Ebola in the United States

2014–2016: The West Africa Epidemic Response

During the largest Ebola outbreak in history, 11 people were treated for Ebola in the United States. Seven were medically evacuated after infection in West Africa; four were diagnosed in the United States — one traveler from Liberia, two nurses infected caring for him, and one physician who fell ill after returning from Guinea. Until September 25, 2014, every Ebola patient in the country had been diagnosed abroad and flown in for care (CDC MMWR 2014;63:1087).

What Treatment in a U.S. or European Hospital Achieved — the 27-Patient Series

The outcomes of every laboratory-confirmed Ebola patient cared for in the United States and Europe from August 2014 through December 2015 were pooled by Uyeki et al. (NEJM 2016;374:636). There were 27 patients, median age 36; 22 (81%) were healthcare personnel; 24 had been infected in West Africa and three (the two Dallas nurses and a Spanish nurse) acquired the infection in the U.S. or Europe. Nearly all received intravenous fluids and electrolyte replacement; 9 (33%) needed mechanical ventilation, 5 (19%) needed dialysis-type renal replacement, and 23 (85%) received investigational therapies. Five died — a mortality of 18.5% — against roughly 70% among patients with known outcomes in West Africa at the time (WHO Ebola Response Team, NEJM 2014). The authors attribute the difference to intensive supportive care: fluids, electrolyte correction, nutrition, and critical care for respiratory and renal failure. It is the strongest evidence that Ebola's fatality rate is a function of the care available, not only of the virus — and it is the reason the 2026 gap between Uganda's 10% and DRC's 48% is plausible rather than surprising (see symptoms).

How the 2014 Screening System Performed — the Numbers

• Exit screening: from August to November 10, 2014, an estimated 80,000 travelers departed Guinea, Liberia and Sierra Leone by air, about 12,000 of them en route to the United States. Boarding was denied to ill travelers and to those reporting high-risk exposure, and no traveler was reported symptomatic with Ebola in flight after the procedures began (CDC MMWR 2014;63:1163).
• Entry screening and active monitoring: from October 2014 all travelers from affected countries were funneled to five U.S. airports and monitored for 21 days. Georgia alone monitored 1,070 travelers through March 31, 2015; 30 required medical evaluation and three were tested for Ebola — none positive (CDC MMWR 2015;64:347).
• Military deployment: about 2,500 U.S. service members deployed to Liberia were monitored twice daily and for 21 days after return; 32 developed a fever during deployment and none had Ebola (CDC MMWR 2015;64:690).

Those figures are the empirical basis for the 2026 assessment. In the largest epidemic ever, with tens of thousands of arrivals monitored, the United States recorded four diagnoses and one imported case that transmitted.

The 1989 Reston Incident

Reston virus was discovered in macaques imported from the Philippines to a primate-holding facility in Reston, Virginia in 1989 — and, per CDC, to facilities in Philadelphia and Alice, Texas. Four people developed antibodies but never experienced symptoms; a further Texas episode in 1996 infected no one. Reston virus is the one orthoebolavirus known not to cause illness in people. It was the first Ebola virus identified outside Africa and was dramatized in Richard Preston's book The Hot Zone.

• A running count of Americans under monitoring. In 2014–15 state health departments published monitoring totals; for 2026, CDC's pages describe the monitoring process but do not give a national count of travelers enrolled (checked September 14, 2026). We do not know how many people are currently in the 21-day window.
• How many suspected cases have been tested in the U.S. CDC says its Laboratory Response Network is ready and that its consult team is available 24/7, but no tally of 2026 evaluations or tests has been published. In 2014–15, Georgia alone evaluated 30 travelers and tested three.
• Americans infected abroad. The two U.S. citizens treated in Germany appear in WHO's reports as part of DRC's count; CDC's U.S. tally excludes them because they were neither diagnosed nor treated in the United States. Both conventions are correct; they answer different questions.

"Low" is a statement about likelihood in the general population, not about what would happen to a person who was infected — CDC scores that impact as high. It is also a three-month assessment that CDC re-issues; the September 8 update kept it unchanged. Compared to what? For Ebola's U.S. exposure and death rates alongside 14 other viruses — most of which cause more American deaths every week than Ebola has in history — see the Virus Risk Perspective and this site's Ebola risk perspective.