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Ebola Hemorrhagic Fever Outbreak in DR Congo, 1976-1977: Discoveries, Epidemiology, and Patient Management

This article provides an overview of the Ebola Hemorrhagic Fever outbreak in DR Congo (Zaire) from 1976-1977, including the discoveries made by the International Commission, epidemiological data, and the management of patients.

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Ebola Hemorrhagic Fever Outbreak in DR Congo, 1976-1977: Discoveries, Epidemiology, and Patient Management

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  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 (cont’d) 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. Touched cases Attended burial Cared for case Slept in same room Prepared cadaver Aided in delivery of child from sick patient 126 126 119 116 116 104 86 86 71 69 59 18 91 98 84 86 58 74 84 86 71 68 58 9 ns ns ns ns ns p<0.001 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% YesCases% Yes P

  15. Ebola Hemorrhagic Fever in DR Congo (Zaire), 1976 Distribution of Cases in Villages CasesNumber 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 Transmission History 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 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  1:64 after 3 weeks of symptom onset

  20. Ebola Hemorrhagic Fever, DR Congo (Zaire), 1977 • Infection: • IFA titer  1:64 with no symptoms/signs August 15- • November 19, 1976 Case Definitions • 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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