EBOLA CONFIRMED - WHO Warns That Ebola Outbreak in Republic of Congo Could Be Spreading

By Laurie Garrett

Staff Writer

February 20, 2003

The World Health Organization announced Wednesday that two particularly deadly viruses have reemerged: Ebola and an unusual form of avian influenza that is lethal to humans.

An outbreak of Ebola, a hemorrhagic fever virus, has been under way in the Republic of Congo for more than a month, but is in such a remote region that blood samples from victims didn't reach the Geneva-based WHO until recently. So far, at least 80 people in western, mountainous Kelle province have been infected, 64 of whom have died, according to WHO. The outbreak is in a remote area, hundreds of miles from the capital of Brazzaville, near the border of Gabon.

The outbreak appears to have begun in December, killing at least two mountain gorillas in a nearby region, Dr. David Heymann, WHO head of epidemic responses, said in an interview. Conservationists notified authorities before Christmas, and blood samples tested positive for Ebola virus.

The rain forest that spans the Democratic Republic of Congo, the Republic of Congo and Gabon is "a real focus of endemicity for Ebola," Heymann said. "Gorillas and chimps get it, they weaken or die. The people hunt them, and get infected when they butcher the primates and come in contact with the contaminated blood."

Human burial procedures are suspected in subsequent human infection. Family members wash down the body of the deceased and, if they aren't wearing protective gloves and garments, are exposed to the virus. A victim's blood circulatory system typically hemorrhages, and viruses may be present in their sweat and vomit as well as body cavities.

Initial attempts by WHO workers to intervene in local burial practices were met with hostility and fear, and many local people reportedly ran from their would-be rescuers. Two medical anthropologists on the 10-member WHO team have had success convincing the Congolese to let scientists, dressed in protective gear, handle the burials, Heymann said.

Congolese villagers have stoned and beaten to death 4 teachers accused of casting an evil spell to cause an outbreak of Ebola fever that has killed nearly 70 people, a local official said on Fri 21 Feb 2003.

The outbreak of Ebola in the districts of Kelle and Mbomo near the Republic of the Congo's northern border with Gabon. Many locals believe occult forces are at work. "In Kelle, people continue to believe that Ebola fever is a spell that has been cast on them by witches, and 4 teachers accused of being the cause of the disease have been beaten and stoned to death," said Dieudonne Hossie, a local official.

On Wed 19 Feb 2003, the World Health Organisation confirmed the outbreak of haemorrhagic fever was Ebola, and put the death toll at 64. State radio put the death toll at 68 on Fri 21 Feb 2003.

This is the second Ebola fever outbreak in little more than a year in the Republic of Congo's remote northwest. Kelle and Mbomo have been placed in quarantine, schools and churches have been closed, and people are banned from entering or leaving the area. Ebola killed at least 73 people in Congo and Gabon in an outbreak from October 2001 to February 2002.

Since the last WHO update dated Thu 13 Feb 2003, when the number of suspected cases was 73, the number of deaths has risen from 59 to 68.

As of Wed 25 Feb 2003, a total of 5 laboratory-confirmed and 90 probable cases, including 77 deaths (case fatality rate 81 percent) from Ebola hemorrhagic fever, has been reported in the districts of Mbomo and Kellé in Cuvette Ouest Region

Experts in clinical management and a logistician have joined the international team from the Global Outbreak Alert and Response Network, the Congolese Ministry of Health and WHO. Isolation wards have been set up in Kelle and Mbomo Hospitals, and are receiving patients.

Since the previous WHO Update released on Tue 18 Feb 2003, the number of probable and confirmed cases of Ebola hemorrhagic fever has increased by 22, and the number of deaths by 18.

As of Thu 27 Feb 2003, a total of 5 laboratory-confirmed and 92 probable cases, including 80 deaths, from Ebola haemorrhagic fever, has been reported in the districts of Mbomo and Kelle in Cuvette Ouest Region

The Congolese government has sent food for the communities in these districts. The Ministry of Health, WHO and the international team from the Global Outbreak Alert and Response Network are training local health workers in clinical management of the disease; carrying out active case finding and contact tracing; and providing protective clothing and essential medical equipment:

They are also developing public health education messages about Ebola fever with local leaders through the local radio and print media, and, with volunteers from the national Red Cross Society, working to increase community awareness and understanding of Ebola fever.

These figures represent an increase of 2 cases and 3 deaths in the 48 hours since Wed 25 Feb 2003.

Republic of the Congo: Ebola Fever Death Toll Rises to 81

According to the data published today by the Congolese Ministry of Health, at least 81 persons have died as a result of the epidemic of Ebola hemorrhagic fever in the Cuvette Ouest Region (northwest Congo), on the border with Gabon. The Ministry of Health information bulletin indicates that the district of Kelle, 430 miles northwest of Brazzaville, where the main focus of the epidemic is located, registered 72 deaths, while the neighboring district of Mbomo, almost 500 miles further north, reported 9 victims since the disease appeared on 4 Jan 2003. In 1996, a similar epidemic caused the death of hundreds of people in the Democratic Republic of Congo (DRC).

Shortly before, WHO spokesperson Fadela Chaib had stated that in Cuvette Ouest, 80 of the 97 cases of Ebola hemorrhagic fever registered had died. According to the WHO data, 72 of the 85 cases registered in Kelle died, as did 8 of the 12 cases registered in Mbomo. According to Chaib, local communities have begun to have a better understanding of this highly contagious disease, and have less fear, thanks in part to the medical and expert teams that have arrived and who are instructing them to not eat dead monkeys found in the forest, as well as to change their burial rites.

The Ministry of Health report increases the number of death reported by WHO by one.

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