that starts as an epidemic will eventually either die out (with the possibility of it resurging in a theoretically predictable cyclical manner) or reach the endemic steady state, depending on a number of factors, including the virulence of the disease and its mode of transmission . If a disease is in an endemic steady state in a population, the relation above allows us to estimate the R 0 (an important parameter ) of a particular infection. This in turn can be fed into a mathematical model for the epidemic. Based on the reproduction number, we can define the epidemic waves, such as the first wave, second wave, etc. for COVID-19 in different regions and countries. While it might be common to say that AIDS is endemic in some countries, meaning that it is regularly found in an area, this is a use of the word in its etymological, rather than epidemiological or ecological , form. [ citation needed ] Some in the public wrongly assume that endemic COVID-19 means the disease severity would necessarily be mild. Endemic COVID-19 could be mild if previously acquired immunity reduces the risk of death and disability during future infections, but in itself endemicity only means that there will be a steady, predictable number of sick people. This is a short, incomplete list of some infections that are usually considered endemic: Smallpox was an endemic disease until it was eradicated through vaccination. The word endemic comes from the Greek : ἐν , en , "in, within" and δῆμος , demos , "people". [ citation needed ]

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Zoonosis/html

Zoonosis

A zoonosis ( / z oʊ ˈ ɒ n ə s ɪ s , ˌ z oʊ ə ˈ n oʊ s ɪ s / ; plural zoonoses ) or zoonotic disease is an infectious disease of humans caused by a pathogen (an infectious agent, such as a bacterium , virus , parasite , or prion ) that can jump from a non-human (usually a vertebrate ) to a human and vice versa. Major modern diseases such as Ebola and salmonellosis are zoonoses. HIV was a zoonotic disease transmitted to humans in the early part of the 20th century, though it has now evolved into a separate human-only disease. Human infection with animal influenza viruses is rare, as they do not transmit easily to or among humans. However, avian and swine influenza viruses in particular possess high zoonotic potential, and these occasionally recombine with human strains of the flu and can cause pandemics such as the 2009 swine flu . Taenia solium infection is one of the neglected tropical diseases with public health and veterinary concern in endemic regions. Zoonoses can be caused by a range of disease pathogens such as emergent viruses , bacteria, fungi and parasites; of 1,415 pathogens known to infect humans, 61% were zoonotic. Most human diseases originated in non-humans; however, only diseases that routinely involve non-human to human transmission, such as rabies , are considered direct zoonoses. Zoonoses have different modes of transmission. In direct zoonosis the disease is directly transmitted from non-humans to humans through media such as air (influenza) or bites and saliva (rabies). In contrast, transmission can also occur via an intermediate species (referred to as a vector ), which carry the disease pathogen without getting sick. When humans infect non-humans, it is called reverse zoonosis or anthroponosis. The term is from Greek : ζῷον zoon "animal" and νόσος nosos "sickness". Host genetics plays an important role in determining which non-human viruses will be able to make copies of themselves in the human body. Dangerous non-human viruses are those that require few mutations to begin replicating themselves in human cells. These viruses are dangerous since the required combinations of mutations might randomly arise in the natural reservoir . The emergence of zoonotic diseases originated with the domestication of animals. Zoonotic transmission can occur in any context in which there is contact with or consumption of animals, animal products, or animal derivatives. This can occur in a companionistic (pets), economic (farming, trade, butchering, etc.), predatory (hunting, butchering, or consuming wild game), or research context. Recently, there has been a rise in frequency of appearance of new zoonotic diseases. "Approximately 1.67 million undescribed viruses are thought to exist in mammals and birds, up to half of which are estimated to have the potential to spill over into humans", says a study led by researchers at the University of California, Davis . According to a report from the United Nations Environment Programme and International Livestock Research Institute a large part of the causes are environmental like climate change , unsustainable agriculture, exploitation of wildlife, and land use change . Others are linked to changes in human society such as an increase in mobility. The organizations propose a set of measures to stop the rise. The most significant zoonotic pathogens causing foodborne diseases are Escherichia coli O157:H7 , Campylobacter , Caliciviridae , and Salmonella . In 2006 a conference held in Berlin focused on the issue of zoonotic pathogen effects on food safety , urging government intervention and public vigilance against the risks of catching food-borne diseases from farm-to-table dining. Many food-borne outbreaks can be linked to zoonotic pathogens. Many different types of food that have an animal origin can become contaminated. Some common food items linked to zoonotic contaminations include eggs, seafood, meat, dairy, and even some vegetables. Outbreaks involving contaminated food should be handled in preparedness plans to prevent widespread outbreaks and to efficiently and effectively contain outbreaks. Contact with farm animals can lead to disease in farmers or others that come into contact with infected farm animals. Glanders primarily affects those who work closely with horses and donkeys. Close contact with cattle can lead to cutaneous anthrax infection, whereas inhalation anthrax infection is more common for workers in slaughterhouses , tanneries , and wool mills . Close contact with sheep who have recently given birth can lead to infection with the bacterium Chlamydia psittaci , causing chlamydiosis (and enzootic abortion in pregnant women), as well as increase the risk of Q fever , toxoplasmosis , and listeriosis , in the pregnant or otherwise immunocompromised . Echinococcosis is caused by a tapeworm, which can spread from infected sheep by food or water contaminated by feces or wool. Avian influenza is common in chickens, and, while it is rare in humans, the main public health worry is that a strain of avian influenza will recombine with a human influenza virus and cause a pandemic like the 1918 Spanish flu . [ citation needed ] In 2017, free-range chickens in the UK were temporarily ordered to remain inside due to the threat of avian influenza. Cattle are an important reservoir of cryptosporidiosis , which mainly affects the immunocompromised. Reports have shown mink can also become infected. In Western countries, hepatitis E burden is largely dependent on exposure to animal products, and pork is a significant source of infection, in this respect. Veterinarians are exposed to unique occupational hazards when it comes to zoonotic disease. In the US, studies have highlighted an increased risk of injuries and lack of veterinary awareness of these hazards. Research has proved the importance for continued clinical veterinarian education on occupational risks associated with musculoskeletal injuries, animal bites, needle-sticks, and cuts. A July 2020 report by the United Nations Environment Programme stated that the increase in zoonotic pandemics is directly attributable to anthropogenic destruction of nature and the increased global demand for meat and that the industrial farming of pigs and chickens in particular will be a primary risk factor for the spillover of zoonotic diseases in the future. Habitat loss of viral reservoir species has been identified as a significant source in at least one spillover event . The wildlife trade may increase spillover risk because it directly increases the number of interactions across animal species, sometimes in small spaces. The origin of the ongoing COVID-19 pandemic is traced to the wet markets in China . Zoonotic disease emergence is demonstrably linked to the consumption of wildlife meat, exacerbated by human encroachment into natural habitats and amplified by the unsanitary conditions of wildlife markets. These markets, where diverse species converge, facilitate the mixing and transmission of pathogens, including those responsible for outbreaks of HIV-1, Ebola, and mpox , and potentially even the COVID-19 pandemic. Notably, small mammals often harbor a vast array of zoonotic bacteria and viruses, yet endemic bacterial transmission among wildlife remains largely unexplored. Therefore, accurately determining the pathogenic landscape of traded wildlife is crucial for guiding effective measures to combat zoonotic diseases and documenting the societal and environmental costs associated with this practice. Pets can transmit a number of diseases. Dogs and cats are routinely vaccinated against rabies . Pets can also transmit ringworm and Giardia , which are endemic in both animal and human populations. Toxoplasmosis is a common infection of cats; in humans it is a mild disease although it can be dangerous to pregnant women. Dirofilariasis is caused by Dirofilaria immitis through mosquitoes infected by mammals like dogs and cats. Cat-scratch disease is caused by Bartonella henselae and Bartonella quintana , which are transmitted by fleas that are endemic to cats. Toxocariasis is the infection of humans by any of species of roundworm , including species specific to dogs ( Toxocara canis ) or cats ( Toxocara cati ). Cryptosporidiosis can be spread to humans from pet lizards, such as the leopard gecko . Encephalitozoon cuniculi is a microsporidial parasite carried by many mammals, including rabbits, and is an important opportunistic pathogen in people immunocompromised by HIV/AIDS , organ transplantation , or CD4+ T-lymphocyte deficiency. Pets may also serve as a reservoir of viral disease and contribute to the chronic presence of certain viral diseases in the human population. For instance, approximately 20% of domestic dogs, cats, and horses carry anti-hepatitis E virus antibodies and thus these animals probably contribute to human hepatitis E burden as well. For non-vulnerable populations (e.g., people who are not immunocompromised) the associated disease burden is, however, small. [ citation needed ] Furthermore, the trade of non domestic animals such as wild animals as pets can also increase the risk of zoonosis spread. Outbreaks of zoonoses have been traced to human interaction with, and exposure to, other animals at fairs , live animal markets , petting zoos , and other settings. In 2005, the Centers for Disease Control and Prevention (CDC) issued an updated list of recommendations for preventing zoonosis transmission in public settings. The recommendations, developed in conjunction with the National Association of State Public Health Veterinarians , include educational responsibilities of venue operators, limiting public animal contact, and animal care and management. Hunting involves humans tracking, chasing, and capturing wild animals, primarily for food or materials like fur. However, other reasons like pest control or managing wildlife populations can also exist. Transmission of zoonotic diseases, those leaping from animals to humans, can occur through various routes: direct physical contact, airborne droplets or particles, bites or vector transport by insects, oral ingestion, or even contact with contaminated environments. Wildlife activities like hunting and trade bring humans closer to dangerous zoonotic pathogens, threatening global health. According to the Center for Diseases Control and Prevention (CDC) hunting and consuming wild animal meat ("bushmeat") in regions like Africa can expose people to infectious diseases due to the types of animals involved, like bats and primates. Unfortunately, common preservation methods like smoking or drying aren't enough to eliminate these risks. Although bushmeat provides protein and income for many, the practice is intricately linked to numerous emerging infectious diseases like Ebola, HIV, and SARS , raising critical public health concerns. A review published in 2022 found evidence that zoonotic spillover linked to wildmeat consumption has been reported across all continents. Kate Jones , Chair of Ecology and Biodiversity at University College London , says zoonotic diseases are increasingly linked to environmental change and human behavior. The disruption of pristine forests driven by logging, mining, road building through remote places, rapid urbanization, and population growth is bringing people into closer contact with animal species they may never have been near before. The resulting transmission of disease from wildlife to humans, she says, is now "a hidden cost of human economic development". In a guest article, published by IPBES , President of the EcoHealth Alliance and zoologist Peter Daszak , along with three co-chairs of the 2019 Global Assessment Report on Biodiversity and Ecosystem Services , Josef Settele, Sandra Díaz , and Eduardo Brondizio, wrote that "rampant deforestation, uncontrolled expansion of agriculture, intensive farming , mining and infrastructure development, as well as the exploitation of wild species have created a 'perfect storm' for the spillover of diseases from wildlife to people." Joshua Moon, Clare Wenham, and Sophie Harman said that there is evidence that decreased biodiversity has an effect on the diversity of hosts and frequency of human-animal interactions with potential for pathogenic spillover. An April 2020 study, published in the Proceedings of the Royal Society ' s Part B journal, found that increased virus spillover events from animals to humans can be linked to biodiversity loss and environmental degradation , as humans further encroach on wildlands to engage in agriculture, hunting, and resource extraction they become exposed to pathogens which normally would remain in these areas. Such spillover events have been tripling every decade since 1980. An August 2020 study, published in Nature , concludes that the anthropogenic destruction of ecosystems for the purpose of expanding agriculture and human settlements reduces biodiversity and allows for smaller animals such as bats and rats, which are more adaptable to human pressures and also carry the most zoonotic diseases, to proliferate. This in turn can result in more pandemics. In October 2020, the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services published its report on the 'era of pandemics' by 22 experts in a variety of fields and concluded that anthropogenic destruction of biodiversity is paving the way to the pandemic era and could result in as many as 850,000 viruses being transmitted from animals – in particular birds and mammals – to humans. The increased pressure on ecosystems is being driven by the "exponential rise" in consumption and trade of commodities such as meat, palm oil , and metals, largely facilitated by developed nations, and by a growing human population . According to Peter Daszak, the chair of the group who produced the report, "there is no great mystery about the cause of the Covid-19 pandemic, or of any modern pandemic. The same human activities that drive climate change and biodiversity loss also drive pandemic risk through their impacts on our environment." According to a report from the United Nations Environment Programme and International Livestock Research Institute , entitled "Preventing the next pandemic – Zoonotic diseases and how to break the chain of transmission", climate change is one of the 7 human-related causes of the increase in the number of zoonotic diseases. The University of Sydney issued a study, in March 2021, that examines factors increasing the likelihood of epidemics and pandemics like the COVID-19 pandemic. The researchers found that "pressure on ecosystems, climate change and economic development are key factors" in doing so. More zoonotic diseases were found in high-income countries . A 2022 study dedicated to the link between climate change and zoonosis found a strong link between climate change and the epidemic emergence in the last 15 years, as it caused a massive migration of species to new areas, and consequently contact between species which do not normally come in contact with one another. Even in a scenario with weak climatic changes, there will be 15,000 spillover of viruses to new hosts in the next decades. The areas with the most possibilities for spillover are the mountainous tropical regions of Africa and southeast Asia. Southeast Asia is especially vulnerable as it has a large number of bat species that generally do not mix, but could easily if climate change forced them to begin migrating. A 2021 study found possible links between climate change and transmission of COVID-19 through bats. The authors suggest that climate-driven changes in the distribution and robustness of bat species harboring coronaviruses may have occurred in eastern Asian hotspots (southern China, Myanmar, and Laos), constituting a driver behind the evolution and spread of the virus. The most significant zoonotic pathogens causing foodborne diseases are Escherichia coli O157:H7 , Campylobacter , Caliciviridae , and Salmonella . In 2006 a conference held in Berlin focused on the issue of zoonotic pathogen effects on food safety , urging government intervention and public vigilance against the risks of catching food-borne diseases from farm-to-table dining. Many food-borne outbreaks can be linked to zoonotic pathogens. Many different types of food that have an animal origin can become contaminated. Some common food items linked to zoonotic contaminations include eggs, seafood, meat, dairy, and even some vegetables. Outbreaks involving contaminated food should be handled in preparedness plans to prevent widespread outbreaks and to efficiently and effectively contain outbreaks. Contact with farm animals can lead to disease in farmers or others that come into contact with infected farm animals. Glanders primarily affects those who work closely with horses and donkeys. Close contact with cattle can lead to cutaneous anthrax infection, whereas inhalation anthrax infection is more common for workers in slaughterhouses , tanneries , and wool mills . Close contact with sheep who have recently given birth can lead to infection with the bacterium Chlamydia psittaci , causing chlamydiosis (and enzootic abortion in pregnant women), as well as increase the risk of Q fever , toxoplasmosis , and listeriosis , in the pregnant or otherwise immunocompromised . Echinococcosis is caused by a tapeworm, which can spread from infected sheep by food or water contaminated by feces or wool. Avian influenza is common in chickens, and, while it is rare in humans, the main public health worry is that a strain of avian influenza will recombine with a human influenza virus and cause a pandemic like the 1918 Spanish flu . [ citation needed ] In 2017, free-range chickens in the UK were temporarily ordered to remain inside due to the threat of avian influenza. Cattle are an important reservoir of cryptosporidiosis , which mainly affects the immunocompromised. Reports have shown mink can also become infected. In Western countries, hepatitis E burden is largely dependent on exposure to animal products, and pork is a significant source of infection, in this respect. Veterinarians are exposed to unique occupational hazards when it comes to zoonotic disease. In the US, studies have highlighted an increased risk of injuries and lack of veterinary awareness of these hazards. Research has proved the importance for continued clinical veterinarian education on occupational risks associated with musculoskeletal injuries, animal bites, needle-sticks, and cuts. A July 2020 report by the United Nations Environment Programme stated that the increase in zoonotic pandemics is directly attributable to anthropogenic destruction of nature and the increased global demand for meat and that the industrial farming of pigs and chickens in particular will be a primary risk factor for the spillover of zoonotic diseases in the future. Habitat loss of viral reservoir species has been identified as a significant source in at least one spillover event . The wildlife trade may increase spillover risk because it directly increases the number of interactions across animal species, sometimes in small spaces. The origin of the ongoing COVID-19 pandemic is traced to the wet markets in China . Zoonotic disease emergence is demonstrably linked to the consumption of wildlife meat, exacerbated by human encroachment into natural habitats and amplified by the unsanitary conditions of wildlife markets. These markets, where diverse species converge, facilitate the mixing and transmission of pathogens, including those responsible for outbreaks of HIV-1, Ebola, and mpox , and potentially even the COVID-19 pandemic. Notably, small mammals often harbor a vast array of zoonotic bacteria and viruses, yet endemic bacterial transmission among wildlife remains largely unexplored. Therefore, accurately determining the pathogenic landscape of traded wildlife is crucial for guiding effective measures to combat zoonotic diseases and documenting the societal and environmental costs associated with this practice.Pets can transmit a number of diseases. Dogs and cats are routinely vaccinated against rabies . Pets can also transmit ringworm and Giardia , which are endemic in both animal and human populations. Toxoplasmosis is a common infection of cats; in humans it is a mild disease although it can be dangerous to pregnant women. Dirofilariasis is caused by Dirofilaria immitis through mosquitoes infected by mammals like dogs and cats. Cat-scratch disease is caused by Bartonella henselae and Bartonella quintana , which are transmitted by fleas that are endemic to cats. Toxocariasis is the infection of humans by any of species of roundworm , including species specific to dogs ( Toxocara canis ) or cats ( Toxocara cati ). Cryptosporidiosis can be spread to humans from pet lizards, such as the leopard gecko . Encephalitozoon cuniculi is a microsporidial parasite carried by many mammals, including rabbits, and is an important opportunistic pathogen in people immunocompromised by HIV/AIDS , organ transplantation , or CD4+ T-lymphocyte deficiency. Pets may also serve as a reservoir of viral disease and contribute to the chronic presence of certain viral diseases in the human population. For instance, approximately 20% of domestic dogs, cats, and horses carry anti-hepatitis E virus antibodies and thus these animals probably contribute to human hepatitis E burden as well. For non-vulnerable populations (e.g., people who are not immunocompromised) the associated disease burden is, however, small. [ citation needed ] Furthermore, the trade of non domestic animals such as wild animals as pets can also increase the risk of zoonosis spread. Outbreaks of zoonoses have been traced to human interaction with, and exposure to, other animals at fairs , live animal markets , petting zoos , and other settings. In 2005, the Centers for Disease Control and Prevention (CDC) issued an updated list of recommendations for preventing zoonosis transmission in public settings. The recommendations, developed in conjunction with the National Association of State Public Health Veterinarians , include educational responsibilities of venue operators, limiting public animal contact, and animal care and management.Hunting involves humans tracking, chasing, and capturing wild animals, primarily for food or materials like fur. However, other reasons like pest control or managing wildlife populations can also exist. Transmission of zoonotic diseases, those leaping from animals to humans, can occur through various routes: direct physical contact, airborne droplets or particles, bites or vector transport by insects, oral ingestion, or even contact with contaminated environments. Wildlife activities like hunting and trade bring humans closer to dangerous zoonotic pathogens, threatening global health. According to the Center for Diseases Control and Prevention (CDC) hunting and consuming wild animal meat ("bushmeat") in regions like Africa can expose people to infectious diseases due to the types of animals involved, like bats and primates. Unfortunately, common preservation methods like smoking or drying aren't enough to eliminate these risks. Although bushmeat provides protein and income for many, the practice is intricately linked to numerous emerging infectious diseases like Ebola, HIV, and SARS , raising critical public health concerns. A review published in 2022 found evidence that zoonotic spillover linked to wildmeat consumption has been reported across all continents. Kate Jones , Chair of Ecology and Biodiversity at University College London , says zoonotic diseases are increasingly linked to environmental change and human behavior. The disruption of pristine forests driven by logging, mining, road building through remote places, rapid urbanization, and population growth is bringing people into closer contact with animal species they may never have been near before. The resulting transmission of disease from wildlife to humans, she says, is now "a hidden cost of human economic development". In a guest article, published by IPBES , President of the EcoHealth Alliance and zoologist Peter Daszak , along with three co-chairs of the 2019 Global Assessment Report on Biodiversity and Ecosystem Services , Josef Settele, Sandra Díaz , and Eduardo Brondizio, wrote that "rampant deforestation, uncontrolled expansion of agriculture, intensive farming , mining and infrastructure development, as well as the exploitation of wild species have created a 'perfect storm' for the spillover of diseases from wildlife to people." Joshua Moon, Clare Wenham, and Sophie Harman said that there is evidence that decreased biodiversity has an effect on the diversity of hosts and frequency of human-animal interactions with potential for pathogenic spillover. An April 2020 study, published in the Proceedings of the Royal Society ' s Part B journal, found that increased virus spillover events from animals to humans can be linked to biodiversity loss and environmental degradation , as humans further encroach on wildlands to engage in agriculture, hunting, and resource extraction they become exposed to pathogens which normally would remain in these areas. Such spillover events have been tripling every decade since 1980. An August 2020 study, published in Nature , concludes that the anthropogenic destruction of ecosystems for the purpose of expanding agriculture and human settlements reduces biodiversity and allows for smaller animals such as bats and rats, which are more adaptable to human pressures and also carry the most zoonotic diseases, to proliferate. This in turn can result in more pandemics. In October 2020, the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services published its report on the 'era of pandemics' by 22 experts in a variety of fields and concluded that anthropogenic destruction of biodiversity is paving the way to the pandemic era and could result in as many as 850,000 viruses being transmitted from animals – in particular birds and mammals – to humans. The increased pressure on ecosystems is being driven by the "exponential rise" in consumption and trade of commodities such as meat, palm oil , and metals, largely facilitated by developed nations, and by a growing human population . According to Peter Daszak, the chair of the group who produced the report, "there is no great mystery about the cause of the Covid-19 pandemic, or of any modern pandemic. The same human activities that drive climate change and biodiversity loss also drive pandemic risk through their impacts on our environment." According to a report from the United Nations Environment Programme and International Livestock Research Institute , entitled "Preventing the next pandemic – Zoonotic diseases and how to break the chain of transmission", climate change is one of the 7 human-related causes of the increase in the number of zoonotic diseases. The University of Sydney issued a study, in March 2021, that examines factors increasing the likelihood of epidemics and pandemics like the COVID-19 pandemic. The researchers found that "pressure on ecosystems, climate change and economic development are key factors" in doing so. More zoonotic diseases were found in high-income countries . A 2022 study dedicated to the link between climate change and zoonosis found a strong link between climate change and the epidemic emergence in the last 15 years, as it caused a massive migration of species to new areas, and consequently contact between species which do not normally come in contact with one another. Even in a scenario with weak climatic changes, there will be 15,000 spillover of viruses to new hosts in the next decades. The areas with the most possibilities for spillover are the mountainous tropical regions of Africa and southeast Asia. Southeast Asia is especially vulnerable as it has a large number of bat species that generally do not mix, but could easily if climate change forced them to begin migrating. A 2021 study found possible links between climate change and transmission of COVID-19 through bats. The authors suggest that climate-driven changes in the distribution and robustness of bat species harboring coronaviruses may have occurred in eastern Asian hotspots (southern China, Myanmar, and Laos), constituting a driver behind the evolution and spread of the virus. During most of human prehistory groups of hunter-gatherers were probably very small. Such groups probably made contact with other such bands only rarely. Such isolation would have caused epidemic diseases to be restricted to any given local population, because propagation and expansion of epidemics depend on frequent contact with other individuals who have not yet developed an adequate immune response . To persist in such a population, a pathogen either had to be a chronic infection, staying present and potentially infectious in the infected host for long periods, or it had to have other additional species as reservoir where it can maintain itself until further susceptible hosts are contacted and infected. In fact, for many "human" diseases, the human is actually better viewed as an accidental or incidental victim and a dead-end host . Examples include rabies, anthrax, tularemia, and West Nile fever. Thus, much of human exposure to infectious disease has been zoonotic. Many diseases, even epidemic ones, have zoonotic origin and measles , smallpox , influenza , HIV, and diphtheria are particular examples. Various forms of the common cold and tuberculosis also are adaptations of strains originating in other species. [ citation needed ] Some experts have suggested that all human viral infections were originally zoonotic. Zoonoses are of interest because they are often previously unrecognized diseases or have increased virulence in populations lacking immunity. The West Nile virus first appeared in the United States in 1999 , in the New York City area. Bubonic plague is a zoonotic disease, as are salmonellosis , Rocky Mountain spotted fever , and Lyme disease . A major factor contributing to the appearance of new zoonotic pathogens in human populations is increased contact between humans and wildlife. This can be caused either by encroachment of human activity into wilderness areas or by movement of wild animals into areas of human activity. An example of this is the outbreak of Nipah virus in peninsular Malaysia, in 1999, when intensive pig farming began within the habitat of infected fruit bats. The unidentified infection of these pigs amplified the force of infection, transmitting the virus to farmers, and eventually causing 105 human deaths. Similarly, in recent times avian influenza and West Nile virus have spilled over into human populations probably due to interactions between the carrier host and domestic animals. [ citation needed ] Highly mobile animals, such as bats and birds, may present a greater risk of zoonotic transmission than other animals due to the ease with which they can move into areas of human habitation. Because they depend on the human host for part of their life-cycle, diseases such as African schistosomiasis , river blindness , and elephantiasis are not defined as zoonotic, even though they may depend on transmission by insects or other vectors . The first vaccine against smallpox by Edward Jenner in 1800 was by infection of a zoonotic bovine virus which caused a disease called cowpox . Jenner had noticed that milkmaids were resistant to smallpox. Milkmaids contracted a milder version of the disease from infected cows that conferred cross immunity to the human disease. Jenner abstracted an infectious preparation of 'cowpox' and subsequently used it to inoculate persons against smallpox. As a result of vaccination, smallpox has been eradicated globally, and mass inoculation against this disease ceased in 1981. There are a variety of vaccine types, including traditional inactivated pathogen vaccines, subunit vaccines , live attenuated vaccines . There are also new vaccine technologies such as viral vector vaccines and DNA/RNA vaccines , which include many of the COVID-19 vaccines .

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Bunyavirales/html

Bunyavirales

Bunyavirales is an order of segmented negative-strand RNA viruses with mainly tripartite genomes. Member viruses infect arthropods , plants , protozoans , and vertebrates . It is the only order in the class Ellioviricetes . The name Bunyavirales derives from Bunyamwera , where the original type species Bunyamwera orthobunyavirus was first discovered. Ellioviricetes is named in honor of late virologist Richard M. Elliott for his early work on bunyaviruses. Bunyaviruses belong to the fifth group of the Baltimore classification system , which includes viruses with a negative-sense , single-stranded RNA genome. They have an enveloped , spherical virion. Though generally found in arthropods or rodents, certain viruses in this order occasionally infect humans. Some of them also infect plants. In addition, there is a group of bunyaviruses whose replication is restricted to arthropods and is known as insect-specific bunyaviruses. A majority of bunyaviruses are vector-borne. With the exception of Hantaviruses and Arenaviruses , all viruses in the Bunyavirales order are transmitted by arthropods (mosquitos, tick, or sandfly). Hantaviruses are transmitted through contact with rodent feces. Incidence of infection is closely linked to vector activity, for example, mosquito-borne viruses are more common in the summer. Human infections with certain members of Bunyavirales , such as Crimean-Congo hemorrhagic fever orthonairovirus , are associated with high levels of morbidity and mortality, consequently handling of these viruses is done in biosafety level 4 laboratories. They are also the cause of severe fever with thrombocytopenia syndrome . Hantaviruses are another medically important member of the order Bunyvirales . They are found worldwide, and are relatively common in Korea , Scandinavia (including Finland ), Russia , western North America and parts of South America. Hantavirus infections are associated with high fever, lung edema, and pulmonary failure. The mortality rate varies significantly depending on the form, being up to 50% in New World hantaviruses (the Americas), up to 15% in Old World hantaviruses (Asia and Europe), and as little as 0.1% in Puumala virus (mostly Scandinavia). The antibody reaction plays an important role in decreasing levels of viremia .Bunyavirus morphology is somewhat similar to that of the Paramyxoviridae family; Bunyavirales form enveloped, spherical virions with diameters of 80–120 nm . These viruses contain no matrix proteins. Instead, the viral surface glycoproteins which form a continuous layer on the virion surface are thought to play a role in the formation of new virions by budding from a cell membrane. Bunyaviruses have bi- or tripartite genomes consisting of a large (L) and small(s), or large (L), medium (M), and small (S) RNA segment. These RNA segments are single-stranded, and exist in a helical formation within the virion. Besides, they exhibit a pseudo-circular structure due to each segment's complementary ends. The L segment encodes the RNA-dependent RNA polymerase , necessary for viral RNA replication and mRNA synthesis. The M segment encodes the viral glycoproteins , which project from the viral surface and aid the virus in attaching to and entering the host cell. The S segment encodes the nucleocapsid protein (N). Most bunyaviruses have a negative-sense L and M segment. The S segment of the genus Phlebovirus , and both M and S segment of the genus Tospovirus are ambisense . Ambisense means that some of the genes on the RNA strand are negative sense and others are positive sense. The ambisense S segment codes for the viral nucleoprotein (N) in the negative sense and a nonstructural protein (NSs) in the positive sense. The ambisense M segment codes for glycoprotein (GP) in the negative sense and a nonstructural protein (NSm) in the positive sense. The total genome size ranges from 10.5 to 22.7 kbp . The ambisense genome requires two rounds of transcription to be carried out. First, the negative-sense RNA is transcribed to produce mRNA and a full-length replicative intermediate. From this intermediate, a subgenomic mRNA encoding the small segment nonstructural protein is produced while the polymerase produced following the first round of transcription can now replicate the full-length RNA to produce viral genomes. [ citation needed ] Bunyaviruses replicate in the cytoplasm , while the viral proteins transit through the ER and Golgi apparatus . Mature virions bud from the Golgi apparatus into vesicles which are transported to the cell surface. [ citation needed ] Bunyaviruses infect arthropods , plants , protozoans , and vertebrates . Plants can host bunyaviruses from the families Tospoviridae and Fimoviridae (e.g. tomato, pigeonpea, melon, wheat, raspberry, redbud, and rose). Members of some families are insect-specific, for example the phasmavirids, first isolated from phantom midges , and since identified in diverse insects including moths , wasps and bees , and other true flies .Bunyavirus morphology is somewhat similar to that of the Paramyxoviridae family; Bunyavirales form enveloped, spherical virions with diameters of 80–120 nm . These viruses contain no matrix proteins. Instead, the viral surface glycoproteins which form a continuous layer on the virion surface are thought to play a role in the formation of new virions by budding from a cell membrane. Bunyaviruses have bi- or tripartite genomes consisting of a large (L) and small(s), or large (L), medium (M), and small (S) RNA segment. These RNA segments are single-stranded, and exist in a helical formation within the virion. Besides, they exhibit a pseudo-circular structure due to each segment's complementary ends. The L segment encodes the RNA-dependent RNA polymerase , necessary for viral RNA replication and mRNA synthesis. The M segment encodes the viral glycoproteins , which project from the viral surface and aid the virus in attaching to and entering the host cell. The S segment encodes the nucleocapsid protein (N). Most bunyaviruses have a negative-sense L and M segment. The S segment of the genus Phlebovirus , and both M and S segment of the genus Tospovirus are ambisense . Ambisense means that some of the genes on the RNA strand are negative sense and others are positive sense. The ambisense S segment codes for the viral nucleoprotein (N) in the negative sense and a nonstructural protein (NSs) in the positive sense. The ambisense M segment codes for glycoprotein (GP) in the negative sense and a nonstructural protein (NSm) in the positive sense. The total genome size ranges from 10.5 to 22.7 kbp . The ambisense genome requires two rounds of transcription to be carried out. First, the negative-sense RNA is transcribed to produce mRNA and a full-length replicative intermediate. From this intermediate, a subgenomic mRNA encoding the small segment nonstructural protein is produced while the polymerase produced following the first round of transcription can now replicate the full-length RNA to produce viral genomes. [ citation needed ] Bunyaviruses replicate in the cytoplasm , while the viral proteins transit through the ER and Golgi apparatus . Mature virions bud from the Golgi apparatus into vesicles which are transported to the cell surface. [ citation needed ]Bunyaviruses infect arthropods , plants , protozoans , and vertebrates . Plants can host bunyaviruses from the families Tospoviridae and Fimoviridae (e.g. tomato, pigeonpea, melon, wheat, raspberry, redbud, and rose). Members of some families are insect-specific, for example the phasmavirids, first isolated from phantom midges , and since identified in diverse insects including moths , wasps and bees , and other true flies .There are 477 virus species recognised in this order. The phylogenetic tree diagram provides a full list of member species and the hosts which they infect. The order is organized into the following 12 families: Bunyaviruses that cause disease in humans include: [ citation needed ] Bunyaviruses have segmented genomes, making them capable of rapid reassortment and increasing the risk of outbreak. The bunyavirus that causes severe fever with thrombocytopenia syndrome can undergo recombination both by reassortment of genome segments and by intragenic homologous recombination . Bunyaviridae are transmitted by hematophagous arthropods including mosquitoes, midges, flies, and ticks. The viral incubation period is about 48 hours. Symptomatic infection typically causes non-specific flu-like symptoms with fever lasting for about three days. Because of their non-specific symptoms , Bunyavirus infections are frequently mistaken for other illnesses. For example, Bwamba fever is often mistaken for malaria. Prevention depends on the reservoir, amplifying hosts and how the viruses are transmitted, i.e. the vector, whether ticks or mosquitoes and which animals are involved. Preventive measures include general hygiene, limiting contact with vector saliva, urine, feces, or bedding. There is no licensed vaccine for bunyaviruses. As precautions Cache Valley virus and Hantavirus research are conducted in BSL-2 (or higher), Rift Valley Fever virus research is conducted in BSL-3 (or higher), Congo-Crimean Hemorrhagic Fever virus research is conducted in BSL-4 laboratories. [ citation needed ]1940s: Crimean–Congo hemorrhagic fever is discovered in Russia 1951: 3,000 cases of Hantavirus were reported in South Korea in 1951, a time when UN forces were fighting on the 38th parallel during the Korean War 1956: Cache Valley virus isolated in Culiseta inornata mosquitoes in Utah 1960: La Crosse virus was first recognized in a fatal case of encephalitis in La Crosse, Wisconsin 1977: Rift Valley Fever virus caused approximately 200,000 cases and 598 deaths in Egypt 2017: Bunyavirales order is created

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Christian_Happi/html

Christian Happi

Christian Happi is a Professor of Molecular Biology and Genomics in the Department of Biological Sciences and the Director of the African Centre of Excellence for Genomics of Infectious Diseases , both at Redeemer's University . He is known for leading the team of scientists that used genomic sequencing to identify a single point of infection from an animal reservoir to a human in the Ebola outbreak in West Africa . His research focus is on infectious diseases , including malaria , Lassa fever , Ebola virus disease , HIV , and SARS-CoV-2 .Professor Happi was born in Sangmélima , Cameroon , fourth of seven children. He graduated from the University of Yaounde , Cameroon, in 1993 with a Bachelor of Science in Biochemistry with honors. He obtained his PhD from the University of Ibadan , Nigeria, in 2000 and went on to Harvard University as a Postdoctoral Fellow from 2000 to 2003. He subsequently worked at Harvard University as a Research Scientist from 2004 to 2007. He became an adjunct Professor at Harvard University School of Public Health between 2007–2011.Happi has led several public health sequencing efforts in Africa. His team rapidly sequenced Nigeria's first Ebola case, and up to 20 cases a day throughout the outbreak . He sequenced Lassa fever strains in a 2018 outbreak, helping researchers to conclude that the Lassa fever outbreak was due to spread by rats, rather than a mutation which had made it easier to spread between people. He also played significant roles in genomics efforts such as 1000 Genomes Project and H3Africa . More recently he has led efforts for SARS-CoV-2 in Nigeria. In 2020 he gave a TED talk called A virus detection network to stop the next pandemic . His awards and honors include; 2020 Bailey K. Ashford Medal 2019 HUGO African Prize 2011 & 2012, ExxonMobil Malaria Leadership Fellow 2011, Merle A. Sande Health Leadership Award 2010, Scholarship to Second Annual Course on Point-of-Care Diagnostics for Global Health, University of Washington Seattle (USA) 2010, Boroughs Wellcome and Bill & Melinda Gates Awards, Genome Epidemiology Meeting (GEM), Wellcome Trust Conference Centre, Hinxton (UK) 2009 – 2014, Wellcome Trust Research Grant Award 2009, European Union-Developing Countries Clinical Trials Partnership (EDCTP) Senior Research Fellowship Award (The Hague, Netherlands) 2008, Chair, Scientific Advisory Committee Africa Health Research Organization (AHRO) (Ghana) 2007, Turner Biosciences Research Award (USA) 2005 – 2008, Plasmodium falciparum Pathogenesis and Applied Genomics Research Award, World Bank/UNICEF/WHO/TDR 2004, Chair, Molecular Parasitology session, 50th Annual Meeting and Anniversary of the ASTMH, Philadelphia, Pennsylvania, USA 2003 – 2005, Member of the International Scientific Committee of the 4th MIM Pan African conference on Malaria (Cameroon) 1999, Best Postgraduate Student, PIMRAT, College of Medicine, University of Ibadan, Ibadan, Nigeria 1998, Wellcome Trust Award to the 1st Gordon Conference on Malaria (Oxford, UK) 1995, Best International Postgraduate Student, International Student association (ISA), University of Ibadan, Nigeria 1994 – 1997, Organization of African Unity (OAU) Research and Training Scholarship 1988 – 1993, Cameroon Government ScholarshipHis awards and honors include; 2020 Bailey K. Ashford Medal 2019 HUGO African Prize 2011 & 2012, ExxonMobil Malaria Leadership Fellow 2011, Merle A. Sande Health Leadership Award 2010, Scholarship to Second Annual Course on Point-of-Care Diagnostics for Global Health, University of Washington Seattle (USA) 2010, Boroughs Wellcome and Bill & Melinda Gates Awards, Genome Epidemiology Meeting (GEM), Wellcome Trust Conference Centre, Hinxton (UK) 2009 – 2014, Wellcome Trust Research Grant Award 2009, European Union-Developing Countries Clinical Trials Partnership (EDCTP) Senior Research Fellowship Award (The Hague, Netherlands) 2008, Chair, Scientific Advisory Committee Africa Health Research Organization (AHRO) (Ghana) 2007, Turner Biosciences Research Award (USA) 2005 – 2008, Plasmodium falciparum Pathogenesis and Applied Genomics Research Award, World Bank/UNICEF/WHO/TDR 2004, Chair, Molecular Parasitology session, 50th Annual Meeting and Anniversary of the ASTMH, Philadelphia, Pennsylvania, USA 2003 – 2005, Member of the International Scientific Committee of the 4th MIM Pan African conference on Malaria (Cameroon) 1999, Best Postgraduate Student, PIMRAT, College of Medicine, University of Ibadan, Ibadan, Nigeria 1998, Wellcome Trust Award to the 1st Gordon Conference on Malaria (Oxford, UK) 1995, Best International Postgraduate Student, International Student association (ISA), University of Ibadan, Nigeria 1994 – 1997, Organization of African Unity (OAU) Research and Training Scholarship 1988 – 1993, Cameroon Government ScholarshipHe is married and has three children.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Confusion/html

Confusion

In medicine , confusion is the quality or state of being bewildered or unclear. The term "acute mental confusion" is often used interchangeably with delirium in the International Statistical Classification of Diseases and Related Health Problems and the Medical Subject Headings publications to describe the pathology . These refer to the loss of orientation , or the ability to place oneself correctly in the world by time, location and personal identity. Mental confusion is sometimes accompanied by disordered consciousness (the loss of linear thinking) and memory loss (the inability to correctly recall previous events or learn new material). The word confusion derives from the Latin word, confundo , which means "confuse, mix, blend, pour together, disorder, embroil."Confusion may result from drug side effects or from a relatively sudden brain dysfunction. Acute confusion is often called delirium (or "acute confusional state"), although delirium often includes a much broader array of disorders than simple confusion. These disorders include the inability to focus attention; various impairments in awareness, and temporal or spatial dis-orientation. Mental confusion can result from chronic organic brain pathologies, such as dementia [ citation needed ] , as well. The most common causes of drug induced acute confusion are dopaminergic drugs (used for the treatment of Parkinson's disease ), diuretics , tricyclic , tetracyclic antidepressants and benzodiazepines or alcohol . The elderly, and especially those with pre-existing dementia, are most at risk for drug induced acute confusional states. New research is finding a link between vitamin D deficiency and cognitive impairment (which includes "foggy brain"). The most common causes of drug induced acute confusion are dopaminergic drugs (used for the treatment of Parkinson's disease ), diuretics , tricyclic , tetracyclic antidepressants and benzodiazepines or alcohol . The elderly, and especially those with pre-existing dementia, are most at risk for drug induced acute confusional states. New research is finding a link between vitamin D deficiency and cognitive impairment (which includes "foggy brain").

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Ross_River_virus/html

Ross River virus

Ross River virus ( RRV ) is a small encapsulated single-strand RNA Alphavirus endemic to Australia, Papua New Guinea and other islands in the South Pacific. It is responsible for a type of mosquito -borne, non-lethal but extremely debilitating tropical disease known as Ross River fever , previously termed "epidemic polyarthritis ". There is no known cure, and it can last in the host's system for up to 20 years. The virus is suspected to be enzootic in populations of various native Australian mammals, and has been found on occasion in horses. Taxonomically, Ross River virus belongs to the virus genus Alphavirus , which is part of the family Togaviridae . The alphaviruses are a group of small enveloped single-strand positive-sense RNA viruses. RRV belongs to a subgroup of "Old World" (Eurasian-African-Australasian) alphaviruses, and belongs to the SF antigenic complex of the genus Alphavirus. The virions (virus particles) themselves contain their genome in a protein capsid 700 à in diameter. They are characterised by the presence of two glycoproteins (E1 and E2) embedded as trimeric dimers in a host-derived lipid envelope . Because RRV is transmitted by mosquitos , it is considered an arbovirus , a non-taxonomic term for viruses borne by arthropod vectors .In 1928, an outbreak of acute febrile arthritis was recorded in Narrandera and Hay in New South Wales , Australia. In 1943, several outbreaks of arthralgia and arthritis were described in the Northern Territory , Queensland and the Schouten Islands , off the northern coast of Papua New Guinea . The name "epidemic polyarthritis" was coined for the disease. In 1956, an epidemic occurred in the Murray Valley which was compared to "acute viral polyarthritis" caused by the Chikungunya virus . The Australian disease seemed to progress in a milder fashion. In 1956, serological testing suggested an unknown new species of alphavirus (group A arbovirus) was the likely culprit. In July and August 1956 and 1957, a virus recovered from mosquitoes collected near Tokyo , Japan , and was dubbed Sagiyama virus . For a time, it was thought to be a separate species, but is now considered conspecific with Ross River virus . In 1959, a new alphavirus was identified in samples from a mosquito ( Aedes vigilax ) trapped in the Ross River , located in Townsville , Queensland, Australia. Further serological testing showed that patients who had suffered "epidemic polyarthritis" in Queensland had antibodies to the virus. The new virus was named Ross River virus , and the disease Ross River fever . The virus itself was first isolated in 1972 using suckling mice . It was found that RRV isolated from human serum could kill mice. However, the serum containing the virus that was used had come from an Aboriginal boy from Edward River , North Queensland. The child had a fever and a rash but no arthritis, making the link between RRV and Ross River fever less than concrete. The largest-ever outbreak of the virus was in 1979–1980 and occurred in the western Pacific. The outbreak involved the islands of Fiji , Samoa , the Cook Islands , and New Caledonia . However, RRV was later isolated in humans following a series of epidemic polyarthritis outbreaks in Fiji , Samoa and the Cook Islands during 1979. RRV was isolated in an Australian patient suffering from Ross River fever in 1985. In 2010, Ross River virus was found to have made its way to the Aundh area in Pune , India , and spread to other parts of the city. The RRV infection is characterised by inflammation and pain to multiple joints. Hydration by sufficient fluid intake is recommended, to ensure that the fever does not rise to very dangerous levels. It is also recommended that a doctor be consulted immediately as regular paracetamol gives only temporary reprieve from the fever. [ citation needed ]In rural and regional areas of Australia, the continued prevalence of Ross River virus is thought to be supported by natural reservoirs such as large marsupial mammals. Antibodies to Ross River virus have been found in a wide variety of placental and marsupial mammals, and also in a few bird species. It is not presently known what reservoir hosts support Ross River virus in metropolitan areas such as Brisbane . The southern saltmarsh mosquito ( Aedes camptorhynchus ), which is known to carry the Ross River virus , was discovered in Napier, New Zealand , in 1998. Due to an 11-year program by the New Zealand Ministry of Health , and later the Ministry of Agriculture & Fisheries , the species was declared completely eradicated from New Zealand in July 2010. As of September 2006, there has never been a report of a case of Ross River virus acquired within New Zealand. Separate mosquito species may act as vector, widespread across areas and seasonal/geographical locations. In southern and northern regions, the Aedes group ( A. camptorhynchus and A. vigilax ) are the main RRV carriers. However, inland the Culex annulirostris is the main carrier with Aedes mosquitoes becoming active during wet seasons. Due to the expansion and housing demand in the south west of Western Australia , residential development is occurring closer to wetlands in spite of the fact that the ecosystem is known for mosquito breeding. Particularly in the Peel region where living near water is desirable for aesthetic value. Over the decade of June 2011 – 2012 the population increased by 44,000 residents averaging a rate of 4.5 per cent per annum. In June 2013 the Peel region accounted for approximately five per cent of the State's population and predicted to account for around 6.7 per cent of Western Australia's population by 2031. A study comparing the risk of contracting Ross River virus (RRV) and the distance of the dwellings from Muddy Lakes. The reports showed within a one kilometre buffer zone there were approximately 1550 mosquitos in traps per night with 89% of them being Ae. camptorhynchus decreasing to approximately 450 mosquitos with 57% Ae. camptorhynchus at the six kilometre buffer zone. The study suggests that there is a significantly higher risk of contracting RRV when living closer to Muddy Lakes however, there was a rise in the two kilometre buffer zone of 3700 mosquitos with 94% Ae. camptorhynchus . A similar trend in the study same study conducted in the Peel region resulting in less mosquitoes the further away the buffer distance. In 1995–96 Leschenault and Capel-Busselton were affected by an outbreak of 524 cases of RRV disease. Although this occurred around a decade ago, the data analysed the total RRV cases per 1000 persons for each 500m buffer zone. This shows an elevated risk of contracting the disease if living in close proximity to the Leschenault Estuary , within 2 km being the strongest disease risk gradient. Evidence shows that there is a strong correlation between contracting RRV when living in close proximity to wetlands in the south west of Western Australia. However, due to continuous growth and development of residential areas around these wetlands it is expected that problems with RRV disease will occur.There are several factors that can contribute to an individual's risk for Ross River virus in Australia. These risks were trialed in a study conducted in tropical Australia which illustrate that factors such as camping, light coloured clothing, exposure to certain flora and fauna and specific protective mechanisms are able to increase or decrease the likelihood of contracting the virus. By increasing the frequency of camping the individual's risk increases eight-fold, suggesting that an increased exposure to wildlife increases risk. This is shown by the narrow 95% confidence interval of 1.07–4.35 within the study. For example, an individual's exposure to kangaroos , wallabies and bromeliad plants also increased risk, suggesting that they are reservoirs for infection, breeding sites for mosquitoes and potential vectors of the virus. Ross River virus antibodies have been found in captive populations of tammar wallabies and wallaroos in urban areas in New South Wales, Australia, and are potential reservoirs for the virus. Although these areas show a higher risk for the virus, humans should still enjoy the wildlife but consider that preventive mechanisms as increasingly important while camping.Ross River virus can be easily prevented through small behavioural mechanisms which should be of high importance in tropical areas and during participation of outdoor activities. Firstly, insect repellent should be rigorously used as to prevent bites from insects that specifically include mosquitoes which are vectors that carry the disease. A study in tropical Australia shows a very narrow 95% confidence interval of 0.20–1.00 for a decrease in Ross River virus risk as a result of increased use of insect repellent, suggesting a strong correlation between the two. Following, burning citronella candles are based on the same principle, that it repels insects that are vectors of the virus. Burning such candles also show a strong correlation with decreased Ross River virus risk shown in the same study with a narrow 95% confidence interval of 0.10–0.78. Secondly, wearing light coloured clothing decrease the risk of Ross River virus three-fold. This is again based on the repelling of vectors such as mosquitoes through the use of bright colours. Lastly, high risk areas should be minimised by mechanisms of prevention that are applied within households. For example, screens should be fitted to windows and doors to prevent entry of insects carrying the virus and potential breeding areas such as open water containers or water holding plants should be removed. Therefore, specific climatic environments should be assessed for high risk factors and the appropriate precautions should be taken in response.The study of RRV has been recently facilitated by a mouse model. Inbred mice infected with RRV develop hind-limb arthritis/arthralgia. The disease in mice, similar to humans, is characterised by an inflammatory infiltrate including macrophages which are immunopathogenic and exacerbate disease. Furthermore, recent data indicate that the serum component, C3, directly contributes to disease since mice deficient in the C3 protein do not suffer from severe disease following infection. Ross River virus can cause multiple symptoms in someone who is infected, the most common being arthritis or joint pain. Other symptoms include a rash on the limbs of the body, which often occurs roughly 10 days after arthritis begins. Lymph nodes may enlarge, most commonly in the arm pits or groin region, and rarely a feeling of 'pins and needles' in the persons hands and feet, but only occurs in a small number of people. The virus also causes moderate symptoms in horses . The symptoms of Ross River virus are important to recognise for early diagnosis and therefore early treatment. Symptoms have been illustrated in a case report of an infected Thuringian traveller returning from South-East Australia. This case showed flu-like symptoms that include fever , chills , headache and pains in the body. Additionally, joint pain arose in which some joints become swollen and joint stiffness was particularly noticeable. A clinical examination of the infected individual shows a significant decrease of specific antibodies despite the normal blood count levels. A rash is a good indication that is likely to occur but usually disappears after ten days. The symptoms of Ross River virus are important to be aware of so that early treatment can be administered before the virus worsens. The time between catching the disease and experiencing symptoms is anywhere between three days to three weeks, usually it takes about 1–2 weeks. A person can be tested for Ross River virus by a blood test , other illnesses may need to be excluded before diagnosis. Testing for Ross River virus should occur in patients who are experiencing acute polyarthritis, tiredness and/or rashes (~90%) with a history of travel within areas prone to infection from the virus. Serology (blood tests) is the appropriate manner by which to diagnose Ross River virus . Within 7 days of infection, the virus produces Immunoglobulin M (IgM) and is a presumptive positive diagnosis. IgM may persist for months or even years and therefore false positives may be triggered by Barmah Forest virus , rubella , Q fever or rheumatoid factor . To completely test for Ross River virus , a second serology test must be conducted 10–14 days after the first. The patient may then be declared positive for Ross River virus infection if there is a 4-fold increase of IgM antibody count. Ross River fever is also known as Ross River virus infection or Ross River virus disease . Ross River virus is named after the Ross River in Townsville, which is the place where it was first identified. Ross River fever is the most common mosquito-borne disease in Australia, and nearly 5000 people are reported to be infected with the virus each year.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Rabies/html

Rabies

Rabies is a viral disease that causes encephalitis in humans and other mammals . It was historically referred to as hydrophobia ("fear of water") due to the symptom of panic when presented with liquids to drink. Early symptoms can include fever and abnormal sensations at the site of exposure. These symptoms are followed by one or more of the following symptoms: nausea, vomiting, violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body, confusion, and loss of consciousness . Once symptoms appear, the result is virtually always death. The time period between contracting the disease and the start of symptoms is usually one to three months but can vary from less than one week to more than one year. The time depends on the distance the virus must travel along peripheral nerves to reach the central nervous system . Rabies is caused by lyssaviruses , including the rabies virus and Australian bat lyssavirus . It is spread when an infected animal bites or scratches a human or other animals. Saliva from an infected animal can also transmit rabies if the saliva comes into contact with the eyes, mouth, or nose. Globally, dogs are the most common animal involved. In countries where dogs commonly have the disease, more than 99% of rabies cases are the direct result of dog bites . In the Americas , bat bites are the most common source of rabies infections in humans, and less than 5% of cases are from dogs. Rodents are very rarely infected with rabies. The disease can be diagnosed only after the start of symptoms. Animal control and vaccination programs have decreased the risk of rabies from dogs in a number of regions of the world. Immunizing people before they are exposed is recommended for those at high risk, including those who work with bats or who spend prolonged periods in areas of the world where rabies is common. In people who have been exposed to rabies, the rabies vaccine and sometimes rabies immunoglobulin are effective in preventing the disease if the person receives the treatment before the start of rabies symptoms. Washing bites and scratches for 15 minutes with soap and water, povidone-iodine , or detergent may reduce the number of viral particles and may be somewhat effective at preventing transmission. As of 2016 [ update ] , only fourteen people were documented to have survived a rabies infection after showing symptoms. However, research conducted in 2010 among a population of people in Peru with a self-reported history of one or more bites from vampire bats (commonly infected with rabies), found that out of 73 individuals reporting previous bat bites, seven people had rabies virus-neutralizing antibodies (rVNA). Since only one member of this group reported prior vaccination for rabies, the findings of the research suggest previously undocumented cases of infection and viral replication followed by an abortive infection. This could indicate that people may have an exposure to the virus without treatment and develop natural antibodies as a result. Rabies causes about 59,000 deaths worldwide per year, about 40% of which are in children under the age of 15. More than 95% of human deaths from rabies occur in Africa and Asia. Rabies is present in more than 150 countries and on all continents but Antarctica. More than 3 billion people live in regions of the world where rabies occurs. A number of countries, including Australia and Japan, as well as much of Western Europe, do not have rabies among dogs. Many Pacific islands do not have rabies at all. It is classified as a neglected tropical disease . The name rabies is derived from the Latin rabies , "madness". The Greeks derived the word lyssa , from lud or "violent"; this root is used in the genus name of the rabies virus, Lyssavirus . The period between infection and the first symptoms (incubation period) is typically one to three months in humans. This period may be as short as four days or longer than six years, depending on the location and severity of the wound and the amount of virus introduced. Initial symptoms of rabies are often nonspecific such as fever and headache. As rabies progresses and causes inflammation of the brain and meninges , symptoms can include slight or partial paralysis , anxiety , insomnia , confusion , agitation , abnormal behavior, paranoia , terror , and hallucinations . The person may also have fear of water. The symptoms eventually progress to delirium , and coma . Death usually occurs two to ten days after first symptoms. Survival is almost unknown once symptoms have presented, even with intensive care. Rabies has also occasionally been referred to as hydrophobia ("fear of water") throughout its history. It refers to a set of symptoms in the later stages of an infection in which the person has difficulty swallowing, shows panic when presented with liquids to drink, and cannot quench their thirst. Saliva production is greatly increased, and attempts to drink, or even the intention or suggestion of drinking, may cause excruciatingly painful spasms of the muscles in the throat and larynx . Since the infected individual cannot swallow saliva and water, the virus has a much higher chance of being transmitted, because it multiplies and accumulates in the salivary glands and is transmitted through biting. Hydrophobia is commonly associated with furious rabies, which affects 80% of rabies-infected people. This form of rabies causes irrational aggression in the host, which aids in the spreading of the virus through animal bites; [ medical citation needed ] a "foaming at the mouth" effect, caused by the accumulation of saliva, is also commonly associated with rabies in the public perception and in popular culture. The remaining 20% may experience a paralytic form of rabies that is marked by muscle weakness , loss of sensation, and paralysis ; this form of rabies does not usually cause fear of water. Rabies is caused by a number of lyssaviruses including the rabies virus and Australian bat lyssavirus . Duvenhage lyssavirus may cause a rabies-like infection. The rabies virus is the type species of the Lyssavirus genus , in the family Rhabdoviridae , order Mononegavirales . Lyssavirions have helical symmetry, with a length of about 180 nm and a cross-section of about 75 nm. These virions are enveloped and have a single-stranded RNA genome with negative sense . The genetic information is packed as a ribonucleoprotein complex in which RNA is tightly bound by the viral nucleoprotein. The RNA genome of the virus encodes five genes whose order is highly conserved: nucleoprotein (N), phosphoprotein (P), matrix protein (M), glycoprotein (G), and the viral RNA polymerase (L). To enter cells, trimeric spikes on the exterior of the membrane of the virus interact with a specific cell receptor, the most likely one being the acetylcholine receptor. The cellular membrane pinches in a procession known as pinocytosis and allows entry of the virus into the cell by way of an endosome . The virus then uses the acidic environment, which is necessary, of that endosome and binds to its membrane simultaneously, releasing its five proteins and single-strand RNA into the cytoplasm. Once within a muscle or nerve cell, the virus undergoes replication. The L protein then transcribes five mRNA strands and a positive strand of RNA all from the original negative strand RNA using free nucleotides in the cytoplasm. These five mRNA strands are then translated into their corresponding proteins (P, L, N, G and M proteins) at free ribosomes in the cytoplasm. Some proteins require post-translational modifications. For example, the G protein travels through the rough endoplasmic reticulum , where it undergoes further folding, and is then transported to the Golgi apparatus , where a sugar group is added to it ( glycosylation ). When there are enough viral proteins, the viral polymerase will begin to synthesize new negative strands of RNA from the template of the positive-strand RNA. These negative strands will then form complexes with the N, P, L and M proteins and then travel to the inner membrane of the cell, where a G protein has embedded itself in the membrane. The G protein then coils around the N-P-L-M complex of proteins taking some of the host cell membrane with it, which will form the new outer envelope of the virus particle. The virus then buds from the cell. From the point of entry, the virus is neurotropic , traveling along the neural pathways into the central nervous system . The virus usually first infects muscle cells close to the site of infection, where they are able to replicate without being 'noticed' by the host's immune system. Once enough virus has been replicated, they begin to bind to acetylcholine receptors at the neuromuscular junction. The virus then travels through the nerve cell axon via retrograde transport , as its P protein interacts with dynein , a protein present in the cytoplasm of nerve cells. Once the virus reaches the cell body it travels rapidly to the central nervous system (CNS), replicating in motor neurons and eventually reaching the brain. After the brain is infected, the virus travels centrifugally to the peripheral and autonomic nervous systems, eventually migrating to the salivary glands, where it is ready to be transmitted to the next host. : 317All warm-blooded species, including humans, may become infected with the rabies virus and develop symptoms. Birds were first artificially infected with rabies in 1884; however, infected birds are largely, if not wholly, asymptomatic, and recover. Other bird species have been known to develop rabies antibodies , a sign of infection, after feeding on rabies-infected mammals. The virus has also adapted to grow in cells of cold-blooded vertebrates. Most animals can be infected by the virus and can transmit the disease to humans. Worldwide, about 99% of human rabies cases come from domestic dogs. Other sources of rabies in humans include bats , monkeys , raccoons , foxes , skunks , cattle , wolves , coyotes , cats , and mongooses (normally either the small Asian mongoose or the yellow mongoose). Rabies may also spread through exposure to infected bears , domestic farm animals , groundhogs , weasels , and other wild carnivorans . However, lagomorphs , such as hares and rabbits , and small rodents , such as chipmunks , gerbils , guinea pigs , hamsters , mice , rats , and squirrels , are almost never found to be infected with rabies and are not known to transmit rabies to humans. Bites from mice, rats, or squirrels rarely require rabies prevention because these rodents are typically killed by any encounter with a larger, rabid animal, and would, therefore, not be carriers. The Virginia opossum (a marsupial, unlike the other mammals named in this paragraph, which are all eutherians / placental ), has a lower internal body temperature than the rabies virus prefers and therefore is resistant but not immune to rabies. Marsupials , along with monotremes ( platypuses and echidnas ), typically have lower body temperatures than similarly sized eutherians . The virus is usually present in the nerves and saliva of a symptomatic rabid animal. The route of infection is usually, but not always, by a bite. In many cases, the infected animal is exceptionally aggressive, may attack without provocation, and exhibits otherwise uncharacteristic behavior. This is an example of a viral pathogen modifying the behavior of its host to facilitate its transmission to other hosts. After a typical human infection by bite, the virus enters the peripheral nervous system . It then travels retrograde along the efferent nerves toward the central nervous system . During this phase, the virus cannot be easily detected within the host, and vaccination may still confer cell-mediated immunity to prevent symptomatic rabies. When the virus reaches the brain , it rapidly causes encephalitis , the prodromal phase, which is the beginning of the symptoms. Once the patient becomes symptomatic, treatment is almost never effective and mortality is over 99%. Rabies may also inflame the spinal cord , producing transverse myelitis . Although it is theoretically possible for rabies-infected humans to transmit it to others by biting or otherwise, no such cases have ever been documented, because infected humans are usually hospitalized and necessary precautions taken. Casual contact, such as touching a person with rabies or contact with non-infectious fluid or tissue (urine, blood, feces), does not constitute an exposure and does not require post-exposure prophylaxis. But as the virus is present in sperm and vaginal secretions, it might be possible for rabies to spread through sex. There are only a small number of recorded cases of human-to-human transmission of rabies, and all occurred through organ transplants , most frequently with corneal transplantation , from infected donors. Rabies can be difficult to diagnose because, in the early stages, it is easily confused with other diseases or even with a simple aggressive temperament. The reference method for diagnosing rabies is the fluorescent antibody test (FAT), an immunohistochemistry procedure, which is recommended by the World Health Organization (WHO). The FAT relies on the ability of a detector molecule (usually fluorescein isothiocyanate) coupled with a rabies-specific antibody, forming a conjugate, to bind to and allow the visualisation of rabies antigen using fluorescent microscopy techniques. Microscopic analysis of samples is the only direct method that allows for the identification of rabies virus-specific antigen in a short time and at a reduced cost, irrespective of geographical origin and status of the host. It has to be regarded as the first step in diagnostic procedures for all laboratories. Autolysed samples can, however, reduce the sensitivity and specificity of the FAT. The RT PCR assays proved to be a sensitive and specific tool for routine diagnostic purposes, particularly in decomposed samples or archival specimens. The diagnosis can be reliably made from brain samples taken after death. The diagnosis can also be made from saliva, urine, and cerebrospinal fluid samples, but this is not as sensitive or reliable as brain samples. Cerebral inclusion bodies called Negri bodies are 100% diagnostic for rabies infection but are found in only about 80% of cases. If possible, the animal from which the bite was received should also be examined for rabies. Some light microscopy techniques may also be used to diagnose rabies at a tenth of the cost of traditional fluorescence microscopy techniques, allowing identification of the disease in less-developed countries. A test for rabies, known as LN34, is easier to run on a dead animal's brain and might help determine who does and does not need post-exposure prevention. The test was developed by the Centers for Disease Control and Prevention (CDC) in 2018. The differential diagnosis in a case of suspected human rabies may initially include any cause of encephalitis , in particular infection with viruses such as herpesviruses , enteroviruses , and arboviruses such as West Nile virus . The most important viruses to rule out are herpes simplex virus type one, varicella zoster virus , and (less commonly) enteroviruses, including coxsackieviruses , echoviruses , polioviruses , and human enteroviruses 68 to 71. New causes of viral encephalitis are also possible, as was evidenced by the 1999 outbreak in Malaysia of 300 cases of encephalitis with a mortality rate of 40% caused by Nipah virus , a newly recognized paramyxovirus . Likewise, well-known viruses may be introduced into new locales, as is illustrated by the outbreak of encephalitis due to West Nile virus in the eastern United States. Almost all human exposure to rabies was fatal until a vaccine was developed in 1885 by Louis Pasteur and Émile Roux . Their original vaccine was harvested from infected rabbits, from which the virus in the nerve tissue was weakened by allowing it to dry for five to ten days. Similar nerve tissue-derived vaccines are still used in some countries, as they are much cheaper than modern cell culture vaccines. The human diploid cell rabies vaccine was started in 1967. Less expensive purified chicken embryo cell vaccine and purified vero cell rabies vaccine are now available. A recombinant vaccine called V-RG has been used in Belgium, France, Germany, and the United States to prevent outbreaks of rabies in undomesticated animals. Immunization before exposure has been used in both human and nonhuman populations, where, as in many jurisdictions, domesticated animals are required to be vaccinated. The Missouri Department of Health and Senior Services Communicable Disease Surveillance 2007 Annual Report states the following can help reduce the risk of contracting rabies: Vaccinating dogs, cats, and ferrets against rabies Keeping pets under supervision Not handling wild animals or strays Contacting an animal control officer upon observing a wild animal or a stray, especially if the animal is acting strangely If bitten by an animal, washing the wound with soap and water for 10 to 15 minutes and contacting a healthcare provider to determine if post-exposure prophylaxis is required 28 September is World Rabies Day , which promotes the information, prevention, and elimination of the disease. In Asia and in parts of the Americas and Africa, dogs remain the principal host. Mandatory vaccination of animals is less effective in rural areas. Especially in developing countries, pets may not be privately kept and their destruction may be unacceptable. Oral vaccines can be safely distributed in baits, a practice that has successfully reduced rabies in rural areas of Canada , France , and the United States . In Montreal , Quebec, Canada, baits are successfully used on raccoons in the Mount-Royal Park area. Vaccination campaigns may be expensive, but cost-benefit analysis suggests baits may be a cost-effective method of control. In Ontario , a dramatic drop in rabies was recorded when an aerial bait-vaccination campaign was launched. The number of recorded human deaths from rabies in the United States has dropped from 100 or more annually in the early 20th century to one or two per year due to widespread vaccination of domestic dogs and cats and the development of human vaccines and immunoglobulin treatments. Most deaths now result from bat bites, which may go unnoticed by the victim and hence untreated. Treatment after exposure can prevent the disease if given within 10 days. The rabies vaccine is 100% effective if given before symptoms of rabies appear. Every year, more than 15 million people get vaccinated after potential exposure. While this works well, the cost is significant. In the US it is recommended people receive one dose of human rabies immunoglobulin (HRIG) and four doses of rabies vaccine over a 14-day period. HRIG is expensive and makes up most of the cost of post-exposure treatment, ranging as high as several thousand dollars. In the UK, one dose of HRIG costs the National Health Service £1,000, although this is not flagged as a "high-cost medication". A full course of vaccine costs £120–180. As much as possible of HRIG should be injected around the bites, with the remainder being given by deep intramuscular injection at a site distant from the vaccination site. People who have previously been vaccinated against rabies do not need to receive the immunoglobulin—only the postexposure vaccinations on days 0 and 3. The side effects of modern cell-based vaccines are similar to the side effects of flu shots. The old nerve-tissue-based vaccination required multiple injections into the abdomen with a large needle but is inexpensive. It is being phased out and replaced by affordable World Health Organization intradermal-vaccination regimens. In children less than a year old, the lateral thigh is recommended. Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is effective in reducing the number of viral particles. Povidone-iodine or alcohol is then recommended to reduce the virus further. Awakening to find a bat in the room, or finding a bat in the room of a previously unattended child or mentally disabled or intoxicated person, is an indication for post-exposure prophylaxis (PEP). The recommendation for the precautionary use of PEP in bat encounters where no contact is recognized has been questioned in the medical literature, based on a cost–benefit analysis . However, a 2002 study has supported the protocol of precautionary administration of PEP where a child or mentally compromised individual has been alone with a bat, especially in sleep areas, where a bite or exposure may occur with the victim being unaware. Once rabies develops, death almost certainly follows. Palliative care in a hospital setting is recommended with administration of large doses of pain medication, and sedatives in preference to physical restraint. Ice fragments can be given by mouth for thirst, but there is no good evidence intravenous hydration is of benefit. A treatment known as the Milwaukee protocol, which involves putting a person into a chemically induced coma and using antiviral medications , has been proposed. It initially came into use in 2003, following Jeanna Giese, a teenage girl from Wisconsin , becoming the first person known to have survived rabies without preventive treatments before symptom onset. The protocol has been tried multiple times since, but has been assessed as an ineffective treatment, and concerns raised about the costs and ethics of its use. Treatment after exposure can prevent the disease if given within 10 days. The rabies vaccine is 100% effective if given before symptoms of rabies appear. Every year, more than 15 million people get vaccinated after potential exposure. While this works well, the cost is significant. In the US it is recommended people receive one dose of human rabies immunoglobulin (HRIG) and four doses of rabies vaccine over a 14-day period. HRIG is expensive and makes up most of the cost of post-exposure treatment, ranging as high as several thousand dollars. In the UK, one dose of HRIG costs the National Health Service £1,000, although this is not flagged as a "high-cost medication". A full course of vaccine costs £120–180. As much as possible of HRIG should be injected around the bites, with the remainder being given by deep intramuscular injection at a site distant from the vaccination site. People who have previously been vaccinated against rabies do not need to receive the immunoglobulin—only the postexposure vaccinations on days 0 and 3. The side effects of modern cell-based vaccines are similar to the side effects of flu shots. The old nerve-tissue-based vaccination required multiple injections into the abdomen with a large needle but is inexpensive. It is being phased out and replaced by affordable World Health Organization intradermal-vaccination regimens. In children less than a year old, the lateral thigh is recommended. Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is effective in reducing the number of viral particles. Povidone-iodine or alcohol is then recommended to reduce the virus further. Awakening to find a bat in the room, or finding a bat in the room of a previously unattended child or mentally disabled or intoxicated person, is an indication for post-exposure prophylaxis (PEP). The recommendation for the precautionary use of PEP in bat encounters where no contact is recognized has been questioned in the medical literature, based on a cost–benefit analysis . However, a 2002 study has supported the protocol of precautionary administration of PEP where a child or mentally compromised individual has been alone with a bat, especially in sleep areas, where a bite or exposure may occur with the victim being unaware. Once rabies develops, death almost certainly follows. Palliative care in a hospital setting is recommended with administration of large doses of pain medication, and sedatives in preference to physical restraint. Ice fragments can be given by mouth for thirst, but there is no good evidence intravenous hydration is of benefit. A treatment known as the Milwaukee protocol, which involves putting a person into a chemically induced coma and using antiviral medications , has been proposed. It initially came into use in 2003, following Jeanna Giese, a teenage girl from Wisconsin , becoming the first person known to have survived rabies without preventive treatments before symptom onset. The protocol has been tried multiple times since, but has been assessed as an ineffective treatment, and concerns raised about the costs and ethics of its use. Vaccination after exposure, PEP, is highly successful in preventing rabies. In unvaccinated humans, rabies is almost certainly fatal after neurological symptoms have developed. In 2010, an estimated 26,000 people died from rabies, down from 54,000 in 1990. The majority of the deaths occurred in Asia and Africa. As of 2015 [ update ] , India (approximately 20,847), followed by China (approximately 6,000) and the Democratic Republic of the Congo (5,600), had the most cases. A 2015 collaboration between the World Health Organization, World Organization of Animal Health (OIE), Food and Agriculture Organization of the United Nation (FAO), and Global Alliance for Rabies Control has a goal of eliminating deaths from rabies by 2030. India has the highest rate of human rabies in the world, primarily because of stray dogs, whose number has greatly increased since a 2001 law forbade the killing of dogs. Effective control and treatment of rabies in India is hindered by a form of mass hysteria known as puppy pregnancy syndrome (PPS). Dog bite victims with PPS, male as well as female, become convinced that puppies are growing inside them, and often seek help from faith healers rather than medical services. An estimated 20,000 people die every year from rabies in India, more than a third of the global total. Australia has an official rabies-free status, although Australian bat lyssavirus (ABLV), discovered in 1996, is a rabies-causing virus related to the rabies virus prevalent in Australian native bat populations. Canine-specific rabies has been eradicated in the United States, but rabies is common among wild animals, and an average of 100 dogs become infected from other wildlife each year. Due to high public awareness of the virus, efforts at vaccination of domestic animals and curtailment of feral populations, and availability of postexposure prophylaxis , incidence of rabies in humans is very rare in the United States. From 1960 to 2018, a total of 125 human rabies cases were reported in the United States; 36 (28%) were attributed to dog bites during international travel. Among the 89 infections acquired in the United States, 62 (70%) were attributed to bats. The most recent rabies death in the United States was in November 2021, where a Texas child was bitten by a bat in late August 2021 but his parents failed to get him treatment. He died less than three months later. Either no or very few cases of rabies are reported each year in Europe; cases are contracted both during travel and in Europe. In Switzerland the disease was virtually eliminated after scientists placed chicken heads laced with live attenuated vaccine in the Swiss Alps . Foxes, proven to be the main source of rabies in the country, ate the chicken heads and became immunized. Italy, after being declared rabies-free from 1997 to 2008, has witnessed a reemergence of the disease in wild animals in the Triveneto regions ( Trentino-Alto Adige/Südtirol , Veneto and Friuli Venezia Giulia ), due to the spreading of an epidemic in the Balkans that also affected Austria. An extensive wild animal vaccination campaign eliminated the virus from Italy again, and it regained the rabies-free country status in 2013, the last reported case of rabies being reported in a red fox in early 2011. The United Kingdom has been free of rabies since the early 20th century except for a rabies-like virus (EBLV-2) in a few Daubenton's bats . There has been one fatal case of EBLV-2 transmission to a human. There have been four deaths from rabies, transmitted abroad by dog bites, since 2000. The last infection in the UK occurred in 1922, and the last death from indigenous rabies was in 1902. Sweden and mainland Norway have been free of rabies since 1886. Bat rabies antibodies (but not the virus) have been found in bats. On Svalbard, animals can cross the arctic ice from Greenland or Russia. Mexico was certified by the World Health Organization as being free of dog-transmitted rabies in 2019 because no case of dog-human transmission had been recorded in two years. India has the highest rate of human rabies in the world, primarily because of stray dogs, whose number has greatly increased since a 2001 law forbade the killing of dogs. Effective control and treatment of rabies in India is hindered by a form of mass hysteria known as puppy pregnancy syndrome (PPS). Dog bite victims with PPS, male as well as female, become convinced that puppies are growing inside them, and often seek help from faith healers rather than medical services. An estimated 20,000 people die every year from rabies in India, more than a third of the global total. Australia has an official rabies-free status, although Australian bat lyssavirus (ABLV), discovered in 1996, is a rabies-causing virus related to the rabies virus prevalent in Australian native bat populations.Canine-specific rabies has been eradicated in the United States, but rabies is common among wild animals, and an average of 100 dogs become infected from other wildlife each year. Due to high public awareness of the virus, efforts at vaccination of domestic animals and curtailment of feral populations, and availability of postexposure prophylaxis , incidence of rabies in humans is very rare in the United States. From 1960 to 2018, a total of 125 human rabies cases were reported in the United States; 36 (28%) were attributed to dog bites during international travel. Among the 89 infections acquired in the United States, 62 (70%) were attributed to bats. The most recent rabies death in the United States was in November 2021, where a Texas child was bitten by a bat in late August 2021 but his parents failed to get him treatment. He died less than three months later. Either no or very few cases of rabies are reported each year in Europe; cases are contracted both during travel and in Europe. In Switzerland the disease was virtually eliminated after scientists placed chicken heads laced with live attenuated vaccine in the Swiss Alps . Foxes, proven to be the main source of rabies in the country, ate the chicken heads and became immunized. Italy, after being declared rabies-free from 1997 to 2008, has witnessed a reemergence of the disease in wild animals in the Triveneto regions ( Trentino-Alto Adige/Südtirol , Veneto and Friuli Venezia Giulia ), due to the spreading of an epidemic in the Balkans that also affected Austria. An extensive wild animal vaccination campaign eliminated the virus from Italy again, and it regained the rabies-free country status in 2013, the last reported case of rabies being reported in a red fox in early 2011. The United Kingdom has been free of rabies since the early 20th century except for a rabies-like virus (EBLV-2) in a few Daubenton's bats . There has been one fatal case of EBLV-2 transmission to a human. There have been four deaths from rabies, transmitted abroad by dog bites, since 2000. The last infection in the UK occurred in 1922, and the last death from indigenous rabies was in 1902. Sweden and mainland Norway have been free of rabies since 1886. Bat rabies antibodies (but not the virus) have been found in bats. On Svalbard, animals can cross the arctic ice from Greenland or Russia.Mexico was certified by the World Health Organization as being free of dog-transmitted rabies in 2019 because no case of dog-human transmission had been recorded in two years. Rabies has been known since around 2000 BC. The first written record of rabies is in the Mesopotamian Codex of Eshnunna ( c. 1930 BC ), which dictates that the owner of a dog showing symptoms of rabies should take preventive measures against bites. If another person were bitten by a rabid dog and later died, the owner was heavily fined. In Ancient Greece, rabies was supposed to be caused by Lyssa , the spirit of mad rage. Ineffective folk remedies abounded in the medical literature of the ancient world. The physician Scribonius Largus prescribed a poultice of cloth and hyena skin; Antaeus recommended a preparation made from the skull of a hanged man. Rabies appears to have originated in the Old World, the first epizootic in the New World occurring in Boston in 1768. Rabies was considered a scourge for its prevalence in the 19th century. In France and Belgium, where Saint Hubert was venerated, the " St Hubert's Key " was heated and applied to cauterize the wound. By an application of magical thinking , dogs were branded with the key in hopes of protecting them from rabies. It was not uncommon for a person bitten by a dog merely suspected of being rabid to commit suicide or to be killed by others. In ancient times the attachment of the tongue (the lingual frenulum , a mucous membrane) was cut and removed, as this was where rabies was thought to originate. This practice ceased with the discovery of the actual cause of rabies. Louis Pasteur's 1885 nerve tissue vaccine was successful, and was progressively improved to reduce often severe side-effects. In modern times, the fear of rabies has not diminished, and the disease and its symptoms, particularly agitation, have served as an inspiration for several works of zombie or similarly themed fiction, often portraying rabies as having mutated into a stronger virus which fills humans with murderous rage or incurable illness, bringing about a devastating, widespread pandemic. Rabies is infectious to mammals ; three stages of central nervous system infection are recognized. The clinical course is often shorter in animals than in humans, but result in similar symptoms and almost always death. The first stage is a one- to three-day period characterized by behavioral changes and is known as the prodromal stage . The second is the excitative stage, which lasts three to four days. This stage is often known as "furious rabies" for the tendency of the affected animal to be hyper-reactive to external stimuli and bite or attack anything near. In some cases, animals skip the excitative stage and develop paralysis, as in the third phase; the paralytic phase. This stage develops due to damage to motor neurons . Incoordination is seen, owing to rear limb paralysis , and drooling and difficulty swallowing is caused by paralysis of facial and throat muscles. Death is usually caused by respiratory arrest .

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Tropical_disease/html

Tropical disease

Tropical diseases are diseases that are prevalent in or unique to tropical and subtropical regions. The diseases are less prevalent in temperate climates , due in part to the occurrence of a cold season , which controls the insect population by forcing hibernation . However, many were present in northern Europe and northern America in the 17th and 18th centuries before modern understanding of disease causation. The initial impetus for tropical medicine was to protect the health of colonial settlers, notably in India under the British Raj . Insects such as mosquitoes and flies are by far the most common disease carrier, or vector . These insects may carry a parasite , bacterium or virus that is infectious to humans and animals. Most often disease is transmitted by an insect bite , which causes transmission of the infectious agent through subcutaneous blood exchange. Vaccines are not available for most of the diseases listed here, and many do not have cures . Human exploration of tropical rainforests , deforestation , rising immigration and increased international air travel and other tourism to tropical regions has led to an increased incidence of such diseases to non-tropical countries. Of particular concern is the habitat loss of reservoir host species. In 1975 the Special Programme for Research and Training in Tropical Diseases (TDR) was established to focus on neglected infectious diseases which disproportionately affect poor and marginalized populations in developing regions of Africa , Asia , Central America and North South America . It was established at the World Health Organization , which is the executing agency, and is co-sponsored by the United Nations Children's Fund , United Nations Development Programme , the World Bank and the World Health Organization . [ citation needed ] TDR's vision is to foster an effective global research effort on infectious diseases of poverty in which disease endemic countries play a pivotal role. It has a dual mission of developing new tools and strategies against these diseases, and to develop the research and leadership capacity in the countries where the diseases occur. The TDR secretariat is based in Geneva, Switzerland, but the work is conducted throughout the world through many partners and funded grants. [ citation needed ] Some examples of work include helping to develop new treatments for diseases, such as ivermectin for onchocerciasis (river blindness); showing how packaging can improve use of artemesinin-combination treatment (ACT) for malaria; demonstrating the effectiveness of bednets to prevent mosquito bites and malaria; and documenting how community-based and community-led programmes increases distribution of multiple treatments. TDR history The current TDR disease portfolio includes the following entries: second stage: insomnia , confusion , ataxia , hemiparesis , paralysis 2 billion (latent, 2018)Additional neglected tropical diseases include: Some tropical diseases are very rare, but may occur in sudden epidemics , such as the Ebola hemorrhagic fever, Lassa fever and the Marburg virus . There are hundreds of different tropical diseases which are less known or rarer, but that, nonetheless, have importance for public health .The so-called "exotic" diseases in the tropics have long been noted both by travelers, explorers, etc., as well as by physicians. One obvious reason is that the hot climate present during all the year and the larger volume of rains directly affect the formation of breeding grounds, the larger number and variety of natural reservoirs and animal diseases that can be transmitted to humans ( zoonosis ), the largest number of possible insect vectors of diseases. It is possible also that higher temperatures may favor the replication of pathogenic agents both inside and outside biological organisms. Socio-economic factors may be also in operation, since most of the poorest nations of the world are in the tropics. Tropical countries like Brazil , which have improved their socio-economic situation and invested in hygiene , public health and the combat of transmissible diseases have achieved dramatic results in relation to the elimination or decrease of many endemic tropical diseases in their territory. [ citation needed ] Climate change , global warming caused by the greenhouse effect , and the resulting increase in global temperatures , are possibly causing tropical diseases and vectors to spread to higher altitudes in mountainous regions, and to higher latitudes that were previously spared, such as the Southern United States , the Mediterranean area, etc. For example, in the Monteverde cloud forest of Costa Rica, global warming enabled Chytridiomycosis, a tropical disease, to flourish and thus force into decline amphibian populations of the Monteverde Harlequin frog. Here, global warming raised the heights of orographic cloud formation, and thus produced cloud cover that would facilitate optimum growth conditions for the implicated pathogen, B. dendrobatidis. [ citation needed ]Vectors are living organisms that pass disease between humans or from animal to human. The vector carrying the highest number of diseases is the mosquito, which is responsible for the tropical diseases dengue and malaria. Many different approaches have been taken to treat and prevent these diseases. NIH-funded research has produced genetically modify mosquitoes that are unable to spread diseases such as malaria. An issue with this approach is global accessibility to genetic engineering technology; Approximately 50% of scientists in the field do not have access to information on genetically modified mosquito trials being conducted. Other prevention methods include: Assisting with economic development in endemic regions can contribute to prevention and treatment of tropical diseases. For example, microloans enable communities to invest in health programs that lead to more effective disease treatment and prevention technology. Educational campaigns can aid in the prevention of various diseases. Educating children about how diseases spread and how they can be prevented has proven to be effective in practicing preventative measures. Educational campaigns can yield significant benefits at low costs. [ citation needed ]Vectors are living organisms that pass disease between humans or from animal to human. The vector carrying the highest number of diseases is the mosquito, which is responsible for the tropical diseases dengue and malaria. Many different approaches have been taken to treat and prevent these diseases. NIH-funded research has produced genetically modify mosquitoes that are unable to spread diseases such as malaria. An issue with this approach is global accessibility to genetic engineering technology; Approximately 50% of scientists in the field do not have access to information on genetically modified mosquito trials being conducted. Other prevention methods include:Assisting with economic development in endemic regions can contribute to prevention and treatment of tropical diseases. For example, microloans enable communities to invest in health programs that lead to more effective disease treatment and prevention technology. Educational campaigns can aid in the prevention of various diseases. Educating children about how diseases spread and how they can be prevented has proven to be effective in practicing preventative measures. Educational campaigns can yield significant benefits at low costs. [ citation needed ]

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Robovirus/html

Robovirus

A robovirus is a zoonotic virus that is transmitted by a rodent vector (i.e., ro dent bo rne). Roboviruses mainly belong to the virus families Arenaviridae and Hantaviridae . Like arbovirus ( ar thropod bo rne) and tibovirus ( ti ck bo rne) the name refers to its method of transmission, known as its vector . This is distinguished from a clade , which groups around a common ancestor. Some scientists now refer to arbovirus and robovirus together with the term ArboRobo-virus. Rodent borne disease can be transmitted through different forms of contact such as rodent bites, scratches, urine, saliva, etc. Potential sites of contact with rodents include habitats such as barns, outbuildings, sheds, and dense urban areas. Transmission of disease through rodents can be spread to humans through direct handling and contact, or indirectly through rodents carrying the disease spread to ticks, mites, fleas (arboborne). [ citation needed ] One example of a robovirus is hantavirus , which causes hantavirus pulmonary syndrome . Humans can be infected with Hantavirus Pulmonary Syndrome through direct contact with rodent droppings, saliva, or urine infected with strains of the virus. These components mix into the air and get transmitted when inhaled through airborne transmission. Lassa virus from the Arenaviridae family causes Lassa hemorrhagic fever and is also a robovirus transmitted by the rodent genus Mastomys natalensis . The multimammate rat is able to excrete the virus in its urine and droppings. These rat are often found in the savannas and forests of Africa. When these rats scavenge and enter households this provides an outlet for direct contact transmission with humans. It has also been found that airborne transmission can occur by engaging in cleaning activities such as sweeping. In some areas of Africa, the Mastomys rodent is caught and used as a source of food. This process can also lead to transmission and infection. Colorado tick fever virus causes high fevers, chills, headache, fatigue and sometimes vomiting, skin rash, and abdominal pain. The virus is caused by a Rocky Mountain wood tick ( Dermacentor andersoni ). It is an arbovirus, but rodents serve as the reservoir. The tick is carried by five species of rodents: the least chipmunk ( Eutamias minimus ), Richardson's ground squirrel ( Urocitellus richardsonii ), deer mice ( Peromyscus maniculatus ), the golden-mantled ground squirrel ( Callospermophilus lateraliss ), and the Uinta chipmunk ( Neotamias umbrinus ). The infected tick will be carried by its rodent host and infect another host (animal or human) as it feeds. Rodent populations are affected by a number of diverse factors, including climatic conditions. Warmer winters and increased rainfall will make it more likely for rodent populations to survive, therefore increasing the number of rodent reservoirs for disease. Increased rainfall accompanied by flooding can also increase human to rodent contact Global climate change will affect the distribution and prevalence of roboviruses. Inadequate hygiene and sanitation, as seen in some European countries, also contribute to increase rodent populations and higher risks of rodent borne disease transmission. One example of a robovirus is hantavirus , which causes hantavirus pulmonary syndrome . Humans can be infected with Hantavirus Pulmonary Syndrome through direct contact with rodent droppings, saliva, or urine infected with strains of the virus. These components mix into the air and get transmitted when inhaled through airborne transmission. Lassa virus from the Arenaviridae family causes Lassa hemorrhagic fever and is also a robovirus transmitted by the rodent genus Mastomys natalensis . The multimammate rat is able to excrete the virus in its urine and droppings. These rat are often found in the savannas and forests of Africa. When these rats scavenge and enter households this provides an outlet for direct contact transmission with humans. It has also been found that airborne transmission can occur by engaging in cleaning activities such as sweeping. In some areas of Africa, the Mastomys rodent is caught and used as a source of food. This process can also lead to transmission and infection. Colorado tick fever virus causes high fevers, chills, headache, fatigue and sometimes vomiting, skin rash, and abdominal pain. The virus is caused by a Rocky Mountain wood tick ( Dermacentor andersoni ). It is an arbovirus, but rodents serve as the reservoir. The tick is carried by five species of rodents: the least chipmunk ( Eutamias minimus ), Richardson's ground squirrel ( Urocitellus richardsonii ), deer mice ( Peromyscus maniculatus ), the golden-mantled ground squirrel ( Callospermophilus lateraliss ), and the Uinta chipmunk ( Neotamias umbrinus ). The infected tick will be carried by its rodent host and infect another host (animal or human) as it feeds. Rodent populations are affected by a number of diverse factors, including climatic conditions. Warmer winters and increased rainfall will make it more likely for rodent populations to survive, therefore increasing the number of rodent reservoirs for disease. Increased rainfall accompanied by flooding can also increase human to rodent contact Global climate change will affect the distribution and prevalence of roboviruses. Inadequate hygiene and sanitation, as seen in some European countries, also contribute to increase rodent populations and higher risks of rodent borne disease transmission.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Chikungunya/html

Chikungunya

Chikungunya is an infection caused by the Chikungunya virus ( CHIKV ). The disease was first identified in 1952 in Tanzania and named based on the Kimakonde words for "to become contorted". Symptoms include fever and joint pain . These typically occur two to twelve days after exposure. Other symptoms may include headache , muscle pain , joint swelling , and a rash . Symptoms usually improve within a week; however, occasionally the joint pain may last for months or years. The risk of death is around 1 in 1,000. The very young, old, and those with other health problems are at risk of more severe disease. The virus is spread between people by two types of mosquitos : Aedes albopictus and Aedes aegypti . They mainly bite during the day. The virus may circulate within a number of animals including birds and rodents . Diagnosis is by either testing the blood for viral RNA or antibodies to the virus. The symptoms can be mistaken for those of dengue fever and Zika fever . It is believed most people become immune after a single infection. The best means of prevention are overall mosquito control and the avoidance of bites in areas where the disease is common. This may be partly achieved by decreasing mosquitos' access to water and by the use of insect repellent and mosquito nets . In November 2023 the USFDA approved an adults-only vaccine ( Ixchiq ) for prevention of the disease. Once infected and symptomatic, recommendations to patients should include rest, fluids, and medications to help with fever and joint pain. In 2014, more than a million suspected cases occurred globally. While the disease is endemic in Africa and Asia, outbreaks have been reported in Europe and the Americas since the 2000s; in 2014, an outbreak was reported in Florida in the continental United States , but as of 2016 there were no further locally-acquired cases. Around 85% of people infected with Chikungunya virus experience symptoms, typically beginning with a sudden high fever above 39 °C (102 °F) . The fever is soon followed by severe muscle and joint pain . Pain usually affects multiple joints in the arms and legs, and is symmetric – i.e. if one elbow is affected, the other is as well. People with Chikungunya also frequently experience headache , back pain, nausea , and fatigue . Around half of those affected develop a rash , with reddening and sometimes small bumps on the palms, foot soles, torso, and face. For some, the rash remains constrained to a small part of the body; for others, the rash can be extensive, covering more than 90% of the skin. Some people experience gastrointestinal issues, with abdominal pain and vomiting. Others experience eye problems, namely sensitivity to light , conjunctivitis , and pain behind the eye. This first set of symptoms – called the "acute phase" of Chikungunya – lasts around a week, after which most symptoms resolve on their own. Many people continue to have symptoms after the "acute phase" resolves, termed the "post-acute phase" for symptoms lasting three weeks to three months, and the "chronic stage" for symptoms lasting longer than three months. In both cases, the lasting symptoms tend to be joint pains: arthritis , tenosynovitis , and/or bursitis . If the affected person had pre-existing joint issues, these tend to worsen. Overuse of a joint can result in painful swelling, stiffness, nerve damage, and neuropathic pain . Typically the joint pain improves with time; however, the chronic stage can last anywhere from a few months to several years. Joint pain is reported in 87–98% of cases, and nearly always occurs in more than one joint, though joint swelling is uncommon. Typically the affected joints are located in both arms and legs. Joints are more likely to be affected if they have previously been damaged by disorders such as arthritis . Pain most commonly occurs in peripheral joints, such as the wrists, ankles, and joints of the hands and feet as well as some of the larger joints, typically the shoulders, elbows and knees. Pain may also occur in the muscles or ligaments . In more than half of cases, normal activity is limited by significant fatigue and pain. Infrequently, inflammation of the eyes may occur in the form of iridocyclitis , or uveitis , and retinal lesions may occur. Temporary damage to the liver may occur. People with Chikungunya occasionally develop neurologic disorders, most frequently swelling or degeneration of the brain, inflammation or degeneration of the myelin sheaths around neurons, Guillain–Barré syndrome , acute disseminated encephalomyelitis , hypotonia (in newborns), and issues with visual processing. In particularly rare cases, people may develop behavioral changes, seizures, irritation of the cerebellum or meninges , oculomotor nerve palsy , or paralysis of the eye muscles . Newborns are susceptible to particularly severe effects of Chikungunya infection. Signs of infection typically begin with fever, rash, and swelling in the extremities. Around half of newborns have a mild case of the disease that resolves on its own; the other half have severe disease with inflammation of the brain and seizures . In severe cases, affected newborns may also have issues with bleeding and bloodflow, and problems with heart function. In addition to newborns, the elderly, and those with diabetes , heart disease , liver and kidney diseases, and human immunodeficiency virus infection tend to have more severe cases of Chikungunya. Around 1 to 5 in 1,000 people with symptomatic Chikungunya die of the disease. Chikungunya virus (CHIKV), is a member of the genus Alphavirus , and family Togaviridae . It was first isolated in 1953 in Tanzania and is an RNA virus with a positive-sense single-stranded genome of about 11.6kb. It is a member of the Semliki Forest virus complex and is closely related to Ross River virus , O'nyong'nyong virus , and Semliki Forest virus . Because it is transmitted by arthropods , namely mosquitoes, it can also be referred to as an arbovirus ( ar thropod- bo rne virus). In the United States, it is classified as a category B priority pathogen , and work requires biosafety level III precautions. Chikungunya is generally transmitted from mosquitoes to humans. Less common modes of transmission include vertical transmission , which is transmission from mother to child during pregnancy or at birth. Transmission via infected blood products and through organ donation is also theoretically possible during times of outbreak, though no cases have yet been documented. The incubation period ranges from one to twelve days, and is most typically three to seven. Chikungunya is related to mosquitoes , their environments, and human behavior. The adaptation of mosquitoes to the changing climate of North Africa around 5,000 years ago made them seek out environments where humans stored water. Human habitation and the mosquitoes' environments were then very closely connected. During periods of epidemics humans are the reservoir of the virus. Because high amounts of virus are present in the blood in the beginning of acute infection, the virus can be spread from a viremic human to a mosquito, and back to a human. During other times, monkeys, birds and other vertebrates have served as reservoirs. Three genotypes of this virus have been described, each with a distinct genotype and antigenic character: West African, East/Central/South African, and Asian genotypes. The Asian lineage originated in 1952 and has subsequently split into two lineages – India (Indian Ocean Lineage) and South East Asian clades. This virus was first reported in the Americas in 2014. Phylogenetic investigations have shown that there are two strains in Brazil – the Asian and East/Central/South African types – and that the Asian strain arrived in the Caribbean (most likely from Oceania) in about March 2013. The rate of molecular evolution was estimated to have a mean rate of 5 × 10 −4 substitutions per site per year (95% higher probability density 2.9–7.9 × 10 −4 ). Chikungunya is spread through bites from Aedes mosquitoes, and the species A. aegypti was identified as the most common vector, though the virus has recently been associated with many other species, including A. albopictus . Research by the Pasteur Institute in Paris has suggested Chikungunya virus strains in the 2005-2006 Reunion Island outbreak incurred a mutation that facilitated transmission by the Asian tiger mosquito ( A. albopictus ). Other species potentially able to transmit Chikungunya virus include Ae. furcifer-taylori , Ae. africanus , and Ae. luteocephalus . Chikungunya virus (CHIKV), is a member of the genus Alphavirus , and family Togaviridae . It was first isolated in 1953 in Tanzania and is an RNA virus with a positive-sense single-stranded genome of about 11.6kb. It is a member of the Semliki Forest virus complex and is closely related to Ross River virus , O'nyong'nyong virus , and Semliki Forest virus . Because it is transmitted by arthropods , namely mosquitoes, it can also be referred to as an arbovirus ( ar thropod- bo rne virus). In the United States, it is classified as a category B priority pathogen , and work requires biosafety level III precautions. Chikungunya is generally transmitted from mosquitoes to humans. Less common modes of transmission include vertical transmission , which is transmission from mother to child during pregnancy or at birth. Transmission via infected blood products and through organ donation is also theoretically possible during times of outbreak, though no cases have yet been documented. The incubation period ranges from one to twelve days, and is most typically three to seven. Chikungunya is related to mosquitoes , their environments, and human behavior. The adaptation of mosquitoes to the changing climate of North Africa around 5,000 years ago made them seek out environments where humans stored water. Human habitation and the mosquitoes' environments were then very closely connected. During periods of epidemics humans are the reservoir of the virus. Because high amounts of virus are present in the blood in the beginning of acute infection, the virus can be spread from a viremic human to a mosquito, and back to a human. During other times, monkeys, birds and other vertebrates have served as reservoirs. Three genotypes of this virus have been described, each with a distinct genotype and antigenic character: West African, East/Central/South African, and Asian genotypes. The Asian lineage originated in 1952 and has subsequently split into two lineages – India (Indian Ocean Lineage) and South East Asian clades. This virus was first reported in the Americas in 2014. Phylogenetic investigations have shown that there are two strains in Brazil – the Asian and East/Central/South African types – and that the Asian strain arrived in the Caribbean (most likely from Oceania) in about March 2013. The rate of molecular evolution was estimated to have a mean rate of 5 × 10 −4 substitutions per site per year (95% higher probability density 2.9–7.9 × 10 −4 ). Chikungunya is spread through bites from Aedes mosquitoes, and the species A. aegypti was identified as the most common vector, though the virus has recently been associated with many other species, including A. albopictus . Research by the Pasteur Institute in Paris has suggested Chikungunya virus strains in the 2005-2006 Reunion Island outbreak incurred a mutation that facilitated transmission by the Asian tiger mosquito ( A. albopictus ). Other species potentially able to transmit Chikungunya virus include Ae. furcifer-taylori , Ae. africanus , and Ae. luteocephalus . Chikungunya virus is passed to humans when a bite from an infected mosquito breaks the skin and introduces the virus into the body. The pathogenesis of chikungunya infection in humans is still poorly understood, despite recent outbreaks. It appears that in vitro , Chikungunya virus is able to replicate in human epithelial and endothelial cells , primary fibroblasts , and monocyte-derived macrophages . Viral replication is highly cytopathic , but susceptible to type-I and -II interferon . In vivo , in studies using living cells, chikungunya virus appears to replicate in fibroblasts, skeletal muscle progenitor cells, and myofibers. The type-1 interferon response seems to play an important role in the host's response to chikungunya infection. Upon infection with chikungunya, the host's fibroblasts produce type-1 alpha and beta interferon ( IFN-α and IFN-β ). In mouse studies, deficiencies in INF-1 in mice exposed to the virus cause increased morbidity and mortality. The chikungunya-specific upstream components of the type-1 interferon pathway involved in the host's response to chikungunya infection are still unknown. Nonetheless, mouse studies suggest that IPS-1 is an important factor, and that IRF3 and IRF7 are important in an age-dependent manner. Mouse studies also suggest that chikungunya evades host defenses and counters the type-I interferon response by producing NS2, a nonstructural protein that degrades RBP1 and turns off the host cell's ability to transcribe DNA. NS2 interferes with the JAK-STAT signaling pathway and prevents STAT from becoming phosphorylated . In the acute phase of chikungunya, the virus is typically present in the areas where symptoms present, specifically skeletal muscles, and joints . In the chronic phase, it is suggested that viral persistence (the inability of the body to entirely rid itself of the virus), lack of clearance of the antigen , or both, contribute to joint pain. The inflammation response during both the acute and chronic phase of the disease results in part from interactions between the virus and monocytes and macrophages. Chikungunya virus disease in humans is associated with elevated serum levels of specific cytokines and chemokines . High levels of specific cytokines have been linked to more severe acute disease: interleukin-6 (IL-6), IL-1β , RANTES , monocyte chemoattractant protein 1 (MCP-1), monokine induced by gamma interferon (MIG), and interferon gamma-induced protein 10 (IP-10). Cytokines may also contribute to chronic Chikungunya virus disease, as persistent joint pain has been associated with elevated levels of IL-6 and granulocyte-macrophage colony-stimulating factor (GM-CSF). In those with chronic symptoms, a mild elevation of C-reactive protein (CRP) has been observed, suggesting ongoing chronic inflammation. However, there is little evidence linking chronic Chikungunya virus disease and the development of autoimmunity . [ citation needed ] The virus consists of four nonstructural proteins and three structural proteins. The structural proteins are the capsid and two envelope glycoproteins: E1 and E2, which form heterodimeric spikes on the viron surface. E2 binds to cellular receptors in order to enter the host cell through receptor-mediated endocytosis . E1 contains a fusion peptide which, when exposed to the acidity of the endosome in eukaryotic cells , dissociates from E2 and initiates membrane fusion that allows the release of nucleocapsids into the host cytoplasm, promoting infection. The mature virion contains 240 heterodimeric spikes of E2/E1, which after release, bud on the surface of the infected cell, where they are released by exocytosis to infect other cells. The virus consists of four nonstructural proteins and three structural proteins. The structural proteins are the capsid and two envelope glycoproteins: E1 and E2, which form heterodimeric spikes on the viron surface. E2 binds to cellular receptors in order to enter the host cell through receptor-mediated endocytosis . E1 contains a fusion peptide which, when exposed to the acidity of the endosome in eukaryotic cells , dissociates from E2 and initiates membrane fusion that allows the release of nucleocapsids into the host cytoplasm, promoting infection. The mature virion contains 240 heterodimeric spikes of E2/E1, which after release, bud on the surface of the infected cell, where they are released by exocytosis to infect other cells. Chikungunya is diagnosed on the basis of clinical, epidemiological, and laboratory criteria. Clinically, acute onset of high fever and severe joint pain would lead to suspicion of chikungunya. Epidemiological criteria consist of whether the individual has traveled to or spent time in an area in which chikungunya is present within the last twelve days (i.e.) the potential incubation period). Laboratory criteria include a decreased lymphocyte count consistent with viremia . However a definitive laboratory diagnosis can be accomplished through viral isolation, RT-PCR, or serological diagnosis. The differential diagnosis may include other mosquito-borne diseases , such as dengue or malaria , or other infections such as influenza . Chronic recurrent polyarthralgia occurs in at least 20% of chikungunya patients one year after infection, whereas such symptoms are uncommon in dengue. Virus isolation provides the most definitive diagnosis, but takes one to two weeks for completion and must be carried out in biosafety level III laboratories . The technique involves exposing specific cell lines to samples from whole blood and identifying Chikungunya virus -specific responses. RT-PCR using nested primer pairs is used to amplify several chikungunya-specific genes from whole blood, generating thousands to millions of copies of the genes in order to identify them. RT-PCR can also be used to quantify the viral load in the blood. Using RT-PCR, diagnostic results can be available in one to two days. Serological diagnosis requires a larger amount of blood than the other methods, and uses an ELISA assay to measure chikungunya-specific IgM levels in the blood serum. One advantage offered by serological diagnosis is that serum IgM is detectable from 5 days to months after the onset of symptoms, but drawbacks are that results may require two to three days, and false positives can occur with infection due to other related viruses, such as o'nyong'nyong virus and Semliki Forest virus . Presently, there is no specific way to test for chronic signs and symptoms associated with Chikungunya fever although nonspecific laboratory findings such as C reactive protein and elevated cytokines can correlate with disease activity. Because no approved vaccine exists, the most effective means of prevention are protection against contact with the disease-carrying mosquitoes and controlling mosquito populations by limiting their habitat . Mosquito control focuses on eliminating the standing water where mosquitos lay eggs and develop as larva; if elimination of the standing water is not possible, insecticides or biological control agents can be added. Methods of protection against contact with mosquitos include using insect repellents with substances such as DEET , icaridin , PMD ( p-menthane-3,8-diol , a substance derived from the lemon eucalyptus tree), or ethyl butylacetylaminopropionate (IR3535). However, increasing insecticide resistance presents a challenge to chemical control methods. [ citation needed ] Wearing bite-proof long sleeves and trousers also offers protection, and garments can be treated with pyrethroids , a class of insecticides that often has repellent properties. Vaporized pyrethroids (for example in mosquito coils) are also insect repellents. As infected mosquitoes often feed and rest inside homes, securing screens on windows and doors will help to keep mosquitoes out of the house. In the case of the day-active A. aegypti and A. albopictus , however, this will have only a limited effect, since many contacts between the mosquitoes and humans occur outdoors. [ citation needed ] A Chikungunya vaccine is a vaccine intended to provide acquired immunity against the chikungunya virus . The most commonly reported side effects include headache, fatigue, muscle pain, joint pain, fever, nausea and tenderness at the injection site. A Chikungunya vaccine is a vaccine intended to provide acquired immunity against the chikungunya virus . The most commonly reported side effects include headache, fatigue, muscle pain, joint pain, fever, nausea and tenderness at the injection site. Currently, no specific treatment for chikungunya is available. Supportive care is recommended, and symptomatic treatment of fever and joint swelling includes the use of nonsteroidal anti-inflammatory drugs such as naproxen , non-aspirin analgesics such as paracetamol (acetaminophen) and fluids. Aspirin is not recommended due to the increased risk of bleeding. Despite anti-inflammatory effects, corticosteroids are not recommended during the acute phase of disease, as they may cause immunosuppression and worsen infection. Passive immunotherapy has potential benefit in treatment of chikungunya. Studies in animals using passive immunotherapy have been effective, and clinical studies using passive immunotherapy in those particularly vulnerable to severe infection are currently in progress. Passive immunotherapy involves administration of anti-CHIKV hyperimmune human intravenous antibodies (immunoglobulins) to those exposed to a high risk of chikungunya infection. No antiviral treatment for Chikungunya virus is currently available, though testing has shown several medications to be effective in vitro . In those who have more than two weeks of arthritis, ribavirin may be useful. The effect of chloroquine is not clear. It does not appear to help acute disease, but tentative evidence indicates it might help those with chronic arthritis. Steroids do not appear to be an effective treatment. NSAIDs and simple analgesics can be used to provide partial symptom relief in most cases. Methotrexate , a drug used in the treatment of rheumatoid arthritis , has been shown to have benefit in treating inflammatory polyarthritis resulting from chikungunya, though the drug mechanism for improving viral arthritis is unclear. In those who have more than two weeks of arthritis, ribavirin may be useful. The effect of chloroquine is not clear. It does not appear to help acute disease, but tentative evidence indicates it might help those with chronic arthritis. Steroids do not appear to be an effective treatment. NSAIDs and simple analgesics can be used to provide partial symptom relief in most cases. Methotrexate , a drug used in the treatment of rheumatoid arthritis , has been shown to have benefit in treating inflammatory polyarthritis resulting from chikungunya, though the drug mechanism for improving viral arthritis is unclear. The mortality rate of chikungunya is slightly less than 1 in 1000. Those over the age of 65, neonates, and those with underlying chronic medical problems are most likely to have severe complications. Neonates are vulnerable as it is possible to vertically transmit chikungunya from mother to infant during delivery, which results in high rates of morbidity, as infants lack fully developed immune systems . The likelihood of prolonged symptoms or chronic joint pain is increased with increased age and prior rheumatological disease. Historically, chikungunya has been present mostly in the developing world . The disease causes an estimated 3 million infections each year. Epidemics in the Indian Ocean, Pacific Islands, and in the Americas, continue to change the distribution of the disease. In Africa, chikungunya is spread by a sylvatic cycle in which the virus largely cycles between other non-human primates , small mammals, and mosquitos between human outbreaks. During outbreaks, due to the high concentration of virus in the blood of those in the acute phase of infection, the virus can circulate from humans to mosquitoes and back to humans. The transmission of the pathogen between humans and mosquitoes that exist in urban environments was established on multiple occasions from strains occurring on the eastern half of Africa in non-human primate hosts. This emergence and spread beyond Africa may have started as early as the 18th century. Currently, available data does not indicate whether the introduction of chikungunya into Asia occurred in the 19th century or more recently, but this epidemic Asian strain causes outbreaks in India and continues to circulate in Southeast Asia. In Africa, outbreaks were typically tied to heavy rainfall causing increased mosquito population. In recent outbreaks in urban centers, the virus has spread by circulating between humans and mosquitoes. Global rates of chikungunya infection are variable, depending on outbreaks. When chikungunya was first identified in 1952, it had a low-level circulation in West Africa, with infection rates linked to rainfall. Beginning in the 1960s, periodic outbreaks were documented in Asia and Africa. However, since 2005, following several decades of relative inactivity, chikungunya has re-emerged and caused large outbreaks in Africa, Asia, and the Americas. In India, for instance, chikungunya re-appeared following 32 years of absence of viral activity. Outbreaks have occurred in Europe, the Caribbean, and South America, areas in which chikungunya was not previously transmitted. Local transmission has also occurred in the United States and Australia, countries in which the virus was previously unknown. In 2005, an outbreak on the island of Réunion was the largest then documented, with an estimated 266,000 cases on an island with a population of approximately 770,000. In a 2006 outbreak, India reported 1.25 million suspected cases. Chikungunya was introduced to the Americas in 2013, first detected on the French island of Saint Martin , and for the next two years in the Americas, 1,118,763 suspected cases and 24,682 confirmed cases were reported by the PAHO . An analysis of the genetic code of Chikungunya virus suggests that the increased severity of the 2005–present outbreak may be due to a change in the genetic sequence which altered the E1 segment of the virus' viral coat protein, a variant called E1-A226V. This mutation potentially allows the virus to multiply more easily in mosquito cells. The change allows the virus to use the Asian tiger mosquito (an invasive species ) as a vector in addition to the more strictly tropical main vector, Aedes aegypti . Enhanced transmission of Chikungunya virus by A. albopictus could mean an increased risk for outbreaks in other areas where the Asian tiger mosquito is present. A albopictus is an invasive species which has spread through Europe, the Americas, the Caribbean, Africa and the Middle East. [ citation needed ] After the detection of zika virus in Brazil in April 2015, the first ever in the Western Hemisphere, it is now thought some chikungunya and dengue cases could in fact be zika virus cases or coinfections .The disease was first described by Marion Robinson and W.H.R. Lumsden in a pair of 1955 papers, following an outbreak in 1952 on the Makonde Plateau , along the border between Mozambique and Tanganyika (the mainland part of modern-day Tanzania ). Since then outbreaks have occurred occasionally in Africa, South Asia, and Southeast Asia; recent outbreaks have spread the disease over a wider range. [ citation needed ] The first recorded outbreak may have been in 1779. This is in agreement with the molecular genetics evidence that suggests it evolved around the year 1700. According to the original paper by Lumsden, the term 'chikungunya' is derived from the Makonde root verb kungunyala , meaning to dry up or become contorted. In concurrent research, Robinson [ citation needed ] glossed the Makonde term more specifically as "that which bends up". It is understood to refer to the contorted posture of people affected with the severe joint pain and arthritic symptoms associated with this disease. Subsequent authors apparently overlooked the references to the Makonde language and assumed the term to have been derived from Swahili , the lingua franca of the region. The erroneous attribution to Swahili has been repeated in numerous print sources. Erroneous spellings of the name of the disease are also in common use. [ citation needed ]Chikungunya is one of more than a dozen agents researched as a potential biological weapon . This disease is part of the group of neglected tropical diseases .

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Crimean–Congo_hemorrhagic_fever/html

Crimean–Congo hemorrhagic fever

Crimean–Congo hemorrhagic fever ( CCHF ) is a viral disease . Symptoms of CCHF may include fever , muscle pains , headache , vomiting, diarrhea , and bleeding into the skin . Onset of symptoms is less than two weeks following exposure. Complications may include liver failure . Survivors generally recover around two weeks after onset. The CCHF virus is typically spread by tick bites or close contact with the blood, secretions, organs or other bodily fluids of infected persons or animals. Groups that are at high risk of infection are farmers and those who work in slaughterhouses . The virus can also spread between people via body fluids . Diagnosis can be made by detecting antibodies , the virus's RNA , or viral proteins (antigens). It is a type of viral hemorrhagic fever . There are no FDA - or WHO -approved therapeutics for CCHF, and a vaccine is not commercially available. Prevention involves avoiding tick bites, following safe practices in meat processing plants, and observing universal healthcare precautions. Treatment is typically with supportive care , and the medication ribavirin may also help. CCHF cases are observed in a wide geographic range including Africa , Russia , the Balkans , the Middle East , and Asia . Typically small outbreaks are seen in areas where the virus is endemic. In 2013 Iran , Russia, Turkey , and Uzbekistan documented more than 50 cases. The fatality rate is typically between 10 and 40%, though fatalities as high as 80% have been observed in some outbreaks. The virus was first observed in Crimea in the 1940s and was later identified as the same agent of what had been called Congo Hemorrhagic Fever. In the past 20 years, CCHF outbreaks have been reported in eastern Europe, particularly in the former Soviet Union , throughout the Mediterranean, in northwestern China , central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent . CCHF is on WHO's priority list for Research and Development and the US National Institute of Allergy and Infectious Diseases (NIH/NIAID) priority A list, as a disease posing the highest level of risk to national security and public health.The clinical illness associated with CCHFV (the CCHF virus) is a severe form of hemorrhagic fever . Following infection by a tick bite, the incubation period is typically two to three days but can last as long as nine days, while the incubation period following contact with infected blood or tissues is usually five to six days with a documented maximum of 13 days. The onset of symptoms ushering in the pre-hemorrhagic phase is sudden, with fever, myalgia (muscle ache), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). Typical symptoms include nausea, vomiting (which may progress to severe bleeding and can be fatal if not treated), diarrhea, abdominal pain and sore throat early in the acute infection phase, followed by sharp mood swings, agitations and confusion. After several days, agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable liver enlargement. As the illness progresses into the hemorrhagic phase, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks. Other clinical signs include tachycardia (fast heart rate), lymphadenopathy (enlarged lymph nodes), and a petechiae (a rash caused by bleeding into the skin) on internal mucosal surfaces, such as in the mouth and throat, and on the skin. The petechiae may give way to larger rashes called ecchymoses, and other haemorrhagic phenomena. There is usually evidence of hepatitis, and severely ill patients may experience rapid kidney deterioration, liver failure or pulmonary failure after the fifth day of illness. In documented outbreaks of CCHF, fatality rates in hospitalized patients have ranged from 9% to as high as 70%, though the WHO notes a typical range of 10–40%, with death often occurring in the second week of illness. In patients who recover, improvement generally begins on the ninth or tenth day after the onset of illness. The long-term effects of CCHF infection have not been studied well enough in survivors to determine whether or not specific complications exist. However, recovery is slow.The Crimean–Congo hemorrhagic fever orthonairovirus (CCHFV) is a member of the genus Orthonairovirus , family Nairoviridae of RNA viruses . The virions are 80–120 nanometers (nm) in diameter and are pleomorphic . There are no host ribosomes within the virion. Each virion contains three distinct RNA sequences, which together make up the viral genome. The envelope is single layered and is formed from a lipid bilayer 5 nm thick. It has no external protrusions. The envelope proteins form small projections ~5–10 nm long. The nucleocapsids are filamentous and circular with a length of 200–3000 nm. Viral entry is thought to be clathrin-mediated with the cell surface protein nucleolin playing a role. The genome is circular, negative-sense RNA in three parts – Small (S), Medium (M) and Large (L). The L segment is 11–14.4 kilobases in length while the M and S segments are 4.4–6.3 and 1.7–2.1 kilobases long respectively. The L segment encodes the RNA polymerase , the M segment encodes the envelope glycoproteins (Gc and Gn), and the S segment encodes the nucleocapsid protein. The mutation rates for the three parts of the genome were estimated to be: 1.09 × 10 −4 , 1.52 × 10 −4 and 0.58 × 10 −4 substitutions/site/year for the S, M, and L segments respectively. CCHFV is the most genetically diverse of the arboviruses : its nucleotide sequences frequently differ between different strains, ranging from a 20% variability for the viral S segment to 31% for the M segment. Viruses with diverse sequences can be found within the same geographic area; closely related viruses have been isolated from widely separated regions, suggesting that viral dispersion has occurred possibly by ticks carried on migratory birds or through international livestock trade. Reassortment among genome segments during coinfection of ticks or vertebrates seems likely to have played a role in generating diversity in this virus. [ citation needed ] Based on the sequence data, seven genotypes of CCHFV have been recognised: Africa 1 ( Senegal ), Africa 2 ( Democratic Republic of the Congo and South Africa), Africa 3 (southern and western Africa), Europe 1 ( Albania , Bulgaria , Kosovo , Russia and Turkey ), Europe 2 ( Greece ), Asia 1 ( the Middle East , Iran and Pakistan ) and Asia 2 ( China , Kazakhstan , Tajikistan and Uzbekistan ). [ citation needed ] Ticks are both "environmental reservoir" and vector for the virus, carrying it from wild animals to domestic animals and humans. Tick species identified as infected with the virus include Argas reflexus , Hyalomma anatolicum , Hyalomma detritum , Hyalomma marginatum marginatum and Rhipicephalus sanguineus . [ citation needed ] At least 31 different species of ticks from the genera Haemaphysalis and Hyalomma in southeastern Iran have been found to carry the virus. Wild animals and small mammals, particularly European hare , Middle-African hedgehogs and multimammate rats are the "amplifying hosts" of the virus. Birds are generally resistant to CCHF, with the exception of ostriches . Domestic animals like sheep, goats and cattle can develop high titers of virus in their blood, but tend not to fall ill. The "sporadic infection" of humans is usually caused by a Hyalomma tick bite. Animals can transmit the virus to humans, but this would usually be as part of a disease cluster . When clusters of illness occur, it is typically after people treat, butcher or eat infected livestock, particularly ruminants and ostriches . Outbreaks have occurred in abattoirs and other places where workers have been exposed to infected human or animal blood and fomites [ citation needed ] Humans can infect humans and outbreaks also occur in clinical facilities through infected blood and unclean medical instruments. The Crimean–Congo hemorrhagic fever orthonairovirus (CCHFV) is a member of the genus Orthonairovirus , family Nairoviridae of RNA viruses . The virions are 80–120 nanometers (nm) in diameter and are pleomorphic . There are no host ribosomes within the virion. Each virion contains three distinct RNA sequences, which together make up the viral genome. The envelope is single layered and is formed from a lipid bilayer 5 nm thick. It has no external protrusions. The envelope proteins form small projections ~5–10 nm long. The nucleocapsids are filamentous and circular with a length of 200–3000 nm. Viral entry is thought to be clathrin-mediated with the cell surface protein nucleolin playing a role. The genome is circular, negative-sense RNA in three parts – Small (S), Medium (M) and Large (L). The L segment is 11–14.4 kilobases in length while the M and S segments are 4.4–6.3 and 1.7–2.1 kilobases long respectively. The L segment encodes the RNA polymerase , the M segment encodes the envelope glycoproteins (Gc and Gn), and the S segment encodes the nucleocapsid protein. The mutation rates for the three parts of the genome were estimated to be: 1.09 × 10 −4 , 1.52 × 10 −4 and 0.58 × 10 −4 substitutions/site/year for the S, M, and L segments respectively. CCHFV is the most genetically diverse of the arboviruses : its nucleotide sequences frequently differ between different strains, ranging from a 20% variability for the viral S segment to 31% for the M segment. Viruses with diverse sequences can be found within the same geographic area; closely related viruses have been isolated from widely separated regions, suggesting that viral dispersion has occurred possibly by ticks carried on migratory birds or through international livestock trade. Reassortment among genome segments during coinfection of ticks or vertebrates seems likely to have played a role in generating diversity in this virus. [ citation needed ] Based on the sequence data, seven genotypes of CCHFV have been recognised: Africa 1 ( Senegal ), Africa 2 ( Democratic Republic of the Congo and South Africa), Africa 3 (southern and western Africa), Europe 1 ( Albania , Bulgaria , Kosovo , Russia and Turkey ), Europe 2 ( Greece ), Asia 1 ( the Middle East , Iran and Pakistan ) and Asia 2 ( China , Kazakhstan , Tajikistan and Uzbekistan ). [ citation needed ]The genome is circular, negative-sense RNA in three parts – Small (S), Medium (M) and Large (L). The L segment is 11–14.4 kilobases in length while the M and S segments are 4.4–6.3 and 1.7–2.1 kilobases long respectively. The L segment encodes the RNA polymerase , the M segment encodes the envelope glycoproteins (Gc and Gn), and the S segment encodes the nucleocapsid protein. The mutation rates for the three parts of the genome were estimated to be: 1.09 × 10 −4 , 1.52 × 10 −4 and 0.58 × 10 −4 substitutions/site/year for the S, M, and L segments respectively. CCHFV is the most genetically diverse of the arboviruses : its nucleotide sequences frequently differ between different strains, ranging from a 20% variability for the viral S segment to 31% for the M segment. Viruses with diverse sequences can be found within the same geographic area; closely related viruses have been isolated from widely separated regions, suggesting that viral dispersion has occurred possibly by ticks carried on migratory birds or through international livestock trade. Reassortment among genome segments during coinfection of ticks or vertebrates seems likely to have played a role in generating diversity in this virus. [ citation needed ] Based on the sequence data, seven genotypes of CCHFV have been recognised: Africa 1 ( Senegal ), Africa 2 ( Democratic Republic of the Congo and South Africa), Africa 3 (southern and western Africa), Europe 1 ( Albania , Bulgaria , Kosovo , Russia and Turkey ), Europe 2 ( Greece ), Asia 1 ( the Middle East , Iran and Pakistan ) and Asia 2 ( China , Kazakhstan , Tajikistan and Uzbekistan ). [ citation needed ]Ticks are both "environmental reservoir" and vector for the virus, carrying it from wild animals to domestic animals and humans. Tick species identified as infected with the virus include Argas reflexus , Hyalomma anatolicum , Hyalomma detritum , Hyalomma marginatum marginatum and Rhipicephalus sanguineus . [ citation needed ] At least 31 different species of ticks from the genera Haemaphysalis and Hyalomma in southeastern Iran have been found to carry the virus. Wild animals and small mammals, particularly European hare , Middle-African hedgehogs and multimammate rats are the "amplifying hosts" of the virus. Birds are generally resistant to CCHF, with the exception of ostriches . Domestic animals like sheep, goats and cattle can develop high titers of virus in their blood, but tend not to fall ill. The "sporadic infection" of humans is usually caused by a Hyalomma tick bite. Animals can transmit the virus to humans, but this would usually be as part of a disease cluster . When clusters of illness occur, it is typically after people treat, butcher or eat infected livestock, particularly ruminants and ostriches . Outbreaks have occurred in abattoirs and other places where workers have been exposed to infected human or animal blood and fomites [ citation needed ] Humans can infect humans and outbreaks also occur in clinical facilities through infected blood and unclean medical instruments. Where mammalian tick infection is common, agricultural regulations require de-ticking farm animals before transportation or delivery for slaughter. Personal tick avoidance measures are recommended, such as use of insect repellents, adequate clothing, and body inspection for adherent ticks. [ citation needed ] When feverish patients with evidence of bleeding require resuscitation or intensive care , body substance isolation precautions should be taken. [ citation needed ] Since the 1970s, several vaccine trials around the world against CCHF have been terminated due to high toxicity. As of March 2011 [ update ] , the only available and probably somewhat efficacious CCHF vaccine has been an inactivated antigen preparation then used in Bulgaria. No publication in the scientific literature related to this vaccine exists, which a Turkish virologist called suspicious both because antiquated technology and mouse brain were used to manufacture it. More vaccines are under development, but the sporadic nature of the disease, even in endemic countries, suggests that large trials of vaccine efficacy will be difficult to perform. Finding volunteers may prove challenging, given growing anti-vaccination sentiment and resistance of populations to vaccination against contagious diseases. The number of people to be vaccinated, and the length of time they would have to be followed to confirm protection would have to be carefully defined. Alternatively, many scientists appear to believe that treatment of CCHF with ribavirin is more practical than prevention, but some recently conducted clinical trials appear to counter assumptions of drug efficacy. In 2011, a Turkish research team led by Erciyes University successfully developed the first non-toxic preventive vaccine, which passed clinical trials. As of 2012, the vaccine was pending approval by the US FDA. Since the Ebola epidemic, the WHO jumpstarted a "Blueprint for Research and Development preparedness" on emerging pathogens with epidemic potential, against which there are no medical treatments. CCHF was the top priority on the initial list from December 2015, and is second as of January 2017. Since the 1970s, several vaccine trials around the world against CCHF have been terminated due to high toxicity. As of March 2011 [ update ] , the only available and probably somewhat efficacious CCHF vaccine has been an inactivated antigen preparation then used in Bulgaria. No publication in the scientific literature related to this vaccine exists, which a Turkish virologist called suspicious both because antiquated technology and mouse brain were used to manufacture it. More vaccines are under development, but the sporadic nature of the disease, even in endemic countries, suggests that large trials of vaccine efficacy will be difficult to perform. Finding volunteers may prove challenging, given growing anti-vaccination sentiment and resistance of populations to vaccination against contagious diseases. The number of people to be vaccinated, and the length of time they would have to be followed to confirm protection would have to be carefully defined. Alternatively, many scientists appear to believe that treatment of CCHF with ribavirin is more practical than prevention, but some recently conducted clinical trials appear to counter assumptions of drug efficacy. In 2011, a Turkish research team led by Erciyes University successfully developed the first non-toxic preventive vaccine, which passed clinical trials. As of 2012, the vaccine was pending approval by the US FDA. Since the Ebola epidemic, the WHO jumpstarted a "Blueprint for Research and Development preparedness" on emerging pathogens with epidemic potential, against which there are no medical treatments. CCHF was the top priority on the initial list from December 2015, and is second as of January 2017. Treatment is mostly supportive . Ribavirin has shown some efficacy in vitro and has been used by mouth during outbreaks, [ citation needed ] but there is uncertain evidence to support its use, and this medication can cause serious side effects including hemolytic anemia and liver damage. As of 2011 [ update ] the use of Immunoglobulin preparations has remained unproven and antibody engineering, which raised hopes for monoclonal antibody therapy, has remained in its infancy. CCHF occurs most frequently among agricultural workers, following the bite of an infected tick, and to a lesser extent among slaughterhouse workers exposed to the blood and tissues of infected livestock, and medical personnel through contact with the body fluids of infected persons. As of 2013 [ update ] the northern limit of CCHF has been 50 degrees northern latitude, north of which the Hyalomma ticks have not been found. Per a WHO map from 2008, Hyalomma ticks occurred south of this latitude across all of the Eurasian continent and Africa, sparing only the islands of Sri Lanka , Indonesia and Japan . Serological or virological evidence of CCHF was widespread in Asia, Eastern Europe, the Middle East (except Israel, Lebanon and Jordan), central Africa, Western Africa, South Africa and Madagascar. In 2008, more than 50 cases/year were reported from only 4 countries: Turkey, Iran, Russia and Uzbekistan. 5-49 cases/year were present in South Africa, Central Asia including Pakistan and Afghanistan (but sparing Turkmenistan), in the Middle East only the UAE and the Balkan countries limited to Romania, Bulgaria, Serbia, Montenegro and Albania. In Russia, the disease is limited to Southern and North Caucasian Federal Districts , but climate change may cause it to spread into more northerly areas. A 2014 map by the CDC shows endemic areas (in red) largely unchanged in Africa and the Middle East, but different for the Balkan, including all countries of the former Yugoslavia, and also Greece, but no longer Romania. India 's Northwestern regions of Rajasthan and Gujarat saw their first cases. From 1995 to 2013, 228 cases of CCHF were reported in the Republic of Kosovo, with a case-fatality rate of 25.5%. Between 2002–2008 the Ministry of Health of Turkey reported 3,128 CCHF cases, with a 5% death rate. [ citation needed ] In July 2005, authorities reported 41 cases of CCHF in central Turkey's Yozgat Province , with one death. [ clarification needed ] As of August 2008, a total of 50 deaths were reported for the year thus far in various cities in Turkey due to CCHF. [ clarification needed ] In 2003, 38 people were infected with CCHF in Mauritania , including 35 residents of Nouakchott. In September 2010, an outbreak was reported in Pakistan's Khyber Pakhtunkhwa province. Poor diagnosis and record keeping caused the extent of the outbreak to be uncertain, though some reports indicated over 100 cases, with a case-fatality rate above 10%. [ citation needed ] In January 2011, the first human cases of CCHF in India was reported in Sanand , Gujarat, India, with 4 reported deaths, which included the index patient , treating physician and nurse. As of May 2012 [ update ] , 71 people were reported to have contracted the disease in Iran, resulting in 8 fatalities. [ citation needed ] In October 2012, a British man died from the disease at the Royal Free Hospital in London. He had earlier been admitted to Gartnavel General Hospital in Glasgow , after returning on a flight from Kabul in Afghanistan . In July 2013, seven people died of CCHF in the Karyana village of Babra , Gujarat, India. In August 2013, a farmer from Agago , Uganda was treated at Kalongo Hospital for a confirmed CCHF infection. The deaths of three other individuals in the northern region were suspected to have been caused by the virus. Another unrelated CCHF patient was admitted to Mulago Hospital on the same day. The Ministry of Health announced on the 19th that the outbreak was under control, but the second patient, a 27-year-old woman from Nansana , died on the 21st. She is believed to have contracted the virus from her husband, who returned to Kampala after being treated for CCHF in Juba , South Sudan. In June 2014, cases were diagnosed in Kazakhstan. Ten people, including an ambulance crew, were admitted on to hospital in southern Kazakhstan with suspected CCHF. [ citation needed ] In July 2014 an 8th person was found to be infected with CCHF at Hayatabad Medical Complex (HMC), Pakistan. The eight patients, including a nurse and 6 Afghan nationals, died between April and July 2014. As of 2015 [ update ] , sporadic confirmed cases have been reported from Bhuj , Amreli , Sanand , Idar and Vadnagar in Gujarat, India. In November 2014, a doctor and a labourer in north Gujarat tested positive for the disease. In the following weeks, three more people died from CCHF. In March 2015, one more person died of CCHF in Gujarat. As of 2015, among livestock, CCHF was recognized as "widespread" in India, only 4 years after the first human case had been diagnosed. In August 2016, the first local case of CCHF in Western Europe occurred in Western Spain. A 62-year-old man, who had been bitten by a tick in Spain died on August 25, having infected a nurse. The tick bite occurred in the province of Ávila , 300 km away from the province of Cáceres , where CCHF viral RNA from ticks was amplified in 2010. As of July 2017 [ update ] it was unclear what specific ecology led to the Spanish cases. In August 2016, a number of Pakistani news sources raised concerns regarding the disease. Between January and October 2016, CCHF outbreaks in Pakistan were reported with highest numbers of cases and deaths during August 2016, just before the festival of Eid-al-Adha (held on September 13–15 in 2016). It was hypothesized that the festival could play an important part as people could come into contact with domestic or imported animals potentially infected with CCHF virus. The Pakistani NIH showed there was no correlation, and that CCHF cases have coincided with the peak tick proliferation during the preceding 8–10 years. In 2017, the General Directorate of Public Health in Turkey published official records of infections and casualties involving CCHF between 2008 and 2017. Cases declined form 1,318 in 2009 to 343 in 2017 alongside a lowered mortality rate. Cases are concentrated in rural areas of the Southern Black Sea Region , Central Anatolia Region , and Eastern Anatolia Region during early summer months. On February 2, 2020, an outbreak was reported in Mali involving fourteen cases and seven deaths, days before the COVID-19 pandemic in Africa . In May 2020, a single case was reported in Mauritania. In 2022, an outbreak occurred in Iraq . Between 1 January and 22 May, 212 cases of CCHF were reported to the WHO. Of the 212 cases, 115 were suspected and 97 laboratory confirmed. Twenty seven deaths were recorded, of which 13 were in laboratory confirmed cases. In July 2023, there was a single confirmed fatality of tick-borne CCHF in North Macedonia . As of 2013 [ update ] the northern limit of CCHF has been 50 degrees northern latitude, north of which the Hyalomma ticks have not been found. Per a WHO map from 2008, Hyalomma ticks occurred south of this latitude across all of the Eurasian continent and Africa, sparing only the islands of Sri Lanka , Indonesia and Japan . Serological or virological evidence of CCHF was widespread in Asia, Eastern Europe, the Middle East (except Israel, Lebanon and Jordan), central Africa, Western Africa, South Africa and Madagascar. In 2008, more than 50 cases/year were reported from only 4 countries: Turkey, Iran, Russia and Uzbekistan. 5-49 cases/year were present in South Africa, Central Asia including Pakistan and Afghanistan (but sparing Turkmenistan), in the Middle East only the UAE and the Balkan countries limited to Romania, Bulgaria, Serbia, Montenegro and Albania. In Russia, the disease is limited to Southern and North Caucasian Federal Districts , but climate change may cause it to spread into more northerly areas. A 2014 map by the CDC shows endemic areas (in red) largely unchanged in Africa and the Middle East, but different for the Balkan, including all countries of the former Yugoslavia, and also Greece, but no longer Romania. India 's Northwestern regions of Rajasthan and Gujarat saw their first cases. From 1995 to 2013, 228 cases of CCHF were reported in the Republic of Kosovo, with a case-fatality rate of 25.5%. Between 2002–2008 the Ministry of Health of Turkey reported 3,128 CCHF cases, with a 5% death rate. [ citation needed ] In July 2005, authorities reported 41 cases of CCHF in central Turkey's Yozgat Province , with one death. [ clarification needed ] As of August 2008, a total of 50 deaths were reported for the year thus far in various cities in Turkey due to CCHF. [ clarification needed ] In 2003, 38 people were infected with CCHF in Mauritania , including 35 residents of Nouakchott. In September 2010, an outbreak was reported in Pakistan's Khyber Pakhtunkhwa province. Poor diagnosis and record keeping caused the extent of the outbreak to be uncertain, though some reports indicated over 100 cases, with a case-fatality rate above 10%. [ citation needed ] In January 2011, the first human cases of CCHF in India was reported in Sanand , Gujarat, India, with 4 reported deaths, which included the index patient , treating physician and nurse. As of May 2012 [ update ] , 71 people were reported to have contracted the disease in Iran, resulting in 8 fatalities. [ citation needed ] In October 2012, a British man died from the disease at the Royal Free Hospital in London. He had earlier been admitted to Gartnavel General Hospital in Glasgow , after returning on a flight from Kabul in Afghanistan . In July 2013, seven people died of CCHF in the Karyana village of Babra , Gujarat, India. In August 2013, a farmer from Agago , Uganda was treated at Kalongo Hospital for a confirmed CCHF infection. The deaths of three other individuals in the northern region were suspected to have been caused by the virus. Another unrelated CCHF patient was admitted to Mulago Hospital on the same day. The Ministry of Health announced on the 19th that the outbreak was under control, but the second patient, a 27-year-old woman from Nansana , died on the 21st. She is believed to have contracted the virus from her husband, who returned to Kampala after being treated for CCHF in Juba , South Sudan. In June 2014, cases were diagnosed in Kazakhstan. Ten people, including an ambulance crew, were admitted on to hospital in southern Kazakhstan with suspected CCHF. [ citation needed ] In July 2014 an 8th person was found to be infected with CCHF at Hayatabad Medical Complex (HMC), Pakistan. The eight patients, including a nurse and 6 Afghan nationals, died between April and July 2014. As of 2015 [ update ] , sporadic confirmed cases have been reported from Bhuj , Amreli , Sanand , Idar and Vadnagar in Gujarat, India. In November 2014, a doctor and a labourer in north Gujarat tested positive for the disease. In the following weeks, three more people died from CCHF. In March 2015, one more person died of CCHF in Gujarat. As of 2015, among livestock, CCHF was recognized as "widespread" in India, only 4 years after the first human case had been diagnosed. In August 2016, the first local case of CCHF in Western Europe occurred in Western Spain. A 62-year-old man, who had been bitten by a tick in Spain died on August 25, having infected a nurse. The tick bite occurred in the province of Ávila , 300 km away from the province of Cáceres , where CCHF viral RNA from ticks was amplified in 2010. As of July 2017 [ update ] it was unclear what specific ecology led to the Spanish cases. In August 2016, a number of Pakistani news sources raised concerns regarding the disease. Between January and October 2016, CCHF outbreaks in Pakistan were reported with highest numbers of cases and deaths during August 2016, just before the festival of Eid-al-Adha (held on September 13–15 in 2016). It was hypothesized that the festival could play an important part as people could come into contact with domestic or imported animals potentially infected with CCHF virus. The Pakistani NIH showed there was no correlation, and that CCHF cases have coincided with the peak tick proliferation during the preceding 8–10 years. In 2017, the General Directorate of Public Health in Turkey published official records of infections and casualties involving CCHF between 2008 and 2017. Cases declined form 1,318 in 2009 to 343 in 2017 alongside a lowered mortality rate. Cases are concentrated in rural areas of the Southern Black Sea Region , Central Anatolia Region , and Eastern Anatolia Region during early summer months. On February 2, 2020, an outbreak was reported in Mali involving fourteen cases and seven deaths, days before the COVID-19 pandemic in Africa . In May 2020, a single case was reported in Mauritania. In 2022, an outbreak occurred in Iraq . Between 1 January and 22 May, 212 cases of CCHF were reported to the WHO. Of the 212 cases, 115 were suspected and 97 laboratory confirmed. Twenty seven deaths were recorded, of which 13 were in laboratory confirmed cases. In July 2023, there was a single confirmed fatality of tick-borne CCHF in North Macedonia . In ancient Celtic settlements in the Upper Danube area in Germany, the CCHF virus was detected in archaeological blood samples, indicating that it was endemic at the time. The virus may have evolved around 1500–1100 BC. It is thought that changing climate and agricultural practices around this time could be behind its evolution. In the 12th century a case of a hemorrhagic disease reported from what is now Tajikistan may have been the first known case of Crimean–Congo hemorrhagic fever. [ citation needed ] In 1944, roughly 200 Soviet military agricultural workers were infected by Crimean hemorrhagic fever (CHF), leading to experiments showing a tick-borne viral etiology. In February 1967, virologists John P. Woodall , David Simpson, Ghislaine Courtois and others published initial reports on a virus they called the Congo virus. In 1956, the Congo virus had first been isolated by physician Ghislaine Courtois, head of the Provincial Medical Laboratory, Stanleyville , in the Belgian Congo . Strain V3010, isolated by Courtois, was sent to the Rockefeller Foundation Virus Laboratory (RFVL) in New York City and found to be identical to another strain from Uganda , but to no other named virus at that time. [ citation needed ] In June 1967, Soviet virologist Mikhail Chumakov registered an isolate from a fatal case that occurred in Samarkand in the Catalogue of Arthropod-borne Viruses. In 1969, the Russian strain, which Chumakov had sent to the RFVL, was found to be antigenically indistinguishable from the Congo virus. In 1973, the International Committee on Taxonomy of Viruses adopted Crimean–Congo hemorrhagic fever virus as the official name. These reports include records of the occurrence of the virus or antibodies to the virus from Greece, Portugal, South Africa, Madagascar (the first isolation from there), the Maghreb , Dubai , Saudi Arabia , Kuwait and Iraq.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Rat/html

Rat

Rats are various medium-sized, long-tailed rodents . Species of rats are found throughout the order Rodentia, but stereotypical rats are found in the genus Rattus . Other rat genera include Neotoma (pack rats), Bandicota (bandicoot rats) and Dipodomys (kangaroo rats). Rats are typically distinguished from mice by their size. Usually the common name of a large muroid rodent will include the word "rat", while a smaller muroid's name will include "mouse". The common terms rat and mouse are not taxonomically specific. There are 56 known species of rats in the world. The best-known rat species are the black rat ( Rattus rattus ) and the brown rat ( Rattus norvegicus ). This group, generally known as the Old World rats or true rats, originated in Asia . Rats are bigger than most Old World mice , which are their relatives, but seldom weigh over 500 grams ( 17 + 1 ⁄ 2 oz) in the wild. The term rat is also used in the names of other small mammals that are not true rats. Examples include the North American pack rats (aka wood rats ) and a number of species loosely called kangaroo rats . Rats such as the bandicoot rat ( Bandicota bengalensis ) are murine rodents related to true rats but are not members of the genus Rattus . Male rats are called bucks ; unmated females, does , pregnant or parent females, dams ; and infants, kittens or pups . A group of rats is referred to as a mischief . The common species are opportunistic survivors and often live with and near humans ; therefore, they are known as commensals . They may cause substantial food losses, especially in developing countries. However, the widely distributed and problematic commensal species of rats are a minority in this diverse genus. Many species of rats are island endemics , some of which have become endangered due to habitat loss or competition with the brown, black, or Polynesian rat . Wild rodents, including rats, can carry many different zoonotic pathogens, such as Leptospira , Toxoplasma gondii , and Campylobacter . The Black Death is traditionally believed to have been caused by the microorganism Yersinia pestis , carried by the tropical rat flea ( Xenopsylla cheopis ), which preyed on black rats living in European cities during the epidemic outbreaks of the Middle Ages ; these rats were used as transport hosts. Another zoonotic disease linked to the rat is foot-and-mouth disease . Rats become sexually mature at age 6 weeks, but reach social maturity at about 5 to 6 months of age. The average lifespan of rats varies by species, but many only live about a year due to predation. The black and brown rats diverged from other Old World rats in the forests of Asia during the beginning of the Pleistocene . The characteristic long tail of most rodents is a feature that has been extensively studied in various rat species models, which suggest three primary functions of this structure: thermoregulation , minor proprioception , and a nocifensive -mediated degloving response. Rodent tails—particularly in rat models—have been implicated with a thermoregulation function that follows from its anatomical construction. This particular tail morphology is evident across the family Muridae, in contrast to the bushier tails of Sciuridae , the squirrel family. The tail is hairless and thin skinned but highly vascularized, thus allowing for efficient countercurrent heat exchange with the environment. The high muscular and connective tissue densities of the tail, along with ample muscle attachment sites along its plentiful caudal vertebrae , facilitate specific proprioceptive senses to help orient the rodent in a three-dimensional environment. Murids have evolved a unique defense mechanism termed degloving that allows for escape from predation through the loss of the outermost integumentary layer on the tail. However, this mechanism is associated with multiple pathologies that have been the subject of investigation. [ citation needed ] Multiple studies have explored the thermoregulatory capacity of rodent tails by subjecting test organisms to varying levels of physical activity and quantifying heat conduction via the animals' tails. One study demonstrated a significant disparity in heat dissipation from a rat's tail relative to its abdomen. This observation was attributed to the higher proportion of vascularity in the tail, as well as its higher surface-area-to-volume ratio , which directly relates to heat's ability to dissipate via the skin. These findings were confirmed in a separate study analyzing the relationships of heat storage and mechanical efficiency in rodents that exercise in warm environments. In this study, the tail was a focal point in measuring heat accumulation and modulation. [ citation needed ] On the other hand, the tail's ability to function as a proprioceptive sensor and modulator has also been investigated. As aforementioned, the tail demonstrates a high degree of muscularization and subsequent innervation that ostensibly collaborate in orienting the organism. Specifically, this is accomplished by coordinated flexion and extension of tail muscles to produce slight shifts in the organism's center of mass , orientation, etc., which ultimately assists it with achieving a state of proprioceptive balance in its environment. Further mechanobiological investigations of the constituent tendons in the tail of the rat have identified multiple factors that influence how the organism navigates its environment with this structure. A particular example is that of a study in which the morphology of these tendons is explicated in detail. Namely, cell viability tests of tendons of the rat's tail demonstrate a higher proportion of living fibroblasts that produce the collagen for these fibers. As in humans, these tendons contain a high density of golgi tendon organs that help the animal assess stretching of muscle in situ and adjust accordingly by relaying the information to higher cortical areas associated with balance, proprioception, and movement. [ citation needed ] The characteristic tail of murids also displays a unique defense mechanism known as degloving in which the outer layer of the integument can be detached in order to facilitate the animal's escape from a predator. This evolutionary selective pressure has persisted despite a multitude of pathologies that can manifest upon shedding part of the tail and exposing more interior elements to the environment. Paramount among these are bacterial and viral infection, as the high density of vascular tissue within the tail becomes exposed upon avulsion or similar injury to the structure. The degloving response is a nocifensive response, meaning that it occurs when the animal is subjected to acute pain , such as when a predator snatches the organism by the tail. [ citation needed ] Specially bred rats have been kept as pets at least since the late 19th century. Pet rats are typically variants of the species brown rat , but black rats and giant pouched rats are also sometimes kept. Pet rats behave differently from their wild counterparts depending on how many generations they have been kept as pets. Pet rats do not pose any more of a risk of zoonotic diseases than pets such as cats or dogs . Tamed rats are generally friendly and can be taught to perform selected behaviors. Selective breeding has brought about different color and marking varieties in rats. Genetic mutations have also created different fur types, such as rex and hairless. Congenital malformation in selective breeding have created the dumbo rat, a popular pet choice due to their low, saucer-shaped ears. A breeding standard exists for rat fanciers wishing to breed and show their rat at a rat show. In 1895, Clark University in Worcester, Massachusetts , established a population of domestic albino brown rats to study the effects of diet and for other physiological studies. Over the years, rats have been used in many experimental studies, adding to our understanding of genetics , diseases , the effects of drugs , and other topics that have provided a great benefit for the health and wellbeing of humankind. The aortic arches of the rat are among the most commonly studied in murine models due to marked anatomical homology to the human cardiovascular system . Both rat and human aortic arches exhibit subsequent branching of the brachiocephalic trunk , left common carotid artery , and left subclavian artery , as well as geometrically similar, nonplanar curvature in the aortic branches . Aortic arches studied in rats exhibit abnormalities similar to those of humans, including altered pulmonary arteries and double or absent aortic arches. Despite existing anatomical analogy in the inthrathoracic position of the heart itself, the murine model of the heart and its structures remains a valuable tool for studies of human cardiovascular conditions. The rat's larynx has been used in experimentations that involve inhalation toxicity, allograft rejection, and irradiation responses. One experiment described four features of the rat's larynx. The first being the location and attachments of the thyroarytenoid muscle, the alar cricoarytenoid muscle, and the superior cricoarytenoid muscle, the other of the newly named muscle that ran from the arytenoid to a midline tubercle on the cricoid. The newly named muscles were not seen in the human larynx. In addition, the location and configuration of the laryngeal alar cartilage was described. The second feature was that the way the newly named muscles appear to be familiar to those in the human larynx. The third feature was that a clear understanding of how MEPs are distributed in each of the laryngeal muscles was helpful in understanding the effects of botulinum toxin injection. The MEPs in the posterior cricoarytenoid muscle, lateral cricoarytenoid muscle, cricothyroid muscle, and superior cricoarytenoid muscle were focused mostly at the midbelly. In addition, the medial thyroarytenoid muscle were focused at the midbelly while the lateral thyroarytenoid muscle MEPs were focused at the anterior third of the belly. The fourth and final feature that was cleared up was how the MEPs were distributed in the thyroarytenoid muscle. Laboratory rats have also proved valuable in psychological studies of learning and other mental processes (Barnett 2002), as well as to understand group behavior and overcrowding (with the work of John B. Calhoun on behavioral sink ). A 2007 study found rats to possess metacognition , a mental ability previously only documented in humans and some primates . Domestic rats differ from wild rats in many ways. They are calmer and less likely to bite; they can tolerate greater crowding; they breed earlier and produce more offspring; and their brains , livers , kidneys , adrenal glands , and hearts are smaller (Barnett 2002). Brown rats are often used as model organisms for scientific research. Since the publication of the rat genome sequence, and other advances, such as the creation of a rat SNP chip , and the production of knockout rats , the laboratory rat has become a useful genetic tool, although not as popular as mice . When it comes to conducting tests related to intelligence , learning, and drug abuse , rats are a popular choice due to their high intelligence, ingenuity, aggressiveness , and adaptability . Their psychology seems in many ways similar to that of humans. Entirely new breeds or "lines" of brown rats, such as the Wistar rat , have been bred for use in laboratories. Much of the genome of Rattus norvegicus has been sequenced. Early studies found evidence both for and against measurable intelligence using the "g factor" in rats. Part of the difficulty of understanding animal cognition , generally, is determining what to measure. One aspect of intelligence is the ability to learn, which can be measured using a maze like the T-maze . Experiments done in the 1920s showed that some rats performed better than others in maze tests, and if these rats were selectively bred, their offspring also performed better, suggesting that in rats an ability to learn was heritable in some way. Early studies found evidence both for and against measurable intelligence using the "g factor" in rats. Part of the difficulty of understanding animal cognition , generally, is determining what to measure. One aspect of intelligence is the ability to learn, which can be measured using a maze like the T-maze . Experiments done in the 1920s showed that some rats performed better than others in maze tests, and if these rats were selectively bred, their offspring also performed better, suggesting that in rats an ability to learn was heritable in some way. Rat meat is a food that, while taboo in some cultures, is a dietary staple in others. Rats have been used as working animals. Tasks for working rats include the sniffing of gunpowder residue, demining , acting and animal-assisted therapy . Rats have a keen sense of smell and are easy to train. These characteristics have been employed, for example, by the Belgian non-governmental organization APOPO , which trains rats (specifically African giant pouched rats ) to detect landmines and diagnose tuberculosis through smell. Rats have long been considered deadly pests. Once considered a modern myth, the rat flood in India occurs every fifty years, as armies of bamboo rats descend upon rural areas and devour everything in their path. Rats have long been held up as the chief villain in the spread of the Bubonic Plague ; however, recent studies show that rats alone could not account for the rapid spread of the disease through Europe in the Middle Ages . Still, the Centers for Disease Control does list nearly a dozen diseases directly linked to rats. Most urban areas battle rat infestations. A 2015 study by the American Housing Survey (AHS) found that eighteen percent of homes in Philadelphia showed evidence of rodents. Boston , New York City , and Washington, D.C. , also demonstrated significant rodent infestations. Indeed, rats in New York City are famous for their size and prevalence. The urban legend that the rat population in Manhattan equals that of its human population was definitively refuted by Robert Sullivan in his book Rats but illustrates New Yorkers' awareness of the presence, and on occasion boldness and cleverness, of the rodents. New York has specific regulations for eradicating rats; multifamily residences and commercial businesses must use a specially trained and licensed rat catcher . Chicago was declared the "rattiest city" in the US by the pest control company Orkin in 2020, for the sixth consecutive time. It's followed by Los Angeles , New York, Washington, DC, and San Francisco . To help combat the problem, a Chicago animal shelter has placed more than 1000 feral cats (sterilized and vaccinated) outside of homes and businesses since 2012, where they hunt and catch rats while also providing a deterrent simply by their presence. Rats have the ability to swim up sewer pipes into toilets. Rats will infest any area that provides shelter and easy access to sources of food and water, including under sinks, near garbage, and inside walls or cabinets. Rats can serve as zoonotic vectors for certain pathogens and thus spread disease, such as bubonic plague , Lassa fever , leptospirosis , and Hantavirus infection. Researchers studying New York City wastewater have also cited rats as the potential source of "cryptic" SARS-CoV-2 lineages, due to unknown viral RNA fragments in sewage matching mutations previously shown to make SARS-CoV-2 more adept at rodent-based transmission. Rats are also associated with human dermatitis because they are frequently infested with blood feeding rodent mites such as the tropical rat mite ( Ornithonyssus bacoti ) and spiny rat mite ( Laelaps echidnina ), which will opportunistically bite and feed on humans, where the condition is known as rat mite dermatitis . Rats can serve as zoonotic vectors for certain pathogens and thus spread disease, such as bubonic plague , Lassa fever , leptospirosis , and Hantavirus infection. Researchers studying New York City wastewater have also cited rats as the potential source of "cryptic" SARS-CoV-2 lineages, due to unknown viral RNA fragments in sewage matching mutations previously shown to make SARS-CoV-2 more adept at rodent-based transmission. Rats are also associated with human dermatitis because they are frequently infested with blood feeding rodent mites such as the tropical rat mite ( Ornithonyssus bacoti ) and spiny rat mite ( Laelaps echidnina ), which will opportunistically bite and feed on humans, where the condition is known as rat mite dermatitis . When introduced into locations where rats previously did not exist, they can wreak an enormous degree of environmental degradation . Rattus rattus , the black rat , is considered to be one of the world's worst invasive species. Also known as the ship rat , it has been carried worldwide as a stowaway on seagoing vessels for millennia and has usually accompanied men to any new area visited or settled by human beings by sea. Rats first got to countries such as America and Australia by stowing away on ships. The similar species Rattus norvegicus , the brown rat or wharf rat , has also been carried worldwide by ships in recent centuries. The ship or wharf rat has contributed to the extinction of many species of wildlife, including birds, small mammals, reptiles, invertebrates, and plants, especially on islands. True rats are omnivorous , capable of eating a wide range of plant and animal foods, and have a very high birth rate . When introduced to a new area, they quickly reproduce to take advantage of the new food supply. In particular, they prey on the eggs and young of forest birds, which on isolated islands often have no other predators and thus have no fear of predators . Some experts believe that rats are to blame for between forty percent and sixty percent of all seabird and reptile extinctions, with ninety percent of those occurring on islands. Thus man has indirectly caused the extinction of many species by accidentally introducing rats to new areas. Rats are found in nearly all areas of Earth which are inhabited by human beings. The only rat-free continent is Antarctica , which is too cold for rat survival outdoors, and its lack of human habitation does not provide buildings to shelter them from the weather. However, rats have been introduced to many of the islands near Antarctica, and because of their destructive effect on native flora and fauna, efforts to eradicate them are ongoing. In particular, Bird Island (just off rat-infested South Georgia Island ), where breeding seabirds could be badly affected if rats were introduced, is subject to special measures and regularly monitored for rat invasions. As part of island restoration , some islands' rat populations have been eradicated to protect or restore the ecology . Hawadax Island, Alaska was declared rat free after 229 years and Campbell Island, New Zealand after almost 200 years. Breaksea Island in New Zealand was declared rat free in 1988 after an eradication campaign based on a successful trial on the smaller Hawea Island nearby. In January 2015, an international "Rat Team" set sail from the Falkland Islands for the British Overseas Territory of South Georgia and the South Sandwich Islands on board a ship carrying three helicopters and 100 tons of rat poison with the objective of "reclaiming the island for its seabirds". Rats have wiped out more than 90% of the seabirds on South Georgia, and the sponsors hope that once the rats are gone, it will regain its former status as home to the greatest concentration of seabirds in the world. The South Georgia Heritage Trust, which organized the mission describes it as "five times larger than any other rodent eradication attempted worldwide". That would be true if it were not for the rat control program in Alberta (see below). The Canadian province of Alberta is notable for being the largest inhabited area on Earth which is free of true rats due to very aggressive government rat control policies. It has large numbers of native pack rats , also called bushy-tailed wood rats, but they are forest-dwelling vegetarians which are much less destructive than true rats. Alberta was settled relatively late in North American history and only became a province in 1905. Black rats cannot survive in its climate at all, and brown rats must live near people and in their structures to survive the winters. There are numerous predators in Canada's vast natural areas which will eat non-native rats, so it took until 1950 for invading rats to make their way over land from Eastern Canada. Immediately upon their arrival at the eastern border with Saskatchewan , the Alberta government implemented an extremely aggressive rat control program to stop them from advancing further. A systematic detection and eradication system was used throughout a control zone about 600 kilometres (400 mi) long and 30 kilometres (20 mi) wide along the eastern border to eliminate rat infestations before the rats could spread further into the province. Shotguns, bulldozers, high explosives, poison gas, and incendiaries were used to destroy rats. Numerous farm buildings were destroyed in the process. Initially, tons of arsenic trioxide were spread around thousands of farm yards to poison rats, but soon after the program commenced the rodenticide and medical drug warfarin was introduced, which is much safer for people and more effective at killing rats than arsenic. Forceful government control measures, strong public support and enthusiastic citizen participation continue to keep rat infestations to a minimum. The effectiveness has been aided by a similar but newer program in Saskatchewan which prevents rats from even reaching the Alberta border. Alberta still employs an armed rat patrol to control rats along Alberta's borders. About ten single rats are found and killed per year, and occasionally a large localized infestation has to be dug out with heavy machinery, but the number of permanent rat infestations is zero. Ancient Romans did not generally differentiate between rats and mice, instead referring to the former as mus maximus (big mouse) and the latter as mus minimus (little mouse). On the Isle of Man , there is a taboo against the word " rat ". The rat (sometimes referred to as a mouse) is the first of the twelve animals of the Chinese zodiac . People born in this year are expected to possess qualities associated with rats, including creativity, intelligence, honesty, generosity, ambition, a quick temper and wastefulness. People born in a year of the rat are said to get along well with "monkeys" and "dragons", and to get along poorly with "horses". In Indian tradition, rats are seen as the vehicle of Ganesha , and a rat's statue is always found in a temple of Ganesh. In the northwestern Indian city of Deshnoke , the rats at the Karni Mata Temple are held to be destined for reincarnation as Sadhus ( Hindu holy men). The attending priests feed milk and grain to the rats, of which the pilgrims also partake. European associations with the rat are generally negative. For instance, "Rats!" is used as a substitute for various vulgar interjections in the English language. These associations do not draw, per se , from any biological or behavioral trait of the rat, but possibly from the association of rats (and fleas ) with the 14th-century medieval plague called the Black Death . Rats are seen as vicious, unclean, parasitic animals that steal food and spread disease. In 1522, the rats in Autun , France were charged and put on trial for destroying crops. However, some people in European cultures keep rats as pets and conversely find them to be tame, clean, intelligent, and playful. Rats are often used in scientific experiments ; animal rights activists allege the treatment of rats in this context is cruel. The term "lab rat" is used, typically in a self-effacing manner, to describe a person whose job function requires them to spend a majority of their work time engaged in bench-level research (such as postgraduate students in the sciences). Rats are frequently blamed for damaging food supplies and other goods, or spreading disease. Their reputation has carried into common parlance: in the English language , "rat" is often an insult or is generally used to signify an unscrupulous character; it is also used, as a synonym for the term nark , to mean an individual who works as a police informant or who has turned state's evidence . Writer/director Preston Sturges created the humorous alias "Ratskywatsky" for a soldier who seduced, impregnated, and abandoned the heroine of his 1944 film, The Miracle of Morgan's Creek . It is a term ( noun and verb ) in criminal slang for an informant – "to rat on someone" is to betray them by informing the authorities of a crime or misdeed they committed. Describing a person as "rat-like" usually implies he or she is unattractive and suspicious. Among trade unions , the word "rat" is also a term for nonunion employers or breakers of union contracts, and this is why unions use inflatable rats . Depictions of rats in fiction are historically inaccurate and negative. The most common falsehood is the squeaking almost always heard in otherwise realistic portrayals (i.e. non anthropomorphic ). While the recordings may be of actual squeaking rats, the noise is uncommon – they may do so only if distressed, hurt, or annoyed. Normal vocalizations are very high-pitched, well outside the range of human hearing. Rats are also often cast in vicious and aggressive roles when in fact, their shyness helps keep them undiscovered for so long in an infested home. The actual portrayals of rats vary from negative to positive with a majority in the negative and ambiguous. The rat plays a villain in several mouse societies; from Brian Jacques's Redwall and Robin Jarvis's The Deptford Mice , to the roles of Disney's Professor Ratigan and Kate DiCamillo's Roscuro and Botticelli . They have often been used as a mechanism in horror; being the titular evil in stories like The Rats or H.P. Lovecraft's The Rats in the Walls and in films like Willard and Ben . Another terrifying use of rats is as a method of torture , for instance in Room 101 in George Orwell's Nineteen Eighty-Four or The Pit and the Pendulum by Edgar Allan Poe . Selfish helpfulness —those willing to help for a price— has also been attributed to fictional rats. Templeton, from E. B. White's Charlotte's Web , repeatedly reminds the other characters that he is only involved because it means more food for him, and the cellar-rat of John Masefield's The Midnight Folk requires bribery to be of any assistance. By contrast, the rats appearing in the Doctor Dolittle books tend to be highly positive and likeable characters, many of whom tell their remarkable life stories in the Mouse and Rat Club established by the animal-loving doctor. Some fictional works use rats as the main characters. Notable examples include the society created by O'Brien's Mrs. Frisby and the Rats of NIMH , and others include Doctor Rat , and Rizzo the Rat from The Muppets . Pixar 's 2007 animated film Ratatouille is about a rat described by Roger Ebert as "earnest... lovable, determined, [and] gifted" who lives with a Parisian garbage-boy-turned-chef. Mon oncle d'Amérique (" My American Uncle "), a 1980 French film , illustrates Henri Laborit 's theories on evolutionary psychology and human behaviors by using short sequences in the storyline showing lab rat experiments. In Harry Turtledove 's science fiction novel Homeward Bound , humans unintentionally introduce rats to the ecology at the home world of an alien race which previously invaded Earth and introduced some of its own fauna into its environment. A. Bertram Chandler pitted the space-bound protagonist of a long series of novels, Commodore Grimes, against giant, intelligent rats who took over several stellar systems and enslaved their human inhabitants. " The Stainless Steel Rat " is nickname of the (human) protagonist of a series of humorous science fiction novels written by Harry Harrison . Wererats, therianthropic creatures able to take the shape of a rat, have appeared in the fantasy or horror genre since the 1970s. The term is a neologism coined in analogy to werewolf . [ citation needed ] The concept has since become common in role playing games like Dungeons & Dragons and fantasy fiction like the Anita Blake series. One of the oldest and most historic stories about rats is " The Pied Piper of Hamelin ", in which a rat-catcher leads away an infestation with enchanted music. The piper is later refused payment, so he in turn leads away the town's children. This tale, traced to Germany around the late 13th century, has inspired adaptations in film, theatre, literature, and even opera. The subject of much research, some theories have intertwined the tale with events related to the Black Plague , in which black rats played an important role. Fictional works based on the tale that focus heavily on the rat aspect include Pratchett's The Amazing Maurice and his Educated Rodents , and Belgian graphic novel Le Bal du Rat Mort ( The Ball of the Dead Rat ). Furthermore, a linguistic phenomenon when a wh-expression drags with it an entire encompassing phrase to the front of the clause has been named pied-piping after "Pied Piper of Hamlin" (see also pied-piping with inversion ).The rat (sometimes referred to as a mouse) is the first of the twelve animals of the Chinese zodiac . People born in this year are expected to possess qualities associated with rats, including creativity, intelligence, honesty, generosity, ambition, a quick temper and wastefulness. People born in a year of the rat are said to get along well with "monkeys" and "dragons", and to get along poorly with "horses". In Indian tradition, rats are seen as the vehicle of Ganesha , and a rat's statue is always found in a temple of Ganesh. In the northwestern Indian city of Deshnoke , the rats at the Karni Mata Temple are held to be destined for reincarnation as Sadhus ( Hindu holy men). The attending priests feed milk and grain to the rats, of which the pilgrims also partake.European associations with the rat are generally negative. For instance, "Rats!" is used as a substitute for various vulgar interjections in the English language. These associations do not draw, per se , from any biological or behavioral trait of the rat, but possibly from the association of rats (and fleas ) with the 14th-century medieval plague called the Black Death . Rats are seen as vicious, unclean, parasitic animals that steal food and spread disease. In 1522, the rats in Autun , France were charged and put on trial for destroying crops. However, some people in European cultures keep rats as pets and conversely find them to be tame, clean, intelligent, and playful. Rats are often used in scientific experiments ; animal rights activists allege the treatment of rats in this context is cruel. The term "lab rat" is used, typically in a self-effacing manner, to describe a person whose job function requires them to spend a majority of their work time engaged in bench-level research (such as postgraduate students in the sciences). Rats are frequently blamed for damaging food supplies and other goods, or spreading disease. Their reputation has carried into common parlance: in the English language , "rat" is often an insult or is generally used to signify an unscrupulous character; it is also used, as a synonym for the term nark , to mean an individual who works as a police informant or who has turned state's evidence . Writer/director Preston Sturges created the humorous alias "Ratskywatsky" for a soldier who seduced, impregnated, and abandoned the heroine of his 1944 film, The Miracle of Morgan's Creek . It is a term ( noun and verb ) in criminal slang for an informant – "to rat on someone" is to betray them by informing the authorities of a crime or misdeed they committed. Describing a person as "rat-like" usually implies he or she is unattractive and suspicious. Among trade unions , the word "rat" is also a term for nonunion employers or breakers of union contracts, and this is why unions use inflatable rats . Rats are frequently blamed for damaging food supplies and other goods, or spreading disease. Their reputation has carried into common parlance: in the English language , "rat" is often an insult or is generally used to signify an unscrupulous character; it is also used, as a synonym for the term nark , to mean an individual who works as a police informant or who has turned state's evidence . Writer/director Preston Sturges created the humorous alias "Ratskywatsky" for a soldier who seduced, impregnated, and abandoned the heroine of his 1944 film, The Miracle of Morgan's Creek . It is a term ( noun and verb ) in criminal slang for an informant – "to rat on someone" is to betray them by informing the authorities of a crime or misdeed they committed. Describing a person as "rat-like" usually implies he or she is unattractive and suspicious. Among trade unions , the word "rat" is also a term for nonunion employers or breakers of union contracts, and this is why unions use inflatable rats . Depictions of rats in fiction are historically inaccurate and negative. The most common falsehood is the squeaking almost always heard in otherwise realistic portrayals (i.e. non anthropomorphic ). While the recordings may be of actual squeaking rats, the noise is uncommon – they may do so only if distressed, hurt, or annoyed. Normal vocalizations are very high-pitched, well outside the range of human hearing. Rats are also often cast in vicious and aggressive roles when in fact, their shyness helps keep them undiscovered for so long in an infested home. The actual portrayals of rats vary from negative to positive with a majority in the negative and ambiguous. The rat plays a villain in several mouse societies; from Brian Jacques's Redwall and Robin Jarvis's The Deptford Mice , to the roles of Disney's Professor Ratigan and Kate DiCamillo's Roscuro and Botticelli . They have often been used as a mechanism in horror; being the titular evil in stories like The Rats or H.P. Lovecraft's The Rats in the Walls and in films like Willard and Ben . Another terrifying use of rats is as a method of torture , for instance in Room 101 in George Orwell's Nineteen Eighty-Four or The Pit and the Pendulum by Edgar Allan Poe . Selfish helpfulness —those willing to help for a price— has also been attributed to fictional rats. Templeton, from E. B. White's Charlotte's Web , repeatedly reminds the other characters that he is only involved because it means more food for him, and the cellar-rat of John Masefield's The Midnight Folk requires bribery to be of any assistance. By contrast, the rats appearing in the Doctor Dolittle books tend to be highly positive and likeable characters, many of whom tell their remarkable life stories in the Mouse and Rat Club established by the animal-loving doctor. Some fictional works use rats as the main characters. Notable examples include the society created by O'Brien's Mrs. Frisby and the Rats of NIMH , and others include Doctor Rat , and Rizzo the Rat from The Muppets . Pixar 's 2007 animated film Ratatouille is about a rat described by Roger Ebert as "earnest... lovable, determined, [and] gifted" who lives with a Parisian garbage-boy-turned-chef. Mon oncle d'Amérique (" My American Uncle "), a 1980 French film , illustrates Henri Laborit 's theories on evolutionary psychology and human behaviors by using short sequences in the storyline showing lab rat experiments. In Harry Turtledove 's science fiction novel Homeward Bound , humans unintentionally introduce rats to the ecology at the home world of an alien race which previously invaded Earth and introduced some of its own fauna into its environment. A. Bertram Chandler pitted the space-bound protagonist of a long series of novels, Commodore Grimes, against giant, intelligent rats who took over several stellar systems and enslaved their human inhabitants. " The Stainless Steel Rat " is nickname of the (human) protagonist of a series of humorous science fiction novels written by Harry Harrison . Wererats, therianthropic creatures able to take the shape of a rat, have appeared in the fantasy or horror genre since the 1970s. The term is a neologism coined in analogy to werewolf . [ citation needed ] The concept has since become common in role playing games like Dungeons & Dragons and fantasy fiction like the Anita Blake series. One of the oldest and most historic stories about rats is " The Pied Piper of Hamelin ", in which a rat-catcher leads away an infestation with enchanted music. The piper is later refused payment, so he in turn leads away the town's children. This tale, traced to Germany around the late 13th century, has inspired adaptations in film, theatre, literature, and even opera. The subject of much research, some theories have intertwined the tale with events related to the Black Plague , in which black rats played an important role. Fictional works based on the tale that focus heavily on the rat aspect include Pratchett's The Amazing Maurice and his Educated Rodents , and Belgian graphic novel Le Bal du Rat Mort ( The Ball of the Dead Rat ). Furthermore, a linguistic phenomenon when a wh-expression drags with it an entire encompassing phrase to the front of the clause has been named pied-piping after "Pied Piper of Hamlin" (see also pied-piping with inversion ).One of the oldest and most historic stories about rats is " The Pied Piper of Hamelin ", in which a rat-catcher leads away an infestation with enchanted music. The piper is later refused payment, so he in turn leads away the town's children. This tale, traced to Germany around the late 13th century, has inspired adaptations in film, theatre, literature, and even opera. The subject of much research, some theories have intertwined the tale with events related to the Black Plague , in which black rats played an important role. Fictional works based on the tale that focus heavily on the rat aspect include Pratchett's The Amazing Maurice and his Educated Rodents , and Belgian graphic novel Le Bal du Rat Mort ( The Ball of the Dead Rat ). Furthermore, a linguistic phenomenon when a wh-expression drags with it an entire encompassing phrase to the front of the clause has been named pied-piping after "Pied Piper of Hamlin" (see also pied-piping with inversion ).

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Coppetts_Wood_Hospital/html

Coppetts Wood Hospital

Coppetts Wood Hospital was an infectious diseases isolation hospital in Muswell Hill , North London. It was used to treat, amongst other things, patients suffering from Tuberculosis and Lassa fever .The hospital had its origins as an isolation hospital for residents in the Hornsey area, built by the Hornsey Local Board of Health ( Municipal Borough of Hornsey ). It was located close to Coppetts Wood in Muswell Hill, between 1887 and 1888. It was extended in 1893-1894 and again in 1906. By 1913 it had 25 beds. In 1922 it expanded its intake to take patients from the Finchley and Wood Green . By 1927 it had 130 beds. It joined the National Health Service in 1948. It reached its peak capacity in 1954 with 144 beds. In 1968 the infectious diseases department of the Royal Free Hospital transferred to the hospital. However, in 2000 most of the hospitals services transferred back to the Royal Free Hospital and Coppetts Wood Hospital remained only as a small infectious diseases ward which finally closed, and with it the hospital itself, in 2008. In 2000, an aid worker was hopitalised there with Lassa Fever and died, and in 2003, a British Soldier was hospitalised there suffering from Lassa Fever.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Kyasanur_Forest_disease/html

Kyasanur Forest disease

Kyasanur forest disease ( KFD ) is a tick-borne viral haemorrhagic fever endemic to South-western part of India. The disease is caused by a virus belonging to the family Flaviviridae . KFDV is transmitted to humans through the bite of infected hard ticks ( Haemaphysalis spinigera ) which act as a reservoir of KFDV.The symptoms of the disease include a high fever with frontal headaches, chills, severe muscle pain, vomiting, and other gastrointestinal symptoms. Bleeding problems may occur 3–4 days after initial symptom onset. Patients may experience abnormally low blood pressure, and low platelet, red blood cell, and white blood cell count. After 1–2 weeks of symptoms, some patients recover without complication. However, the illness is biphasic for a subset of patients (10-20%) who experience a second wave of symptoms at the beginning of the third week. These symptoms include fever and signs of neurological manifestations, such as severe headache, mental disturbances, tremors, and vision deficits. The convalescent period is typically very long, lasting several months. Muscle aches and weakness also occur during this period, and the patient is unable to engage in physical activities.Kyasanur Forest virus The KFD virus is a typical flavivirus measuring about 40-60 nm in diameter. The genome of KFDV consists of 10,774 nucleotides of single-stranded, positive-sense RNA encoding a single polyprotein that is cleaved post-translationally into three structural (C, prM/M and E) and seven non-structural (NS1, NS2a, NS2b, NS3, NS4a, NS4b and NS5) proteins. The genome of KFDV is very similar (>92% homologous) to that of Alkhurma Hemorrhagic Fever Virus which is primarily found in Saudi Arabia . These two species both belong to the family Flaviviridae and diverged over 700 years ago and have thus remained geographically separated. A variety of animals are thought to be reservoir hosts for the disease, including porcupines, rats, squirrels, mice, and shrews. Monkeys are the main amplifying hosts for KFD virus and they are also affected by the virus. The surili Presbytis entellus and the bonnet macaque are very susceptible to the KFD virus. They develop tremendous viremia and infect the ticks. The vector for disease transmission is Haemaphysalis spinigera , a forest tick . Humans contract infection from the bite of nymphs of the tick. Man is a terminal host and there no human-to-human transmission because the human domestic environment does not sustain the ticks.Kyasanur Forest virus The KFD virus is a typical flavivirus measuring about 40-60 nm in diameter. The genome of KFDV consists of 10,774 nucleotides of single-stranded, positive-sense RNA encoding a single polyprotein that is cleaved post-translationally into three structural (C, prM/M and E) and seven non-structural (NS1, NS2a, NS2b, NS3, NS4a, NS4b and NS5) proteins. The genome of KFDV is very similar (>92% homologous) to that of Alkhurma Hemorrhagic Fever Virus which is primarily found in Saudi Arabia . These two species both belong to the family Flaviviridae and diverged over 700 years ago and have thus remained geographically separated. A variety of animals are thought to be reservoir hosts for the disease, including porcupines, rats, squirrels, mice, and shrews. Monkeys are the main amplifying hosts for KFD virus and they are also affected by the virus. The surili Presbytis entellus and the bonnet macaque are very susceptible to the KFD virus. They develop tremendous viremia and infect the ticks. The vector for disease transmission is Haemaphysalis spinigera , a forest tick . Humans contract infection from the bite of nymphs of the tick. Man is a terminal host and there no human-to-human transmission because the human domestic environment does not sustain the ticks.The pathogenesis of KFDV is not completely understood . Research using mice models found that KFDV primarily replicated in the brain. Other research has expanded on this by described neurological changes that occurred within infected organisms. This experiment was completed by using KFDV-infected mice and discovered that KFDV caused gliosis , inflammation, and cell death in the brain. They posited that KFDV could be primarily a neuropathic disease and other symptoms are due to this pathogenesis. In earlier days suspected case were confirmed in a laboratory by serum inoculation into suckling mice (Swiss Albino mice) and subsequent death of mice was leveled as KFD Positive case. Other methods of diagnosis included hemagglutination inhibition (HI), complement fixation , neutralization tests . However, new research has introduced more efficient molecular based methods to diagnose KFDV. These methods include: RT-PCR, nested RT-PCR , TaqMan-based real-time RT-PCR , Immunoglobin M antibodies and Immunoglobin G detection by ELISA . The two methods involving RT- PCR are able to function by attaching a primer to the NS-5 gene, which is highly conserved among the genus to which KFDV belongs. PCR positivity is limited to 8–10 days from the onset of symptoms. The ELISA based methods allows for the detections of anti-KFDV antibodies in patients typically from 5th day of onset of symptoms up to 3 months. Prevention is by vaccination, as well as preventive measures such as protective clothing and tick population control. The vaccine for KFDV consists of formalin -inactivated KFDV. The vaccine has a 62.4% effectiveness rate for individuals who receive two doses. For individuals who receive an additional dose, the effectiveness increases to 82.9%. Specific antiviral treatments are not available as of 2022. The spill-over of Kyasanur forest disease happens at the crossroads of the animal-human interaction, especially villages adjoining forest areas and inter-state borders. People who frequently visit the forest areas of the Western Ghats region such as forest guards and officials, range forest officer (RFO), forest watchers, shepherds, firewood collectors, dry leaf collectors, hunters, people who handle dead animal carcasses, travelers who camp in the forest areas, tribal communities living inside the forest areas (Jenu kurubas and Betta kurubas), cashew nut workers especially those who engage in cleaning the dry leaves before the harvest season (seen in Pali and Mauxi outbreaks, North Goa), and areca nut farm workers working in infected tick areas will have a high risk of acquiring KFD infection. People who live in the KFD endemic areas and refuse to take KFD vaccination are at risk in contracting the infection.The disease was first reported from Kattinakere village forest which is in the Kyasanur forest range of Karnataka in India in March 1957. When the officials visited the Kattinakere forest and discovered the diseases they noticed a sign board informing that this was the Kyasanur forest range. Hence the name. The disease first manifested as an epizootic outbreak among monkeys, killing several of them in the year 1957. Hence the disease is also locally known as "monkey disease" or "monkey fever". The similarity with Russian spring-summer encephalitis was noted by the British neurovirologist Hubert Webb and the possibility of migratory birds carrying the disease was raised. Studies began to look for the possible species that acted as reservoirs for the virus and the agents responsible for transmission. Subsequent studies failed to find any involvement of migratory birds, although the possibility of their role in initial establishment was not ruled out. The virus was found to be quite distinctive and not closely related to the Russian virus strains. Antigenic relatedness is, however, close to many other strains including the Omsk hemorrhagic fever (OHF) and birds from Siberia have been found to show an antigenic response to KFD virus. Sequence based studies note the distinctiveness of OHF. Early studies in India were conducted in collaboration with the US Army Medical Research Unit and this led to controversy and conspiracy theories. Subsequent studies based on sequencing found that the Alkhurma virus found in Saudi Arabia is closely related. In 1989 a patient in Nanjianin, China was found with fever symptoms and in 2009 its viral gene sequence was found to exactly match with that of the KFD reference virus of 1957. This has been questioned, though, since the Indian virus shows variations in sequence over time and the exact match with the virus sequence of 1957 and the Chinese virus of 1989 is not expected. This study also found using immune response tests that birds and humans in the region appeared to have been exposed to the virus. Another study has suggested that the virus is recent in origin dating the nearest common ancestor of it and related viruses to around 1942, based on the estimated rate of sequence substitutions. The study also raises the possibility of bird involvement in long-distance transfer. It appears that these viruses diverged 700 years ago. A recent outbreak in 2020, claimed two lives in Siddapura , Karnataka. The peak season for this disease in Malnad is from March till May but has been observed to peak earlier in the year as well. There were a total of 55 reported cases in Shivamogga district, Karntaka. The disease initially reported from Shimoga district of Karnataka which is a primitive sylvan territory in Western Ghats of India. The disease spread out to other districts of Karnataka involving districts of Chikkamagalore, Uttara Kannada, Dakshina Kannada, Udupi, Chamarajanagar (2012), Belagavi (2016). In 2013, KFDV was detected in monkey autopsies from Nilgiris district of Tamil Nadu state. Monkey deaths and human cases have now been reported from three neighbouring states bordering Karnataka, i.e., Wayanad (2013) and Malappuram districts of Kerala (2014), North Goa district of Goa state (2015), and Sindhudurg district of Maharashtra (2016). There are reported serological evidence for KFD detected in humans in other parts of India, namely Kutch and Saurashtra regions of Gujarat state, Kingaon and Parbatpur of West Bengal state. A seroprevalence study in Andaman and Nicobar islands in 2002 revealed a high prevalence of hemagglutination inhibition (HI) antibodies against KFDV. The disease has a fatality rate of 3-10%, and it affects 400-500 people annually. The disease was first noted at Kyasanur village near Sagar in Shivamogga district of Karnataka. The virus has been detected in monkeys in parts of Bandipur National Park (Chamarajnagar) and parts of the Nilgiris. Human infection occurred in Bandipur through handling of dead monkeys that were infected. A human carrier was also detected in Wayanad (Kerala). The disease has shown its presence in the adjacent states of Karnataka including Kerala, Maharashtra, Goa, Tamil Nadu and Gujarat.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/The_Americans_season_5/html

The Americans season 5

The fifth season of the American television drama series The Americans , comprising 13 episodes, aired on FX from March 7 to May 30, 2017. The show moved to Tuesdays, having aired on Wednesdays for its first four seasons. The events of the fifth season take place between February 1984 and August 1984, shown by the reference to the TV broadcasts of the 1984 Winter Olympics in episode 1 and the coverage of Ronald Reagan's " We begin bombing in five minutes " joke in episode 13. In May 2016, FX renewed the series for a 13-episode fifth season to air in 2017; and a sixth and final 10-episode season to air in 2018. The season began principal photography on October 11, 2016; filming was completed on March 13, 2017. The fifth season has received widespread critical acclaim. On Rotten Tomatoes , it received a 95% approval rating with an average score of 9.09 out of 10 based on 37 reviews, with a critics consensus of: "In its penultimate season, The Americans brings long-simmering storylines to a boil while heightening the spy-thriller stakes and deepening the domestic drama—all brought vividly to life by superb performances from its veteran cast." On Metacritic , the season has a score of 94 out of 100 based on 19 reviews, indicating "universal acclaim". Matthew Gilbert of The Boston Globe gave it a highly positive review and wrote, "The drama remains as tense as ever, with strong, careful writing and an abundance of fine performances". Tim Goodman of The Hollywood Reporter also lauded the series, "It's extremely well-constructed, with slow-burning storylines that are paying off in superb dramatic depth" and praised its "top-tier acting" and "artfully crafted visuals". In regards to the premiere, some criticisms came from Emily VanDerWerff of Vox who noted that the symbolism of "spending a long time digging a hole so deep that you probably can't escape it—while knowing you'll lose friends along the way—is a little on-the-nose", while Mike Hale of The New York Times was not very excited with the first episode's "grainy montage set to martial music that began with images of collectivist agricultural might before seguing to blighted fields and long lines outside stores." Libby Nelson of Vox thought that "the agriculture plot was the weakest link" in the second episode. The fifth season was criticized for becoming too slow, turning the show from "slow burn" into just "warm embers". According to Fields and Weisberg, they wanted the fifth season "to feel different as it unspooled", harvesting the story pieces created in the fourth season. The fifth season was not meant as a set-up for the sixth season. With pacing of the fifth season slowed down intentionally, Weisberg and Fields admitted that they did not expect "this much of a backlash" for "hitting the brakes too hard". They were upset by criticism, but suggested waiting until the series is over, hoping for the response to become more muted in context of the sixth and final season. For the 33rd TCA Awards , The Americans received a nomination for Outstanding Achievement in Drama. For the 69th Primetime Emmy Awards , the series received four nominations– Matthew Rhys for Outstanding Lead Actor in a Drama Series, Keri Russell for Outstanding Lead Actress in a Drama Series, Alison Wright for Outstanding Guest Actress in a Drama Series, and Joel Fields and Joe Weisberg for Outstanding Writing for a Drama Series for "The Soviet Division". The fifth season has received widespread critical acclaim. On Rotten Tomatoes , it received a 95% approval rating with an average score of 9.09 out of 10 based on 37 reviews, with a critics consensus of: "In its penultimate season, The Americans brings long-simmering storylines to a boil while heightening the spy-thriller stakes and deepening the domestic drama—all brought vividly to life by superb performances from its veteran cast." On Metacritic , the season has a score of 94 out of 100 based on 19 reviews, indicating "universal acclaim". Matthew Gilbert of The Boston Globe gave it a highly positive review and wrote, "The drama remains as tense as ever, with strong, careful writing and an abundance of fine performances". Tim Goodman of The Hollywood Reporter also lauded the series, "It's extremely well-constructed, with slow-burning storylines that are paying off in superb dramatic depth" and praised its "top-tier acting" and "artfully crafted visuals". In regards to the premiere, some criticisms came from Emily VanDerWerff of Vox who noted that the symbolism of "spending a long time digging a hole so deep that you probably can't escape it—while knowing you'll lose friends along the way—is a little on-the-nose", while Mike Hale of The New York Times was not very excited with the first episode's "grainy montage set to martial music that began with images of collectivist agricultural might before seguing to blighted fields and long lines outside stores." Libby Nelson of Vox thought that "the agriculture plot was the weakest link" in the second episode. The fifth season was criticized for becoming too slow, turning the show from "slow burn" into just "warm embers". According to Fields and Weisberg, they wanted the fifth season "to feel different as it unspooled", harvesting the story pieces created in the fourth season. The fifth season was not meant as a set-up for the sixth season. With pacing of the fifth season slowed down intentionally, Weisberg and Fields admitted that they did not expect "this much of a backlash" for "hitting the brakes too hard". They were upset by criticism, but suggested waiting until the series is over, hoping for the response to become more muted in context of the sixth and final season. For the 33rd TCA Awards , The Americans received a nomination for Outstanding Achievement in Drama. For the 69th Primetime Emmy Awards , the series received four nominations– Matthew Rhys for Outstanding Lead Actor in a Drama Series, Keri Russell for Outstanding Lead Actress in a Drama Series, Alison Wright for Outstanding Guest Actress in a Drama Series, and Joel Fields and Joe Weisberg for Outstanding Writing for a Drama Series for "The Soviet Division".

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Mosquito-borne_disease/html

Mosquito-borne disease

Mosquito-borne diseases or mosquito-borne illnesses are diseases caused by bacteria, viruses or parasites transmitted by mosquitoes . Nearly 700 million people get a mosquito-borne illness each year, resulting in over 725,000 deaths. Diseases transmitted by mosquitoes include malaria , dengue , West Nile virus , chikungunya , yellow fever , filariasis , tularemia , dirofilariasis , Japanese encephalitis , Saint Louis encephalitis , Western equine encephalitis , Eastern equine encephalitis , Venezuelan equine encephalitis , Ross River fever , Barmah Forest fever , La Crosse encephalitis , and Zika fever , as well as newly detected Keystone virus and Rift Valley fever . In January 2024, an Australian research group proved that Mycobacterium ulcerans , the causative pathogen of Buruli ulcer is transmitted by mosquitos. This is the first described mosquito-borne transmission of a bacterial disease. There is no evidence as of April 2020 that COVID-19 can be transmitted by mosquitoes, and it is extremely unlikely this could occur. The female mosquito of the genus Anopheles may carry the malaria parasite . Four different species of protozoa cause malaria: Plasmodium falciparum , Plasmodium malariae , Plasmodium ovale and Plasmodium vivax (see Plasmodium ). Worldwide, malaria is a leading cause of premature mortality, particularly in children under the age of five, with an estimated 207 million cases and more than half a million deaths in 2012, according to the World Malaria Report 2013 published by the World Health Organization (WHO). The death toll increased to one million as of 2018 according to the American Mosquito Control Association. In January 2024, a publication by an Australian research group demonstrated significant genetic similarity between Mycobacterium ulcerans in humans and possums, compared to PCR screening of M. ulcerans from trapped Aedes notoscriptus mosquitoes, and concluded that Mycobacterium ulcerans , the causative pathogen of Buruli ulcer , is transmitted by mosquitos. Botflies are known to parasitize humans or other mammalians, causing myiasis , and to use mosquitoes as intermediate vector agents to deposit eggs on a host. The human botfly Dermatobia hominis attaches its eggs to the underside of a mosquito, and when the mosquito takes a blood meal from a human or an animal, the body heat of the mammalian host induces hatching of the larvae. [ citation needed ] Some species of mosquito can carry the filariasis worm, a parasite that causes a disfiguring condition (often referred to as elephantiasis ) characterized by a great swelling of several parts of the body; worldwide, around 40 million people are living with a filariasis disability. [ citation needed ] The viral diseases yellow fever , dengue fever , Zika fever and chikungunya are transmitted mostly by Aedes aegypti mosquitoes. [ citation needed ] Other viral diseases like epidemic polyarthritis , Rift Valley fever , Ross River fever , St. Louis encephalitis , West Nile fever , Japanese encephalitis , La Crosse encephalitis and several other encephalitic diseases are carried by several different mosquitoes. Eastern equine encephalitis (EEE) and Western equine encephalitis (WEE) occur in the United States where they cause disease in humans, horses, and some bird species. Because of the high mortality rate, EEE and WEE are regarded as two of the most serious mosquito-borne diseases in the United States. Symptoms range from mild flu-like illness to encephalitis, coma, and death. Viruses carried by arthropods such as mosquitoes or ticks are known collectively as arboviruses . West Nile virus was accidentally introduced into the US in 1999 and by 2003 had spread to almost every state with over 3,000 cases in 2006. Other species of Aedes as well as Culex and Culiseta are also involved in the transmission of disease. [ citation needed ] Myxomatosis is spread by biting insects, including mosquitoes. The female mosquito of the genus Anopheles may carry the malaria parasite . Four different species of protozoa cause malaria: Plasmodium falciparum , Plasmodium malariae , Plasmodium ovale and Plasmodium vivax (see Plasmodium ). Worldwide, malaria is a leading cause of premature mortality, particularly in children under the age of five, with an estimated 207 million cases and more than half a million deaths in 2012, according to the World Malaria Report 2013 published by the World Health Organization (WHO). The death toll increased to one million as of 2018 according to the American Mosquito Control Association. In January 2024, a publication by an Australian research group demonstrated significant genetic similarity between Mycobacterium ulcerans in humans and possums, compared to PCR screening of M. ulcerans from trapped Aedes notoscriptus mosquitoes, and concluded that Mycobacterium ulcerans , the causative pathogen of Buruli ulcer , is transmitted by mosquitos. Botflies are known to parasitize humans or other mammalians, causing myiasis , and to use mosquitoes as intermediate vector agents to deposit eggs on a host. The human botfly Dermatobia hominis attaches its eggs to the underside of a mosquito, and when the mosquito takes a blood meal from a human or an animal, the body heat of the mammalian host induces hatching of the larvae. [ citation needed ]Some species of mosquito can carry the filariasis worm, a parasite that causes a disfiguring condition (often referred to as elephantiasis ) characterized by a great swelling of several parts of the body; worldwide, around 40 million people are living with a filariasis disability. [ citation needed ]The viral diseases yellow fever , dengue fever , Zika fever and chikungunya are transmitted mostly by Aedes aegypti mosquitoes. [ citation needed ] Other viral diseases like epidemic polyarthritis , Rift Valley fever , Ross River fever , St. Louis encephalitis , West Nile fever , Japanese encephalitis , La Crosse encephalitis and several other encephalitic diseases are carried by several different mosquitoes. Eastern equine encephalitis (EEE) and Western equine encephalitis (WEE) occur in the United States where they cause disease in humans, horses, and some bird species. Because of the high mortality rate, EEE and WEE are regarded as two of the most serious mosquito-borne diseases in the United States. Symptoms range from mild flu-like illness to encephalitis, coma, and death. Viruses carried by arthropods such as mosquitoes or ticks are known collectively as arboviruses . West Nile virus was accidentally introduced into the US in 1999 and by 2003 had spread to almost every state with over 3,000 cases in 2006. Other species of Aedes as well as Culex and Culiseta are also involved in the transmission of disease. [ citation needed ] Myxomatosis is spread by biting insects, including mosquitoes. A mosquito's period of feeding is often undetected; the bite only becomes apparent because of the immune reaction it provokes. When a mosquito bites a human, it injects saliva and anti-coagulants . With the initial bite to an individual, there is no reaction, but with subsequent bites, the body's immune system develops antibodies . The bites become inflamed and itchy within 24 hours. This is the usual reaction in young children. With more bites, the sensitivity of the human immune system increases, and an itchy red hive appears in minutes where the immune response has broken capillary blood vessels and fluid has collected under the skin. This type of reaction is common in older children and adults. Some adults can become desensitized to mosquitoes and have little or no reaction to their bites, while others can become hyper-sensitive with bites causing blistering, bruising, and large inflammatory reactions, a response known as skeeter syndrome . One study found Dengue virus and Zika virus altered the skin bacteria of rats in a way that caused their body odor to be more attractive to mosquitoes. Symptoms of illness are specific to the type of viral infection and vary in severity, based on the individuals infected. Symptoms vary in severity, from mild unnoticeable symptoms to more common symptoms like fever, rash, headache, achy muscle and joints, and conjunctivitis. Symptoms can last several days to weeks, but death resulting from this infection is rare. Most people infected with the West Nile virus usually do not develop symptoms. However, some individuals can develop cases of severe fatigue, weakness, headaches, body aches, joint and muscle pain, vomiting, diarrhea, and rash, which can last for weeks or months. More serious symptoms have a greater risk of appearing in people over 60 years of age, or those with cancer, diabetes, hypertension, and kidney disease. Dengue fever is mostly characterized by high fever, headaches, joint pain, and rash. However, more severe instances can lead to hemorrhagic fever, internal bleeding, and breathing difficulty, which can be fatal. People infected with this virus can develop sudden onset fever along with debilitating joint and muscle pain, rash, headache, nausea, and fatigue. Symptoms can last a few days or be prolonged to weeks and months. Although patients can recover completely, there have been cases in which joint pain has persisted for several months and can extend beyond that for years. Other people can develop heart complications, eye problems, and even neurological complications. Symptoms vary in severity, from mild unnoticeable symptoms to more common symptoms like fever, rash, headache, achy muscle and joints, and conjunctivitis. Symptoms can last several days to weeks, but death resulting from this infection is rare. Most people infected with the West Nile virus usually do not develop symptoms. However, some individuals can develop cases of severe fatigue, weakness, headaches, body aches, joint and muscle pain, vomiting, diarrhea, and rash, which can last for weeks or months. More serious symptoms have a greater risk of appearing in people over 60 years of age, or those with cancer, diabetes, hypertension, and kidney disease. Dengue fever is mostly characterized by high fever, headaches, joint pain, and rash. However, more severe instances can lead to hemorrhagic fever, internal bleeding, and breathing difficulty, which can be fatal. People infected with this virus can develop sudden onset fever along with debilitating joint and muscle pain, rash, headache, nausea, and fatigue. Symptoms can last a few days or be prolonged to weeks and months. Although patients can recover completely, there have been cases in which joint pain has persisted for several months and can extend beyond that for years. Other people can develop heart complications, eye problems, and even neurological complications. Mosquitoes carrying such arboviruses stay healthy because their immune systems recognizes the virions as foreign particles and "chop off" the virus' genetic coding, rendering it inert. Human infection with a mosquito-borne virus occurs when a female mosquito bites someone while its immune system is still in the process of destroying the virus's harmful coding. [ clarification needed ] It is not completely known how mosquitoes handle eukaryotic parasites to carry them without being harmed. Data has shown that the malaria parasite Plasmodium falciparum alters the mosquito vector's feeding behavior by increasing frequency of biting in infected mosquitoes, thus increasing the chance of transmitting the parasite. The mechanism of transmission of this disease starts with the injection of the parasite into the victim's blood when malaria-infected female Anopheles mosquitoes bite into a human being. The parasite uses human liver cells as hosts for maturation where it will continue to replicate and grow, moving into other areas of the body via the bloodstream. The spread of this infection cycle then continues when other mosquitoes bite the same individual. The result will cause that mosquito to ingest the parasite and allow it to transmit the Malaria disease into another person through the same mode of bite injection. Flaviviridae viruses transmissible via vectors like mosquitoes include West Nile virus and yellow fever virus, which are single stranded, positive-sense RNA viruses enveloped in a protein coat. Once inside the host's body, the virus will attach itself to a cell's surface through receptor-mediated endocytosis. This essentially means that the proteins and DNA material of the virus are ingested into the host cell. The viral RNA material will undergo several changes and processes inside the host's cell so that it can release more viral RNA that can then be replicated and assembled to infect neighboring host cells. Mosquito-borne flaviviruses also encode viral antagonists to the innate immune system in order to cause persistent infection in mosquitoes and a broad spectrum of diseases in humans. The data on transmissibility via insect vectors of hepatitis C virus, also belonging to family Flaviviridae (as well as for hepatitis B virus, belonging to family Hepadnaviridae ) are inconclusive. WHO states that "There is no insect vector or animal reservoir for HCV", while there are experimental data supporting at least the presence of [PCR]-detectable hepatitis C viral RNA in Culex mosquitoes for up to 13 days. Currently, there are no specific vaccine therapies for West Nile virus approved for humans; however, vaccines are available and some show promise for animals, as a means to intervene with the mechanism of spreading such pathogens. Doctors can typically identify a mosquito bite by sight. A doctor will perform a physical examination and ask about medical history as well as any travel history. Be ready to give details on any international trips, including the dates you were traveling, the countries you visited and any contact you had with mosquitoes. Diagnosing dengue fever can be difficult, as its symptoms often overlap with many other diseases such as malaria and typhoid fever . Laboratory tests can detect evidence of the dengue viruses, however the results often come back too late to assist in directing treatment. Medical testing can confirm the presence of West Nile fever or a West Nile-related illness, such as meningitis or encephalitis. If infected, a blood test may show a rising level of antibodies to the West Nile virus. A lumbar puncture (spinal tap) is the most common way to diagnose meningitis, by analyzing the cerebrospinal fluid surrounding your brain and spinal cord. The fluid sample may show an elevated white cell count and antibodies to the West Nile virus if you were exposed. In some cases, an electroencephalography (EEG) or magnetic resonance imaging (MRI) scan can help detect brain inflammation. A Zika virus infection might be suspected if symptoms are present and an individual has traveled to an area with known Zika virus transmission. Zika virus can only be confirmed by a laboratory test of body fluids, such as urine or saliva, or by blood test. Laboratory blood tests can identify evidence of chikungunya or other similar viruses such as dengue and Zika. Blood test may confirm the presence of IgM and IgG anti-chikungunya antibodies. IgM antibodies are highest 3 to 5 weeks after the beginning of symptoms and will continue be present for about 2 months. Diagnosing dengue fever can be difficult, as its symptoms often overlap with many other diseases such as malaria and typhoid fever . Laboratory tests can detect evidence of the dengue viruses, however the results often come back too late to assist in directing treatment. Medical testing can confirm the presence of West Nile fever or a West Nile-related illness, such as meningitis or encephalitis. If infected, a blood test may show a rising level of antibodies to the West Nile virus. A lumbar puncture (spinal tap) is the most common way to diagnose meningitis, by analyzing the cerebrospinal fluid surrounding your brain and spinal cord. The fluid sample may show an elevated white cell count and antibodies to the West Nile virus if you were exposed. In some cases, an electroencephalography (EEG) or magnetic resonance imaging (MRI) scan can help detect brain inflammation. A Zika virus infection might be suspected if symptoms are present and an individual has traveled to an area with known Zika virus transmission. Zika virus can only be confirmed by a laboratory test of body fluids, such as urine or saliva, or by blood test. Laboratory blood tests can identify evidence of chikungunya or other similar viruses such as dengue and Zika. Blood test may confirm the presence of IgM and IgG anti-chikungunya antibodies. IgM antibodies are highest 3 to 5 weeks after the beginning of symptoms and will continue be present for about 2 months. There is a re-emergence of mosquito vectored viruses (arthropod-borne viruses) called arboviruses carried by the Aedes aegypti mosquito. Examples are the Zika virus, chikungunya virus, yellow fever and dengue fever. The re-emergence of the viruses has been at a faster rate, and over a wider geographic area, than in the past. The rapid re-emergence is due to expanding global transportation networks, the mosquito's increasing ability to adapt to urban settings, the disruption of traditional land use and the inability to control expanding mosquito populations. Like malaria, arboviruses do not have a vaccine. (The only exception is yellow fever.) Prevention is focused on reducing the adult mosquito populations, controlling mosquito larvae and protecting individuals from mosquito bites. Depending on the mosquito vector, and the affected community, a variety of prevention methods may be deployed at one time. The use of insecticide treated mosquito nets (ITNs) are at the forefront of preventing mosquito bites that cause malaria. The prevalence of ITNs in sub-Saharan Africa has grown from 3% of households to 50% of households from 2000 to 2010 with over 254 million insecticide treated nets distributed throughout sub-Saharan Africa for use against the mosquito vectors Anopheles gambiae and Anopheles funestus which carry malaria. Because the Anopheles gambiae feeds indoors (endophagic) and rests indoors after feeding (endophilic), insecticide treated nets (ITNs) interrupt the mosquito's feeding pattern. The ITNs continue to offer protection, even after there are holes in the nets, because of their excito-repellency properties which reduce the number of mosquitoes that enter the home. The World Health Organization (WHO) recommends treating ITNs with the pyrethroid class of insecticides. There is an emerging concern of mosquito resistance to insecticides used in ITNs. Twenty-seven (27) sub-Saharan African countries have reported Anopheles vector resistance to pyrethroid insecticides. Indoor spraying of insecticides is another prevention method widely used to control mosquito vectors. To help control the Aedes aegypti mosquito, homes are sprayed indoors with residual insecticide applications. Indoor residual spraying (IRS) reduces the female mosquito population and mitigates the risk of dengue virus transmission. Indoor residual spraying is completed usually once or twice a year. Mosquitoes rest on walls and ceilings after feeding and are killed by the insecticide. Indoor spraying can be combined with spraying the exterior of the building to help reduce the number of mosquito larvae and subsequently, the number of adult mosquitoes. There are other methods that an individual can use to protect themselves from mosquito bites. Limiting exposure to mosquitoes from dusk to dawn when the majority of mosquitoes are active and wearing long sleeves and long pants during the period mosquitoes are most active. Placing screens on windows and doors is a simple and effective means of reducing the number of mosquitoes indoors. Anticipating mosquito contact and using a topical mosquito repellant with icaridin or DEET is also recommended. Draining or covering water receptacles, both indoor and outdoors, is also a simple but effective prevention method. Removing debris and tires, cleaning drains, and cleaning gutters help larval control and reduce the number of adult mosquitoes. There is a vaccine for yellow fever which was developed in the 1930s, the yellow 17D vaccine , and it is still in use today. The initial yellow fever vaccination provides lifelong protection for most people and provides immunity within 30 days of the vaccine. Reactions to the yellow fever vaccine have included mild headache and fever, and muscle aches. There are rare cases of individuals presenting with symptoms that mirror the disease itself. The risk of complications from the vaccine are greater for individuals over 60 years of age. In addition, the vaccine is not usually administered to babies under nine months of age, pregnant women, people with allergies to egg protein, and individuals living with AIDS/HIV . The World Health Organization (WHO) reports that 105 million people have been vaccinated for yellow fever in West Africa from 2000 to 2015. To date, there are relatively few vaccines against mosquito-borne diseases, this is due to the fact that most viruses and bacteria caused by mosquitos are highly mutatable. The National Institute of Allergy and Infectious Disease (NIAID) began Phase 1 clinical trials of a new vaccine that would be nearly universal in protecting against the majority of mosquito-borne diseases. The arboviruses have expanded their geographic range and infected populations that had no recent community knowledge of the diseases carried by the Aedes aegypti mosquito. Education and community awareness campaigns are necessary for prevention to be effective. Communities are educated on how the disease is spread, how they can protect themselves from infection and the symptoms of infection. Community health education programs can identify and address the social/economic and cultural issues that can hinder preventative measures. Community outreach and education programs can identify which preventative measures a community is most likely to employ. Leading to a targeted prevention method that has a higher chance of success in that particular community. Community outreach and education includes engaging community health workers and local healthcare providers, local schools and community organizations to educate the public on mosquito vector control and disease prevention. The use of insecticide treated mosquito nets (ITNs) are at the forefront of preventing mosquito bites that cause malaria. The prevalence of ITNs in sub-Saharan Africa has grown from 3% of households to 50% of households from 2000 to 2010 with over 254 million insecticide treated nets distributed throughout sub-Saharan Africa for use against the mosquito vectors Anopheles gambiae and Anopheles funestus which carry malaria. Because the Anopheles gambiae feeds indoors (endophagic) and rests indoors after feeding (endophilic), insecticide treated nets (ITNs) interrupt the mosquito's feeding pattern. The ITNs continue to offer protection, even after there are holes in the nets, because of their excito-repellency properties which reduce the number of mosquitoes that enter the home. The World Health Organization (WHO) recommends treating ITNs with the pyrethroid class of insecticides. There is an emerging concern of mosquito resistance to insecticides used in ITNs. Twenty-seven (27) sub-Saharan African countries have reported Anopheles vector resistance to pyrethroid insecticides. Indoor spraying of insecticides is another prevention method widely used to control mosquito vectors. To help control the Aedes aegypti mosquito, homes are sprayed indoors with residual insecticide applications. Indoor residual spraying (IRS) reduces the female mosquito population and mitigates the risk of dengue virus transmission. Indoor residual spraying is completed usually once or twice a year. Mosquitoes rest on walls and ceilings after feeding and are killed by the insecticide. Indoor spraying can be combined with spraying the exterior of the building to help reduce the number of mosquito larvae and subsequently, the number of adult mosquitoes. There are other methods that an individual can use to protect themselves from mosquito bites. Limiting exposure to mosquitoes from dusk to dawn when the majority of mosquitoes are active and wearing long sleeves and long pants during the period mosquitoes are most active. Placing screens on windows and doors is a simple and effective means of reducing the number of mosquitoes indoors. Anticipating mosquito contact and using a topical mosquito repellant with icaridin or DEET is also recommended. Draining or covering water receptacles, both indoor and outdoors, is also a simple but effective prevention method. Removing debris and tires, cleaning drains, and cleaning gutters help larval control and reduce the number of adult mosquitoes. There is a vaccine for yellow fever which was developed in the 1930s, the yellow 17D vaccine , and it is still in use today. The initial yellow fever vaccination provides lifelong protection for most people and provides immunity within 30 days of the vaccine. Reactions to the yellow fever vaccine have included mild headache and fever, and muscle aches. There are rare cases of individuals presenting with symptoms that mirror the disease itself. The risk of complications from the vaccine are greater for individuals over 60 years of age. In addition, the vaccine is not usually administered to babies under nine months of age, pregnant women, people with allergies to egg protein, and individuals living with AIDS/HIV . The World Health Organization (WHO) reports that 105 million people have been vaccinated for yellow fever in West Africa from 2000 to 2015. To date, there are relatively few vaccines against mosquito-borne diseases, this is due to the fact that most viruses and bacteria caused by mosquitos are highly mutatable. The National Institute of Allergy and Infectious Disease (NIAID) began Phase 1 clinical trials of a new vaccine that would be nearly universal in protecting against the majority of mosquito-borne diseases. The arboviruses have expanded their geographic range and infected populations that had no recent community knowledge of the diseases carried by the Aedes aegypti mosquito. Education and community awareness campaigns are necessary for prevention to be effective. Communities are educated on how the disease is spread, how they can protect themselves from infection and the symptoms of infection. Community health education programs can identify and address the social/economic and cultural issues that can hinder preventative measures. Community outreach and education programs can identify which preventative measures a community is most likely to employ. Leading to a targeted prevention method that has a higher chance of success in that particular community. Community outreach and education includes engaging community health workers and local healthcare providers, local schools and community organizations to educate the public on mosquito vector control and disease prevention. Numerous drugs have been used to treat yellow fever disease with minimal satisfaction to date. Patients with multisystem organ involvement will require critical care support such as possible hemodialysis or mechanical ventilation . Rest, fluids, and acetaminophen are also known to relieve milder symptoms of fever and muscle pain. Due to hemorrhagic complications, aspirin should be avoided. Infected individuals should avoid mosquito exposure by staying indoors or using a mosquito net . Dengue infection's therapeutic management is simple, cost effective and successful in saving lives by adequately performing timely institutionalized interventions. Treatment options are restricted, while no effective antiviral drugs for this infection have been accessible to date. Patients in the early phase of the dengue virus may recover without hospitalization. However, ongoing clinical research is in the works to find specific anti-dengue drugs. Dengue fever occurs via Aedes aegypti mosquito (it acts as a vector). Zika virus vaccine clinical trials are to be conducted and established. There are efforts being put toward advancing antiviral therapeutics against zika virus for swift control. Present day Zika virus treatment is symptomatic through antipyretics and analgesics . Currently there are no publications regarding viral drug screening. Nevertheless, therapeutics for this infection have been used. There are no treatment modalities for acute and chronic chikungunya that currently exist. Most treatment plans use supportive and symptomatic care like analgesics for pain and anti-inflammatories for inflammation caused by arthritis . In acute stages of this virus, rest, antipyretics and analgesics are used to subside symptoms. Most use non-steroidal anti-inflammatory drugs (NSAIDs). In some cases, joint pain may resolve from treatment but stiffness remains. The sterile insect technique (SIT) uses irradiation to sterilize insect pests before releasing them in large numbers to mate with wild females. Since they do not produce any offspring, the population, and consequently the disease incidence, is reduced over time. Used successfully for decades to combat fruit flies and livestock pests such as screwworm and tsetse flies , the technique can be adapted also for some disease-transmitting mosquito species. Pilot projects are being initiated or are under way in different parts of the world. Numerous drugs have been used to treat yellow fever disease with minimal satisfaction to date. Patients with multisystem organ involvement will require critical care support such as possible hemodialysis or mechanical ventilation . Rest, fluids, and acetaminophen are also known to relieve milder symptoms of fever and muscle pain. Due to hemorrhagic complications, aspirin should be avoided. Infected individuals should avoid mosquito exposure by staying indoors or using a mosquito net . Dengue infection's therapeutic management is simple, cost effective and successful in saving lives by adequately performing timely institutionalized interventions. Treatment options are restricted, while no effective antiviral drugs for this infection have been accessible to date. Patients in the early phase of the dengue virus may recover without hospitalization. However, ongoing clinical research is in the works to find specific anti-dengue drugs. Dengue fever occurs via Aedes aegypti mosquito (it acts as a vector).Zika virus vaccine clinical trials are to be conducted and established. There are efforts being put toward advancing antiviral therapeutics against zika virus for swift control. Present day Zika virus treatment is symptomatic through antipyretics and analgesics . Currently there are no publications regarding viral drug screening. Nevertheless, therapeutics for this infection have been used. There are no treatment modalities for acute and chronic chikungunya that currently exist. Most treatment plans use supportive and symptomatic care like analgesics for pain and anti-inflammatories for inflammation caused by arthritis . In acute stages of this virus, rest, antipyretics and analgesics are used to subside symptoms. Most use non-steroidal anti-inflammatory drugs (NSAIDs). In some cases, joint pain may resolve from treatment but stiffness remains. The sterile insect technique (SIT) uses irradiation to sterilize insect pests before releasing them in large numbers to mate with wild females. Since they do not produce any offspring, the population, and consequently the disease incidence, is reduced over time. Used successfully for decades to combat fruit flies and livestock pests such as screwworm and tsetse flies , the technique can be adapted also for some disease-transmitting mosquito species. Pilot projects are being initiated or are under way in different parts of the world. Mosquito-borne diseases, such as dengue fever and malaria , typically affect developing countries and areas with tropical climates. Mosquito vectors are sensitive to climate changes and tend to follow seasonal patterns. Between years there are often dramatic shifts in incidence rates. The occurrence of this phenomenon in endemic areas makes mosquito-borne viruses difficult to treat. Dengue fever is caused by infection through viruses of the family Flaviviridae. The illness is most commonly transmitted by Aedes aegypti mosquitoes in tropical and subtropical regions. Dengue virus has four different serotypes, each of which are antigenically related but have limited cross-immunity to reinfection. Although dengue fever has a global incidence of 50–100 million cases, only several hundreds of thousands of these cases are life-threatening. The geographic prevalence of the disease can be examined by the spread of Aedes aegypti . Over the last twenty years, there has been a geographic spread of the disease. Dengue incidence rates have risen sharply within urban areas which have recently become endemic hot spots for the disease. The recent spread of Dengue can also be attributed to rapid population growth, increased coagulation in urban areas, and global travel. Without sufficient vector control, the dengue virus has evolved rapidly over time, posing challenges to both government and public health officials. [ citation needed ] Malaria is caused by a protozoan called Plasmodium falciparum . P. falciparum parasites are transmitted mainly by the Anopheles gambiae complex in rural Africa. In just this area, P. falciparum infections comprise an estimated 200 million clinical cases and 1 million annual deaths. 75% of individuals affected in this region are children. As with dengue, changing environmental conditions have led to novel disease characteristics. Due to increased illness severity, treatment complications, and mortality rates, many public health officials concede that malaria patterns are rapidly transforming in Africa. Scarcity of health services, rising instances of drug resistance, and changing vector migration patterns are factors that public health officials believe contribute to malaria's dissemination. Climate heavily affects mosquito vectors of malaria and dengue. Climate patterns influence the lifespan of mosquitos as well as the rate and frequency of reproduction. Climate change impacts have been of great interest to those studying these diseases and their vectors. Additionally, climate impacts mosquito blood feeding patterns as well as extrinsic incubation periods. Climate consistency gives researchers an ability to accurately predict annual cycling of the disease but recent climate unpredictability has eroded researchers' ability to track the disease with such precision.In many insect species, such as Drosophila melanogaster , researchers found that a natural infection with the bacteria strain Wolbachia pipientis increases the fitness of the host by increasing resistance to RNA viral infections. Robert L. Glaser and Mark A. Meola investigated Wolbachia -induced resistance to West Nile virus (WNV) in Drosophila melanogaster (fruit flies). Two groups of fruit flies were naturally infected with Wolbachia . Glaser and Meola then cured one group of fruit flies of Wolbachia using tetracycline. Both the infected group and the cured groups were then infected with WNV. Flies infected with Wolbachia were found to have a changed phenotype that caused resistance to WNV. The phenotype was found to be caused by a "dominant, maternally transmitted, cytoplasmic factor". The WNV-resistance phenotype was then reversed by curing the fruit flies of Wolbachia . Since Wolbachia is also maternally transmitted, it was found that the WNV-resistant phenotype is directly related to the Wolbachia infection. West Nile virus is transmitted to humans and animals through the Southern house mosquito, Culex quinquefasciatus . Glaser and Meola knew vector compatibility could be reduced through Wolbachia infection due to studies done with other species of mosquitoes, mainly, Aedes aegypti . Their goal was to transfer WNV resistance to Cx. quinquefasciatus by inoculating the embryos of the mosquito with the same strain of Wolbachia that naturally occurred in the fruit flies. Upon infection, Cx. quinquefasciatus showed an increased resistance to WNV that was transferable to offspring. The ability to genetically modify mosquitoes in the lab and then have the infected mosquitoes transmit it to their offspring showed that it was possible to transmit the bacteria to wild populations to decrease human infections. [ citation needed ] In 2011, Ary Hoffmann and associates produced the first case of Wolbachia -induced arbovirus resistance in wild populations of Aedes aegypti through a small project called Eliminate Dengue: Our Challenge. This was made possible by an engineered strain of Wolbachia termed w Mel that came from D. melanogaster . The transfer of w Mel from D. melanogaster into field-caged populations of the mosquito Aedes aegypti induced resistance to dengue, yellow fever, and chikungunya viruses. Although other strains of Wolbachia also reduced susceptibility to dengue infection, they also put a greater demand on the fitness of Ae. aegypti . w Mel was different in that it was thought to only cost the organism a small portion of its fitness. w Mel-infected Ae. aegypti were released into two residential areas in the city of Cairns, Australia over a 14-week period. Hoffmann and associates, released a total of 141,600 infected adult mosquitoes in Yorkeys Knob suburb and 157,300 in Gordonvale suburb. After release, the populations were monitored for three years to record the spread of w Mel. Population monitoring was gauged by measuring larvae laid in traps. At the beginning of the monitoring period but still within the release period, it was found that w Mel-infected Ae. aegypti had doubled in Yorkeys Knob and increased 1.5-fold in Gordonvale. Uninfected Ae. aegypti populations were in decline. By the end of the three years, w Mel-infected Ae. aegypti had stable populations of about 90%. However, these populations were isolated to the Yorkeys Knob and Gordonvale suburbs due to unsuitable habitat surrounding the neighborhoods. Although populations flourished in these areas with nearly 100% transmission, no signs of spread were noted, proving disappointing for some. Following this experiment, Tom L. Schmidt and his colleagues conducted an experiment releasing Wolbachia -infected Aedes aegypti using different site selection methods occurred in different areas of Cairns during 2013. The release sites were monitored over two years. This time the release was done in urban areas that were adjacent to adequate habitat to encourage mosquito dispersal. Over the two years, the population doubled, and spatial spread was also increased, unlike the first release, giving ample satisfactory results. By increasing the spread of the Wolbachia -infected mosquitoes, the researchers were able to establish that population of a large city was possible if the mosquitoes were given adequate habitat to spread into upon release in different local locations throughout the city. In both of these studies, no adverse effects on public health or the natural ecosystem occurred. This made it an extremely attractive alternative to traditional insecticide methods given the increased pesticide resistance occurring from heavy use. From the success seen in Australia, the researchers were able to begin operating in more threatened portions of the world. The Eliminate Dengue program spread to 10 countries throughout Asia, Latin America, and the Western Pacific blooming into the non-profit organization, World Mosquito Program, as of September 2017. They still use the same technique of infecting wild populations of Ae. aegypti as they did in Australia, but their target diseases now include Zika, chikungunya and yellow fever as well as dengue. Although not alone in their efforts to use Wolbachia- infected mosquitoes to reduce mosquito-borne disease, the World Mosquito Program method is praised for being self-sustaining in that it causes permanent phenotype change rather than reducing mosquito populations through cytoplasmic incompatibility through male-only dispersal.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Zika_fever/html

Zika fever

Zika fever , also known as Zika virus disease or simply Zika , is an infectious disease caused by the Zika virus . Most cases have no symptoms, but when present they are usually mild and can resemble dengue fever . Symptoms may include fever , red eyes , joint pain , headache, and a maculopapular rash . Symptoms generally last less than seven days. It has not caused any reported deaths during the initial infection. Mother-to-child transmission during pregnancy can cause microcephaly and other brain malformations in some babies. Infections in adults have been linked to Guillain–Barré syndrome (GBS). Zika fever is mainly spread via the bite of mosquitoes of the Aedes type. It can also be sexually transmitted and potentially spread by blood transfusions . Infections in pregnant women can spread to the baby. Diagnosis is by testing the blood, urine, or saliva for the presence of the virus's RNA when the person is sick, or the blood for antibodies after symptoms are present more than a week. Prevention involves decreasing mosquito bites in areas where the disease occurs and proper use of condoms. Efforts to prevent bites include the use of insect repellent , covering much of the body with clothing, mosquito nets , and getting rid of standing water where mosquitoes reproduce. There is no effective vaccine . Health officials recommended that women in areas affected by the 2015–16 Zika outbreak consider putting off pregnancy and that pregnant women not travel to these areas. While there is no specific treatment, paracetamol (acetaminophen) may help with the symptoms. Admission to hospital is rarely necessary. The virus that causes the disease was first isolated in Africa in 1947. The first documented outbreak among people occurred in 2007 in the Federated States of Micronesia . An outbreak started in Brazil in 2015, and spread to the Americas, Pacific, Asia, and Africa. This led the World Health Organization to declare it a Public Health Emergency of International Concern in February 2016. The emergency was lifted in November 2016, but 84 countries still reported cases as of March 2017. The last proven case of Zika spread in the Continental United States was in 2017. Most people who are infected have no or few symptoms. Otherwise the most common signs and symptoms of Zika fever are fever , rash , conjunctivitis (red eyes), muscle and joint pain , and headache, which are similar to signs and symptoms of dengue and chikungunya fever. The time from a mosquito bite to developing symptoms is not yet known, but is probably a few days to a week. The disease lasts for several days to a week and is usually mild enough that people do not have to go to a hospital. Due to being in the same family as dengue, there has been concern that it could cause similar bleeding disorders. However that has only been documented in one case, with blood seen in semen, also known as hematospermia . Zika virus infections have been strongly associated with Guillain–Barré syndrome (GBS), which is a rapid onset of muscle weakness caused by the immune system damaging the peripheral nervous system, and which can progress to paralysis. While both GBS and Zika infection can simultaneously occur in the same individual, it is difficult to definitively identify Zika virus as the cause of GBS. Though Zika virus has been shown to infect human Schwann cells . Several countries affected by Zika outbreaks have reported increases in the rate of new cases of GBS. During the 2013–2014 outbreak in French Polynesia there were 42 reported cases of GBS over a 3-month period, compared to between 3 and 10 annually prior to the outbreak. The disease spreads from mother to child in the womb and can cause multiple problems, most notably microcephaly , in the baby. The full range of birth defects caused by infection during pregnancy is not known, but they appear to be common, with large scale abnormalities seen in up to 42% of live births. The most common observed associations have been abnormalities with brain and eye development such as microcephaly and chorioretinal scarring. Less commonly there have been systemic abnormalities such as hydrops fetalis , where there is abnormal accumulation of fluid in the fetus. These abnormalities can lead to intellectual problems, seizures , vision problems , hearing problems , problems feeding and slow development. Whether the stage of pregnancy at which the mother becomes infected affects the risk to the fetus is not well understood, nor is whether other risk factors affect outcomes. One group has estimated the risk of a baby developing microcephaly at about 1% when the mother is infected during the first trimester, with the risk of developing microcephaly becoming uncertain beyond the first trimester. Affected babies might appear normal but actually have brain abnormalities; infection in newborns could also lead to brain damage. Zika virus infections have been strongly associated with Guillain–Barré syndrome (GBS), which is a rapid onset of muscle weakness caused by the immune system damaging the peripheral nervous system, and which can progress to paralysis. While both GBS and Zika infection can simultaneously occur in the same individual, it is difficult to definitively identify Zika virus as the cause of GBS. Though Zika virus has been shown to infect human Schwann cells . Several countries affected by Zika outbreaks have reported increases in the rate of new cases of GBS. During the 2013–2014 outbreak in French Polynesia there were 42 reported cases of GBS over a 3-month period, compared to between 3 and 10 annually prior to the outbreak. The disease spreads from mother to child in the womb and can cause multiple problems, most notably microcephaly , in the baby. The full range of birth defects caused by infection during pregnancy is not known, but they appear to be common, with large scale abnormalities seen in up to 42% of live births. The most common observed associations have been abnormalities with brain and eye development such as microcephaly and chorioretinal scarring. Less commonly there have been systemic abnormalities such as hydrops fetalis , where there is abnormal accumulation of fluid in the fetus. These abnormalities can lead to intellectual problems, seizures , vision problems , hearing problems , problems feeding and slow development. Whether the stage of pregnancy at which the mother becomes infected affects the risk to the fetus is not well understood, nor is whether other risk factors affect outcomes. One group has estimated the risk of a baby developing microcephaly at about 1% when the mother is infected during the first trimester, with the risk of developing microcephaly becoming uncertain beyond the first trimester. Affected babies might appear normal but actually have brain abnormalities; infection in newborns could also lead to brain damage. Zika virus is a mosquito - borne flavivirus closely related to the dengue and yellow fever viruses. While mosquitoes are the vector , the main reservoir species remains unknown, though serological evidence has been found in both West African monkeys and rodents. Transmission is via the bite of mosquitoes from the genus Aedes , primarily Aedes aegypti in tropical regions. It has also been isolated from Ae. africanus , Ae. apicoargenteus , Ae. luteocephalus , Ae. albopictus , Ae. vittatus and Ae. furcifer . During the 2007 outbreak on Yap Island in the South Pacific, Aedes hensilli was the vector, while Aedes polynesiensis spread the virus in French Polynesia in 2013. Zika virus can also spread by sexual transmission from infected men to their partners. Zika virus has been isolated from semen samples, with one person having 100,000 times more virus in semen than blood or urine, two weeks after being infected. It is unclear why levels in semen can be higher than other body fluids, and it is also unclear how long infectious virus can remain in semen. There have also been cases of men with no symptoms of Zika virus infection transmitting the disease. The CDC has recommended that all men who have travelled to affected areas should wait at least 6 months before trying to attempt conception , regardless of whether they were ill. To date there have been no reported sexual transmissions from women to their sexual partners. Oral, anal or vaginal sex can spread the disease. Cases of vertical perinatal transmission have been reported. The CDC recommends that women with Zika fever should wait at least 8 weeks after they start having symptoms of disease before attempting to conceive. There have been no reported cases of transmission from breastfeeding, but infectious virus has been found in breast milk. Like other flaviviruses it could potentially be transmitted by blood transfusion and several affected countries have developed strategies to screen blood donors. The U.S. FDA has recommended universal screening of blood products for Zika. The virus is detected in 3% of asymptomatic blood donors in French Polynesia. Zika virus is a mosquito - borne flavivirus closely related to the dengue and yellow fever viruses. While mosquitoes are the vector , the main reservoir species remains unknown, though serological evidence has been found in both West African monkeys and rodents. Transmission is via the bite of mosquitoes from the genus Aedes , primarily Aedes aegypti in tropical regions. It has also been isolated from Ae. africanus , Ae. apicoargenteus , Ae. luteocephalus , Ae. albopictus , Ae. vittatus and Ae. furcifer . During the 2007 outbreak on Yap Island in the South Pacific, Aedes hensilli was the vector, while Aedes polynesiensis spread the virus in French Polynesia in 2013. Zika virus can also spread by sexual transmission from infected men to their partners. Zika virus has been isolated from semen samples, with one person having 100,000 times more virus in semen than blood or urine, two weeks after being infected. It is unclear why levels in semen can be higher than other body fluids, and it is also unclear how long infectious virus can remain in semen. There have also been cases of men with no symptoms of Zika virus infection transmitting the disease. The CDC has recommended that all men who have travelled to affected areas should wait at least 6 months before trying to attempt conception , regardless of whether they were ill. To date there have been no reported sexual transmissions from women to their sexual partners. Oral, anal or vaginal sex can spread the disease. Cases of vertical perinatal transmission have been reported. The CDC recommends that women with Zika fever should wait at least 8 weeks after they start having symptoms of disease before attempting to conceive. There have been no reported cases of transmission from breastfeeding, but infectious virus has been found in breast milk. Like other flaviviruses it could potentially be transmitted by blood transfusion and several affected countries have developed strategies to screen blood donors. The U.S. FDA has recommended universal screening of blood products for Zika. The virus is detected in 3% of asymptomatic blood donors in French Polynesia. In fruit flies microcephaly appears to be caused by the flavivirid virus protein NS4A , which can disrupt brain growth by hijacking a pathway which regulates growth of new neurons. It is difficult to diagnose Zika virus infection based on clinical signs and symptoms alone due to overlaps with other arboviruses that are endemic to similar areas. The US Centers for Disease Control and Prevention (CDC) advises that "based on the typical clinical features, the differential diagnosis for Zika virus infection is broad. In addition to dengue, other considerations include leptospirosis , malaria , rickettsia , group A streptococcus , rubella , measles , and parvovirus , enterovirus , adenovirus , and alphavirus infections (e.g., chikungunya, Mayaro , Ross River , Barmah Forest , O'nyong'nyong , and Sindbis viruses)." In small case series, routine chemistry and complete blood counts have been normal in most patients. A few have been reported to have mild leukopenia , thrombocytopenia , and elevated liver transaminases . Zika virus can be identified by reverse transcriptase PCR (RT-PCR) in acutely ill patients. However, the period of viremia can be short and the World Health Organization (WHO) recommends RT-PCR testing be done on serum collected within 1 to 3 days of symptom onset or on saliva samples collected during the first 3 to 5 days. When evaluating paired samples, Zika virus was detected more frequently in saliva than serum. Urine samples can be collected and tested up to 14 days after the onset of symptoms, as the virus has been seen to survive longer in the urine than either saliva or serum. The longest period of detectable virus has been 11 days and Zika virus does not appear to establish latency. Later on, serology for the detection of specific IgM and IgG antibodies to Zika virus can be used. IgM antibodies can be detectable within 3 days of the onset of illness. Serological cross-reactions with closely related flaviviruses such as dengue and West Nile virus as well as vaccines to flaviviruses are possible. As of 2019, the FDA has authorized two tests to detect Zika virus antibodies. The CDC recommends screening some pregnant women even if they do not have symptoms of infection. Pregnant women who have traveled to affected areas should be tested between two and twelve weeks after their return from travel. Due to the difficulties with ordering and interpreting tests for Zika virus, the CDC also recommends that healthcare providers contact their local health department for assistance. For women living in affected areas, the CDC has recommended testing at the first prenatal visit with a doctor as well as in the mid-second trimester , though this may be adjusted based on local resources and the local burden of Zika virus. Additional testing should be done if there are any signs of Zika virus disease. Women with positive test results for Zika virus infection should have their fetus monitored by ultrasound every three to four weeks to monitor fetal anatomy and growth. For infants with suspected congenital Zika virus disease, the CDC recommends testing with both serologic and molecular assays such as RT-PCR, IgM ELISA and plaque reduction neutralization test (PRNT). RT-PCR of the infants serum and urine should be performed in the first two days of life. Newborns with a mother who was potentially exposed and who have positive blood tests, microcephaly or intracranial calcifications should have further testing including a thorough physical investigation for neurologic abnormalities, dysmorphic features, splenomegaly, hepatomegaly, and rash or other skin lesions. Other recommended tests are cranial ultrasound, hearing evaluation, and eye examination. Testing should be done for any abnormalities encountered as well as for other congenital infections such as syphilis , toxoplasmosis , rubella, cytomegalovirus infection, lymphocytic choriomeningitis virus infection, and herpes simplex virus . Some tests should be repeated up to 6 months later as there can be delayed effects, particularly with hearing. In response to the widespread transmission of Zika virus during the 2016 outbreak and concerns of viral genetic material detected in breast milk the World Health Organization (WHO) released a Guideline of infant feeding in areas of Zika virus transmission, first in 2016 and updated in 2021, where the evidence showed that despite the detection of Zika virus in breast milk, there is unclear evidence of transmission to the infant, and considering that Zika virus infection among infants is mild, the balance between desirable and undesirable effects favours breastfeeding versus not breastfeeding. According to the 2021WHO guidelines: The CDC recommends screening some pregnant women even if they do not have symptoms of infection. Pregnant women who have traveled to affected areas should be tested between two and twelve weeks after their return from travel. Due to the difficulties with ordering and interpreting tests for Zika virus, the CDC also recommends that healthcare providers contact their local health department for assistance. For women living in affected areas, the CDC has recommended testing at the first prenatal visit with a doctor as well as in the mid-second trimester , though this may be adjusted based on local resources and the local burden of Zika virus. Additional testing should be done if there are any signs of Zika virus disease. Women with positive test results for Zika virus infection should have their fetus monitored by ultrasound every three to four weeks to monitor fetal anatomy and growth. For infants with suspected congenital Zika virus disease, the CDC recommends testing with both serologic and molecular assays such as RT-PCR, IgM ELISA and plaque reduction neutralization test (PRNT). RT-PCR of the infants serum and urine should be performed in the first two days of life. Newborns with a mother who was potentially exposed and who have positive blood tests, microcephaly or intracranial calcifications should have further testing including a thorough physical investigation for neurologic abnormalities, dysmorphic features, splenomegaly, hepatomegaly, and rash or other skin lesions. Other recommended tests are cranial ultrasound, hearing evaluation, and eye examination. Testing should be done for any abnormalities encountered as well as for other congenital infections such as syphilis , toxoplasmosis , rubella, cytomegalovirus infection, lymphocytic choriomeningitis virus infection, and herpes simplex virus . Some tests should be repeated up to 6 months later as there can be delayed effects, particularly with hearing. In response to the widespread transmission of Zika virus during the 2016 outbreak and concerns of viral genetic material detected in breast milk the World Health Organization (WHO) released a Guideline of infant feeding in areas of Zika virus transmission, first in 2016 and updated in 2021, where the evidence showed that despite the detection of Zika virus in breast milk, there is unclear evidence of transmission to the infant, and considering that Zika virus infection among infants is mild, the balance between desirable and undesirable effects favours breastfeeding versus not breastfeeding. According to the 2021WHO guidelines: The virus is spread by mosquitoes, making mosquito avoidance an important element to disease control. The CDC recommends that individuals: The CDC also recommends strategies for controlling mosquitoes such as eliminating standing water, repairing septic tanks and using screens on doors and windows. Spraying insecticide is used to kill flying mosquitoes and larvicide can be used in water containers. Because Zika virus can be sexually transmitted, men who have gone to an area where Zika fever is occurring should be counseled to either abstain from sex or use condoms for 6 months after travel if their partner is pregnant or could potentially become pregnant. Breastfeeding is still recommended by the WHO, even by women who have had Zika fever. There have been no recorded cases of Zika transmission to infants through breastfeeding, though the replicative virus has been detected in breast milk. When returning from travel, with or without symptoms, it is suggested that prevention of mosquito bites continue for 3 weeks in order reduce the risk of virus transmission to uninfected mosquitos. Because of the "growing evidence of a link between Zika and microcephaly", in January 2016, the CDC issued a travel alert advising pregnant women to consider postponing travel to countries and territories with ongoing local transmission of Zika virus. Later, the advice was updated to caution pregnant women to avoid these areas entirely if possible and, if travel is unavoidable, to protect themselves from mosquito bites. Male partners of pregnant women and couples contemplating pregnancy who must travel to areas where Zika is active are advised to use condoms or abstain from sex. The agency also suggested that women thinking about becoming pregnant should consult with their physicians before traveling. In September 2016, the CDC travel advisories included: Cape Verde Many parts of the Caribbean: Anguilla, Antigua and Barbuda, Aruba, The Bahamas, Barbados, Bonaire, British Virgin Islands, Cayman Islands, Cuba, Curaçao, Dominica, Dominican Republic, Grenada, Guadeloupe, Haiti, Jamaica, Martinique, Puerto Rico, Saba, Saint Saint Barthélemy, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Sint Eustatius, Sint Maarten, Trinidad and Tobago, and the U.S. Virgin Islands Central America: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama Mexico Most of South America: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, and Venezuela Several Pacific Islands: American Samoa, Fiji, Marshall Islands, Micronesia, New Caledonia, Papua New Guinea, Samoa, and Tonga In Asia: Singapore, Malaysia, Brunei In December 2020, no active Zika outbreaks were reported by the CDC. Both the regional Pan American Health Organization (PAHO) as well as the WHO have issued statements of concern about the widespread public health impact of the Zika virus and its links to GBS and microcephaly. The WHO Director-General, Margaret Chan , issued a statement in February 2016 "declaring that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern." The declaration allowed the WHO to coordinate international response to the virus as well as gave its guidance the force of international law under the International Health Regulations . The declaration was ended in November 2016. As of 2016 there was no available vaccine. Development was a priority of the US National Institutes of Health (NIH), but officials stated that development of a vaccine could take years. To speed new drug development regulatory strategies were proposed by the WHO and NIH. Animal and early human studies were underway as of September 2016. As of December 2019, there were several vaccine candidates in various stages of development. Disease control in the affected countries currently centres around mosquito control. Several approaches are available for the management of Aedes aegypti mosquito populations, including the destruction of larval breeding sites (the aquatic pools in which eggs are laid and larvae hatch prior to mosquito development into flying adults); and, insecticides targeting either the larval stages, adult mosquitoes or both. Additionally, a whole host of novel technologies are under current development for mosquito control and the World Health Organization has recently lent its support for the accelerated development of modern methods for mosquito control such as the use of Wolbachia bacteria to render mosquitoes resistant to the virus, and, the release of sterilized male mosquitoes that breed with wild female mosquitoes to give rise to non-viable offspring (offspring that do not survive to the biting, adult stage). Oxitec 's genetically modified OX513A mosquito was approved by Brazil's National Biosecurity Technical Commission (CTNBio) in April 2014 and it was being used to try to combat mosquitoes carrying the Zika virus in the town of Piracicaba , São Paulo in 2016. In the 1940s and 1950s, the Aedes aegypti mosquito was eradicated on some Caribbean islands and in at least eighteen Latin American countries. Decreasing political will and presumably available money, mosquito resistance to insecticide, and a pace of urbanization which exceeded eradication efforts led to this mosquito's comeback. Because of the "growing evidence of a link between Zika and microcephaly", in January 2016, the CDC issued a travel alert advising pregnant women to consider postponing travel to countries and territories with ongoing local transmission of Zika virus. Later, the advice was updated to caution pregnant women to avoid these areas entirely if possible and, if travel is unavoidable, to protect themselves from mosquito bites. Male partners of pregnant women and couples contemplating pregnancy who must travel to areas where Zika is active are advised to use condoms or abstain from sex. The agency also suggested that women thinking about becoming pregnant should consult with their physicians before traveling. In September 2016, the CDC travel advisories included: Cape Verde Many parts of the Caribbean: Anguilla, Antigua and Barbuda, Aruba, The Bahamas, Barbados, Bonaire, British Virgin Islands, Cayman Islands, Cuba, Curaçao, Dominica, Dominican Republic, Grenada, Guadeloupe, Haiti, Jamaica, Martinique, Puerto Rico, Saba, Saint Saint Barthélemy, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Sint Eustatius, Sint Maarten, Trinidad and Tobago, and the U.S. Virgin Islands Central America: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama Mexico Most of South America: Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, and Venezuela Several Pacific Islands: American Samoa, Fiji, Marshall Islands, Micronesia, New Caledonia, Papua New Guinea, Samoa, and Tonga In Asia: Singapore, Malaysia, Brunei In December 2020, no active Zika outbreaks were reported by the CDC. Both the regional Pan American Health Organization (PAHO) as well as the WHO have issued statements of concern about the widespread public health impact of the Zika virus and its links to GBS and microcephaly. The WHO Director-General, Margaret Chan , issued a statement in February 2016 "declaring that the recent cluster of microcephaly cases and other neurological disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern." The declaration allowed the WHO to coordinate international response to the virus as well as gave its guidance the force of international law under the International Health Regulations . The declaration was ended in November 2016. As of 2016 there was no available vaccine. Development was a priority of the US National Institutes of Health (NIH), but officials stated that development of a vaccine could take years. To speed new drug development regulatory strategies were proposed by the WHO and NIH. Animal and early human studies were underway as of September 2016. As of December 2019, there were several vaccine candidates in various stages of development. Disease control in the affected countries currently centres around mosquito control. Several approaches are available for the management of Aedes aegypti mosquito populations, including the destruction of larval breeding sites (the aquatic pools in which eggs are laid and larvae hatch prior to mosquito development into flying adults); and, insecticides targeting either the larval stages, adult mosquitoes or both. Additionally, a whole host of novel technologies are under current development for mosquito control and the World Health Organization has recently lent its support for the accelerated development of modern methods for mosquito control such as the use of Wolbachia bacteria to render mosquitoes resistant to the virus, and, the release of sterilized male mosquitoes that breed with wild female mosquitoes to give rise to non-viable offspring (offspring that do not survive to the biting, adult stage). Oxitec 's genetically modified OX513A mosquito was approved by Brazil's National Biosecurity Technical Commission (CTNBio) in April 2014 and it was being used to try to combat mosquitoes carrying the Zika virus in the town of Piracicaba , São Paulo in 2016. In the 1940s and 1950s, the Aedes aegypti mosquito was eradicated on some Caribbean islands and in at least eighteen Latin American countries. Decreasing political will and presumably available money, mosquito resistance to insecticide, and a pace of urbanization which exceeded eradication efforts led to this mosquito's comeback. There is currently no specific treatment for Zika virus infection. Care is supportive with treatment of pain, fever, and itching. Some authorities have recommended against using aspirin and other NSAIDs as these have been associated with hemorrhagic syndrome when used for other flaviviruses. Additionally, aspirin use is generally avoided in children when possible due to the risk of Reye syndrome . Zika virus had been relatively little studied until the major outbreak in 2015, and no specific antiviral treatments are available as yet. Advice to pregnant women is to avoid any risk of infection so far as possible, as once infected there is little that can be done beyond supportive treatment. Most of the time, Zika fever resolves on its own in two to seven days, but rarely, some people develop Guillain–Barré syndrome . The fetus of a pregnant woman who has Zika fever may die or be born with congenital central nervous system malformations, like microcephaly . In April 1947, as part of studies sponsored by the Rockefeller Foundation into yellow fever , 6 caged rhesus monkeys were placed in the canopy of the Zika Forest of Uganda. On April 18 one of the monkeys (no. 776) developed a fever and blood samples revealed the first known case of Zika fever. Population surveys at the time in Uganda found 6.1% of individuals to be seropositive for Zika. The first human cases were reported in Nigeria in 1954. A few outbreaks have been reported in tropical Africa and in some areas in Southeast Asia. Until recently there were no documented cases of Zika virus in the Indian subcontinent , however, the first cases were reported in 2017 from Gujarat state and Tamil Nadu, more cases were reported in Rajasthan state involving an outbreak of 153 reported cases and in a pregnant women living in Kerala state. A 1954 study assessing blood samples from several people from different states found antibodies to Zika in healthy people in India which could indicate past exposure, though it could also be due to cross-reaction with other flaviviruses. By using phylogenetic analysis of Asian strains, it was estimated that Zika virus had moved to Southeast Asia by 1945. In 1977–1978, Zika virus infection was described as a cause of fever in Indonesia. Before 2007, there were only 13 reported natural infections with Zika virus, all with a mild, self-limited febrile illness. As of July 2019, evidence of local transmission from mosquitoes to humans has been reported in a total of 87 countries from four of six WHO Regions ; African, Americas, South-East Asia and Western Pacific. The first major outbreak, with 185 confirmed cases, was reported in 2007 in the Yap Islands of the Federated States of Micronesia. A total of 108 cases were confirmed by PCR or serology and 72 additional cases were suspected. The most common symptoms were rash, fever, arthralgia, and conjunctivitis, and no deaths were reported. The mosquito Aedes hensilli , which was the predominant species identified in Yap during the outbreak, was probably the main vector of transmission. While the way of introduction of the virus on Yap Island remains uncertain, it is likely to have happened through introduction of infected mosquitoes or a human infected with a strain related to those in Southeast Asia. This was also the first time Zika fever had been reported outside Africa and Asia. Before the Yap Island outbreak, only 14 human cases had ever been reported. In 2013–2014, several outbreaks of Zika were reported in French Polynesia , New Caledonia , Easter Island and the Cook Islands . The source of the virus was thought to be an independent introduction of the virus from Southeast Asia , unrelated to the Yap Islands outbreak. Genetic analyses of Zika virus strains suggest that Zika first entered the Americas between May and December 2013. It was first detected in the Western Hemisphere in February 2014, and rapidly spread throughout South and Central America, reaching Mexico in November 2015. In 2016 it established local transmission in Florida and Texas. The first death in the United States due to Zika occurred in February 2016. In May 2015, Brazil officially reported its first 16 cases of the illness. Although, a case of illness was reported in March 2015 in a returning traveller. According to the Brazilian Health Ministry, as of November 2015 there was no official count of the number of people infected with the virus in Brazil, since the disease is not subject to compulsory notification. Even so, cases were reported in 14 states of the country. Mosquito-borne Zika virus is suspected to be the cause of 2,400 possible cases of microcephaly and 29 infant deaths in Brazil in 2015 (of the 2400 or so notified cases in 2015, 2165 were under investigation in December 2015, 134 were confirmed and 102 were ruled out for microcephaly). The Brazilian Health Ministry has reported at least 2,400 suspected cases of microcephaly in the country in 2015 as of 12 December, and 29 fatalities. Before the Zika outbreak, only an average of 150 to 200 cases per year were reported in Brazil. In the state of Pernambuco the reported rates of microcephaly in 2015 are 77 times higher than in the previous 5 years. A model using data from a Zika outbreak in French Polynesia estimated the risk of microcephaly in children born to mothers who acquired Zika virus in the first trimester to be 1%. On 24 January 2016, the WHO warned that the virus is likely to spread to nearly all countries of the Americas, since its vector, the mosquito Aedes aegypti , is found in all countries in the region, except for Canada and continental Chile . The mosquito and dengue fever have been detected in Chile's Easter Island, some 3,500 km (2,200 mi) away from its closest point in mainland Chile, since 2002. In February 2016, WHO declared the outbreak a Public Health Emergency of International Concern as evidence grew that Zika is a cause of birth defects and neurological problems. In April 2016, WHO stated there is a scientific consensus, based on preliminary evidence, that Zika is a cause of microcephaly in infants and Guillain–Barré syndrome in adults. Studies of this and prior outbreaks have found Zika infection during pregnancy to be associated with early pregnancy loss and other pregnancy problems. In the Americas the number of cases peaked during the first half of 2016 and declined through 2017–2018, with a total of 31,587 suspected, probable, and confirmed cases of ZIKV disease were reported in the Region of the Americas. Of these, 3,473 (11%) were laboratory confirmed. In general, transmission persists at low levels in some areas and is not uniformly distributed within countries. In 2016 imported or locally transmitted Zika was reported in all the countries of Asia except Brunei, Hong Kong, Myanmar and Nepal. Serological surveys have indicated that Zika virus is endemic in most areas of Asia, though at a low level. While there was a sharp rise in the number of cases of Zika detected in Singapore after the 2016 Summer Olympics in Brazil, genetic analysis revealed that the strains were more closely related to strains from Thailand than from those causing the epidemic in the Americas. The first major outbreak, with 185 confirmed cases, was reported in 2007 in the Yap Islands of the Federated States of Micronesia. A total of 108 cases were confirmed by PCR or serology and 72 additional cases were suspected. The most common symptoms were rash, fever, arthralgia, and conjunctivitis, and no deaths were reported. The mosquito Aedes hensilli , which was the predominant species identified in Yap during the outbreak, was probably the main vector of transmission. While the way of introduction of the virus on Yap Island remains uncertain, it is likely to have happened through introduction of infected mosquitoes or a human infected with a strain related to those in Southeast Asia. This was also the first time Zika fever had been reported outside Africa and Asia. Before the Yap Island outbreak, only 14 human cases had ever been reported. In 2013–2014, several outbreaks of Zika were reported in French Polynesia , New Caledonia , Easter Island and the Cook Islands . The source of the virus was thought to be an independent introduction of the virus from Southeast Asia , unrelated to the Yap Islands outbreak. Genetic analyses of Zika virus strains suggest that Zika first entered the Americas between May and December 2013. It was first detected in the Western Hemisphere in February 2014, and rapidly spread throughout South and Central America, reaching Mexico in November 2015. In 2016 it established local transmission in Florida and Texas. The first death in the United States due to Zika occurred in February 2016. In May 2015, Brazil officially reported its first 16 cases of the illness. Although, a case of illness was reported in March 2015 in a returning traveller. According to the Brazilian Health Ministry, as of November 2015 there was no official count of the number of people infected with the virus in Brazil, since the disease is not subject to compulsory notification. Even so, cases were reported in 14 states of the country. Mosquito-borne Zika virus is suspected to be the cause of 2,400 possible cases of microcephaly and 29 infant deaths in Brazil in 2015 (of the 2400 or so notified cases in 2015, 2165 were under investigation in December 2015, 134 were confirmed and 102 were ruled out for microcephaly). The Brazilian Health Ministry has reported at least 2,400 suspected cases of microcephaly in the country in 2015 as of 12 December, and 29 fatalities. Before the Zika outbreak, only an average of 150 to 200 cases per year were reported in Brazil. In the state of Pernambuco the reported rates of microcephaly in 2015 are 77 times higher than in the previous 5 years. A model using data from a Zika outbreak in French Polynesia estimated the risk of microcephaly in children born to mothers who acquired Zika virus in the first trimester to be 1%. On 24 January 2016, the WHO warned that the virus is likely to spread to nearly all countries of the Americas, since its vector, the mosquito Aedes aegypti , is found in all countries in the region, except for Canada and continental Chile . The mosquito and dengue fever have been detected in Chile's Easter Island, some 3,500 km (2,200 mi) away from its closest point in mainland Chile, since 2002. In February 2016, WHO declared the outbreak a Public Health Emergency of International Concern as evidence grew that Zika is a cause of birth defects and neurological problems. In April 2016, WHO stated there is a scientific consensus, based on preliminary evidence, that Zika is a cause of microcephaly in infants and Guillain–Barré syndrome in adults. Studies of this and prior outbreaks have found Zika infection during pregnancy to be associated with early pregnancy loss and other pregnancy problems. In the Americas the number of cases peaked during the first half of 2016 and declined through 2017–2018, with a total of 31,587 suspected, probable, and confirmed cases of ZIKV disease were reported in the Region of the Americas. Of these, 3,473 (11%) were laboratory confirmed. In general, transmission persists at low levels in some areas and is not uniformly distributed within countries. In 2016 imported or locally transmitted Zika was reported in all the countries of Asia except Brunei, Hong Kong, Myanmar and Nepal. Serological surveys have indicated that Zika virus is endemic in most areas of Asia, though at a low level. While there was a sharp rise in the number of cases of Zika detected in Singapore after the 2016 Summer Olympics in Brazil, genetic analysis revealed that the strains were more closely related to strains from Thailand than from those causing the epidemic in the Americas. It is named after the Zika Forest near Entebbe , Uganda , where the Zika virus was first identified. Zika virus was first identified in the late 1940s in Kampala, Uganda, Africa but was first confirmed in Brazil. Since it was first identified, Zika has been found in more than 27 countries and territories. Following the initial Zika outbreak in Northeastern Brazil in May 2015, physicians observed a very large surge of reports of infants born with microcephaly , with 20 times the number of expected cases. Many of these cases have since been confirmed, leading WHO officials to project that approximately 2,500 infants will be found to have born in Brazil with Zika-related microcephaly. Proving that Zika causes these effects was difficult and complex for several reasons. For example, the effects on an infant might not be seen until months after the mother's initial infection, long after the time when Zika is easily detected in the body. In addition, research was needed to determine the mechanism by which Zika produced these effects. Since the initial outbreak, studies that use several different methods found evidence of a link, leading public health officials to conclude that it appears increasingly likely the virus is linked to microcephaly and miscarriage. On 1 February 2016, the World Health Organization declared recently reported clusters of microcephaly and other neurological disorders a Public Health Emergency of International Concern (PHEIC). On 8 March 2016, the WHO Committee reconfirmed that the association between Zika and neurological disorders is of global concern. The Zika virus was first linked with newborn microcephaly during the Brazil Zika virus outbreak. In 2015, there were 2,782 suspected cases of microcephaly compared with 147 in 2014 and 167 in 2013. Confirmation of many of the recent cases is pending, and it is difficult to estimate how many cases went unreported before the recent awareness of the risk of virus infections. In November 2015, the Zika virus was isolated in a newborn baby from the northeastern state of Ceará , Brazil, with microcephaly and other congenital disorders . The Lancet medical journal reported in January 2016 that the Brazilian Ministry of Health had confirmed 134 cases of microcephaly "believed to be associated with Zika virus infection" with an additional 2,165 cases in 549 counties in 20 states remaining under investigation. An analysis of 574 cases of microcephaly in Brazil during 2015 and the first week of 2016, reported in March 2016, found an association with maternal illness involving rash and fever during the first trimester of pregnancy. During this period, 12 Brazilian states reported increases of at least 3 standard deviations (SDs) in cases of microcephaly compared with 2000–14, with the northeastern states of Bahia, Paraíba and Pernambuco reporting increases of more than 20 SDs. In January 2016, a baby in Oahu , Hawaii, was born with microcephaly, the first case in the United States of brain damage linked to the virus. The baby and mother tested positive for a past Zika virus infection. The mother, who had probably acquired the virus while traveling in Brazil in May 2015 during the early stages of her pregnancy, had reported her bout of Zika. She recovered before relocating to Hawaii. Her pregnancy had progressed normally, and the baby's condition was not known until birth. In February 2016, ocular disorders in newborns have been linked to Zika virus infection. In one study in Pernambuco state in Brazil, about 40 percent of babies with Zika-related microcephaly also had scarring of the retina with spots, or pigment alteration . On 20 February 2016, Brazilian scientists announced that they had successfully sequenced the Zika virus genome and expressed hope that this would help in both developing a vaccine and in determining the nature of any link to birth defects. Also in February 2016, rumors that microcephaly is caused by the use of the larvicide pyriproxyfen in drinking water were refuted by scientists. "It's important to state that some localities that do not use pyriproxyfen also had reported cases of microcephaly", read a Brazilian government statement. The Brazilian government also refuted conspiracy theories that chickenpox and rubella vaccinations or genetically modified mosquitoes were causing increases in microcephaly. Researchers also suspected that Zika virus could be transmitted by a pregnant woman to her baby (" vertical transmission "). This remained unproven until February 2016, when a paper by Calvet et al. was published, showing not only was the Zika virus genome found in the amniotic fluid but also IgM antibodies against the virus. This means that not only can the virus cross the placental barrier, but also the antibodies produced by the mother can reach the fetus, which suggests that vertical transmission is plausible in these cases. One other study published in March 2016 by Mlakar and colleagues analyzed autopsy tissues from a fetus with microcephaly that was probably related to Zika virus; researchers found ZIKV in the brain tissue and suggested that the brain injuries were probably associated with the virus, which also shed a light on the vertical transmission theory. Also in March 2016, first solid evidence was reported on how the virus affects the development of the brain, indicating that it appears to preferentially kill developing brain cells. The first cases of birth defects linked to Zika in Colombia and in Panama were reported in March 2016. In the same month, researchers published a prospective cohort study that found profound impacts in 29 percent of infants of mothers infected with Zika, some of whom were infected late in pregnancy. This study did not suffer from some of the difficulties of studying Zika: the study followed women who presented to a Rio de Janeiro clinic with fever and rash within the last five days. The women were then tested for Zika using PCR, then the progress of the pregnancies were followed using ultrasound. A high rate of the autoimmune disease Guillain–Barré syndrome (GBS), noted in the French Polynesia outbreak, has also been found in the outbreak that began in Brazil. Laboratory analysis found Zika infections in some patients with GBS in Brazil, El Salvador, Suriname and Venezuela, and the WHO declared on 22 March 2016 that Zika appeared to be "implicated" in GBS infection and that if the pattern was confirmed it would represent a global public health crisis. It is named after the Zika Forest near Entebbe , Uganda , where the Zika virus was first identified. Zika virus was first identified in the late 1940s in Kampala, Uganda, Africa but was first confirmed in Brazil. Since it was first identified, Zika has been found in more than 27 countries and territories. Following the initial Zika outbreak in Northeastern Brazil in May 2015, physicians observed a very large surge of reports of infants born with microcephaly , with 20 times the number of expected cases. Many of these cases have since been confirmed, leading WHO officials to project that approximately 2,500 infants will be found to have born in Brazil with Zika-related microcephaly. Proving that Zika causes these effects was difficult and complex for several reasons. For example, the effects on an infant might not be seen until months after the mother's initial infection, long after the time when Zika is easily detected in the body. In addition, research was needed to determine the mechanism by which Zika produced these effects. Since the initial outbreak, studies that use several different methods found evidence of a link, leading public health officials to conclude that it appears increasingly likely the virus is linked to microcephaly and miscarriage. On 1 February 2016, the World Health Organization declared recently reported clusters of microcephaly and other neurological disorders a Public Health Emergency of International Concern (PHEIC). On 8 March 2016, the WHO Committee reconfirmed that the association between Zika and neurological disorders is of global concern. The Zika virus was first linked with newborn microcephaly during the Brazil Zika virus outbreak. In 2015, there were 2,782 suspected cases of microcephaly compared with 147 in 2014 and 167 in 2013. Confirmation of many of the recent cases is pending, and it is difficult to estimate how many cases went unreported before the recent awareness of the risk of virus infections. In November 2015, the Zika virus was isolated in a newborn baby from the northeastern state of Ceará , Brazil, with microcephaly and other congenital disorders . The Lancet medical journal reported in January 2016 that the Brazilian Ministry of Health had confirmed 134 cases of microcephaly "believed to be associated with Zika virus infection" with an additional 2,165 cases in 549 counties in 20 states remaining under investigation. An analysis of 574 cases of microcephaly in Brazil during 2015 and the first week of 2016, reported in March 2016, found an association with maternal illness involving rash and fever during the first trimester of pregnancy. During this period, 12 Brazilian states reported increases of at least 3 standard deviations (SDs) in cases of microcephaly compared with 2000–14, with the northeastern states of Bahia, Paraíba and Pernambuco reporting increases of more than 20 SDs. In January 2016, a baby in Oahu , Hawaii, was born with microcephaly, the first case in the United States of brain damage linked to the virus. The baby and mother tested positive for a past Zika virus infection. The mother, who had probably acquired the virus while traveling in Brazil in May 2015 during the early stages of her pregnancy, had reported her bout of Zika. She recovered before relocating to Hawaii. Her pregnancy had progressed normally, and the baby's condition was not known until birth. In February 2016, ocular disorders in newborns have been linked to Zika virus infection. In one study in Pernambuco state in Brazil, about 40 percent of babies with Zika-related microcephaly also had scarring of the retina with spots, or pigment alteration . On 20 February 2016, Brazilian scientists announced that they had successfully sequenced the Zika virus genome and expressed hope that this would help in both developing a vaccine and in determining the nature of any link to birth defects. Also in February 2016, rumors that microcephaly is caused by the use of the larvicide pyriproxyfen in drinking water were refuted by scientists. "It's important to state that some localities that do not use pyriproxyfen also had reported cases of microcephaly", read a Brazilian government statement. The Brazilian government also refuted conspiracy theories that chickenpox and rubella vaccinations or genetically modified mosquitoes were causing increases in microcephaly. Researchers also suspected that Zika virus could be transmitted by a pregnant woman to her baby (" vertical transmission "). This remained unproven until February 2016, when a paper by Calvet et al. was published, showing not only was the Zika virus genome found in the amniotic fluid but also IgM antibodies against the virus. This means that not only can the virus cross the placental barrier, but also the antibodies produced by the mother can reach the fetus, which suggests that vertical transmission is plausible in these cases. One other study published in March 2016 by Mlakar and colleagues analyzed autopsy tissues from a fetus with microcephaly that was probably related to Zika virus; researchers found ZIKV in the brain tissue and suggested that the brain injuries were probably associated with the virus, which also shed a light on the vertical transmission theory. Also in March 2016, first solid evidence was reported on how the virus affects the development of the brain, indicating that it appears to preferentially kill developing brain cells. The first cases of birth defects linked to Zika in Colombia and in Panama were reported in March 2016. In the same month, researchers published a prospective cohort study that found profound impacts in 29 percent of infants of mothers infected with Zika, some of whom were infected late in pregnancy. This study did not suffer from some of the difficulties of studying Zika: the study followed women who presented to a Rio de Janeiro clinic with fever and rash within the last five days. The women were then tested for Zika using PCR, then the progress of the pregnancies were followed using ultrasound. A high rate of the autoimmune disease Guillain–Barré syndrome (GBS), noted in the French Polynesia outbreak, has also been found in the outbreak that began in Brazil. Laboratory analysis found Zika infections in some patients with GBS in Brazil, El Salvador, Suriname and Venezuela, and the WHO declared on 22 March 2016 that Zika appeared to be "implicated" in GBS infection and that if the pattern was confirmed it would represent a global public health crisis. Early in the 2015–16 Zika virus epidemic , research was begun to better understand how Zika virus causes microcephaly and other neurological disorders. However, with the 2019 election of Jair Bolsonaro in Brazil, who cut funding for research, and the emergence of the COVID-19 pandemic in early 2020, most Zika-related research projects were abandoned or reduced. It may involve infection of the primary neural stem cells of the fetal brain, known as neural progenitor cells. The main roles of brain stem cells are to proliferate until the correct number is achieved, and then to produce neurons through the process of neurogenesis . Zika proteins NS4A and NS4B have also been shown to directly suppress neurogenesis. Infection of brain stem cells can cause cell death, which reduces the production of future neurons and leads to a smaller brain. Zika also appears to have an equal tropism for cells of the developing eye, leading to high rates of eye abnormalities as well. In addition to inducing cell death, infection of neural progenitor cells may alter the process of cell proliferation, causing a depletion in the pool of progenitor cells. A large number of cases of microcephaly have been associated with inherited gene mutations, and specifically with mutations that lead to dysfunction of the mitotic spindle . There is some evidence that Zika virus may directly or indirectly interfere with mitotic function, this may play a role in altering cell proliferation. Another line of research considers that Zika, unlike other flaviviruses, may target developing brain cells after it crosses the placenta, and considers the resulting damage likely to be the result of inflammation as a byproduct of the immune response to the infection of those cells. Some experimental methods of prevention include breeding and releasing mosquitoes that have been genetically modified to prevent them from transmitting pathogens, or have been infected with the Wolbachia bacterium, believed to inhibit the spread of viruses. A strain of Wolbachia helped to reduce the vector competence of the Zika virus in infected Aedes aegypti released in Medellin, Colombia. Gene drive is a technique for changing wild populations, for instance to combat insects so they cannot transmit diseases (in particular mosquitoes in the cases of malaria and Zika). Another method which been researched aims to render male mosquitoes infertile by nuclear radiation in the hope to reduce populations; this is done with a cobalt-60 gamma cell irradiator. In 2016 the World Health Organization encouraged field trials of transgenic male Aedes aegypti mosquitoes developed by Oxitec to try to halt the spread of the Zika virus. Early in the 2015–16 Zika virus epidemic , research was begun to better understand how Zika virus causes microcephaly and other neurological disorders. However, with the 2019 election of Jair Bolsonaro in Brazil, who cut funding for research, and the emergence of the COVID-19 pandemic in early 2020, most Zika-related research projects were abandoned or reduced. It may involve infection of the primary neural stem cells of the fetal brain, known as neural progenitor cells. The main roles of brain stem cells are to proliferate until the correct number is achieved, and then to produce neurons through the process of neurogenesis . Zika proteins NS4A and NS4B have also been shown to directly suppress neurogenesis. Infection of brain stem cells can cause cell death, which reduces the production of future neurons and leads to a smaller brain. Zika also appears to have an equal tropism for cells of the developing eye, leading to high rates of eye abnormalities as well. In addition to inducing cell death, infection of neural progenitor cells may alter the process of cell proliferation, causing a depletion in the pool of progenitor cells. A large number of cases of microcephaly have been associated with inherited gene mutations, and specifically with mutations that lead to dysfunction of the mitotic spindle . There is some evidence that Zika virus may directly or indirectly interfere with mitotic function, this may play a role in altering cell proliferation. Another line of research considers that Zika, unlike other flaviviruses, may target developing brain cells after it crosses the placenta, and considers the resulting damage likely to be the result of inflammation as a byproduct of the immune response to the infection of those cells. Some experimental methods of prevention include breeding and releasing mosquitoes that have been genetically modified to prevent them from transmitting pathogens, or have been infected with the Wolbachia bacterium, believed to inhibit the spread of viruses. A strain of Wolbachia helped to reduce the vector competence of the Zika virus in infected Aedes aegypti released in Medellin, Colombia. Gene drive is a technique for changing wild populations, for instance to combat insects so they cannot transmit diseases (in particular mosquitoes in the cases of malaria and Zika). Another method which been researched aims to render male mosquitoes infertile by nuclear radiation in the hope to reduce populations; this is done with a cobalt-60 gamma cell irradiator. In 2016 the World Health Organization encouraged field trials of transgenic male Aedes aegypti mosquitoes developed by Oxitec to try to halt the spread of the Zika virus.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/SIGA_Technologies/html

SIGA Technologies

SIGA Technologies, Inc. is an American pharmaceutical company founded in 1995, based in New York City , which develops and sells pharmaceutical solutions for the antiviral treatment of smallpox , monkeypox , cowpox , and vaccinia complications. In September 2009, SIGA Technologies received a $1.6 million research fund from the National Institutes of Health ("NIH") for its broad-spectrum antiviral candidates. In August 2011, SIGA Technologies was awarded a $7.7 million grant from the National Institutes of Health (NIH) to develop an antiviral drug for treating and preventing Lassa fever and others of arenavirus origin. That year, it sealed a contract worth over $400 million to sell its antiviral drug Tpoxx to the United States Biomedical Advanced Research and Development Authority (BARDA) for the purpose of its development and distribution. Also in 2011, it was ordered to pay $232 million in damages in a legal dispute with PharmAthene over rights to the smallpox drug tecovirimat. In July 2013, SIGA Technologies delivered about 590,000 courses of its smallpox antiviral drug tecovirimat (Arestvy) to the United States Government's Strategic National Stockpile (SNS), meeting the requirement of Government's Biomedical Advanced Research and Development Authority (BARDA). In May 2018, a US Food and Drug Administration (FDA) advisory committee decided that the benefits of SIGA's small molecule antiviral treatment, Tpoxx, outweigh its potential risks. Later in July, FDA granted the approval of Tpoxx to SIGA after the drug was evaluated in 359 healthy human volunteers. In July 2019, SIGA signed a $23 million contract with the United States Department of Defense to create Tpoxx's post-exposure prophylaxis. Tecovirimat was approved for medical use in the European Union in January 2022. In 2021, SIGA submitted an intravenous version of Tpoxx to the FDA for approval, which was approved in May 2022. In December 2021, Health Canada approved oral Tpoxx for the treatment of smallpox in adults and pediatric patients weighing at least 13kg. In January 2022, the European Medicines Agency approved oral tecovirimat for smallpox, monkeypox, cowpox and vaccinia complications in adults and children with a body weight of at least 13kg. Intravenous (IV) Tpoxx has no lower weight cap and can be used in infants under the Investigational New Drug protocol. The Centers for Disease Control and Prevention and the FDA have relaxed regulations to make it easier for doctors in the United States to prescribe Tpoxx to treat people with monkeypox. SIGA has a well established cooperation with US federal agencies for its research and development activities. It provides countermeasures to the Strategic National Stockpile (SNS) and the Department of Defense (DoD), such as Category A pathogens using BSL-3 or -4 work. In September 2018, it signed a contract with BARDA for the delivery of oral and IV formulations of Tpoxx to the Strategic National Stockpile, effective for the following years. SIGA's products include tecovirimat , sold under the brand name Tpoxx, the first drug approved by the FDA to treat adults and children for smallpox. In 2008, SIGA won its fourth listing on the Deloitte Tri-State Area Technology Fast 50, then at #44.

Wiki

Lassa fever

https://api.wikimedia.org/core/v1/wikipedia/en/page/Pandemic/html

Pandemic

A pandemic ( / p æ n ˈ d ɛ m ɪ k / pan-DEM-ik ) is an epidemic of an infectious disease that has spread across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals. Widespread endemic diseases with a stable number of infected individuals such as recurrences of seasonal influenza are generally excluded as they occur simultaneously in large regions of the globe rather than being spread worldwide. Throughout human history , there have been a number of pandemics of diseases such as smallpox . The Black Death , caused by the Plague , wiped out up to half of the population of Europe in the 14th century. The term pandemic had not been used then, but was used for later epidemics, including the 1918 H1N1 influenza A pandemic—more commonly known as the Spanish flu —which is the deadliest pandemic in history . The most recent pandemics include the HIV/AIDS pandemic , [lower-alpha 1] the 2009 swine flu pandemic and the COVID-19 pandemic . Almost all these diseases still circulate among humans though their impact now is often far less. In response to the COVID-19 pandemic, 194 member states of the World Health Organization began negotiations on an International Treaty on Pandemic Prevention, Preparedness and Response , with a requirement to submit a draft of this treaty to the 77th World Health Assembly during its 2024 convention. A medical dictionary definition of pandemic is " an epidemic occurring on a scale that crosses international boundaries, usually affecting people on a worldwide scale ". A disease or condition is not a pandemic merely because it is widespread or kills many people; it must also be infectious. For instance, cancer is responsible for many deaths but is not considered a pandemic because the disease is not contagious —i.e. easily transmissible—and not even simply infectious . This definition differs from colloquial usage in that it encompasses outbreaks of relatively mild diseases. The World Health Organization (WHO) has a category of Public Health Emergency of International Concern , defined as " an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response ". There is a rigorous process underlying this categorization and a clearly defined trajectory of responses. A WHO-sponsored international body, tasked with preparing an international agreement on pandemic prevention, preparedness and response has defined a pandemic as " the global spread of a pathogen or variant that infects human populations with limited or no immunity through sustained and high transmissibility from person to person, overwhelming health systems with severe morbidity and high mortality, and causing social and economic disruptions, all of which require effective national and global collaboration and coordination for its control ". The word comes from the Greek παν- pan- meaning "all", or "every" and δῆμος demos "people". A common early characteristic of a pandemic is a rapid, sometimes exponential , growth in the number of infections, coupled with a widening geographical spread. WHO utilises different criteria to declare a Public Health Emergency of International Concern (PHEIC), its nearest equivalent to the term pandemic. The potential consequences of an incident are considered, rather than its current status. For example, polio was declared a PHEIC in 2014 even though only 482 cases were reported globally in the previous year; this was justified by concerns that polio might break out of its endemic areas and again become a significant health threat globally. The PHEIC status of polio is reviewed regularly and is ongoing, despite the small number of cases annually. [lower-alpha 2] The end of a pandemic is more difficult to delineate. Generally, past epidemics & pandemics have faded out as the diseases become accepted into people's daily lives and routines, becoming endemic . The transition from pandemic to endemic may be defined based on: - a high proportion of the global population having immunity (through either natural infection or vaccination) fewer deaths health systems step down from emergency status perceived personal risk is lessened restrictive measures such as travel restrictions removed less coverage in public media. An endemic disease is always present in a population, but at a relatively low and predictable level. There may be periodic spikes of infections or seasonality, (e.g. influenza ) but generally the burden on health systems is manageable. A common early characteristic of a pandemic is a rapid, sometimes exponential , growth in the number of infections, coupled with a widening geographical spread. WHO utilises different criteria to declare a Public Health Emergency of International Concern (PHEIC), its nearest equivalent to the term pandemic. The potential consequences of an incident are considered, rather than its current status. For example, polio was declared a PHEIC in 2014 even though only 482 cases were reported globally in the previous year; this was justified by concerns that polio might break out of its endemic areas and again become a significant health threat globally. The PHEIC status of polio is reviewed regularly and is ongoing, despite the small number of cases annually. [lower-alpha 2] The end of a pandemic is more difficult to delineate. Generally, past epidemics & pandemics have faded out as the diseases become accepted into people's daily lives and routines, becoming endemic . The transition from pandemic to endemic may be defined based on: - a high proportion of the global population having immunity (through either natural infection or vaccination) fewer deaths health systems step down from emergency status perceived personal risk is lessened restrictive measures such as travel restrictions removed less coverage in public media. An endemic disease is always present in a population, but at a relatively low and predictable level. There may be periodic spikes of infections or seasonality, (e.g. influenza ) but generally the burden on health systems is manageable. Pandemic prevention comprises activities such as anticipatory research and development of therapies and vaccines, as well as monitoring for pathogens and disease outbreaks which may have pandemic potential. Routine vaccination programs are a type of prevention strategy, holding back diseases such as influenza and polio which have caused pandemics in the past, and could do so again if not controlled. Prevention overlaps with preparedness which aims to curtail an outbreak and prevent it getting out of control - it involves strategic planning, data collection and modelling to measure the spread, stockpiling of therapies, vaccines, and medical equipment, as well as public health awareness campaigning. By definition, a pandemic involves many countries so international cooperation, data sharing, and collaboration are essential; as is universal access to tests and therapies. Collaboration - In response to the COVID-19 pandemic, WHO established a Pandemic Hub in September 2021 in Berlin, aiming to address weaknesses around the world in how countries detect, monitor and manage public health threats. The Hub's initiatives include using artificial intelligence to analyse more than 35,000 data feeds for indications of emerging health threats, as well as improving facilities and coordination between academic institutions and WHO member countries. Detection - In May 2023, WHO launched the International Pathogen Surveillance Network (IPSN) (hosted by the Pandemic Hub) aiming to detect and respond to disease threats before they become epidemics and pandemics, and to optimize routine disease surveillance. The network provides a platform to connect countries, improving systems for collecting and analysing samples of potentially harmful pathogens . Therapies and Vaccines - The Coalition for Epidemic Preparedness Innovations (CEPI) is developing a program to condense new vaccine development timelines to 100 days, a third of the time it took to develop a COVID-19 vaccine. CEPI aims to reduce global epidemic and pandemic risk by developing vaccines against known pathogens as well as enabling rapid response to Disease X . In the US, the National Institute of Allergy and Infectious Diseases (NIAID) has developed a Pandemic Preparedness Plan which focuses on identifying viruses of concern and developing diagnostics and therapies (including prototype vaccines) to combat them. Modeling is important to inform policy decisions. It helps to predict the burden of disease on healthcare facilities, the effectiveness of control measures, projected geographical spread, and timing and extent of future pandemic waves. Public Awareness involves disseminating reliable information, ensuring consistency on message, transparency, and steps to discredit misinformation . Stockpiling involves maintaining strategic stockpiles of emergency supplies such as personal protective equipment, drugs and vaccines, and equipment such as respirators. Many of these items have limited shelf life , so they require stock rotation even though they may be rarely used. The COVID-19 pandemic highlighted a number of ethical and political issues which must be considered during a pandemic. These included decisions about who should be prioritised for treatment while resources are scarce; whether or not to make vaccination compulsory; the timing and extent of constraints on individual liberty, how to sanction individuals who do not comply with emergency regulations, and the extent of international collaboration and resource sharing. The COVID-19 pandemic highlighted a number of ethical and political issues which must be considered during a pandemic. These included decisions about who should be prioritised for treatment while resources are scarce; whether or not to make vaccination compulsory; the timing and extent of constraints on individual liberty, how to sanction individuals who do not comply with emergency regulations, and the extent of international collaboration and resource sharing. The basic strategies in the control of an outbreak are containment and mitigation . Containment may be undertaken in the early stages of the outbreak, including contact tracing and isolating infected individuals to stop the disease from spreading to the rest of the population, other public health interventions on infection control, and therapeutic countermeasures such as vaccinations which may be effective if available. When it becomes apparent that it is no longer possible to contain the spread of the disease, management will then move on to the mitigation stage, in which measures are taken to slow the spread of the disease and mitigate its effects on society and the healthcare system. In reality, containment and mitigation measures may be undertaken simultaneously. A key part of managing an infectious disease outbreak is trying to decrease the epidemic peak, known as " flattening the curve ". This helps decrease the risk of health services being overwhelmed and provides more time for a vaccine and treatment to be developed. A broad group of non-pharmaceutical interventions may be taken to manage the outbreak. In a flu pandemic, these actions may include personal preventive measures such as hand hygiene, wearing face-masks, and self-quarantine; community measures aimed at social distancing such as closing schools and canceling mass gatherings; community engagement to encourage acceptance and participation in such interventions; and environmental measures such as cleaning of surfaces. Another strategy, suppression , requires more extreme long-term non-pharmaceutical interventions to reverse the pandemic by reducing the basic reproduction number to less than 1. The suppression strategy, which includes stringent population-wide social distancing, home isolation of cases, and household quarantine, was undertaken by China during the COVID-19 pandemic where entire cities were placed under lockdown; such a strategy may carry with it considerable social and economic costs. For a novel influenza virus , WHO previously applied a six-stage classification to delineate the process by which the virus moves from the first few infections in humans through to a pandemic. Starting with phase 1 (infections identified in animals only), it moves through phases of increasing infection and spread to phase 6 (pandemic). In February 2020, a WHO spokesperson clarified that the system is no longer in use. In 2014, the United States Centers for Disease Control and Prevention (CDC) introduced a framework for characterising the progress of an influenza pandemic titled the Pandemic Intervals Framework . The six intervals of the framework are as follows: investigation of cases of novel influenza, recognition of increased potential for ongoing transmission, initiation of a pandemic wave, acceleration of a pandemic wave, deceleration of a pandemic wave, and preparation for future pandemic waves. At the same time, the CDC adopted the Pandemic Severity Assessment Framework (PSAF) to assess the severity of influenza pandemics. The PSAF rates the severity of an influenza outbreak on two dimensions: clinical severity of illness in infected persons; and the transmissibility of the infection in the population. This tool was not applied during the COVID-19 pandemic. For a novel influenza virus , WHO previously applied a six-stage classification to delineate the process by which the virus moves from the first few infections in humans through to a pandemic. Starting with phase 1 (infections identified in animals only), it moves through phases of increasing infection and spread to phase 6 (pandemic). In February 2020, a WHO spokesperson clarified that the system is no longer in use. In 2014, the United States Centers for Disease Control and Prevention (CDC) introduced a framework for characterising the progress of an influenza pandemic titled the Pandemic Intervals Framework . The six intervals of the framework are as follows: investigation of cases of novel influenza, recognition of increased potential for ongoing transmission, initiation of a pandemic wave, acceleration of a pandemic wave, deceleration of a pandemic wave, and preparation for future pandemic waves. At the same time, the CDC adopted the Pandemic Severity Assessment Framework (PSAF) to assess the severity of influenza pandemics. The PSAF rates the severity of an influenza outbreak on two dimensions: clinical severity of illness in infected persons; and the transmissibility of the infection in the population. This tool was not applied during the COVID-19 pandemic. SARS-CoV-2 , a new strain of coronavirus , was first detected in the city of Wuhan, Hubei Province , China, in December 2019. The outbreak was characterized as a Public Health Emergency of International Concern (PHEIC) between January 2020 and May 2023 by WHO. The number of people infected with COVID-19 has reached more than 767 million worldwide, with a death toll of 6.9 million. [lower-alpha 3] It is considered likely that the virus will eventually become endemic and, like the common cold, cause less severe disease for most people. HIV/AIDS was first identified as a disease in 1981, and is an ongoing worldwide public health issue. Since then, HIV/AIDS has killed an estimated 40 million people with a further 630,000 deaths annually; 39 million people are currently living with HIV infection. [lower-alpha 4] HIV has a zoonotic origin, having originated in nonhuman primates in Central Africa and transferred to humans in the early 20th century. The most frequent mode of transmission of HIV is through sexual contact with an infected person. There may be a short period of mild, nonspecific symptoms followed by an asymptomatic (but nevertheless infectious) stage called clinical latency - without treatment, this stage can last between 3 and 20 years. The only way to detect infection is by means of a HIV test. There is no vaccine to prevent HIV infection, but the disease can be held in check by means of antiretroviral therapy . Historical accounts of epidemics are often vague or contradictory in describing how victims were affected. A rash accompanied by a fever might be smallpox, measles, scarlet fever, or varicella , and it is possible that epidemics overlapped, with multiple infections striking the same population at once. It is often impossible to know the exact causes of mortality, although ancient DNA studies can sometimes detect residues of certain pathogens. It is assumed that, prior to the neolithic revolution around 10,000 BC, disease outbreaks were limited to a single family or clan, and did not spread widely before dying out. The domestication of animals increased human-animal contact, increasing the possibility of zoonotic infections. The advent of agriculture, and trade between settled groups, made it possible for pathogens to spread widely. As population increased, contact between groups became more frequent. A history of epidemics maintained by the Chinese Empire from 243 B.C. to 1911 A.C. shows an approximate correlation between the frequency of epidemics and the growth of the population. Here is an incomplete list of known epidemics which spread widely enough to merit the title "pandemic". Beginning from the Middle Ages, encounters between European settlers and native populations in the rest of the world often introduced epidemics of extraordinary virulence. Settlers introduced novel diseases which were endemic in Europe, such as smallpox , measles , pertussis .and influenza , to which the indigenous peoples had no immunity. The Europeans infected with such diseases typically carried them in a dormant state , were actively infected but asymptomatic , or had only mild symptoms. Smallpox was the most destructive disease that was brought by Europeans to the Native Americans, both in terms of morbidity and mortality. The first well-documented smallpox epidemic in the Americas began in Hispaniola in late 1518 and soon spread to Mexico. Estimates of mortality range from one-quarter to one-half of the population of central Mexico. It is estimated that over the 100 years after European arrival in 1492, the indigenous population of the Americas dropped from 60 million to only 6 million, due to a combination of disease, war, and famine. The majority these deaths are attributed to successive waves of introduced diseases such as smallpox, measles, and typhoid fever. In Australia , smallpox was introduced by European settlers in 1789 devastating the Australian Aboriginal population, killing an estimated 50% of those infected with the disease during the first decades of colonisation. In the early 1800s, measles, smallpox and intertribal warfare killed an estimated 20,000 New Zealand Māori . In 1848–49, as many as 40,000 out of 150,000 Hawaiians are estimated to have died of measles , whooping cough and influenza . Measles killed more than 40,000 Fijians , approximately one-third of the population, in 1875, and in the early 19th century devastated the Great Andamanese population. In Hokkaido , an epidemic of smallpox introduced by Japanese settlers is estimated to have killed 34% of the native Ainu population in 1845. SARS-CoV-2 , a new strain of coronavirus , was first detected in the city of Wuhan, Hubei Province , China, in December 2019. The outbreak was characterized as a Public Health Emergency of International Concern (PHEIC) between January 2020 and May 2023 by WHO. The number of people infected with COVID-19 has reached more than 767 million worldwide, with a death toll of 6.9 million. [lower-alpha 3] It is considered likely that the virus will eventually become endemic and, like the common cold, cause less severe disease for most people. HIV/AIDS was first identified as a disease in 1981, and is an ongoing worldwide public health issue. Since then, HIV/AIDS has killed an estimated 40 million people with a further 630,000 deaths annually; 39 million people are currently living with HIV infection. [lower-alpha 4] HIV has a zoonotic origin, having originated in nonhuman primates in Central Africa and transferred to humans in the early 20th century. The most frequent mode of transmission of HIV is through sexual contact with an infected person. There may be a short period of mild, nonspecific symptoms followed by an asymptomatic (but nevertheless infectious) stage called clinical latency - without treatment, this stage can last between 3 and 20 years. The only way to detect infection is by means of a HIV test. There is no vaccine to prevent HIV infection, but the disease can be held in check by means of antiretroviral therapy . SARS-CoV-2 , a new strain of coronavirus , was first detected in the city of Wuhan, Hubei Province , China, in December 2019. The outbreak was characterized as a Public Health Emergency of International Concern (PHEIC) between January 2020 and May 2023 by WHO. The number of people infected with COVID-19 has reached more than 767 million worldwide, with a death toll of 6.9 million. [lower-alpha 3] It is considered likely that the virus will eventually become endemic and, like the common cold, cause less severe disease for most people. HIV/AIDS was first identified as a disease in 1981, and is an ongoing worldwide public health issue. Since then, HIV/AIDS has killed an estimated 40 million people with a further 630,000 deaths annually; 39 million people are currently living with HIV infection. [lower-alpha 4] HIV has a zoonotic origin, having originated in nonhuman primates in Central Africa and transferred to humans in the early 20th century. The most frequent mode of transmission of HIV is through sexual contact with an infected person. There may be a short period of mild, nonspecific symptoms followed by an asymptomatic (but nevertheless infectious) stage called clinical latency - without treatment, this stage can last between 3 and 20 years. The only way to detect infection is by means of a HIV test. There is no vaccine to prevent HIV infection, but the disease can be held in check by means of antiretroviral therapy . Historical accounts of epidemics are often vague or contradictory in describing how victims were affected. A rash accompanied by a fever might be smallpox, measles, scarlet fever, or varicella , and it is possible that epidemics overlapped, with multiple infections striking the same population at once. It is often impossible to know the exact causes of mortality, although ancient DNA studies can sometimes detect residues of certain pathogens. It is assumed that, prior to the neolithic revolution around 10,000 BC, disease outbreaks were limited to a single family or clan, and did not spread widely before dying out. The domestication of animals increased human-animal contact, increasing the possibility of zoonotic infections. The advent of agriculture, and trade between settled groups, made it possible for pathogens to spread widely. As population increased, contact between groups became more frequent. A history of epidemics maintained by the Chinese Empire from 243 B.C. to 1911 A.C. shows an approximate correlation between the frequency of epidemics and the growth of the population. Here is an incomplete list of known epidemics which spread widely enough to merit the title "pandemic".Beginning from the Middle Ages, encounters between European settlers and native populations in the rest of the world often introduced epidemics of extraordinary virulence. Settlers introduced novel diseases which were endemic in Europe, such as smallpox , measles , pertussis .and influenza , to which the indigenous peoples had no immunity. The Europeans infected with such diseases typically carried them in a dormant state , were actively infected but asymptomatic , or had only mild symptoms. Smallpox was the most destructive disease that was brought by Europeans to the Native Americans, both in terms of morbidity and mortality. The first well-documented smallpox epidemic in the Americas began in Hispaniola in late 1518 and soon spread to Mexico. Estimates of mortality range from one-quarter to one-half of the population of central Mexico. It is estimated that over the 100 years after European arrival in 1492, the indigenous population of the Americas dropped from 60 million to only 6 million, due to a combination of disease, war, and famine. The majority these deaths are attributed to successive waves of introduced diseases such as smallpox, measles, and typhoid fever. In Australia , smallpox was introduced by European settlers in 1789 devastating the Australian Aboriginal population, killing an estimated 50% of those infected with the disease during the first decades of colonisation. In the early 1800s, measles, smallpox and intertribal warfare killed an estimated 20,000 New Zealand Māori . In 1848–49, as many as 40,000 out of 150,000 Hawaiians are estimated to have died of measles , whooping cough and influenza . Measles killed more than 40,000 Fijians , approximately one-third of the population, in 1875, and in the early 19th century devastated the Great Andamanese population. In Hokkaido , an epidemic of smallpox introduced by Japanese settlers is estimated to have killed 34% of the native Ainu population in 1845. Prevention of future pandemics requires steps to identify future causes of pandemics and to take preventive measures before the disease moves uncontrollably into the human population. For example, influenza is a rapidly evolving disease which has caused pandemics in the past and has potential to cause future pandemics. WHO collates the findings of 144 national influenza centres worldwide which monitor emerging flu viruses. Virus variants which are assessed as likely to represent a significant risk are identified and can then be incorporated into the next seasonal influenza vaccine program. In a press conference on 28 December 2020, Mike Ryan, head of the WHO Emergencies Program, and other officials said the current COVID-19 pandemic is "not necessarily the big one" and "the next pandemic may be more severe." They called for preparation. WHO and the UN have warned the world must tackle the cause of pandemics and not just the health and economic symptoms. There is always a possibility that a disease which has caused epidemics in the past may return in the future. It is also possible that little known diseases may become more virulent; in order to encourage research, a number of organisations which monitor global health have drawn up lists of diseases which may have pandemic potential; see table below. [lower-alpha 5] Coronavirus diseases are a family of usually mild illnesses in humans, including those such as the common cold , that have resulted in outbreaks and pandemics such as the 1889-1890 pandemic , the 2002–2004 SARS outbreak , Middle East respiratory syndrome–related coronavirus and the COVID-19 pandemic . There is widespread concern that members of the coronavirus family, particularly SARS and MERS have the potential to cause future pandemics. Many human coronaviruses have zoonotic origin, their with natural reservoir in bats or rodents, leading to concerns for future spillover events. Following the end of the COVID-19 pandemic Public Health Emergency of International Concern deceleration by WHO, WHO Director General Tedros Ghebreyesus stated he would not hesitate to re-declare COVID-19 a PHEIC should the global situation worsen in the coming months or years. Influenza was first described by the Greek physician Hippocrates in 412 BC. Since the Middle Ages, influenza pandemics have been recorded every 10 to 30 years as the virus mutates to evade immunity. Influenza is an endemic disease , with a fairly constant number of cases which vary seasonally and can, to a certain extent, be predicted. In a typical year, 5–15% of the population contracts influenza. There are 3–5 million severe cases annually, with up to 650,000 respiratory-related deaths globally each year. The 1889–1890 pandemic is estimated to have caused around a million fatalities, and the " Spanish flu " of 1918–1920 eventually infected about one-third of the world's population and caused an estimate 50 million fatalities. The Global Influenza Surveillance and Response System is a global network of laboratories that has for purpose to monitor the spread of influenza with the aim to provide WHO with influenza control information. More than two million respiratory specimens are tested by GISRS annually to monitor the spread and evolution of influenza viruses through a network of about 150 laboratories in 114 countries representing 91% of the world's population. Antibiotic-resistant microorganisms, which sometimes are referred to as " superbugs ", may contribute to the re-emergence of diseases with pandemic potential that are currently well controlled. For example, cases of tuberculosis that are resistant to traditionally effective treatments remain a cause of great concern to health professionals. Every year, nearly half a million new cases of multidrug-resistant tuberculosis (MDR-TB) are estimated to occur worldwide. China and India have the highest rate of MDR-TB. WHO reports that approximately 50 million people worldwide are infected with MDR-TB, with 79 percent of those cases resistant to three or more antibiotics. Extensively drug-resistant tuberculosis ( XDR-TB ) was first identified in Africa in 2006 and subsequently discovered to exist in 49 countries. During 2021 there were estimated to be around 25,000 cases XDR-TB worldwide. In the past 20 years, other common bacteria including Staphylococcus aureus , Serratia marcescens and Enterococcus , have developed resistance to a wide range of antibiotics . Antibiotic-resistant organisms have become an important cause of healthcare-associated ( nosocomial ) infections. There are two groups of infectious disease that may be affected by climate change. The first group are vector-borne diseases which are transmitted via insects such as mosquitos or ticks. Some of these diseases, such as malaria , yellow fever , and dengue fever , can have potentially severe health consequences. Climate can affect the distribution of these diseases due to the changing geographic range of their vectors, with the potential to cause serious outbreaks in areas where the disease has not previously been known. The other group comprises water-borne diseases such as cholera, dysentery, and typhoid which may increase in prevalence due to changes in rainfall patterns. The October 2020 'era of pandemics' report by the United Nations ' Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services , written by 22 experts in a variety of fields, said the anthropogenic destruction of biodiversity is paving the way to the pandemic era and could result in as many as 850,000 viruses being transmitted from animals—in particular birds and mammals —to humans. The "exponential rise" in consumption and trade of commodities such as meat , palm oil , and metals, largely facilitated by developed nations, and a growing human population , are the primary drivers of this destruction. According to Peter Daszak , the chair of the group who produced the report, "there is no great mystery about the cause of the Covid-19 pandemic or any modern pandemic. The same human activities that drive climate change and biodiversity loss also drive pandemic risk through their impacts on our environment." Proposed policy options from the report include taxing meat production and consumption, cracking down on the illegal wildlife trade, removing high-risk species from the legal wildlife trade, eliminating subsidies to businesses that are harmful to the natural world, and establishing a global surveillance network. In June 2021, a team of scientists assembled by the Harvard Medical School Center for Health and the Global Environment warned that the primary cause of pandemics so far, the anthropogenic destruction of the natural world through such activities including deforestation and hunting , is being ignored by world leaders. Permafrost covers a fifth of the northern hemisphere and is made up of soil that has been kept at temperatures below freezing for long periods. Viable samples of viruses have been recovered from thawing permafrost, after having been frozen for many years, sometimes for millennia. There is a remote possibility that a thawed pathogen could infect humans or animals. There is always a possibility that a disease which has caused epidemics in the past may return in the future. It is also possible that little known diseases may become more virulent; in order to encourage research, a number of organisations which monitor global health have drawn up lists of diseases which may have pandemic potential; see table below. [lower-alpha 5] Coronavirus diseases are a family of usually mild illnesses in humans, including those such as the common cold , that have resulted in outbreaks and pandemics such as the 1889-1890 pandemic , the 2002–2004 SARS outbreak , Middle East respiratory syndrome–related coronavirus and the COVID-19 pandemic . There is widespread concern that members of the coronavirus family, particularly SARS and MERS have the potential to cause future pandemics. Many human coronaviruses have zoonotic origin, their with natural reservoir in bats or rodents, leading to concerns for future spillover events. Following the end of the COVID-19 pandemic Public Health Emergency of International Concern deceleration by WHO, WHO Director General Tedros Ghebreyesus stated he would not hesitate to re-declare COVID-19 a PHEIC should the global situation worsen in the coming months or years. Influenza was first described by the Greek physician Hippocrates in 412 BC. Since the Middle Ages, influenza pandemics have been recorded every 10 to 30 years as the virus mutates to evade immunity. Influenza is an endemic disease , with a fairly constant number of cases which vary seasonally and can, to a certain extent, be predicted. In a typical year, 5–15% of the population contracts influenza. There are 3–5 million severe cases annually, with up to 650,000 respiratory-related deaths globally each year. The 1889–1890 pandemic is estimated to have caused around a million fatalities, and the " Spanish flu " of 1918–1920 eventually infected about one-third of the world's population and caused an estimate 50 million fatalities. The Global Influenza Surveillance and Response System is a global network of laboratories that has for purpose to monitor the spread of influenza with the aim to provide WHO with influenza control information. More than two million respiratory specimens are tested by GISRS annually to monitor the spread and evolution of influenza viruses through a network of about 150 laboratories in 114 countries representing 91% of the world's population. Coronavirus diseases are a family of usually mild illnesses in humans, including those such as the common cold , that have resulted in outbreaks and pandemics such as the 1889-1890 pandemic , the 2002–2004 SARS outbreak , Middle East respiratory syndrome–related coronavirus and the COVID-19 pandemic . There is widespread concern that members of the coronavirus family, particularly SARS and MERS have the potential to cause future pandemics. Many human coronaviruses have zoonotic origin, their with natural reservoir in bats or rodents, leading to concerns for future spillover events. Following the end of the COVID-19 pandemic Public Health Emergency of International Concern deceleration by WHO, WHO Director General Tedros Ghebreyesus stated he would not hesitate to re-declare COVID-19 a PHEIC should the global situation worsen in the coming months or years.Influenza was first described by the Greek physician Hippocrates in 412 BC. Since the Middle Ages, influenza pandemics have been recorded every 10 to 30 years as the virus mutates to evade immunity. Influenza is an endemic disease , with a fairly constant number of cases which vary seasonally and can, to a certain extent, be predicted. In a typical year, 5–15% of the population contracts influenza. There are 3–5 million severe cases annually, with up to 650,000 respiratory-related deaths globally each year. The 1889–1890 pandemic is estimated to have caused around a million fatalities, and the " Spanish flu " of 1918–1920 eventually infected about one-third of the world's population and caused an estimate 50 million fatalities. The Global Influenza Surveillance and Response System is a global network of laboratories that has for purpose to monitor the spread of influenza with the aim to provide WHO with influenza control information. More than two million respiratory specimens are tested by GISRS annually to monitor the spread and evolution of influenza viruses through a network of about 150 laboratories in 114 countries representing 91% of the world's population. Antibiotic-resistant microorganisms, which sometimes are referred to as " superbugs ", may contribute to the re-emergence of diseases with pandemic potential that are currently well controlled. For example, cases of tuberculosis that are resistant to traditionally effective treatments remain a cause of great concern to health professionals. Every year, nearly half a million new cases of multidrug-resistant tuberculosis (MDR-TB) are estimated to occur worldwide. China and India have the highest rate of MDR-TB. WHO reports that approximately 50 million people worldwide are infected with MDR-TB, with 79 percent of those cases resistant to three or more antibiotics. Extensively drug-resistant tuberculosis ( XDR-TB ) was first identified in Africa in 2006 and subsequently discovered to exist in 49 countries. During 2021 there were estimated to be around 25,000 cases XDR-TB worldwide. In the past 20 years, other common bacteria including Staphylococcus aureus , Serratia marcescens and Enterococcus , have developed resistance to a wide range of antibiotics . Antibiotic-resistant organisms have become an important cause of healthcare-associated ( nosocomial ) infections. There are two groups of infectious disease that may be affected by climate change. The first group are vector-borne diseases which are transmitted via insects such as mosquitos or ticks. Some of these diseases, such as malaria , yellow fever , and dengue fever , can have potentially severe health consequences. Climate can affect the distribution of these diseases due to the changing geographic range of their vectors, with the potential to cause serious outbreaks in areas where the disease has not previously been known. The other group comprises water-borne diseases such as cholera, dysentery, and typhoid which may increase in prevalence due to changes in rainfall patterns. The October 2020 'era of pandemics' report by the United Nations ' Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services , written by 22 experts in a variety of fields, said the anthropogenic destruction of biodiversity is paving the way to the pandemic era and could result in as many as 850,000 viruses being transmitted from animals—in particular birds and mammals —to humans. The "exponential rise" in consumption and trade of commodities such as meat , palm oil , and metals, largely facilitated by developed nations, and a growing human population , are the primary drivers of this destruction. According to Peter Daszak , the chair of the group who produced the report, "there is no great mystery about the cause of the Covid-19 pandemic or any modern pandemic. The same human activities that drive climate change and biodiversity loss also drive pandemic risk through their impacts on our environment." Proposed policy options from the report include taxing meat production and consumption, cracking down on the illegal wildlife trade, removing high-risk species from the legal wildlife trade, eliminating subsidies to businesses that are harmful to the natural world, and establishing a global surveillance network. In June 2021, a team of scientists assembled by the Harvard Medical School Center for Health and the Global Environment warned that the primary cause of pandemics so far, the anthropogenic destruction of the natural world through such activities including deforestation and hunting , is being ignored by world leaders. Permafrost covers a fifth of the northern hemisphere and is made up of soil that has been kept at temperatures below freezing for long periods. Viable samples of viruses have been recovered from thawing permafrost, after having been frozen for many years, sometimes for millennia. There is a remote possibility that a thawed pathogen could infect humans or animals. In 2016, the commission on a Global Health Risk Framework for the Future estimated that pandemic disease events would cost the global economy over $6 trillion in the 21st century—over $60 billion per year. The same report recommended spending $4.5 billion annually on global prevention and response capabilities to reduce the threat posed by pandemic events, a figure that the World Bank Group raised to $13 billion in a 2019 report. It has been suggested that such costs be paid from a tax on aviation rather than from, e.g., income taxes, given the crucial role of air traffic in transforming local epidemics into pandemics (being the only factor considered in state-of-the-art models of long-range disease transmission ). The COVID-19 pandemic is expected to have a profound negative effect on the global economy , potentially for years to come, with substantial drops in GDP accompanied by increases in unemployment noted around the world. The slowdown of economic activity early in the COVID-19 pandemic had a profound effect on emissions of pollutants and greenhouse gases. Analysis of ice cores taken from the Swiss Alps have revealed a reduction in atmospheric lead pollution over a four-year period corresponding to the years 1349 to 1353 (when the Black Death was ravaging Europe), indicating a reduction in mining and economic activity generally.

Wiki