Why so few facts about ebola outbreak in

[TLBentley]

Dr. Locke,

I am not going to copy your message back to you, but rather in the
interest of time fwd a message that was sent to State Health offices.  I
will post further information, but am reluctant to post all of the phone
numbers to an area where many comments are anti-CDC and non-professionals
get into Stephen King discussions.   I respect health curiosity and the
quest for kinowledge and understanding.

I will be off line for a few days taking a busman's holiday to the State
Epidemiology office and sitting in on an Environmental Health Director's
mtg with a friend.  Hope the information helps.  State Health offices are
usually pretty decent about keeping us grass-root type informed.  Check
with Harvard's College of Public Health  and their ties to the CDC if you
have more difficulty getting information...or maybe with a nurse
epidemiologist...;->

The following was a bulletin sent to County Public Health Units in FL via
the State's Epidemiology program office early Monday, 5/15/95.

Please feel free to e-mail me.
Trudy L. Bentley, BSN, RN
bent101w at wonder.em.cdc.gov or tlbentley at aol.com
_SUBJECT: Ebola Virus Update
DATE: 05-15-95   16:28 EST
PRIORITY: R

                                                                          
 

The following memo from CDC is being forwarded to you.

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DEPARTMENT OF HEALTH AND HUMAN SERVICES                 Centers for       
  

                                                       Disease Control
Public Health Service                                   and Prevention    
  
Centers for Disease Control and Prevention     (CDC)                      
 
Atlanta, Georgia  30333



In reply, address CD                                  May  12,  1995

Refer to:  NCID:DQ

ADVISORY MEMORANDUM No. 111

SUBJECT: Ebola Virus Hemorrhagic Fever - Zaire

The Government of Zaire and the World Health Organization have reported an
unusual outbreak of Ebola Virus Hemorrhagic Fever in Kikwit,
(approximately
250 miles southeast of Kinshasa) and the surrounding areas within Bandundu
Province, Zaire.  The incubation period (time before symptoms appear) for
Ebola Virus Hemorrhagic Fever may range from 2-21 days.  The average is
approximately 3- week.  The illness is characterized by an abrupt onset of
fever and headache.  Continued fever, headache, general malaise, muscle
aches,
joint pain, and sore throat are commonly followed by vomiting, diarrhea,
and
abdominal pain.  A transient, measles-like skin rash, that subsequently
becomes scaly, often appears at the end of the first week of illness. 
Persons
infected with the virus may suffer internal hemorrhaging, severe organ
failure
and death.

The disease is primarily transmitted by contaminated injections and close
personal contact with severely ill patients.  Transmission usually occurs
by
direct contact with infected blood, secretions, organs, or semen.
Otherwise,
the risk of infection is believed to be very low.  Persons in the
incubation
period are not considered to be a significant risk to those around them.

Travelers to Zaire are at low risk of acquiring the disease under normal
circumstances.  To eliminate the risks, travelers should avoid the Ebola
Virus
areas described above.  Travelers in Zaire should contact the U.S. Embassy
for
further information after arrival in Kinshasa.

For future updates of this advisory, you may call CDC International
Travelers'
Voice Information Service at (404)332-4559 press 1, then press 4, and
listen
for the outbreak menu for Zaire or you may call the CDC Fax Information
Service at (404)332-4565 and request document #221009.

All recipient health departments, travel agencies, airlines, and shipping
companies should notify prospective travelers of the recommendations in
this
advisory.


Brian Many, Ph.D.Director                         Charles R. McCance
Division of Viral and Rickettsial Diseases        Director
National Center for Infectious Diseases           Division of Quarantine
                                                 National Center for      
 
                                                 Infectious Diseases



Ebola virus Hemorrhagic Fever:  General information

What are viral hemorrhagic fevers?

Viral hemorrhagic fevers are a group of diseases caused by viruses from
four
distinct families of viruses: filoviruses, arenaviruses, flaviviruses, and
bunyaviruses, The usual hosts for most of these viruses are rodents or
arthropods (such as ticks and -mosquitoes).  In some cases, such as Ebola
virus, the natural host for the virus is unknown.  All forms of viral
hemorrhagic fever begin with fever and muscle aches.  Depending on the
particular virus, the disease can progress until the patient becomes very
ill
with respiratory problems, severe bleeding, kidney problems, and shook. 
The
severity of viral hemorrhagic fever can range from a relatively mild
illness
to death.


What is Ebola virus?

The Ebola virus is a member of a family of RNA viruses known as
filoviruses. 
When magnified several thousand times by an electron microscope, these
viruses
have the appearance of long filaments or threads.  Ebola virus was
discovered
in 1976 and was named for a river in Zaire, Africa, where it was first
detected.



Ebola virus hemorrhagic fever: How common is it?

Until recently, only three outbreaks of Ebola hemorrhagic fever among
people
had been reported.  The first two outbreaks were in 1976: one in Zaire and
one
in western Sudan, These were large outbreaks, resulting in more than 550
cases
and 340 deaths.  The third outbreak, in 1979 in Sudan, was smaller, with
34
cases and 22 fatalities.  During each of these outbreaks, a majority of
cases
occurred in hospital settings under the challenging conditions of the
developing world.  These conditions, including a lack of adequate medical
supplies and the frequent reusing of needles and syringes, played a major
role
in the spread of disease.  The outbreaks were quickly controlled when
appropriate medical supplies and equipment were -made available and
quarantine
procedures were used.

The source of the Ebola virus in nature remains unknown.  In an attempt to
identify the source, investigators tested thousands of specimens from
animals
captured near the outbreak areas, but their efforts were unsuccessful. 
Monkeys, like humans, appear to be susceptible to infection and may serve
as
a
source of virus if infected.



What do we know about the recent outbreak of Ebola virus infection?

The recent Ebola virus outbreak is centered in Kikwit, Zaire. (Kikwit is a
city of 400,000 located 400 kilometers east of Kinshasa, the capital of
Zaire.) The outbreak appears to have started with a patient who had
surgery
in
Kikwit on April 10, 1995.  Members of the surgical team then developed
symptoms similar to those of a viral hemorrhagic fever disease.  Ebola
hemorrhagic fever was suspected by a Belgium physician who reported the
disease to the Zairian government.  At the request of Zairian health
officials, medical teams from CDC, the World Health Organization, and from
Belgium, France, and South Africa are collaborating to investigate and
control
the outbreak in Zaire.


What are the symptoms of Ebola hemorrhagic fever?

Symptoms of Ebola hemorrhagic fever begin 4 to 16 days after infection. 
Persons develop fever, chills, headaches, muscle aches, and loss of
appetite.

As the disease progresses, vomiting, diarrhea, abdominal pain, sore
throat,
and chest pain can occur.  The blood fails to clot and patients may bleed
from
injection sites as well as into the gastrointestinal tract, skin, and
internal
organs.


How is the Ebola virus spread from person to person?

Ebola virus is spread through close personal contact with a person who is
very
ill with the disease. In previous, outbreaks, person-to-person spread
frequently occurred among hospital care workers or family members who were
caring for an ill person infected with Ebola virus.  Transmission of the
virus
has also occurred as a result of hypodermic needles being reused in the
treatment of patients.  Reusing needles is a common practice in developing
countries, such as Zaire and Sudan, where the health care system is
underfinanced, Medical facilities in the United States do not reuse
needles.

Ebola virus can also be spread from person to person through sexual
contact. 
Close personal contact with persons who are infected but show no signs of
active disease is very unlikely to result in infection.  Patients who have
recovered from an illness caused by Ebola virus do not pose a serious risk
for
spreading the infection.  However, the virus may be present in the genital
secretions of such persons for a brief period after their recovery, and
therefore it is possible they can spread the virus through sexual contact.


How is Ebola hemorrhagic fever diagnosed?

A diagnosis is made by detection of Ebola antigens antibody, or genetic
material, or by culture of the virus from these sources.  Diagnostic tests
are
usually performed on clinical specimens that have been treated to
inactivate
(kill) the virus.  Research on Ebola virus must be done in a special
high-containment laboratory to protect scientists working with infected
tissues. 



How will health officials control the outbreak?

Previous outbreaks of Ebola hemorrhagic fever have been limited.  These
outbreaks were successfully controlled through the isolation of sick
persons
in a place requiring the wearing of mask, gown, and gloves; careful
sterilization of needles and syringes; and proper disposal of waste and
corpses.


How do hospital personnel isolate an ill person?

Hospital personnel isolate ill persons through a method called "barrier
technique." Barrier technique includes the following actions; 1) doctors
and
nurses wear gowns, mask, gloves, and goggles when oaring for patients; 2)
the
patient's visitors are restricted; 3) disposable materials are removed
from
the room and burned after use; 4) all reusable materials are sterilized
before
reuse, and 5) since the virus is easily destroyed by disinfectants, all
hard
surfaces are cleaned with a sanitizing solution.


Are persons in the United States at risk?

Persons in the United States are at risk only if they have had close
personal
contact with patients in Zaire who are infected with Ebola virus.  There
are
no reports that infected persons have left the country of Zaire.  The
Zairian
government has quarantined all persons in the affected areas and
restricted
movement of persons in and out of these areas.  Any persons who wish to
travel
to Zaire are encouraged to contact the U.S. State Department
(202-647-5225)
for travel advisories.


What is CDC's role in the outbreak investigation?

CDC has sent three medical scientists to Zaire to assist with the
investigation.  They will provide advice and assistance in helping to
control
the outbreak and prevent additional cases, collect specimens for
diagnostic
testing, study the clinical course of the disease in the ill persons,, and
look for others who may have been in contact with the infected
individuals. 
They will also instruct the hospital staff in Zaire about how to limit the
spread of the disease.  Efforts will also made to find the source of the
infection.


CDC also has a role in educating the U.S. public about this outbreak and
about
the potential threat of emerging infectious diseases.  For the next
several
days, CDC will issue press releases and will inform the state health
departments about any updates on the disease outbreak in Zaire.






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