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...

Ebola hemorrhagic fever
Ebstein's anomaly
Ectodermal Dysplasia
Ectopic pregnancy
Edwards syndrome
Ehlers-Danlos syndrome
Elective mutism
Ellis-Van Creveld syndrome
Encephalitis lethargica
Encephalomyelitis, Myalgic
Endocarditis, infective
Endomyocardial fibrosis
Eosinophilic fasciitis
Epidermolysis bullosa
Epidermolytic hyperkeratosis
Epiphyseal stippling...
EPP (erythropoietic...
Epstein barr virus...
Erythema multiforme
Esophageal atresia
Esophageal varices
Essential hypertension
Essential thrombocythemia
Essential thrombocytopenia
Essential thrombocytosis
Evan's syndrome
Ewing's Sarcoma
Exploding head syndrome
Hereditary Multiple...
Hereditary Multiple...
Hereditary Multiple...
Hereditary Multiple...

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, 6/30/95

As of June 25, public health authorities have identified 296 persons with viral hemorrhagic fever (VHF) attributable to documented or suspected Ebola virus infection in an outbreak in the city of Kikwit and the surrounding Bandundu region of Zaire (1)(2); 79% of the cases have been fatal, and 90 (32%) of 283 cases in persons for whom occupation was known occurred in health-care workers. This report summarizes characteristics of persons with VHF from an initial description of cases and preliminary findings of an assessment of risk factors for transmission.

A case was defined as confirmed or suspected VHF in a resident of Kikwit or the surrounding Bandundu region identified since January 1. The median age of persons with VHF was 37 years (range: 1 month-71 years); 52% were female. Based on preliminary analysis of 66 cases for which data were available, the most frequent symptoms at onset were fever (94%), diarrhea (80%), and severe weakness (74%); other symptoms included dysphagia (41%) and hiccups (15%). Clinical signs of bleeding occurred in 38% of cases.

Potential risk factors for intrafamilial transmission were evaluated for secondary cases within households of 27 primary household cases identified through May 10. A primary household case was defined as the first case of VHF in a household; household was defined as persons who shared a cooking fire at the onset of illness in the primary household case. Among 173 household members of the 27 primary household cases, there were 28 (16%) secondary case-patients. The risk for developing VHF was higher for spouses of the primary household case-patients than for other household members (10 [45%] of 22 compared with 18 [14%] of 151; rate ratio [RR]=3.8; 95% confidence interval [Cl] = 2.0 - 7.2) and for adults (aged [great than or equal] 18 years) than for children (24 [30%] of 81 compared with four [4%] of 92; RR = 6.7; 95% Cl = 2.4 - 18.4).

Needle sticks or surgical procedures during the 2 weeks before illness were reported for two of the 27 primary household case-patients and none of 28 secondary case-patients. Of the 28 secondary case-patients, 12 had direct contact with blood, vomitus, or stool of the ill person during hospitalization (i.e., later stages of illness), and 17 simultaneously shared the same hospital bed. Of 78 household members who had no direct physical contact with the person with the primary household casepatient during their clinical illness, none developed VHF (95% Cl = 0 - 4).

Reported by: M Musong, MD, Minister of Health, Kinshasa; T Muyembe, MD, Univ of Kinshasa; Technical and Scientific International Coordinating Committee for Viral Hemorrhagic Fever, Kikwit, Zaire. World Health Organization Kinshasa, Zaire. World Health Organization, Brazzaville, Congo. World Health Organization, Geneva, Switzerland. Medecine and Hygiene, Antwerp, Belgium. Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; International Health Program Office; Epidemiology Program Office, CDC.

Editorial Note: The incidence of VHF related to Ebola virus in Kikwit has diminished following the institution of interventions including 1) training of medical and relief personnel on the proper use of protective equipment, 2) initiation of aggressive casefinding; and 3) educational measures in the community (e.g., pamphlets and public announcements)(1)(2). However, cases continue to occur, and each case has the potential to be a source for additional infections. Therefore, ongoing measures including continued intensive surveillance, training activities, and public education are necessary to contain the epidemic.

To maximize prevention and control measures, prompt laboratory diagnosis is an important component of surveillance. An enzyme-linked immunosorbent assay (ELISA) detected Ebola antigen in specimens initially submitted to CDC from 11 of 13 acutely infected persons (1). Ongoing testing of additional specimens will assess the utility of this ELISA as a rapid diagnostic test that could be used locally. In addition, Ebola antigen was detected in multiple formalin-fixed tissue samples (liver, lung, and skin) of seven case-patients by immunohistochemical (IHC) staining using a specific polyclonal antibody. These findings suggest that IHC staining of fixed tissue may assist in surveillance for hemorrhagic fevers in Africa and other countries. Other activities include ecologic studies to identify the natural reservoir of the virus; these studies are focusing especially on mammals, nonmammalian vertebrates, and arthropods.


TABLE I. Summary -- cases of specified notifiable diseases, United

States, cumulative, week ending June 24, 1995 (25th Week)

(*)The case previously reported in 1995 had onset of illness in October 1994. It will now be included in 1994 data.

([dagger])Of 596 cases of known age, 147 (25%) were reported among children less than 5 years of age.

([sections])Updated quarterly from reports to the Division of Sexually Transmitted Diseases and HIV Prevention, National Center for Prevention Services. First quarter data not yet available. -: no reported cases

Transmission associated with health-care providers and caregivers has been a prominent feature of the current and previous VHF outbreaks in Africa attributable to Lassa, Marburg, Ebola, or Crimean-Congo hemorrhagic fever viruses (3). In some outbreaks, transmission from patient to patient within hospitals has been associated with the reuse of unsterile needles and syringes. As in previous outbreaks, high rates of transmission in this outbreak have occurred from patients to health-care workers and to family members who provided nursing care without appropriate barrier precautions to prevent exposure to blood, other body fluids, vomitus, urine, and stool. Based on findings in this report, the risk for transmitting infection from patients appears to be highest during the later stages of illness, which is characterized by vomiting, diarrhea, shock, and often hemorrhage. However, a small number of cases of VHF in Zaire have been reported in family members whose only contact with an infected person was in the domestic setting within a few days after onset of illness.

Updated recommendations for the management of VHFs attributable to these viruses in the United States are presented in a Notice to Readers in this issue (4).



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

(2.)CDC. Update: outbreak of Ebola viral hemorrhagic fever--Zaire, 1995. MMWR 1995; 44:399.

(3.)CDC. Management of patients with suspected viral hemorrhagic fever. MMWR 1988; 37(no. S-3):1-15.

(4.)CDC. Update: management of patients with suspected viral hemorrhagic fever--United States. MMWR 1995; 44:475-79.

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

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