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4 : Responding to Epidemics of Ebola Hemorrhagic Fever: Progress and Lessons Learned from Recent Outbreaks in Uganda, Gabon, and Congo

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Responding to Epidemics of Ebola Hemorrhagic Fever: Progress and Lessons Learned from Recent Outbreaks in Uganda, Gabon, and Congo, Page 1 of 2

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Abstract:

Ebola hemorrhagic fever (EHF) is caused by viruses of the genus of the family. Except for a laboratory-acquired case in England in 1976, human cases of EHF have been noted exclusively in sub-Saharan Africa. Five years after the Kikwit outbreak, the 2000–2001 outbreak in Gulu, Uganda, was the largest outbreak of EHF recorded to date. Analysis of this epidemic, as well as the more recent events in Gabon and Congo, will no doubt further our understanding of EHF. While awaiting more formal presentations of the scientific data, these outbreaks provide the opportunity to reflect on the progress in the domain of EHF since 1995, to speculate on the future, and to reassess needs. The sporadic nature of EHF cases and the difficulty in isolating them when they occur limited the health care worker exposures in the most recent outbreak in Gabon and Congo. The few field surveys undertaken since the Kikwit outbreak have yielded either negative or controversial results, with the latter consisting of a report of the identification of Ebola virus sequences by polymerase chain reaction (PCR) and the observation of virus-like nucleocapsids by electron microscopy in rodents and shrews in the Central African Republic, but without the actual isolation of Ebola virus.

Citation: Bausch D, Rollin P. 2004. Responding to Epidemics of Ebola Hemorrhagic Fever: Progress and Lessons Learned from Recent Outbreaks in Uganda, Gabon, and Congo, p 35-58. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch4
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Figure 1

Phylogenetic tree and map showing the evolutionary relationships and geographic distributions of the different species of Ebola virus. The genetic sequences of viruses from recent outbreaks beginning in 2000 in Uganda and 2001 in Gabon and Congo have not yet been published and are therefore not included, although they have been identified as Sudan and Zaire species, respectively ( ). Marburg virus is shown as an outgroup reference. Imported cases or data based on antibody surveys are not included. Names listed on the phylogenetic tree indicate the geographic location of the outbreak from which the virus was obtained. Ebola virus species are depicted by the following shades: , Zaire; , Sudan; , Côte d'Ivoire; and , Reston. [Phylogenetic tree modified and used with permission from A. Sanchez, (Suppl. 1):iii, 1999.]

Citation: Bausch D, Rollin P. 2004. Responding to Epidemics of Ebola Hemorrhagic Fever: Progress and Lessons Learned from Recent Outbreaks in Uganda, Gabon, and Congo, p 35-58. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch4
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Image of Figure 2
Figure 2

Temporal progression of outbreaks of Ebola hemorrhagic fever. There is a break in the timeline between 1979 and 1989, when no outbreaks were recorded. The year of onset is shown beneath the country involved in each outbreak. Ebola virus species are depicted by the following shades: , Zaire; , Sudan; , Côte d'Ivoire; and , Reston. Arrows indicate importations of Ebola virus from one country to another.

Citation: Bausch D, Rollin P. 2004. Responding to Epidemics of Ebola Hemorrhagic Fever: Progress and Lessons Learned from Recent Outbreaks in Uganda, Gabon, and Congo, p 35-58. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch4
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Figure 3

Scientific publications on Ebola hemorrhagic fever, 1976 to 2000. Source: National Library of Medicine.

Citation: Bausch D, Rollin P. 2004. Responding to Epidemics of Ebola Hemorrhagic Fever: Progress and Lessons Learned from Recent Outbreaks in Uganda, Gabon, and Congo, p 35-58. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch4
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Figure 4

Listings of “viral hemorrhagic fever” or “Ebola hemorrhagic fever” on the Program for Monitoring Emerging Diseases (ProMED) website (http://www.promedmail.org) since the beginning of its service in 1994 through 2001.

Citation: Bausch D, Rollin P. 2004. Responding to Epidemics of Ebola Hemorrhagic Fever: Progress and Lessons Learned from Recent Outbreaks in Uganda, Gabon, and Congo, p 35-58. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch4
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Figure 5

Duration, cases, and case-fatality ratios associated with major outbreaks of EHF, 1976 to 2001. Data for the outbreak in Gabon and Congo in 2001 are preliminary. Outbreaks associated with Ebola-Reston virus, which has not been noted to cause human disease, are not included.

Citation: Bausch D, Rollin P. 2004. Responding to Epidemics of Ebola Hemorrhagic Fever: Progress and Lessons Learned from Recent Outbreaks in Uganda, Gabon, and Congo, p 35-58. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch4
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Figure 6

Typical transmission chain for EHF during an outbreak in Gabon and Congo, 2001 and 2002. A total of 13 cases, marked A through M, were noted in this chain. For each case, the relationship with others in the transmission chain, age (y/o, years old), sex (♂, male; ♀, female), location where the illness began, outcome with the date of death if the illness was fatal, and whether the case was suspected or confirmed is provided. Transmission began with a group of hunters who reportedly became ill after contact with a gorilla found dead in the rain forest during a hunting expedition (cases A to C). Secondary transmission was then noted among friends and family members (cases D, E, and G to J) and in a health care worker (case F). The two villages involved, Oloba, Congo, and Ekata, Gabon, are on contiguous sides of the international border. Crossings by local villagers are frequent.

Citation: Bausch D, Rollin P. 2004. Responding to Epidemics of Ebola Hemorrhagic Fever: Progress and Lessons Learned from Recent Outbreaks in Uganda, Gabon, and Congo, p 35-58. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch4
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Tables

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Table 1

Characteristics of recent outbreaks of EHF in DRC, Uganda, Gabon, and Congo

Citation: Bausch D, Rollin P. 2004. Responding to Epidemics of Ebola Hemorrhagic Fever: Progress and Lessons Learned from Recent Outbreaks in Uganda, Gabon, and Congo, p 35-58. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch4
Generic image for table
Table 2

Case definitions for EHF used in outbreaks in Uganda, Gabon, and Congo

Citation: Bausch D, Rollin P. 2004. Responding to Epidemics of Ebola Hemorrhagic Fever: Progress and Lessons Learned from Recent Outbreaks in Uganda, Gabon, and Congo, p 35-58. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch4

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