Ebola Hemorrhagic Fever Outbreaks in Gabon, 1994–1997: Epidemiologic andHealth Control Issues
Alain-Jean Georges, Eric M. Leroy, Andre´A. Renaut,
Centre International de Recherches Me´ dicales de Franceville, Franceville, Ministe`re de la Sante´ Publique, Faculte´ de Me´decine,
Carol Tevi Benissan, Rene´J. Nabias, Minh Trinh Ngoc,
Universite´ Omar Bongo, Mission Franc ¸aise de Cooperation et d’Action
Paul I. Obiang, J. P. M. Lepage,* Eric J. Bertherat,*
Culturelle, and Ministe`re de la Sante´ Publique, Libreville, Gabon
David D. Be´noni, E. Jean Wickings, Jacques P. Amblard,*Joseph M. Lansoud-Soukate, J. M. Milleliri, Sylvain Baize,and Marie-Claude Georges-Courbot*
From the end of 1994 to the beginning of 1995, 49 patients with hemorrhagic symptoms werehospitalized in the Makokou General Hospital in northeastern Gabon. Yellow fever (YF) virus wasﬁrst diagnosed in serum by use of polymerase chain reaction followed by blotting, and a vaccinationcampaign was immediately instituted. The epidemic, known as the fall 1994 epidemic, ended 6weeks later. However, some aspects of this epidemic were atypical of YF infection, so a retrospectivecheck for other etiologic agents was undertaken. Ebola (EBO) virus was found to be present concomi-tantly with YF virus in the epidemic. Two other epidemics (spring and fall 1996) occurred in thesame province. GP and L genes of EBO virus isolates from all three epidemics were partiallysequenced, which showed a difference of
0.1% in the base pairs. Sequencing also showed that allisolates were very similar to subtype Zaire EBO virus isolates from the Democratic Republic of theCongo.
Johnson et al.  isolated and identiﬁed Ebola (EBO) virus associated with a mortality rate similar to that seen during theDRC and Sudan epidemics .from human cases during a 1976 epidemic of hemorrhagicfever (HF) in the Democratic Republic of the Congo (DRC). During 1994 and 1995, an outbreak of HF occurred in north-eastern Gabon. It was ﬁrst considered to be caused only byDuring the same year, EBO virus was isolated from patientsduring an HF epidemic in Sudan . The viruses, which were yellow fever (YF) virus on the basis of the clinical symptom-atology, routine biochemical tests, and speciﬁc laboratory re-closely related to Marburg virus (all members of the Filoviri-dae), had an 88% and a 53% case fatality rate in DRC  and sults provided by the Centre National de Re´fe´rence des Fie`vresHemorragiques Virales (InstitutPasteur, Paris) [8, 9]. However,Sudan , respectively. A third outbreak, with a case fatalityof 60%, occurred in Sudan in 1979 . In addition, a death retrospective serologic tests detected concomitant EBO virusantibodies among some of the patients and the general popula-was registered in Tandala, DRC, in 1979 . In 1994, a newstrain of EBO virus was isolated from a Swiss researcher with tion [10, 11]. Later efforts to isolate the EBO virus from someof the specimens from the ﬁrst epidemic (1994) were success-a dengue-like syndrome, who had likely been infected duringthe necropsy of a chimpanzee (see Formenty et al., this supple- ful. One year later, in February and in July 1996, two moreHF outbreaks occurred in northeastern Gabon [10–13].ment). The animal had been found dead in the Taı
NationalForest (Coˆte d’Ivoire) during a 2-year epidemic that killed half Herein, we report on three EBO epidemics that occurred between late 1994 and early 1997 in northeastern Gabon .of the population of chimpanzees . A third serious humanepidemic of EBO occurred in 1995 in Kikwit, DRC; it was
It is important to note that during this investigation, we
Informed consent was obtained from the patients or their parents or guard-
continually faced many difﬁculties (e.g., logistics problems and
ians.Financial support:CIRMF is supported bythe Republic of Gabon,the French
cultural and political constraints) in the collection of data and
Ministry of Foreign Affairs (Coope´ration et Action Culturelle), and ELF GA-
managementof our research on this disease. Despiteour efforts,
BON Co. Ltd. (Libreville).
the difﬁculties sometimes led to the loss of important informa-
Reprints or correspondence (current afﬁliation): Dr. Alain-Jean Georges,Chefferie, Hopital d’Instruction des Arme´es Desgenettes, 108 Bd Pinel, 69
tion, and at times, forced us to report the scientiﬁc data in a
275 Lyon, Cedex 03, France (firstname.lastname@example.org).
rather unorthodox manner.
* Current afﬁliations:CHA, Lamaloules Bains,France (J.P.M.L.);IMTSSA,
First epidemic (fall 1994).
The ﬁrst epidemic in Gabon
Le Pharo, Marseille Arme´es, France (E.J.B.); Ministe`re Affaires Etrange`res,Service de l’Action Humanitaire, Paris (J.P.A.); and CBMS, Institut Pasteur,
had two waves of patients, with the ﬁrst beginning in early
December 1994 and the second beginning at the end of January
The Journal of Infectious Diseases 1999;179(Suppl 1):S65–75
to February 1995. All patients in the ﬁrst wave came from 3
1999 by the Infectious Diseases Society of America. All rights reserved.0022–1899/99/79S1–0013$02.00
gold-panning encampments (Me´kouka, Andock, and Minke´ be´)
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