Epidemiology of Epidemic Ebola Virus Disease in Conakry and Surrounding Prefectures, Guinea, 2014–2015

In 2014, Ebola virus disease (EVD) in West Africa was first reported during March in 3 southeastern prefectures in Guinea; from there, the disease rapidly spread across West Africa.We describe the epidemiology of EVD cases reported in Guinea's capital, Conakry, and 4 surrounding prefectures (Coyah, Dubreka, Forecariah, and Kindia), encompassing a full year of the epidemic.A total of 1,355 EVD cases, representing ≈40% of cases reported in Guinea, originated from these areas.Overall, Forecariah had the highest cumulative incidence (4× higher than that in Conakry).Case-fatality percentage ranged from 40% in Conakry to 60% in Kindia.Cumulative incidence was slightly higher among male than female residents, although incidences by prefecture and commune differed by sex.Over the course of the year, Conakry and neighboring prefectures became the EVD epicenter in Guinea. E bola virus disease (EVD) inWest Africa was first re- ported during early March 2014 in Guinea's 3 southeastern prefectures (Gueckedou, Macenta, and Kissidougou), which border Liberia and Sierra Leone; however, retrospective investigations indicate Ebola virus (EBOV) transmission might have occurred in Guinea since December 2013 (1 -4).On March 27, 2014, EVD was reported in Conakry (population 1,667,864), the capital of and largest city in Guinea (1,5).EBOV rapidly spread through much of Guinea, where it was reported in 32 of 34 prefectures, and to Liberia and Sierra Leone, causing the largest EVD epidemic since EBOV was discovered in 1976 (2,3,6).As of November 1, 2015, West Africa reported >28,000 EVD cases, of which >3,800 (including >2,500 deaths) were reported from Guinea; (7).The presence of EVD in Conakry led the Guinea Ministry of Health (MoH) to request assistance from the US Centers for Disease Control and Prevention, the World Health Organization (WHO), Médecins Sans Frontières, and other partners to establish a systematic disease-surveillance process and to implement control measures nationwide.Here we characterize EVD cases in Conakry and the 4 surrounding prefectures, which together became the epicenter of the EVD epidemic in Guinea. MethodsWe conducted a descriptive analysis of data reported in the Epi Info Viral Hemorrhagic Fever Application (Epi Info VHF, http://epiinfovhf.codeplex.com/),software used to maintain the Guinea MoH national case database.Patientspecific data (i.e., demographic, clinical, epidemiologic, and laboratory information) were collected by using a standardized EVD case notification form.Demographic information (age, sex, and residence) was obtained from the standardized notification forms completed during patient admission to an Ebola treatment center (ETC) or at the corpse collection for persons who died outside of an ETC or hospital (community deaths).Final vital outcome status for patients admitted to an ETC was obtained from ETC line listing data; all data were updated in Epi Info VHF.EVD cases were classified into 1 of 3 WHO case definitions: suspected, probable, or laboratory-confirmed cases.A suspected case was defined as disease in a living person with 1) a history of contact with a person who had laboratory-confirmed or probable EVD and 2) who had unexplained bleeding or sudden onset of high fever or >3 of the following signs and symptoms: headache, anorexia/ loss of appetite, lethargy, aching muscles or joints, breathing difficulties, vomiting, diarrhea, stomach pain, difficulty Epidemiology of Epidemic Ebola Virus Disease in Conakry and Surrounding Prefectures,Guinea,