CDC’S RESPONSE TO THE

West African Ebola Epidemic

2014–2015
Sierra Leone’s Deputy Minister of Foreign Affairs and International Cooperation, Dr. Ebun Strasser-King, and Dr. Tom Frieden, CDC Director, meet when she visited CDC 

in November 2014. 
The Long Road

The 2014 Ebola epidemic in West Africa is the first in history. The first case was reported in Guinea 

in March 2014, and the disease spread in the neighboring countries of Liberia and Sierra Leone. Over 

the span of a year, the Ebola epidemic has caused more than 10 times as many cases of Ebola than 

the combined total of all those reported in previous Ebola outbreaks. As the outbreak became more 

widespread, travel-associated cases appeared in Nigeria, Mali, Senegal, and even countries outside 

Africa, including the United States. Overall, nine countries have reported cases of Ebola, more than 

27,000 people have had suspected, probable, or confirmed Ebola, and more than 11,000 have died. 

These numbers are likely to be even higher, as many cases have gone undiagnosed and unreported.

Not only has this epidemic been unprecedented, but so has the public health response launched by 

CDC and its partners. Within a week of the initial report of Ebola, CDC had an expert team on the 

ground in Guinea. Over the past year, CDC has sent more than 1,000 employees to Guinea, Liberia, 

and Sierra Leone, many of whom have gone more than once. Thousands more have worked on the 

response from the agency’s headquarters in Atlanta, Georgia, other areas in the United States, and 

other countries around world. CDC hasn’t done this work alone—in every aspect 

of the response, CDC has collaborated with partners, such as the ministries of 

health in West Africa, the World Health Organization, CDC Foundation, other 

parts of the U.S. government, U.S. Agency for International Development (USAID), 

Doctors Without Borders (MSF), and other non-profit organizations.

The Ebola epidemic has been one of the most challenging global public health 

emergencies in recent times. The size and scope of this epidemic illustrate the 

need for stronger, sustainable disease detection and prevention capacity worldwide. 

On May 9, 2015, more than a year after the outbreak began, the World Health 

Organization declared the end of the Ebola outbreak in Liberia, but at the end of 

June, a new case was reported. Cases continue to be reported in Guinea and Sierra 

Leone. The situation in Liberia shows how important it is to maintain surveillance 

and response capacity even after an outbreak is over. CDC continues to work in 

West Africa with the goal of stopping new cases in the affected countries and 

keeping them from spreading. 

July 9, 2015, marks the one-year anniversary of CDC’s activation and response 

to the Ebola epidemic. Many important partners have responded to the Ebola 

epidemic, and CDC has worked closely with many of these organizations. Rather 

than reflecting the overall world response, this report documents CDC’s work 

during the outbreak, through the stories of our responders.

“It’s like fighting a forest fire. 

Leave behind one burning ember 

and the epidemic could re-ignite. 

That ember could be one case 

undetected, one contact not 

traced or healthcare worker not 

effectively protected, or one burial 

ceremony conducted unsafely.”

Dr. Tom Frieden, CDC Director, August 20, 2014

Rebecca Merrill 

prepares to deploy 

to West Africa to 

support the Ebola 

response.

1
RITE (Rapid Isolation and Treatment of Ebola) team members take a canoe on the last leg of their day-long journey to a remote village with suspected Ebola cases. 

2
“You’ll see that over the past 

20 years, if infected people are 

removed from the community 

within the first two or three days 

of the disease, you can stop the 

chain of transmission.”

Pierre Rollin, Deputy Branch Chief, 

Viral Special Pathogens Branch, CDC

Tracing Contacts 

Contact tracing is a key part of this outbreak. Because the natural reservoir host of Ebola has not 

yet been identified, we don’t know for sure how the virus spreads to humans at the start of an 

outbreak. However, scientists believe that the first patient becomes infected through some kind of 

contact with an infected animal, such as a fruit bat or primate (apes and monkeys). Person-to-person 

transmission follows and can lead to large numbers of cases. 

Experience has taught us that rapid case finding, paired with proper infection control, is critical to 

stop the spread of Ebola. CDC and partners are using contact tracing to identify new Ebola cases 

quickly, which increases patients’ chances of survival, and to isolate patients as soon as they show 

symptoms, which prevents spread to others. Even one missed contact can mean Ebola will continue 

to spread because sick people need care from others. Contact tracing works—it’s been used in each 

of the previous 20 Ebola outbreaks over the past 40 years to successfully control Ebola. During this 

outbreak, success stories from Mali, Nigeria, and Senegal have shown how effective contact tracing 

can be in containing outbreaks. 

David Blackley, CDC 

responder, prepares 

to board a U.S. Army 

helicopter to travel 

to a remote village in 

Liberia as part of a 

RITE (Rapid Isolation 

and Treatment of 

Ebola) team.

3
Contact tracing is the laborious job 

of finding all those who came into 

contact with an Ebola patient and 

checking them for symptoms every day for 

21 days. It is slow, painstaking work, but 

Kari Yacisin, a CDC responder who was 

deployed to Guinea, knows that effective 

contact tracing can make a difference. 

If any of these contacts turn out to be 

infected, their contacts have to be traced 

as well—and so on, until the outbreak is 

contained. The number of contacts can 

be daunting, especially if the patient isn’t 

recognized quickly and separated from 

other people. 

“We must continue educating the 

community, maintaining relationships and 

building trust within the community to get 

control of this outbreak,” said Kari.

Kari Yacisin heads to a remote village in Guinea to complete a day of contact tracing with her team.

4
Ambulance chasing is a discouraged 

practice in the United States—but in 

Liberia it’s exactly what Neil Vora, a 

CDC responder, had to do as part of his efforts 

to stop the spread of Ebola at its source.

“We would follow ambulances that were called 

to pick up patients with suspected Ebola cases. 

We would keep our distance and observe 

how they collected patients and would make 

corrections to any lapse in infection control. 

As soon as the ambulance left we would start 

the contact tracing investigation,” said Neil. 

Neil recently returned from a month working 

in Liberia, during which time he was based in 

Bomi County, a rural area about two hours 

away from Liberia’s capital.

Rapidly identifying contacts of patients with 

Ebola is a key component to stopping the 

spread of the virus. Each patient with Ebola 

can have 10 or more contacts, all of whom 

need to be monitored for 21 days. “If you skip 

just one day, it might be the day the contact 

comes down with Ebola and a whole new chain 

of Ebola transmission can start all over again,” 

Neil said.

More than 100 Ebola cases were identified 

in Bomi County, and while Neil was there, 

he helped local health officials monitor the 

hundreds of contacts from all of these 

Ebola cases. 

Neil Vora prepares for the two-and-half hour drive to Bomi County in Liberia.

5
CDC RITE (Rapid Isolation and Treatment of Ebola) team members would camp in rural communities for several days during 

their outbreak investigation. This picture shows their office in the field.

Several factors contributed to the Ebola 

epidemic in West Africa, and it has 

taken a large number of partners and 

strategies to help get it under control.

Among these factors are health systems that 

were not prepared for an influx of Ebola cases 

and that had limited knowledge of the virus 

and its symptoms. Outbreaks in crowded urban 

centers also constantly seeded new outbreaks 

in remote areas. Satish Pillai, a CDC medical 

officer, was sent to Liberia to help solve some 

of these problems as part of a RITE (Rapid 

Isolation and Treatment of Ebola) team. 

RITE teams are mobilized to respond to remote 

villages and towns following reports of Ebola 

cases by local and county health officials. Their 

goal: stop the chain of Ebola transmission.

“Cases of Ebola in Liberia were showing 

up in remote areas. In many instances, 

someone who contracted Ebola in the capital 

city of Monrovia brought it back to their 

community,” said Satish. “This led to sustained 

transmission of the virus that was hard to 

stop because it was so difficult to reach these 

communities.” RITE teams not only work on 

active case finding and contact tracing but 

also identify the basic sanitation and food 

needs in communities.

“One of the communities we visited was 

banned from the closest market because 

of Ebola fears. We called in the World Food 

Program to help. Another community had 

broken water pumps and could not access 

safe water. We found partners that could fix 

the pump,” Satish said. 

6
Dan Martin, a CDC responder deployed 

for a month to Sierra Leone, said that 

the shadow of Ebola was constantly 

present during his time there. His job involved 

frequent contact with local health workers as 

he helped them improve their ability to detect, 

investigate, and follow up on cases. 

“We’re learning in this outbreak that Ebola is 

not always a death sentence. We’re learning 

how to care for patients so more people can 

live through it,” he said. “Getting to people 

early before they are so sick that they can’t be 

treated will not only improve survival rates but 

also prevent the virus from spreading.”

Dan formed friendships from a distance while 

there. “It’s this very strange juxtaposition 

where on one hand you are always conscious 

of not touching people, of not getting too 

close in a crowd, of constantly sanitizing your 

hands—and on the other hand you’re living very 

happy, collegial lives,” he said.

By the time he left, his team of local health 

workers was prepared to contain clusters of 

Ebola cases—a job that relies on community 

cooperation.

“I recently heard from the CDC staffer who 

replaced me that the team discovered 30 

unreported Ebola cases in a single village,” 

Dan said. “The health official in the village 

thought Ebola was witchcraft and intentionally 

kept their outbreak a secret.” 

Dan Martin (center) crosses a river in Sierra Leone on a human-powered ferry with colleagues Mohamed Okala Sankoh 

and James Fornah. One Land Cruiser, one motorcycle, and about a dozen people were pulled across this river. 7
Kim Lindblade, a CDC epidemiologist, 

deployed to Liberia to investigate 

possible Ebola outbreaks in hard-toreach places. If she saw cases of Ebola, 

her team would quickly start active case 

finding and contact tracing to limit spread 

of the disease.

“Earlier in the epidemic, most Ebola cases 

were in the densely populated city of Monrovia, 

but we found as it continued patients would 

leave and go back to their rural homes, causing 

outbreaks that were far from Ebola treatment 

units (ETUs),” Kim said.

CDC worked with ministry of health colleagues 

to isolate patients with cases of Ebola and 

arrange their safe transport to the nearest ETU 

and then track down their contacts.

 “Over time, we started hearing about rural 

outbreaks faster. At the beginning, it could take 

weeks to hear about the first case, but by the 

time I left in late December, we were hearing 

about them within the first few days of illness. 

This led to outbreaks being resolved quicker, 

in less than half the time,” she said.

Kim recalls a report of two very sick people who 

had driven from Monrovia in a car with a patient 

suspected to have Ebola. When they arrived at 

the patient’s home, Kim and her team found 

more than 20 people living in the house.

“It was late in the evening and we had to 

scramble to buy chlorine and buckets to help 

them disinfect the home. We worked with the 

county health team to move the people to a 

quarantine facility the next day, and 21 days 

later every one of them left without becoming 

sick with Ebola,” she said. 

Kim Lindblade and her team were dropped off in a football field near Geleyansiesu, Liberia, by a U.S. military helicopter. 

The remote village had many Ebola-related deaths. 8
An “Ebola is Real” campaign poster in a Liberian village.

9
CDC artist’s rendering of the Ebola virus. There are five identified Ebola virus species, four of which are known to cause disease in humans.

10
Ebola by the Numbers

27,000+

Total number

of cases

11,000+

Total number

of deaths

24,665

Health workers trained 

by CDC in West Africa

2,471

CDC deployments

to West Africa

650

U.S. healthcare workers 

trained in Anniston

4

Patients diagnosed with 

Ebola in the U.S.

11

U.S. Patients with Ebola 

treated in the U.S.

150,000

U.S. healthcare workers 

trained by webinars and calls

59,665,191

Number of views for CDC’s Ebola website

EBOLA

11
Lindsey Horton, CDC responder, demonstrates how to clean up infected body fluids at an Ebola treatment unit in Guinea.

12
Strengthening Health Care 

and Preventing Infections 

Effective infection control can protect communities and the healthcare workers who serve them. 

Before the Ebola outbreak, infection control in health facilities in Guinea, Liberia, and Sierra Leone 

was often minimal at best. Fragile healthcare systems added to the rapid spread of the virus and 

made it difficult to contain the epidemic. In addition, community behaviors needed to change to 

keep people from getting Ebola when caring for people who were sick or participating in traditional 

burials. Responders on the ground in West Africa have been working closely with partners and 

the ministries of health to provide training and health education to reduce the spread of disease. 

In addition to training, CDC and partners hosted innovative microplanning sessions in Liberia, 

which focused on early detection and safe isolation of patients, safe burials, and infection control 

in healthcare settings.

When the first case of Ebola was diagnosed in the 

United States, CDC worked to tighten infection 

control procedures. We used the knowledge gained 

from managing this case to improve preparation of 

healthcare workers and hospitals around the country.

“We simulated triage of 

people with unknown Ebola 

status, putting on and taking 

off authentic ETU protective 

equipment, drawing blood 

from a patient with confirmed 

Ebola, transporting a body to 

the morgue, and cleaning up 

contaminated body fluids”

Kim Newsome, instructor at training course, 

Anniston, Alabama

The inside of a mock 

Ebola treatment unit at 

CDC’s training course 

for healthcare workers 

in Anniston, Alabama.

13
The mock Ebola treatment unit (ETU) 

was a sparse, low-technology space 

that contrasted sharply with the 

high technology protective equipment ETU 

workers must wear every day. Bright yellow 

suits, orange plastic dividers, hospital 

cots, and antiseptic sprayers filled the unit, 

copying every detail of the West African 

ETUs where volunteer clinicians work. From 

the hand washing station at the entrance 

to the station where personal protective 

equipment is removed, the simulated unit 

made Kim Newsome feel as if she had been 

transported to another place. 

Kim left a desk job at CDC where data and 

research drives her day, and the effects 

of her work are several steps removed. In 

Anniston, the purpose of her work had a 

face—the ETU volunteer who would soon be 

traveling to West Africa. As an instructor, 

Kim’s goal was to provide mock experiences 

that a real ETU worker might face every day. 

During exercises, most trainers met the 

students in the same way a patient in 

the ETU would see them—dressed in full 

protective gear. Staring into the goggled 

and sometimes anxious eyes of soon-to-be 

ETU clinicians brought the purpose of their 

work into sharp focus. The trainers were 

driven by a common goal of providing 

lifesaving information for people traveling 

to West Africa to care for patients there.

A group of students evaluates how to move a “patient” into the mock ETU at CDC’s training course in Anniston, Alabama.

14
Kwan Kew Lai, a graduate of CDC’s 

training course in Anniston, Alabama, 

served as a doctor with the 

International Medical Corps in an ETU in 

Liberia. She knew the work was going to be 

dangerous, but she also knew her skills were 

desperately needed.

Each day, Kwan Kew had to use her training, 

meticulously donning and doffing her PPE, a 

process that took 15 to 20 minutes each time. 

Even with temperatures reaching 89°F during 

training in Alabama, those conditions were 

nothing like the humid weather the trainees 

would face in West Africa.

The physical demands, weather, and hot gear 

worn in the ETU were not the only challenges 

Kwan Kew faced. It was hard for her to care 

for patients and encourage them to be hopeful 

while being encumbered by PPE.

“What makes it even more poignant is that 

when the patients need close human contact 

the most, in times of extreme suffering, pain, 

and fear, there is none to offer except with

a barrier of protective covering,” she said.

“In the beginning, it hit home to me that there 

was a real possibility of a true exposure; 

however, as time went on, inspired by the 

persistence, dedication, and selfless caring 

of my colleagues, that fear was pushed to the 

back of my mind and the goal of getting

the patients better overwhelmingly became

my main concern.”

A staff member rests outside an Ebola treatment center.

15
Channeling the mentality of a scuba 

diver helped Karen Wong work safely 

and effectively inside an ETU. Karen 

was part of the first team deployed to work 

at the Monrovia Medical Unit in Liberia. 

“Once you put your personal protective 

equipment on, your countdown starts in 

terms of how long you’re able to stay in 

there comfortably,” she explained. Like a 

diver underwater, she needed to go into the 

ETU with a dive plan. “It’s important to figure 

out what everyone needed to do before 

entering the ETU,” she added.

Karen did not dive head first into the 

ETU. “Part of what let me keep going with 

doing this kind of scary, high risk work was 

knowing that I had been trained really well 

in keeping myself safe.” She was one of the 

650 healthcare workers who participated 

in the 3-day training course in Anniston, 

Alabama, that taught medical professionals 

about personal protective equipment, how 

to use it, and how to stay safe as they 

administered care to patients with Ebola.

“One thing they really focused on during 

training was our personal safety. If you 

compromise your safety while treating your 

first patient, you won’t be able to help the 

next one,” said Karen.

Karen Wong ready to admit a patient at the Monrovia Medical Unit in Monrovia, Liberia.

16
When thinking about infection control 

in Guinea, it’s helpful to picture 

the average health facility in that 

country. It’s usually one to two rooms, it 

doesn’t have electricity or running water, and 

it’s crowded with sick patients.

Heidi Soeters and Lindsey Horton, both CDC 

responders, implemented an infection control 

training course for Guinean healthcare workers.

“Our infection control program trains frontline 

healthcare workers, everyone from doctors 

and nurses to janitors and ambulance drivers. 

The training included hands-on exercises 

in hand washing, triage of patients, putting 

on protective equipment, and cleaning up 

contaminated fluids,” Lindsey said.

Heidi and Lindsey served as technical advisors 

for the training sponsor, Catholic Relief 

Services. Students were recruited from nearby 

health facilities, but on the first day of training, 

people came from as far as 25 miles away.

“On the first day of the course, we had 80 

students enrolled, but more than 100 more 

showed up eager to be trained and begging 

to have a spot in the course. Fortunately, we 

were able to add more sessions to cover all 

healthcare workers in three priority regions 

of Guinea,” Lindsey said. “These efforts 

have the added benefit of being important 

not just in the context of an Ebola epidemic, 

but also because they are creating lasting 

improvements in infection control that should 

be there for years to come.” 

Close to 250 people showed up for the first day of Heidi Soeters’ and Lindsey Horton’s training.

17
One thing that comes with an outbreak 

is a need to bury bodies. With Ebola, 

this cannot be done casually because 

corpses are the most infectious thing out 

there. “If you come into contact with the 

dead body of an Ebola victim, you are very 

likely to get Ebola yourself. Therefore, people 

need to be specifically trained on how to 

bury bodies of people who died from Ebola,” 

said Leisha Nolen, CDC responder. They 

are trained how to put on protective suites, 

masks, goggles, and gloves; how to collect 

bodies; how to wrap the corpses; and how 

to bury them. Keep in mind, the people on 

burial teams usually work on farms or building 

houses—burying bodies is not their usual job, 

so all of this is as terrible to them as it would 

be to you. And it turns out that the obvious 

part of their job, putting on the equipment 

and burying the bodies, is not the most 

difficult part of their job. Instead, it is the part 

no one expected that is the hardest: the part 

where the teams have to convince families 

that taking their loved one to be buried is the 

right thing to do. In Sierra Leone, washing 

and burying the dead is an important part of 

honoring their family. 

“Burial teams told me over and over how they 

had to sit and talk to families for hours before 

the family would let them take the corpse 

away for safe burial,” Leisha explained. “And 

they would sit and talk for hours just to make 

a family understand why it was helping the 

whole community to allow their loved one to 

be buried without the usual ritual.”

A burial team buries an Ebola victim in Sierra Leone. 

18
During the response, John Brooks, lead 

for CDC’s Ebola Response Medical Care 

Task Force, was responsible for teaching 

U.S. doctors, nurses, and the general public 

about how Ebola spreads and how to prevent 

infection. He and his team led dozens of calls 

with hospitals on the science behind Ebola and 

taught them how to evaluate patients reporting 

symptoms of the virus. 

“It was a hectic time. The public had been 

seized with fear of Ebola, and we were doing 

our best to manage that fear with sciencebased information,” said John.

 “I learned a powerful lesson during my Ebola 

work, and that is the power of fear. Fear is a 

natural emotion; it’s supposed to protect us 

from injury or infection. When you see that 

lion, you run! But too much fear can be a bad 

thing. It was our responsibility to understand 

the science behind Ebola and use that to 

encourage positive action, not panic,” he said.

“To understand an epidemic, you often need 

the 35,000-foot view, looking for trends and 

patterns,” John said. “But you also need to 

find out what’s going on at ground level, 

what’s happening to the people at risk of, 

and being affected by, the condition you’re 

trying to prevent.”

John Brooks was the lead of CDC’s Ebola Medical Care Task Force in September–October 2014 and March 2015. 

19
One of the ways CDC helped to prepare 

U.S. hospitals for a possible patient 

with Ebola was by sending teams 

of CDC experts in infection prevention and 

control, occupational health, and diagnostic 

laboratory practices—called Rapid Ebola 

Preparedness (REP) teams—to 81 facilities 

in 21 states and Washington, DC, to assess 

their readiness for caring for patients with 

Ebola. Ron Hall, an Ebola responder based 

in CDC’s National Institute for Occupational 

Safety and Health, was part of one of these 

REP teams. He visited U.S. hospitals to 

evaluate their readiness to safely care for 

a patient with Ebola. “You’re working in 

hospitals versus a disaster site, but from an 

occupational safety and health point of view, 

we’re still looking out for the workers, which 

are healthcare workers,” he said.

REP teams were composed of 4 to 10 CDC 

experts in infection control, occupational 

health, and laboratory issues, as well as 

external local experts. According to Ron, 

“this holistic approach was very important 

in helping these hospitals achieve what they 

need to achieve: taking care of patients with 

Ebola safely and efficiently without getting 

anyone else sick.” 

The United States has expanded its network 

of hospitals prepared and certified to treat 

Ebola patients, increasing capacity from just 

three facilities to 55 facilities in 17 states 

and Washington, DC.

Healthcare workers practice providing care for a patient with Ebola in a mock scenario.

20
When the first case of Ebola was 

diagnosed in the United States, 

and two nurses became infected 

with the disease, a group at CDC worked 

quickly to create training on personal 

protective equipment for healthcare workers 

in the United States.

CDC worked with a diverse group of partners 

to provide Ebola infection control training 

to U.S. healthcare workers through a 

multifaceted approach. CDC and partners 

worked together to provide U.S. healthcare 

workers with the information they needed 

through web-based tools, daily calls, mobilefriendly training applications, live training 

events, and in-depth clinical trainings by 

experts at Emory University Hospital and 

Nebraska Medical Center. With strategic 

partners, CDC was able to reach more than 

150,000 healthcare workers. 

CDC also partnered with Partnership for 

Quality Care and healthcare unions to 

conduct live training events in New York City, 

Los Angeles, and Philadelphia, reaching more 

than 6,500 people in-person, and more than 

20,000 via live webcast. Additionally, CDC, 

Emory University Hospital, and Nebraska 

Medical Center trained more than 460 

healthcare workers from 87 healthcare 

systems, including 37 new Ebola treatment 

centers, on all aspects of infection control 

and care for patients with Ebola.

Brian Christiansen, CDC Infection Control Team (left), at an Ebola educational session or healthcare workers at the 

Jacob Javits Center in New York in October 2014. 21
CDC microbiologist James Graziano and virologist Johanna Salazar test blood samples for Ebola at CDC’s lab in Bo, Sierra Leone. 

22
Mobilizing Laboratories 

Laboratories, and the Ebola testing they perform, play a crucial role in responding to Ebola both in 

West Africa and in the United States. The results of each Ebola test can be life-changing for patients. 

A negative test result might mean release from a hospital or Ebola treatment unit (ETU) after a 

long illness for a survivor, or peace of mind for a person who might be worried they have Ebola. A 

positive test result could mean life-saving admittance to an ETU and information for loved ones and 

contact tracers to better understand and reduce risks of new potential Ebola cases. An effective lab 

infrastructure, therefore, is essential for countries to rapidly detect and contain Ebola cases. 

When lab responders arrived in Liberia and Sierra Leone, they identified a need for labs and quickly 

set up mobile labs in both countries. CDC runs a lab in Bo, Sierra Leone, jointly ran another lab in 

Liberia with the National Institutes of Health, and supports labs in Liberia with the U.S. Department 

of Defense. CDC’s Bo lab processed more than 2,000 samples in a 3-week 

period and has now processed more than 20,000 samples. In addition, CDC 

supports labs in Guinea, Liberia, and Sierra Leone by providing training, 

testing equipment, and supplies, as well as overseeing the transition of labs 

to ministries of health.

In the United States, CDC has increased the number of labs that are able to 

test for Ebola. Prior to this outbreak, Ebola could only be confirmed at the 

CDC lab in Atlanta, Georgia, or the lab at the U.S. Army Medical Research 

Institute of Infectious Diseases. Now, 56 Laboratory Response Network labs 

across the country are able to test for Ebola, more than quadrupling capacity 

and vastly decreasing the turnaround time for test results.

Staff process data 

from specimen results 

at the CDC lab in Bo, 

Sierra Leone.

“During our first days there, I 

went out to get samples from a 

person on a motorbike. He was 

very anxious because his whole 

district was worried about the 

result, which ended up positive, 

and we learned the next day that 

the patient had died. It brought 

home to me that what we were 

doing has life or death impacts.”

Brandy Russell, Ebola responder, Sierra Leone

23
CDC tries to set up labs close to 

treatment centers. “Usually Ebola 

treatment units are run by Doctors 

Without Borders (MSF),” said Ute Stroeher, 

a CDC laboratorian.

CDC epidemiologists who lead contact 

tracing teams often find people who have 

been exposed to patients with Ebola. If those 

people develop Ebola symptoms during their 

21-day monitoring period, such as a fever, 

they are brought back to the treatment 

centers where healthcare workers wearing 

personal protective equipment carefully take 

a blood sample and send it to the lab. Early 

and accurate testing is critical. If the sample 

tests negative, the patient is referred to a 

non-Ebola clinic for diagnosis and treatment 

and for follow-up testing if indicated. If the 

sample tests positive, the patient is isolated 

in a treatment center.

That isn’t the end of the lab’s contribution to 

helping patients with Ebola, though. Patients 

who survive Ebola must eventually leave the 

treatment center. That happens only when 

their bodies have cleared the virus and the 

lab test comes back negative.

“We had a very little girl, about a year and a 

half old, who got Ebola from her mother. We 

don’t have many kids that small survive—and 

this child was so ill everyone thought she 

wouldn’t make it,” said Ute. “But she pulled 

through. And finally, I had a negative test for 

her and she could leave the treatment center. 

That made my day.”

CDC staff spray a bleach solution on paperwork received from a rural health post at CDC’s lab in Bo, Sierra Leone.

24
I

n August 2014, CDC microbiologist Barry 

Fields was deployed to Liberia to help 

set up a new mobile lab in Monrovia in 

collaboration with the National Institutes 

of Health (NIH). Setting up a molecular 

diagnostics lab in the field without utilities 

or infrastructure is quite a challenge. 

When Barry’s team arrived in Monrovia, they 

realized very quickly that the outbreak had 

reached settlements in the city. A lab was 

critically needed in Monrovia to deal with these 

cases. The CDC-NIH team worked quickly to 

establish a mobile lab in close proximity to the 

ETU set up on the grounds of the Eternal Love 

Winning Africa (ELWA) Hospital. 

Although Barry has worked in many outbreak 

investigations, the situation in Liberia was 

particularly challenging for him. One of his 

greatest concerns was how close the lab was 

to the ETU and the many patients walking back 

and forth. This foot traffic posed contamination 

risks for him and his team. According to 

Barry, having a team in which all members 

had international experience and knew how to 

work in an emergency situation with limited 

resources made a huge difference. Because 

of their collective experience, they were able 

to quickly adjust and set up more than 700 

pounds of lab equipment that had been 

shipped to Liberia by CDC-Kenya.

Because of the heavy rains at that time in 

Monrovia, the mobile labs were eventually 

moved to a house formerly occupied by 

Samaritan’s Purse on the ELWA grounds. 

According to Barry, this facility is ideal, 

especially when compared to the tent they 

were in before.

The initial mobile lab set up by CDC and the National Institutes of Health in Monrovia, Liberia. 

25
I

n West Africa, lab samples can arrive 

by many different methods—motorbike, 

couriers, helicopters—and too often the lack 

of transportation makes it difficult to get the 

samples to the lab quickly.

John Saindon, a CDC laboratorian deployed to 

Liberia, worked with U.S. government partners 

to improve the alignment of U.S. government 

labs with the country’s ETUs. They reduced the 

amount of time it took to get test results from 

5 to 7 days to less than 24 hours, simply by 

reducing the amount of time it took for samples 

to reach the labs. 

Sometimes it wasn’t just about how quickly the 

samples reached the lab, but the state they 

were in when they got there. “The samples 

arrived in all different types of containers and 

weren’t always labeled well,” said Brian Bird, 

a CDC laboratorian deployed to Sierra Leone. 

“We had samples in coffee pots and glass jars. 

It was quite a challenge.”

Despite the challenges of working in and 

supporting the field labs in West Africa, 

both Brian and John found the experience 

to be rewarding.

“When we were in Kenema, one of the 

highlights of my public health career was 

when we discharged 12 to 14 children all at 

one time,” said Brian. “They were so full of 

life. It was like looking at the future of Sierra 

Leone after it had come through such a horrible 

tragedy, but there it was looking you right in 

the face.” 

John Saindon with members of the U.S. Army identifying Ebola lab sites in Greenville, Liberia.

26
L

ab Team 5 in Bo, Sierra Leone—the first 

and only all-woman team to run an Ebola 

testing lab in the heart of the epidemic—set 

records for the most Ebola samples processed 

in one day (162), the most samples tested in 21 

days (2,012), and the most samples tested in 

28 days (about 2,700).

Like the previous four teams deployed to test 

blood samples for Ebola, Lab Team 5 was 

a group of highly trained lab technicians 

with extensive experience handling deadly 

pathogens in high security BSL-4 labs. They were 

prepared to work with Ebola under challenging 

circumstances during the most dangerous step 

in the testing process—removing potentially 

infected blood from a vial and inactivating it 

so that it could be safely tested in later steps. 

Samples came to the CDC lab from eight 

different districts. To overcome frustrating delays 

in delivery from remote forested regions, the 

team completed plans to have samples carried 

to Bo by U.N. helicopter. A constant stream of 

samples arrived by UN helicopter, ambulance, 

taxi, motorcycle, and also by hand from the 

Doctors Without Borders Ebola (MSF) treatment 

unit adjacent to the lab.

While the team worked in harsh conditions, often 

with unreliable electricity, the best times were 

evenings when they would hear the community 

drumming from outside the nearby ETU. 

“One of the doctors told us that was what 

families did when they celebrated the release of 

an Ebola survivor. We were doing their testing, 

and whether they could be released depended 

on us,” said Angela Sanchez. 

Team 5 member Aridth Gibbons in the Bo lab, Sierra Leone.

27
CDC responder Karlyn Beer (left) and local officials look across a river that acts as a border between Liberia and Côte d’Ivoire. The power lines show how electricity is 

generated in Côte d’Ivoire and carried across to Liberia. 28
Protecting Borders 

A disease threat anywhere is a disease threat everywhere, and the Ebola epidemic has shown how 

easily infectious diseases can cross borders—land, rivers, and even oceans. From the start of the 

epidemic, porous country borders among the three West African countries and a highly mobile 

population aided the rapid spread of Ebola from its origin in Guinea. In West Africa, border control 

measures are mostly nonexistent—getting to another country is often as simple as taking a boat 

across a river. This makes it easy for a disease like Ebola to spread across countries and it complicates 

contact tracing. 

In West Africa, CDC works with airlines, airports, ministries of health, and other partners to provide 

technical assistance for conducting exit screening and travel restriction in countries with Ebola. Exit 

screening helps to identify travelers who may have symptoms of Ebola, or who have been exposed to 

Ebola, to prevent them from leaving a country until it is confirmed they are not sick. 

Once travelers land in the United States, more measures are in place to protect the public. CDC 

works closely with partners at major U.S. ports of entry to recognize signs of infectious disease 

in travelers. Since October 2014, CDC has been working with CBP to identify travelers who could 

have been exposed while in West Africa and conduct 

enhanced entry screening at five U.S. airports. CDC 

has similarly been working with the states, providing 

information and guidance, so that they can monitor 

these travelers once they arrive at their destinations. 

Screening and monitoring not only protects the health 

of these travelers but also reduces the chances of them 

spreading Ebola to others.

Health screening 

at the Conakry 

Maritime Port 

in Guinea. 

To protect borders, CDC 

advises travelers about health 

threats, writes messages for 

airport message boards and 

signs, develops guidance for 

airlines and other partners, 

and trains customs agents and 

airport Emergency Medical 

Services personnel to identify 

symptoms of Ebola in travelers 

coming to the United States 

from countries with outbreaks. 

We also develop materials and 

training to screen travelers 

leaving countries with Ebola.

29
Small boats regularly cross the river that 

divides the countries of Guinea and 

Sierra Leone, taking people back and 

forth across the border. 

Along this river bank, CDC responder Rupa 

Narra taught infection control to Guinean 

medical workers who were screening boat 

passengers for symptoms of Ebola.

“They had two physicians, a nurse, and a 

couple other people working in a tiny health 

post made out of a tarp. The staff was really 

welcoming and happy to have the training.”

Before becoming an officer in CDC’s Epidemic 

Intelligence Service, Rupa worked for Doctors 

Without Borders (MSF). During her deployment, 

she struggled with not having a role in direct 

patient care, especially when Ebola patient 

admissions tripled at the MSF facility adjacent 

to her office during her 30-day trip.

“Seeing how stretched thin they were with 

human resources was the most devastating, 

helpless, heartbreaking feeling possible,” she 

said. But she found a way to help by educating 

MSF nurses about infection control. “It really 

opened up some new roles for us in the field 

and showed us some other needs that were 

different from surveillance and data entry.”

Rupa also spent time in Conakry, the capital of 

Guinea, working with their Ebola data system 

and on contact tracing activities. “Ebola was 

the talk of the town,” she said. “You couldn’t go 

through 10 minutes of your day without hearing 

local people speaking about Ebola and what is 

going on. Everyone’s lives have changed.”

Rupa Narra (second from right), provides an infection control lesson to healthcare workers staffing a health inspection 

station at the border of Guinea. 30
When Blanche Collins arrived as the 

newest addition to CDC’s Border 

Health Team in Sierra Leone, she 

quickly dove in to help ensure that exit 

screening was being performed properly at 

Lungi International Airport. Since August 

2014, CDC staff have partnered with airports, 

airlines, and others to help with exit screening 

and border health issues in countries with 

Ebola outbreaks. The screening—which includes 

temperature checks and looking closely for 

signs of illness—is designed to reduce spread 

of Ebola by preventing people who have 

symptoms or exposures from traveling.

Blanche helped the Lungi airport team check 

and evaluate travelers leaving Sierra Leone. 

During a typical day at the airport, she would 

check health declaration forms or ensure 

the quality of standard operations, such as 

checking temperatures or providing chlorinated 

water for hand washing. Then at night, she 

would watch exit screening of passengers 

before their flight departed.

She also had a chance to see the country, 

traveling to border crossings between Sierra 

Leone and Guinea to train CDC partners. 

She taught them how to use noncontact 

thermometers for screening arriving travelers 

and how to put on and take off personal 

protective equipment. Her duties took her to 

seaports as well, leading training sessions.

Blanche said that her month in Sierra Leone 

was one of the best experiences of her career. 

“The moment we became involved in this 

response, I knew I wanted to go to West Africa 

to contribute.” And after she came home, she 

knew she wanted to go back.

Health officials at the airport in Lungi, Sierra Leone.

31
Karen Wong, a CDC medical officer, 

deployed to Liberia in 2014 to work 

in the Monrovia Medical Unit for 

two months.

“Since I treated patients with Ebola, I was 

required to do direct active monitoring for 21 

days when I returned to the U.S.,” said Karen. 

“When I returned, staff at the airport took 

my temperature, asked questions about my 

exposure to Ebola and symptoms, and provided 

me with a CARE (Check and Report Ebola) Kit.”

The CARE Kit contains information about 

Ebola, tools to check and track temperature 

and symptoms for 21 days, and information 

on whom to contact.

Direct active monitoring requires a public 

health worker to observe Ebola response 

workers at least once every day to see if they 

have a fever or other symptoms. This direct 

active monitoring can be done in-person 

or via video chat for 21 days. “A colleague 

of mine, who is a public health worker, was 

responsible for observing me. Sometimes 

we met in-person, but other times I took 

my temperature while I video chatted with 

her,” said Karen. “It was very easy to do and 

important for keeping everyone safe.”

 “Although I had gotten a flu shot earlier, taking 

my temperature every day and seeing a normal 

reading was reassuring,” said Karen. The flu 

has some symptoms similar to those of Ebola, 

and if Karen had any flu symptoms, she would 

have needed a medical evaluation and possibly 

Ebola testing. She was relieved when she was 

confirmed Ebola-free at the end of 21 days. 

“I went out with friends to celebrate completing 

my monitoring—it was a good day.” 

A digital thermometer is included in the Ebola CARE Kit for travelers to monitor themselves for fever.

32
Derek Sakris was working at Chicago’s 

O’Hare International Airport in late 2014 

when an officer from Customs and Border 

Protection (CBP) told him that a traveler who 

had been screened the previous day was back 

and needed assistance. The traveler was David 

Johnson, a native of Liberia and now a U.S. 

citizen who had just returned to the United 

States from West Africa. He had been searching 

for family members who were separated in 

wartime. His hopes were realized when he 

located his brothers and sisters in Sierra Leone. 

David returned penniless, only to find that his 

landlord had moved his belongings out of his 

rented apartment. Friends refused to house him 

because they feared he might have Ebola. He 

hadn’t eaten for two days. With nowhere else 

to turn, David spent the night at the airport.

When Derek heard about the stranded traveler’s 

plight, he mobilized resources. He contacted 

partner agencies to secure life necessities 

for David. CBP officers bought him food and 

the Chicago Department of Public Health and 

American Red Cross provided lodging and meal 

vouchers for David during his 21-day active 

monitoring period.

To provide for his long-term needs, CBP enlisted 

Travelers Aid Chicago. The social service 

program helps travelers in crisis, offering social 

and emotional support. A case manager helped 

David find a job and long-term housing.

“In public health work, it is rare that you get 

to observe someone getting immediate help 

like this. You don’t always witness the impact 

of your help, but this was one of those nice 

occurrences,” Derek said.

CBP officer Pila and Chicago Quarantine Station officer Derek Sakris with traveler David Johnson. 

33
How CDC is Protecting our Borders

Entry Screening in the United States

All air travelers entering the United States who have been in Guinea, 

Liberia, or Sierra Leone are being routed through five U.S. airports (New 

York’s JFK International, Washington-Dulles, Newark, Chicago-O’Hare, 

and Atlanta) for entry screening. 

• Entry screening helps to prevent further spread of Ebola and protect the 

health of all Americans by identifying travelers who may be sick with 

Ebola or may have had an exposure to Ebola and by ensuring that these 

travelers are directed to appropriate care. 

• These inbound travelers receive Check and Report Ebola (CARE) 

Kits that contain further information about Ebola. This kit includes 

information about Ebola, tools to help travelers check their temperature 

and symptoms each day for 21 days, and information about who to call if 

they have symptoms. 

Active Monitoring

The purpose of active monitoring is to ensure that a person’s health 

is closely followed by public health authorities so that, if symptoms 

develop, action can be taken immediately to isolate the person from 

others and arrange for medical evaluation. People who have been in 

a country with widespread transmission are actively monitored. 

Active monitoring means that the state or local public health 

authority checks daily with the traveler to see if he or she has 

symptoms and fever. The traveler reports daily on temperature 

and symptoms consistent with Ebola (including severe headache, 

fatigue, muscle pain, weakness, diarrhea, vomiting, abdominal pain, or 

unexplained bleeding).

Exit Screening in West Africa

CDC works with airlines, airports, ministries of health, and other partners 

in West Africa to provide assistance for conducting exit screening and 

travel restriction in countries with Ebola transmission. Exit screening 

efforts in West Africa help identify travelers who may have symptoms 

consistent with Ebola or who have been exposed to Ebola, to prevent them 

from leaving a country until it is confirmed that they are not sick with 

Ebola and are therefore not at risk of spreading Ebola. CDC believes that 

screening outbound passengers in West Africa is one of the most highly 

effective measures for preventing the spread of Ebola. 

Ebola information in the Conakry, Guinea airport. 

This video features CDC Ebola expert, Dr. Pierre Rollin.

34
Screening by the Numbers*

203,453

Travelers screened when

leaving a country with

widespread transmission

122,931

Guinea

35,685

Liberia

44,834

Sierra Leone

150

Travelers denied boarding

in countries with widespread

transmission

*10/11/2014 – 5/30/2015

18,672

Travelers who entered the 

U.S. from Guinea, Liberia, 

and Sierra Leone

3,797

Guinea

9,576

Liberia

4,413

Sierra Leone

13,304

CARE kits distributed

12,300

CARE phones distributed

35
A family under voluntary quarantine in the Kaffu Bullom community of Port Loko, Sierra Leone, looks on as Soriba Suma, a CDC responder, uses pictures to teach them about 

Ebola and safe practices. 36
Communicating & Educating

In an emergency response, communication is often the first line of defense. Fighting disease becomes 

less stressful when communities understand what they can do, when journalists report accurate 

information quickly, and when officials know how to communicate effectively. During a disease 

outbreak, communication strategies provide the essential bridge between science and the public—

creating audience-tailored products, spreading accurate information through the best channels, 

fighting rumors and stigma, and ensuring the response respects a community’s needs. 

During a large-scale epidemic like Ebola, scientists aren’t the only experts needed to help stem the 

spread of disease. CDC also sends teams of experts in communication, education, anthropology, and 

behavioral science to help communities with low technology access get the information they need to 

protect themselves—through radio, posters and billboards, and face-to-face visits.

“It was clear to me that Ebola had 

changed everyday life for Liberians. 

Hugs and handshakes, common 

greetings in Liberia, were too risky 

because of Ebola. Soccer teams 

wouldn’t meet for practice. Fresh 

fruits and vegetables weren’t 

being brought into Liberia from 

neighboring countries. The efforts 

to confine the virus also confined 

so many aspects of everyday life.”

Karlyn Beer, Ebola responder, Liberia

“Ebola is real: Let’s stop

the sprea[d] of Ebola.”

This banner was displayed 

on the vehicle of the zonal 

head for the Kings Gray 

community near ELWA 

hospital in Monrovia, 

Liberia.

37
Ebola talk was everywhere. At church, 

where parishioners heard sermons 

about communicable diseases, they 

also heard about Ebola. Talk was on the radio 

and music television, where performers sang 

songs about the deadly virus. It was visible 

outside Ebola treatment units where patients 

were sometimes turned away because of a 

lack of beds.

Erik Reaves, a CDC responder deployed to 

Liberia, says many of his Liberian colleagues 

had family members or friends who had died 

or were sick, and at times they would break 

down and cry. “They’re just trying to do what 

they can to keep pushing forward and help 

the response, but it was taking an emotional 

toll on them,” he said.

Erik and his team worked with local health 

officers to identify their technical capabilities, 

and evaluated their ability to respond to and 

monitor cases. He helped them get ready 

to transition from written records to tablets 

and smartphones, a program funded by 

the CDC Foundation to support timelier 

reporting of cases.

Educational messages on Ebola are delivered in unique ways in Liberia. Here, a mural shows symptoms of Ebola. 

38
When Monique Tuyisenge-Onyegbula 

arrived in West Africa, she brought 

more than the standard trunkful 

of CDC-issued gear and personal protective 

equipment.

“What I brought was my technical skills and 

my understanding of the culture and customs,” 

said Monique, who was born in Michigan but 

raised in Rwanda. To add to that unique mix 

of cultures, she is now married to a Nigerian. 

She has lived and worked in several African 

nations. In addition to English, she speaks 

Kinyarwanda (common to Rwanda and 

Burundi), Swahili, and French.

Monique is quick to point out there is no single 

“African culture”—it’s a big continent of many 

nations and people.

“But we do share things in common, such 

as the proper way to address elders or our 

difficulty remembering to avoid touching 

others during an Ebola outbreak—touching is 

a big thing in Africa,” she said. “I don’t have 

to think about these things because I am an 

African, an insider. I am received not as ‘they 

are coming to help us,’ but as ‘we are helping 

ourselves.’”

Monique said that is what is important: 

working with youth, local people, and 

community leaders to spread the message. 

“We from CDC can’t reach all these people, so 

must rely on the volunteers in the communities 

to spread the awareness. We train as many 

as we can, giving anyone and everyone the 

skill and knowledge to educate others on 

preventive measures.”

Guinea Red Cross volunteers travel door-to-door sharing information about Ebola.

39
I

n the Kroo Bay Slum in Sierra Leone, life 

expectancy was 35 years—and then Ebola 

hit. In that neighborhood, Nicole Hawk, a 

CDC communication expert, saw what she was 

up against.

“People are living on top of each other, 

lacking basic sanitation and medical care. It 

was really eye-opening. It’s vital that we do 

what we can to stop this outbreak,” she said.

For a month, Nicole helped craft and 

distribute Ebola-prevention messages for the 

general population in Freetown, Sierra Leone. 

During her deployment, the team began to 

shift its messaging from the basic “Ebola 

is real” to steps people can take to protect 

themselves and their families from the virus.

The visit to the slum highlighted how hard 

those messages are to follow.

“Washing your hands isn’t easy when you 

don’t have regular access to clean water. 

Quarantining someone in a separate room 

isn’t easy when an entire family lives in 

one room, and getting help isn’t easy when 

ambulances can’t get in because of a lack of 

roads,” Nicole said. “It really made me realize 

just how critical it is that we be on the ground 

trying to stop the virus.”

Nicole said her work has never been so 

important or gratifying. “I felt like the work 

we were doing was having a direct impact on 

saving lives.”

Materials developed at CDC headquarters in Atlanta, Georgia, are being used in Sierra Leone to educate people in villages.

40
When Kelsey Mirkovic deployed to 

Guinea, she quickly saw one of the 

reasons Ebola had managed to 

spread so easily through three West African 

nations. Families often live on both sides of the 

shallow, narrow river that divides Guinea from 

Sierra Leone and Liberia. People can easily 

shout across the muddy stream, and boatmen 

readily ferry travelers from one nation to the 

next. If people can cross freely, so can Ebola.

Armed with her “intermediate” French, Kelsey 

visited area villages. Although the nation’s 

official language was French, sometimes only 

one person in a village might speak it, so she 

worked with that person to translate important 

health messages into the local language. In this 

manner, she worked to gain the confidence of 

village leaders and to train community health 

workers to spread the word about how to avoid 

getting—and stop spreading—Ebola.

Kelsey’s team trained them to follow up with 

anyone who was exposed to patients with 

Ebola, checking on them every day for three 

weeks. Every day, except Sunday, the workers 

would report their findings to a supervisor.

“One day, the community workers reported that 

a person with Ebola symptoms had refused to 

go to into isolation at the treatment center,” 

Kelsey says. “It was a Monday, so the report 

was two days old. Worried, I met with the 

village chief, who pressured the person to go 

to the center.”

Out of that one meeting, many lives were saved. 

The grateful village chief presented Kelsey with 

a symbolic gift of cocoa pods and a coffee 

plant. For her, the gift symbolized not how much 

she gave, but how much she received.

A river dividing Guinea and Liberia shows how easily people can travel from one country to the other. 

41
A common sight in Liberia during the rainy season, two trucks are stuck in mud, causing a traffic jam that forced CDC responder Karlyn Beer to sleep in her car overnight.

42
Overcoming Challenges

The Ebola epidemic, larger and more widespread than any previous Ebola outbreak, has caused 

public health responders to face new and challenging obstacles—from hard-to-reach places and 

impassable roads to personal protective gear, transportation, and laboratory needs. A global 

health crisis always generates new ideas and bold solutions to problems that surface during an 

outbreak response. Every day, responders come up with innovative ways to handle the unexpected 

challenges in this Ebola epidemic. In the past year, CDC responders have found themselves 

conducting trainings by flashlight, reconstructing bridges to get to remote villages, and finding 

other workarounds when resources were scarce. CDC and other organizations have also started 

work on better tools to battle Ebola in the future, through vaccine trials, new uses for technologies, 

development of rapid diagnostics, and partnerships. 

“...Creativity is possibly just as 

valuable as all the hard facts 

and materials. When there is no 

money, people are working beyond 

exhaustion and options are limited, 

thinking creatively can be the thing 

to pull you through.” 

Leisha Nolen, Ebola responder, Sierra Leone

Contact tracer Dorissa 

Bestman uses a tablet 

to follow up on her daily 

contacts in the New Cru 

Town section of Monrovia, 

Liberia. A trial program 

conducted by CDC partner 

eHealth Africa in Liberia is 

using technology to load 

and store data where pencil 

and paper is the standard. 

43
Healthcare workers in West Africa report 

that some personnel are able to wear 

their PPE for only 40 minutes at a time 

because of high temperatures and humid 

conditions. Even in the United States, where 

management of patients with Ebola is done in 

air-conditioned environments, uncomfortable 

PPE is a common complaint and causes a 

burden for healthcare workers.

In September 2014, President Obama 

announced a “Grand Challenge” to design 

improved PPE for use by healthcare workers 

during treatment of Ebola patients. CDC’s 

National Institute for Occupational Safety 

and Health (NIOSH) is partnering with other 

U.S. agencies on the “Fighting Ebola: A 

Grand Challenge for Development” to help 

healthcare workers on the front lines provide 

better care and stop the spread of Ebola. 

The USAID-led Grand Challenge includes 

developing, testing, and improving PPE to 

address issues of protection, heat stress, 

and comfort for healthcare workers. 

NIOSH conducts research that supports the 

epidemic response and the Grand Challenge 

and is working closely with federal partners 

on the Grand Challenge, including (but not 

limited to) participating in crowdsourcing 

events to promote innovation, reviewing 

promising ideas that can be scaled to the 

field, and setting performance, test, and 

evaluation requirements.

A NIOSH sweating thermal manikin with the PPE ensemble commonly used by Doctors Without Borders (MSF) for high 

exposure areas. 44
Soon after CDC responder José Hagan 

arrived in Liberia, his team learned of 

rampant Ebola outbreaks in remote 

parts of the country. Hours later he found 

himself trekking miles into the jungle.

José described coming across grave after 

grave along the path as they approached a 

village. “When we finally got to the village, it 

was deserted. People were hiding in the forest 

or had fled to neighboring villages, taking the 

virus with them.”

José and his colleagues immediately started 

contact tracing. “We quickly learned that 

contact tracing wouldn’t work here. There were 

dozens of unknown Ebola contacts scattered 

across the dense forest and there was no 

cellphone signal to coordinate teams. Villages 

were connected only by narrow forest trails 

that were unreachable even by motorbike.”

José and his team set up a system based on 

a traditional method of communication used 

in these villages for hundreds of years.

“We worked with the village chiefs in the 

surrounding area to identify trusted members 

of their community who would be responsible 

for asking every villager how they were feeling 

each day. They would have a runner, usually 

a child, sprint the information back to the 

central village, which then connected every 

day with the district health team to pass on 

the information.”

As Ebola cases were found, José helped set 

up an isolation area and brought in Doctors 

Without Borders (MSF) to treat patients. 

José Hagan (second from left) and his World Health Organization and County Health Department colleagues stand on a 

bridge they had to reconstruct to communicate with nearby villages. 45
Teams responding to the Ebola outbreak 

in West Africa often face the challenge of 

finding people and communities living in 

remote areas. Maps of these regions often do 

not exist, aren’t correct, or are outdated. Basic 

information—location of houses, buildings, 

villages, and roads—is not easily accessible, 

making contact tracing extremely difficult.

To help the response effort, volunteers from 

around the world are using an open-source 

online mapping platform, called OpenStreetMap 

(OSM), to create detailed maps of Guinea, 

Sierra Leone, Liberia, and parts of Mali.

OSM’s goal is to make a free map of the 

world available to everyone. The Humanitarian 

OpenStreetMap Team (HOT) is a U.S.-based, 

non-profit organization that uses OSM 

data and tools to prepare and respond to 

humanitarian disasters. Because OSM data 

can be downloaded for free, volunteer mappers 

generate data that are useful to CDC and other 

agencies involved in the Ebola response. CDC 

is supporting and promoting volunteer mapping 

in affected West African areas where CDC 

teams work.

In the eight months since HOT began mapping 

countries with Ebola outbreaks, more than 

2,500 volunteers mapped more than 750,000 

buildings and hundreds of kilometers of roads, 

resulting in detailed maps of affected West 

African communities. Not only do these maps 

help first responders and other organizations 

around the world, they also contribute to the 

national information infrastructure essential to 

the recovery and rebuilding of affected regions. 

CDC responders Yoshinori Nakazawa and Jessica Hancock Allen used OpenStreetMap data on a tablet computer to help 

navigate to this small village between Kambia town and Kabaia in Kambia District, Sierra Leone. 46
CDC is conducting the Sierra Leone 

Trial to Introduce a Vaccine against 

Ebola (STRIVE), in collaboration with 

the Sierra Leone College of Medicine and 

Allied Health Sciences and the country’s 

Ministry of Health and Sanitation. 

The vaccine trial, which launched in April 

2015, is testing an Ebola vaccine among 

more than 8,000 health and other frontline 

workers in five districts of Sierra Leone that 

have been heavily affected by the outbreak. 

The vaccine used in the trial, called 

rVSV-ZEBOV, cannot cause Ebola but can 

potentially stimulate an immune response to 

protect against the disease. The vaccine was 

developed by the Public Health Agency of 

Canada’s National Microbiology Laboratory 

and licensed to NewLink Genetics. The 

vaccine has been studied in hundreds of 

people in Africa, Canada, Europe, and the 

United States. Early studies have shown that 

the rVSV-ZEBOV candidate vaccine produces 

an immune response. 

While it’s not clear yet whether the vaccine 

will be the Ebola prevention tool public 

health officials (and the world) are so eager 

for, the results of the trial may still help to 

save lives in the current and future Ebola 

outbreaks. The study will also strengthen 

research in Sierra Leone’s institutions by 

providing training and research experience 

to hundreds of Sierra Leonean staff. Much of 

this work will live on for the future, such as 

renovating structures and building new ones 

to enroll and vaccinate participants, handle 

data management, and store the vaccine. 

Nurses at a vaccination site in Freetown, Sierra Leone, sign for chain of custody for the Ebola vaccine. 

47
Ebola survivor, Ruth, celebrates as she is released from the Ebola treatment unit.

48
Moving Forward

The West African Ebola epidemic is a vivid reminder that even in the 21st Century, disease 

can still threaten not only people’s health, but also the very foundations of national and 

international economies.

The Ebola response has been the largest international outbreak response in CDC’s history. 

Thousands of highly trained public health professionals, in Africa and the United States, 

have helped stop the epidemic in Liberia and are working to stop it in Guinea and Sierra 

Leone. CDC continues alongside many national and international partners in West Africa 

work toward the goal of zero new cases in the affected countries and to strengthen vigilance 

throughout the region.

When that day comes, West Africa will have many systems and resources that it did not 

have before—emergency operations centers, laboratories, stronger surveillance systems, 

vaccine trials, and CDC country offices. But just as people and their expert knowledge and 

skills made the difference in curbing the epidemic, people hold the key to securing national 

and global health in the future.

Having enough trained healthcare and public health professionals in the countries where 

infectious disease risks are greatest is the world’s strongest defense to prevent, detect, 

and respond to threats as soon as they occur. 

Getting to zero for the first time in Liberia 

demanded a massive, worldwide response. 

Yet, the situation in Liberia also shows how 

difficult it is to stay at zero cases. There is a 

need for continued vigilance and the same 

kind of ongoing intensity and commitment 

to protect not only the residents of countries 

where outbreaks will occur, but also their 

neighbors around the world. 

Dr. Tom Frieden 

speaks to a patient 

from the family visitor 

area at the Bong 

Ebola treatment unit 

in Liberia.

“We’ve made great progress, but 

we can’t let down our guard. 

There will continue to be cases 

and clusters of Ebola, but an 

epidemic of the kind we’ve had 

for the past year never has to 

happen again.”

Dr. Tom Frieden, CDC Director, June 30, 2015

49
50
PHOTO CAPTIONS 

Top row, left-to-right

Training in Guinea can be challenging because of 

the mix of languages used across the country. 

This class of midwives and cleaners from Macenta 

were trained in the Malinke language since they do 

not speak French, the official language of Guinea.

A map at the District Emergency Response Center 

in Freetown, Sierra Leone, show the locations of 

recent Ebola cases. The response center houses 

the 117 call center for such cases.

Infection control supervisor Simone Loua (left) 

reinforces proper hand washing techniques 

during a field supervision visit to a small clinic 

in N’Zérékoré, Guinea. 

Bottom row, left-to-right

Health promotion is a key part of preventing 

infection in healthcare settings and in the 

community. A poster in Liberia shows facts 

about Ebola and how to prevent it.

CDC responder Alex Alvarez monitors the 

transportation of soap as part of a program to 

reduce resistance in Guinea. Within two weeks 

of the program’s start, reports showed resistance 

was tangibly reduced. 

CDC responder Soriba Suma uses materials 

developed by CDC to educate quarantined 

families about Ebola in the community of 

Kaffu Bullom, Sierra Leone.

Blood sample tubes at the CDC lab in Bo, 

Sierra Leone.

51
CDC’s Response to Ebola: March 2014 –July 2015

Early reports of Ebola 

virus disease from 

Guinea, CDC field 

team deployed

CDC Emergency 

Operations Center 

activated, CDC 

deployments surge

CDC expands Ebola 

testing among US labs

Dr. Frieden 

travels to 

Guinea, 

Liberia, and 

Sierra Leone

Microplanning 

workshops with 

county leaders 

held in Liberia

CDC laboratory 

established in 

Sierra Leone

CDC works 

with states 

to improve 

hospital 

readiness

CDC implements enhanced 

screening at airports, new 

tracking program for people 

coming from countries 

with Ebola outbreaks

CDC organizes healthcare worker safety course 

in Anniston, Alabama for West Africa volunteers

Liberia outbreak 

declared over

CDC deploys 1000th 

staff member

Spread to Liberia 

and Sierra Leone

CDC issues Level 3

Travel Warnings for West Africa

Traveler with Ebola comes to 

US (Dallas), 2 nurses infected

Spread to Mali, CDC teams 

help stop the outbreak

* Approximate numbers

CDC recommends 

reduced screening for 

passengers from Liberia

New cases 

reported 

in Liberia

Rapid Isolation and Treatment of Ebola (RITE) 

teams help rapidly control new outbreaks in Liberia

Spread to Nigeria and Senegal, 

CDC teams help stop the outbreak

600

500

400

300

200

100

0

MAR

2014

APR MAY JUN JULY AUG SEPT OCT NOV DEC JAN

2015

FEB MAR APR MAY JUN JUL

Guinea Liberia Sierra Leone

R

E

P

O

R

T

ED 

N

EW 

C

A

S

ES 

OF 

E

B

OLA 

P

ER 

W

E

E

K*

No data at 

this time

Pre-EOC Activation 1st Quarter EOC 2nd Quarter EOC 3rd Quarter EOC 4th Quarter EOC
Acknowledgements

Thank you to everyone who told us their stories so that we could share these examples of innovative 

public health work with the world. This book represents a small fraction of the stories from our 

thousands of Ebola responders and shows how our dedicated and determined Ebola responders have 

been navigating the road to zero.

A special thanks to those who worked on this project: Mark Conner, Jennifer McQuiston, 

Laura Smith, Erin Sykes, Curt Wommack, and Cathy Young

Photos on the front and back cover and pages 9, 22, 23, 24, 31, 36, 40, 43, 47, 51 ©David Snyder/

CDC Foundation.

COVER PHOTO CAPTIONS 

Front cover (clockwise)

Yoshinori Nakazawa uses his tablet’s GPS receiver to 

navigate and record geographic information for parts 

of Kambia District, Sierra Leone. The data are sent to 

CDC headquarters and shared with other partners.

Volunteers in Nigeria wear their Stop Ebola T-shirts. 

Freetown residents voluntarily quarantined for 

possible exposure to Ebola patients pose outside 

of their housing block at the Voluntary Quarantine 

Facility in the Hastings community outside of 

Freetown, Sierra Leone.

Back cover (clockwise)

Ebola survivor Mohamed Bangura poses with the 

certificate presented by the government health 

services of Sierra Leone after he survived the Ebola 

virus in August 2014.

EIS officer KP Djawe completes daily tally sheets from 

his contact tracing visit in Kamian, Guinea, with some 

curious onlookers.

A local boy looks on as a CDC team responds to a 

call about a man showing symptoms of Ebola in the 

community of Bolima, in the town of Waterloo just 

outside of Freetown. 

Log bridge in Sinoe County, Liberia. 
For more information, please contact 

Centers for Disease Control and Prevention 

1600 Clifton Road NE, Atlanta, GA 30329-4027 

Telephone: 1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348

E-mail: cdc.gov/info Web: www.cdc.gov

July 9, 2015

CS256104