Patient%20with%20Ebola%20Hemorrhagic%20Fever,%20Bumba%20Zone,%20Equateur%20Province,%20DR%20Congo%20(Zaire),%20October%201976 - PowerPoint PPT Presentation

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Patient%20with%20Ebola%20Hemorrhagic%20Fever,%20Bumba%20Zone,%20Equateur%20Province,%20DR%20Congo%20(Zaire),%20October%201976

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Patient with Ebola Hemorrhagic Fever, Bumba Zone, Equateur ... Virology. Isolation and characterization of Ebola virus. Differentiation from Marburg virus ... – PowerPoint PPT presentation

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Title: Patient%20with%20Ebola%20Hemorrhagic%20Fever,%20Bumba%20Zone,%20Equateur%20Province,%20DR%20Congo%20(Zaire),%20October%201976


1
Patient with Ebola Hemorrhagic Fever, Bumba Zone,
Equateur Province, DR Congo (Zaire), October 1976
2
Active Surveillance for EHF Cases, Equateur
Province, DR Congo (Zaire), November-December 1976
3
Investigations of EHF Cases in Villages, Equateur
Province, DR Congo (Zaire), October-December 1976
Dr. M. Mbuyi Nurse Sukato interviewing mourning
family member
4
Ebola Hemorrhagic Fever in Democratic Republic
of the Congo (Zaire), 1976-1977
Selected Events
Aug 26 First patient presents with fever in
Yambuku, Equateur Province, receives
chloroquine injection fever resolves in 4
days Sept 1 EHF begins in first patient
16 Local clinician reviews 17 patients reports
unknown disease to Kinshasa 23-25
First medical team visit from Kinshasa typhoid
fever suspected, vaccination evacuation of
Belgian nun to capital 30 Yambuku hospital
closed, 11 of 17 staff members dead
Sept 30/ Oct 20
Three nurses die in Kinshasa
5
Ebola Hemorrhagic Fever in Democratic Republic
of the Congo (Zaire), 1976-1977
Selected Events
Oct 2-6 Second medical visit from Kinshasa
specimens collected
3 Health zone quarantined by Minister
8-12 Transmission occurring in Kinshasa hospital
13-14 Filovirus seen on EM in Belgium, UK
and USA 14 New virus (Ebola) identified at CDC
18 International Commission formed
19-27 Survey team to Yambuku reports active
cases in 8
villages 30 Airlift of surveillance teams to NE
DR Congo, covers DRC-Sudan
frontier
6
EHF in DR Congo (Zaire), 1976-1977
Selected Events (contd)
Nov 2 Plasmapheresis program begins with
convalescent patients
4 Widespread surveillance in epidemic zone
5 Last case dies 16 Surveillance, research and
clinical care support
arrives in Yambuku Dec 16 Emergency officially
over Jan 28 Plasmapheresis program ends
7
Ebola Hemorrhagic Fever in Democratic Republic of
the Congo (Zaire), 1976-1977
International Commission Discoveries
Virology
  • Isolation and characterization of Ebola virus
  • Differentiation from Marburg virus
  • Immunology

8
Ebola Hemorrhagic Fever in Democratic Republic of
the Congo (Zaire), 1976-1977
International Commission Discoveries
Clinical
  • Described symptoms and signs including
  • Hemorrhagic manifestations
  • Pancreatitis
  • Incubation period

9
Ebola Hemorrhagic Fever in Democratic Republic of
the Congo (Zaire), 1976-1977
International Commission Discoveries
Patient Management and Control
  • Isolation of patients effective
  • Surveillance of households, villages
  • Plasmapheresis of convalescents

10
Ebola Hemorrhagic Fever in Democratic Republic of
the Congo (Zaire), 1976-1977
International Commission Discoveries
Epidemiology
  • Mode of transmission
  • Risk groups
  • Attack rates individuals, families, villages
  • Geographic distribution and spread

11
Ebola Hemorrhagic Fever in Democratic Republic of
the Congo (Zaire), 1976-1977
International Commission Discoveries
Immunology
  • Developed IFA test for Ebola
  • Found evidence of previous infection

12
Ebola Hemorrhagic Fever in Democratic Republic of
the Congo (Zaire), 1976-1977
Initial Information
  • Epidemic in northern DR Congo (Zaire)
  • 100 of villages affected
  • 100 of persons in villages affected
  • 100 of affected persons in villages dead

13
Ebola Hemorrhagic Fever in Democratic Republic of
the Congo (Zaire), 1976-1977
Initial Information
  • Cause?
  • Typhoid
  • Lassa fever
  • Yellow fever
  • Sources of Information
  • International plantation manager (confidential)
  • World Health Organization (limited)
  • US Embassy (limited)
  • Scientists in Belgium and France

14
Ebola Hemorrhagic Fever in DR Congo (Zaire),
1976 Risk Factors Associated with Person to
Person Spread
Person to Person Family Contacts
(non-infected) Risk Factor Cases
Yes Cases Yes P
15
Ebola Hemorrhagic Fever in DR Congo (Zaire),
1976 Distribution of Cases in Villages
Cases Number of Villages of
Villages Cumulative
1 2-5 6-9 10-14 15-19 20-29 ? 30
17 18 12 4 1 1 2 55
31 64 86 93 95 97 101
31 33 22 7 2 2 4
16
Ebola Hemorrhagic Fever in DR Congo (Zaire), 1976
Family Contact Attack Rate by Generation of
Illness
No. of Subsequent Cases 38 20 3 1 62
No. of Family Exposures 496 459 117 29 1103
No. of Families of Cases 61 62 18 5 146
Attack Rate () 7.5 4.4 2.6 3.4 5.6
Generation 1 2 3 4 Total
persons acquiring disease by injection
17
Ebola Hemorrhagic Fever in DR Congo (Zaire), 1976
Distribution of Ebola Hemorrhagic Fever Cases by
Transmission Type, Yambuku, DR Congo (Zaire), 1976
Cases
Survivors
No. 85 149 43 30 11 318
27 47 14 9 3 100
No. 0 30 4 4 0 38
0 79 11 11 0 101
Transmission History
Injection Person-to-person Both
possible Unknown Neonatal
18
Ebola Hemorrhagic Fever, DR Congo (Zaire), 1977
Case Definitions
  • Probable
  • Living in epidemic area
  • Died after ? 1 days with ? 2 of the following
  • headache, fever, abdominal pain,
    nausea/vomiting,
  • bleeding
  • With 3 preceding weeks received an injection or
    had
  • contact with a probable or proven case
  • No other diagnosis

19
Ebola Hemorrhagic Fever, DR Congo (Zaire), 1977
Case Definitions
  • Proven
  • Ebola virus isolated or shown by EM
  • Or IFA titer of ? 164 after 3 weeks of symptom
    onset

20
Ebola Hemorrhagic Fever, DR Congo (Zaire), 1977
Case Definitions
  • Infection
  • IFA titer ? 164 with no symptoms/signs August
    15-
  • November 19, 1976
  • Possible
  • Headache and/or fever for ? 24 hours with or
    without other signs/symptoms
  • Contact with a probable or proven case, within
    3 weeks
  • Treated with antimalarials, antibiotics,
    antipyretics
  • Bled and checked for antibodies
  • Any case of fever and bleeding anywhere in DR
    Congo
  • Neonatal
  • Newborns of probable cases if died within 28
    days

21
Ebola Hemorrhagic Fever, DR Congo (Zaire), 1977
Case Definitions
  • Primary Contact
  • Face to face contact with a probable or proven
    case
  • Between 2 days before symptom onset and death
    or recovery
  • Surveillance 21 days from last contact
  • Secondary Contact
  • Face to face contact with primary contact

22
Ebola Hemorrhagic Fever, DR Congo (Zaire), 1976-77
Major Gaps and Challenges
  • Natural history undefined
  • Surveillance and response weak
  • No specific treatment or precaution
  • Limited application of modern technologies
  • Few laboratories involved
  • Filovirus and other orphan diseases receive
  • low priority
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