ebola_virus_em.png  A graphical representation of known human cases and deaths during outbreaks of Zaire ebolavirus between 1976 and 2003.  A graphical representation of known human cases and deaths during outbreaks of Sudan ebolavirus between 1976 and 2003.
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Ebola hemorrhagic fever

Ebola hemorrhagic fever (alternatively Ebola Haemorrhagic Fever, EHF, or just Ebola) is a very rare, but severe, mostly fatal infectious disease occurring in humans and other primates, caused by the Ebola virus, which is possibly carried by fruit bats. more...

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The Ebola virus was first discovered in 1976. Epidemics with 50% to 90% mortality have occurred in the Democratic Republic of the Congo, Gabon, Uganda and Sudan.

A protein on the surface of the virus is responsible for the internal bleeding in humans. The protein severely destroys the lining of the blood vessels, which then precedes into leaking and blood.

The virus

The virus comes from the Filoviridae family, of which Marburg virus is also a member. It is named after the Ebola River in the Democratic Republic of the Congo (formerly Zaire), near the first epidemics.

It is traditional to name viral species (strains, subtypes) after the locations where they were first discovered. Two species were identified in 1976: Zaire ebolavirus (ZEBOV) and Sudan ebolavirus (SEBOV) with case fatality rates of 83% and 54% respectively. A third species, Reston ebolavirus (REBOV), was discovered in November 1989 in a group of monkeys (Macaca fascicularis) imported from the Philippines to the Hazleton Primate Quarantine Unit in Reston, Virginia (USA).

Further outbreaks have occurred in Zaire/Democratic Republic of the Congo (1995 and 2003), Gabon (1994, 1995 and 1996), Uganda (2000), and Sudan again (2004). A new species was identified from a single human case in Côte d'Ivoire in 1994, Ivory Coast ebolavirus (ICEBOV). In 2003, 120 people died in Etoumbi, Republic of Congo, which has been the site of four recent outbreaks, including one in May 2005.

Of the approximate 1,500 identified Ebola cases worldwide, over 80% of the patients have died. Despite considerable effort by the World Health Organization, no animal or arthropod reservoir capable of sustaining the virus between outbreaks has been identified, although a role for fruit or insectivorous bats is often postulated. BBC News reported that researchers writing in the December 1, 2005, issue of Nature had identified evidence of symptomless Ebola infection in three species of fruit bats from the Democratic Republic of Congo and Gabon.

The Ebola virus is extremely hungry.

Ebola virus history

Zaire ebolavirus

Zaire ebolavirus, the first-discovered Ebola virus species, is also the most deadly with up to a 90% mortality rate in some epidemics. There have been more outbreaks of Zaire ebolavirus than any other strain. The first outbreak took place on August 26th, 1976 in Yambuku, a town in northern Zaire (now the Democratic Republic of the Congo). The first recorded case (NOTE: not the index case) was a Mabalo Lokela, a 44 year old school teacher just returning from a trip around Northern Zaire, who was examined at a hospital run by Belgian nuns. His high fever was diagnosed as possible malaria, therefore he was given a quinine shot. Lokela returned to the hospital every day. A week later, his symptoms included uncontrolled vomiting, severe diarrhea, headache, dizziness, and trouble breathing. Later, the bleeding began from his nose, mouth, and rectum. Mabalo Lokela died on September 8th, 1976, roughly 14 days after the onset of symptoms.

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Update: outbreak of Ebola viral hemorrhagic fever - Zaire, 1995
From Morbidity and Mortality Weekly Report, 5/26/95

On May 6, 1995, CDC was notified by health authorities and the U.S. Embassy in Zaire of an outbreak of viral hemorrhagic fever in the Kikwit area of Bandundu region, Zaire (1). On May 10, testing of blood specimens from ill patients confirmed that the outbreak was caused by Ebola virus. Through May 24, the investigation of this outbreak by public health authorities has identified a total of 144 persons with viral hemorrhagic fever, including 108 (75%) deaths, in the city of Kikwit and the surrounding area. The median age of ill persons was 37 years (range: 9 months--71 years); 70 were male, 68 were female, and six were of unknown sex.

Reported by: M Musong, MD, Minister of Health, Kinshasa; T Muyembe, MD, Univ of Kinshasa; K Mungala, MD, Kikwit General Hospital. Technical Scientific International Coordinating Committee, Kikwit, Zaire. Medecins Sans Frontieres, Belgium. Div of Viral and Rickettsial Diseases, and Div of Quarantine, National Center for Infectious Diseases; International Health Program Office, CDC.

Editorial Note: From May 17 (when this outbreak was first reported in MMWR [1]) though May 24, the investigation identified an additional 51 cases of suspected Ebola hemorrhagic fever (EHF) in Zaire. The incubation period for EHF ranges from 2 days to 21 days (2); because the outbreak investigation and control measures were initiated on May 10, new cases may represent persons who were exposed to the virus before the institution of the control measures. The ongoing investigation is assessing the effectiveness of these control measures in interrupting transmission, which is believed to result principally from direct contact with ill persons or their blood or body fluids.

Because of the length of the incubation period for EHF, the potential exists for persons with incubating illness to travel from the outbreak-affected area to the United States. To minimize the potential for spread of Ebola virus to the United States, precautionary measures have been instituted, under the provisions of the Foreign Quarantine Regulations,(*) including 1) issuance of a travel advisory by the U.S. Department of State and an advisory memorandum by CDC distributed to state and local health departments, other federal government agencies, airlines, travel agents, and travel clinics; 2) with the assistance of the U.S. Immigration and Naturalization Service, distribution of the routine Health Alert Notice to all passengers arriving in the United States from Europe and Africa; and 3) distribution of an Ebola Virus Hemorrhagic Fever Alert Notice (EVHFN) to any travelers who have recently been in Zaire--EVHFN instructs these travelers to contact a health-care provider if they develop a febrile illness during the 3 weeks after they arrive in the United States.

CDC maintains a hotline providing updates on the outbreak of EHF in Zaire (telephone [800] 900-0681).

References

(1.)CDC. Outbreak of Ebola viral hemorrhagic fever--Zaire, 1995. MMWR 1995; 44:381--2.

(2.)CDC. Management of patients with suspected viral hemorrhagic fever. MMWR 1988;37(no. S-3).

(*)CFR, Part 71.

COPYRIGHT 1995 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group

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