You are on page 1of 24

EBOLA VIRUS,THE 21

st
CENTURY KILLER
Ronnie Carleton 2014
KNO THE VIRUS!
INTRO"UCTION!
T#is s$all %oo& is a '(i)e onl* +or ,are -or&ers, st()ent n(rses an) t#ose .eo.le -#o
#a/e to -or& -it# E%ola .atients -#o $a* %e %ro('#t to t#e UK, Irelan), USA or
E(ro.e +or treat$ent! In .arts o+ A+ri,a ri'#t no- as I -rite t#e /ir(s is o(t o+ ,ontrol
an) s.rea)in'!020141
T#e ris& is #i'# +or all ,are -or&ers -#o -or& -it# .atients an) +or t#ose t#at #a/e
,onta,t -it# t#e$ in,l()in' +a$il* $e$%ers (nless are sa+e'(ar)e) a'ainst ,onta,tin'
t#e /ir(s!
In $* resear,# in 1234 on HIV an) AI"S in A+ri,a t#ere -as a lot o+ ,on,ern a%o(t t#e
HIV an) AI"S /ir(ses an) ,on+(sion -as ra$.ant -it# t#e /ir(s -e -ere )ealin' -it#!
E%ola -as also in +o,(s in t#e o(t%rea& areas %(t at ti$es t#ere -as at ti$es, $ista&es
$a)e an) HIV5AI"S an) E%ola -ere all in t#e %oilin' .ot at t#e one ti$e!
THERE IS NO CURE AN" 607 O8 ALL VICTI9S "IE ITHIN TO EEKS
I8 NOT BE8ORE!
E9BOLA!
E%ola /ir(s )isease 0EV"1 or E%ola #e$orr#a'i, +e/er 0EH81 is t#e #($an )isease
,a(se) %* t#e E%ola /ir(s! S*$.to$s t*.i,all* start t-o )a*s to t#ree -ee&s a+ter
,ontra,tin' t#e /ir(s, -it# a +e/er, sore t#roat, $(s,le .ains, an) #ea)a,#es! T*.i,all*
na(sea, /o$itin', an) )iarr#ea +ollo-, alon' -it# )e,rease) +(n,tionin' o+ t#e li/er an)
&i)ne*s! At t#is .oint, so$e .eo.le %e'in to #a/e %lee)in' .ro%le$s!
T#e /ir(s $a* %e a,:(ire) (.on ,onta,t -it# %loo) or %o)il* +l(i)s o+ an in+e,te)
ani$al 0,o$$onl* $on&e*s or +r(it %ats1!;1< It is not nat(rall* trans$itte) t#ro('# t#e
air!
8r(it %ats are %elie/e) to ,arr* an) s.rea) t#e /ir(s -it#o(t %ein' a++e,te)!
On,e #($an in+e,tion o,,(rs, t#e )isease $a* s.rea) %et-een .eo.le as -ell!
9ale s(r/i/ors $a* %e a%le to trans$it t#e )isease /ia se$en +or nearl* t-o $ont#s!
In or)er to $a&e t#e )ia'nosis, t*.i,all* ot#er )iseases -it# si$ilar s*$.to$s s(,# as
$alaria, ,#olera an) ot#er /iral #e$orr#a'i, +e/ers are +irst e=,l()e)! T#is ta&es ti$e
an) ti$e is so$et#in' a /i,ti$ o+ E%ola )oes not #a/e $(,# o++!
Bloo) sa$.les $a* t#en %e teste) +or /iral anti%o)ies, /iral RNA, or t#e /ir(s itsel+ to
,on+ir$ t#e )ia'nosis! T#en -ait, #o- lon' +or t#e res(lts ,o$in' %a,& +ro$ .at#olo'*>
?re/ention in,l()es )e,reasin' t#e s.rea) o+ )isease +ro$ in+e,te) $on&e*s an) .i's to
#($ans! T#is $a* %e )one %* ,#e,&in' s(,# ani$als +or in+e,tion an) &illin' an)
.ro.erl* )is.osin' o+ t#e %o)ies i+ t#e )isease is )is,o/ere)! ?ro.erl* ,oo&in' $eat an)
-earin' .rote,ti/e ,lot#in' -#en #an)lin' $eat $a* also %e #el.+(l, as is -earin'
.rote,ti/e ,lot#in' an) -as#in' #an)s -#en aro(n) a .erson -it# t#e )isease! Sa$.les
o+ %o)il* +l(i)s an) tiss(es +ro$ .eo.le -it# t#e )isease s#o(l) %e #an)le) -it# s.e,ial
,a(tion! I+ not *o( -ill %e,o$e in+e,te) an) $ore t#an li&el* )ie!
T#ere is no s.e,i+i, treat$ent +or t#e )isease@ e++orts to #el. .ersons -#o are in+e,te)
in,l()e 'i/in' eit#er oral re#*)ration t#era.* 0sli'#tl* s-eet an) salt* -ater to )rin&1
or intra/eno(s +l(i)s! T#e )isease #as #i'# $ortalit* rateA o+ten &illin' %et-een B07
an) 207 o+ t#ose in+e,te) -it# t#e /ir(s!
EV" -as +irst i)enti+ie) in S()an an) t#e "e$o,rati, Re.(%li, o+ t#e Con'o! T#e
)isease t*.i,all* o,,(rs in o(t%rea&s in tro.i,al re'ions o+ S(%CSa#aran A+ri,a!
Bet-een 1234, -#en it -as +irst i)enti+ie), t#ro('# 201D, +e-er t#an 1,000 .eo.le .er
*ear #a/e %een in+e,te)!
T#e lar'est o(t%rea& to )ate is t#e on'oin' 2014 est A+ri,a E%ola o(t%rea&, -#i,# is
a++e,tin' E(inea, Sierra Leone, an) Li%eria!
As o+ F(l* 2014 $ore t#an 1D20 ,ases #a/e %een i)enti+ie)!
E++orts are on'oin' to )e/elo. a /a,,ine@ #o-e/er, none *et e=ists! It is (nli&le*
t#at one -ill %e +o(n) in t#e ne=t +i/e *ear or $ore as t#is /ir(s $a* -ell $(tate!
Si'ns an) s*$.to$s o+ E%ola (s(all* %e'in s())enl* -it# an +l(Cli&e sta'e
,#ara,teriGe) %* +ati'(e, +e/er, #ea)a,#es, an) Hoint, $(s,le, an) a%)o$inal .ain!
Vo$itin', )iarr#ea an) loss o+ a..etite are also ,o$$on!
Less ,o$$on s*$.to$s in,l()e t#e +ollo-in'A sore t#roat, ,#est .ain, #i,,(.s,
s#ortness o+ %reat# an) tro(%le s-allo-in'!
T#e a/era'e ti$e %et-een ,ontra,tin' t#e in+e,tion an) t#e start o+ s*$.to$s is 6 to 10
)a*s, %(t ,an o,,(r %et-een 2 an) 21 )a*s!
S&in $ani+estations $a* in,l()e a $a,(lo.a.(lar ras# 0in a%o(t B07 o+ ,ases1!
Earl* s*$.to$s o+ EV" $a* %e si$ilar to t#ose o+ $alaria, )en'(e +e/er, or ot#er
tro.i,al +e/ers, %e+ore t#e )isease .ro'resses to t#e %lee)in' .#ase!
In t#e %lee)in' .#ase internal an) s(%,(taneo(s %lee)in' $a* .resent itsel+ t#ro('#
re))enin' o+ t#e e*es an) %loo)* /o$it!
Blee)in' into t#e s&in $a* ,reate .ete,#iae, .(r.(ra, e,,#*$oses, an) #e$ato$as
0es.e,iall* aro(n) nee)le inHe,tion sites1!
All .eo.le in+e,te) s#o- so$e s*$.to$s o+ ,ir,(lator* s*ste$ in/ol/e$ent, in,l()in'
i$.aire) %loo) ,lottin'!
Blee)in' +ro$ .(n,t(re sites an) $(,o(s $e$%ranes 0e!'! 'astrointestinal tra,t, nose,
/a'ina an) '($s1 is re.orte) in 40IB07 o+ ,ases! T#ere $a* -ell %e %loo) tra,es in
(rine sa$.les or /oi)in' in a %e)!
T*.es o+ %lee)in' &no-n to o,,(r -it# E%ola /ir(s )isease in,l()e /o$itin' %loo),
,o('#in' it (. or %loo) in t#e stool! 0?oo, )ro..in's! 1
Hea/* %lee)in' is rare an) is (s(all* ,on+ine) to t#e 'astrointestinal tra,t!
In 'eneral, t#e )e/elo.$ent o+ %lee)in' s*$.to$s o+ten in)i,ates a -orse .ro'nosis an)
t#is %loo) loss ,an res(lt in )eat#! In $ost ,ases it )oes!
EV" is ,a(se) %* +o(r o+ +i/e /ir(ses ,lassi+ie) in t#e 'en(s E%ola/ir(s, +a$il*
8ilo/iri)ae, or)er 9onone'a/irales! T#ese +o(r /ir(ses are B(n)i%('*o /ir(s 0B"BV1,
E%ola /ir(s 0EBOV1, S()an /ir(s 0SU"V1, TaJ 8orest /ir(s 0TA8V1! T#e +i+t# /ir(s,
Reston /ir(s 0RESTV1, is not t#o('#t to %e )iseaseC,a(sin' in #($ans! B(t t#ere is no
e/i)en,e t#at it )oes not so %e alert!
"(rin' an o(t%rea& t#ose at #i'#est ris& are #ealt# ,are -or&ers an) ,lose ,onta,ts o+
t#ose -it# t#e in+e,tion! 8a$il* %o)* #(''ers are $ost at ris&K
It is not ,lear #o- E%ola is s.rea)! EV" is %elie/e) to o,,(r a+ter an e%ola /ir(s is
trans$itte) to an initial #($an %* ,onta,t -it# an in+e,te) ani$alLs %o)il* +l(i)s!
T#is $eans all ani$al %o)* +l(i)s an) not H(st t#e %loo)K
H($anCtoC#($an trans$ission ,an o,,(r /ia )ire,t ,onta,t -it# %loo) or %o)il* +l(i)s
+ro$ an in+e,te) .erson 0in,l()in' e$%al$in' o+ an in+e,te) )ea) .erson -#i,# s#o(l)
not %e allo-e)1 or %* ,onta,t -it# ,onta$inate) $e)i,al e:(i.$ent, .arti,(larl*
nee)les an) s*rin'es!
Se$en is in+e,tio(s in s(r/i/ors +or (. to B0 )a*s! 0?lease Note1
Trans$ission t#ro('# oral e=.os(re an) t#ro('# ,onH(n,ti/a e=.os(re is li&el* an) #as
%een ,on+ir$e) in nonC#($an .ri$ates t#at %ein' all $on&e*s an) a.es, so$e o+ -#i,#
are e=.orte) to t#e UK an) E(ro.e +or $e)i,al resear,# an) as +(t(re .ets!
MooLs no- #a/e or s#o(l) #a/e t#e -it to &no- t#e ris&K
T#e .otential +or -i)es.rea) EV" in+e,tions is ,onsi)ere) lo- as t#e )isease is onl*
s.rea) %* )ire,t ,onta,t -it# t#e se,retions +ro$ so$eone -#o is s#o-in' si'ns o+
in+e,tion! I )onLt t#in& t#is is t#e ri'#t a..roa,# or t#e ri'#t a)/i,e 'i/en %* Le=.ertsL
-#o &no- little o+ t#e ris& or ot#er -a*s o+ s.rea)!
T#e :(i,& onset o+ s*$.to$s $a&es it easier to i)enti+* si,& in)i/i)(als an) li$its a
.ersonLs a%ilit* to s.rea) t#e )isease %* tra/elin'! Be,a(se )ea) %o)ies are still
in+e,tio(s, so$e )o,tors )is.ose) o+ t#e$ in a sa+e $anner, )es.ite lo,al tra)itional
%(rial rit(als! T#is .ra,ti,e is less t#an 107 as it stan)s at t#e $o$ent!
9e)i,al -or&ers -#o )o not -ear a..ro.riate .rote,ti/e ,lot#in' $a* also ,ontra,t t#e
)isease! In t#e .ast, #os.italCa,:(ire) trans$ission #as o,,(rre) in A+ri,an #os.itals
)(e to t#e re(se o+ nee)les an) la,& o+ (ni/ersal .re,a(tions! In t#e $arines -e ,all t#is
sel+ in+li,te) -o(n)s or in+e,tions! In t#e UK it is (. to #os.ital $ana'ers to see t#at
t#is )oes not #a..en to sta++ i+ E%ola 'ets #ere!
EV" is not nat(rall* trans$itte) t#ro('# t#e air!;T#e* are, #o-e/er, in+e,tio(s as
%reat#a%le 0!6I1!2 $i,ro$etre la%orator* 'enerate) )ro.lets@ %e,a(se o+ t#is .otential
ro(te o+ in+e,tion, t#ese /ir(ses #a/e %een ,lassi+ie) as Cate'or* A %iolo'i,al -ea.ons!
Re,entl* t#e /ir(s #as %een s#o-n to tra/el -it#o(t ,onta,t +ro$ .i's to nonC#($an
.ri$ates! 8ro$ a terrorist .oint o+ /ie- in t#e UK, Irelan), E(ro.e an) t#e USA it is
s,ar*!
Bats )ro..in's .artiall* i+ t#e* #a/e eaten +r(its an) .(l., t#en lan) $a$$als s(,# as
'orillas an) )(i&ers +ee) on t#ese +allen +r(its! T#is ,#ain o+ e/ents +or$s a .ossi%le
in)ire,t $eans o+ trans$ission +ro$ t#e nat(ral #ost to ani$al .o.(lations, -#i,# #a/e
le) to resear,# to-ar)s /iral s#e))in' in t#e sali/a o+ %ats! 8r(it .ro)(,tion, ani$al
%e#a/ior, an) ot#er +a,tors /ar* at )i++erent ti$es an) .la,es t#at $a* tri''er
o(t%rea&s a$on' ani$al .o.(lations! Bats in t#e +(t(re an) t#eir )ro..in's in t#e UK,
Irelan) an) E(ro.e $a* -ell in ti$e %e,o$e a /e,tor o+ t#e /ir(sK Va$.ire %ats o+ t#e
USA, 9e=i,o are #i'# ris& /e,tors i+ t#e E%ola /ir(s 'ets into t#e s*ste$K
Bats are ,onsi)ere) t#e $ost li&el* nat(ral reser/oir o+ t#e E%ola /ir(s 0EBOV1@ .lants,
art#ro.o)s, an) %ir)s #a/e also %een ,onsi)ere)! S.rin' %ir) $i'rants to E(ro.e an)
t#e UK in 201B $a* %e /e,tors o+ t#e )isease i+ t#e* ,o$e +ro$ est A+ri,a an) Con'o
area!
Bats -ere &no-n to resi)e in t#e ,otton +a,tor* in -#i,# t#e +irst ,ases +or t#e 1234 an)
1232 o(t%rea&s -ere e$.lo*e), an) t#e* #a/e also %een i$.li,ate) in 9ar%(r' /ir(s
in+e,tions in 123B an) 1260!
O+ 24 .lant s.e,ies an) 12 /erte%rate s.e,ies e=.eri$entall* ino,(late) -it# EBOV,
onl* %ats %e,a$e in+e,te)! T#e a%sen,e o+ ,lini,al si'ns in t#ese %ats is ,#ara,teristi, o+
a reser/oir s.e,ies! In a 2002I200D s(r/e* o+ 1,0D0 ani$als in,l()in' 432 %ats +ro$
Ea%on an) t#e Re.(%li, o+ t#e Con'o, 1D +r(it %ats -ere +o(n) to ,ontain EBOV RNA
+ra'$ents!
As o+ 200B, t#ree t*.es o+ +r(it %ats 0H*.si'nat#(s $onstros(s, E.o$o.s +ran:(eti, an)
9*on*,teris tor:(ata1 #a/e %een i)enti+ie) as %ein' in ,onta,t -it# EBOV! T#e* are
no- s(s.e,te) to re.resent t#e EBOV reser/oir #osts!
Anti%o)ies a'ainst E%ola Maire an) Reston /ir(ses #a/e %een +o(n) in +r(it %ats in
Ban'la)es#, t#(s i)enti+*in' .otential /ir(s #osts an) si'ns o+ t#e +ilo/ir(ses in Asia!
In+e,te) %at s.e,ies i+ an*, in E(ro.e, s#o(l) %e ,#e,&e) o(t an) %at -or&ers I a)/ise
-ear 'lo/es an) a $as& i+ t#e* are 'oin' into roosts!
Bet-een 1234 an) 1226, in D0,000 $a$$als, %ir)s, re.tiles, a$.#i%ians, an)
art#ro.o)s sa$.le) +ro$ o(t%rea& re'ions, no e%ola/ir(s -as )ete,te) a.art +ro$
so$e 'eneti, tra,es +o(n) in si= ro)ents 09(s set(los(s an) ?rao$*s1 an) one s#re-
0S*l/isore= oll(la1 ,olle,te) +ro$ t#e Central A+ri,an Re.(%li,! Tra,es o+ EBOV -ere
)ete,te) in t#e ,ar,asses o+ 'orillas an) ,#i$.anGees )(rin' o(t%rea&s in 2001 an)
200D, -#i,# later %e,a$e t#e so(r,e o+ #($an in+e,tions! Ho-e/er, t#e #i'# let#alit*
+ro$ in+e,tion in t#ese s.e,ies $a&es t#e$ (nli&el* as a nat(ral reser/oir sa* t#e
Le=.ertsL, #o-e/er t#in's no- #a/e ,#an'e) an) ,a(tion is nee)e)!
Trans$ission %et-een nat(ral reser/oir an) #($ans is rare, an) o(t%rea&s are (s(all*
tra,ea%le to a sin'le ,ase -#ere an in)i/i)(al #as #an)le) t#e ,ar,ass o+ 'orilla,
,#i$.anGee, or )(i&er!
8r(it %ats are also eaten %* .eo.le in .arts o+ est A+ri,a -#ere t#e* are s$o&e),
'rille) or $a)e into a s.i,* so(.! B(s#$eat o+ all &in)s s#o(l) %e %anne) +ro$ ,o$in'
into E(ro.e an) t#e UK no $atter -#at sort it is! At t#e $o$ent it is 'ettin' in -it#
s$(''lin'!
Li&e all $onone'a/ir(ses, e%ola/irions ,ontain linear nonse'$ente), sin'leCstran),
nonCin+e,tio(s RNA 'eno$es o+ ne'ati/e .olarit* t#at .ossesses in/erseC,o$.le$entar*
DL an) BL ter$ini, )o not .ossess a BL ,a., are not .ol*a)en*late), an) are not ,o/alentl*
lin&e) to a .rotein!
E%ola/ir(s 'eno$es are a..ro=i$atel* 12 &ilo%ase .airs lon' an) ,ontain se/en 'enes
in t#e or)er DLCUTRCN?CV?DBCV?40CE?CV?D0CV?24CLCBLCUTR!;D3< T#e 'eno$es o+ t#e
+i/e )i++erent e%ola/ir(ses 0B"BV, EBOV, RESTV, SU"V, an) TA8V1 )i++er in se:(en,e
an) t#e n($%er an) lo,ation o+ 'ene o/erla.s!
Str(,t(re
Li&e all +ilo/ir(ses, e%ola/irions are +ila$ento(s .arti,les t#at $a* a..ear in t#e s#a.e
o+ a s#e.#er)Ls ,roo& or in t#e s#a.e o+ a NUN or a N4N, an) t#e* $a* %e ,oile), toroi),
or %ran,#e)! In 'eneral, e%ola/irions are 60 n$ in -i)t#, %(t /ar* so$e-#at in len't#!
In 'eneral, t#e $e)ian .arti,le len't# o+ e%ola/ir(ses ran'es +ro$ 234 to 1,064 n$ 0in
,ontrast to $ar%(r'/irions, -#ose $e)ian .arti,le len't# -as $eas(re) at 32BI626
n$1, %(t .arti,les as lon' as 14,000 n$ #a/e %een )ete,te) in tiss(e ,(lt(re!
Re.li,ation
T#e e%ola/ir(s li+e ,*,le %e'ins -it# /irion atta,#$ent to s.e,i+i, ,ellCs(r+a,e re,e.tors,
+ollo-e) %* +(sion o+ t#e /irion en/elo.e -it# ,ell(lar $e$%ranes an) t#e ,on,o$itant
release o+ t#e /ir(s n(,leo,a.si) into t#e ,*tosol!
T#e /iral RNA .ol*$erase, en,o)e) %* t#e L 'ene, .artiall* (n,oats t#e n(,leo,a.si)
an) trans,ri%es t#e 'enes into .ositi/eCstran) $RNAs, -#i,# are t#en translate) into
str(,t(ral an) nonstr(,t(ral .roteins! E%ola/ir(s RNA .ol*$erase 0L1 %in)s to a sin'le
.ro$oter lo,ate) at t#e DL en) o+ t#e 'eno$e! Trans,ri.tion eit#er ter$inates a+ter a
'ene or ,ontin(es to t#e ne=t 'ene )o-nstrea$!
T#is $eans t#at 'enes ,lose to t#e DL en) o+ t#e 'eno$e are trans,ri%e) in t#e 'reatest
a%(n)an,e, -#ereas t#ose to-ar) t#e BL en) are least li&el* to %e trans,ri%e)!
T#e 'ene or)er is, t#ere+ore, a si$.le %(t e++e,ti/e +or$ o+ trans,ri.tional re'(lation!
T#e $ost a%(n)ant .rotein .ro)(,e) is t#e n(,leo.rotein, -#ose ,on,entration in t#e
,ell )eter$ines -#en L s-it,#es +ro$ 'ene trans,ri.tion to 'eno$e re.li,ation!
Re.li,ation res(lts in +(llClen't#, .ositi/eCstran) anti'eno$es t#at are, in t(rn,
trans,ri%e) into ne'ati/eCstran) /ir(s .ro'en* 'eno$e ,o.*! Ne-l* s*nt#esiGe)
str(,t(ral .roteins an) 'eno$es sel+Casse$%le an) a,,($(late near t#e insi)e o+ t#e ,ell
$e$%rane! Virions %() o++ +ro$ t#e ,ell, 'ainin' t#eir en/elo.es +ro$ t#e ,ell(lar
$e$%rane t#e* %() +ro$! T#e $at(re .ro'en* .arti,les t#en in+e,t ot#er ,ells to re.eat
t#e ,*,le!
En)ot#elial ,ells, $onon(,lear .#a'o,*tes, an) #e.ato,*tes are t#e $ain tar'ets o+
in+e,tion! A+ter in+e,tion, a se,rete) 'l*,o.rotein 0sE?1 &no-n as t#e E%ola /ir(s
'l*,o.rotein 0E?1 is s*nt#esiGe)! E%ola re.li,ation o/er-#el$s .rotein s*nt#esis o+
in+e,te) ,ells an) #ost i$$(ne )e+enses!
T#e E? +or$s a tri$eri, ,o$.le=, -#i,# %in)s t#e /ir(s to t#e en)ot#elial ,ells linin'
t#e interior s(r+a,e o+ %loo) /essels! T#e sE? +or$s a )i$eri, .rotein t#at inter+eres
-it# t#e si'nalin' o+ ne(tro.#ils, a t*.e o+ -#ite %loo) ,ell, -#i,# allo-s t#e /ir(s to
e/a)e t#e i$$(ne s*ste$ %* in#i%itin' earl* ste.s o+ ne(tro.#il a,ti/ation! T#ese -#ite
%loo) ,ells also ser/e as ,arriers to trans.ort t#e /ir(s t#ro('#o(t t#e entire %o)* to
.la,es s(,# as t#e l*$.# no)es, li/er, l(n's, an) s.leen!
T#e .resen,e o+ /iral .arti,les an) ,ell )a$a'e res(ltin' +ro$ %())in' ,a(ses t#e
release o+ ,*to&ines 0to %e s.e,i+i,, TN8CO, ILC4, ILC6, et,!1, -#i,# are t#e si'nalin'
$ole,(les +or +e/er an) in+la$$ation! T#e ,*to.at#i, e++e,t, +ro$ in+e,tion in t#e
en)ot#elial ,ells, res(lts in a loss o+ /as,(lar inte'rit*!
T#is loss in /as,(lar inte'rit* is +(rt#ere) -it# s*nt#esis o+ E?, -#i,# re)(,es s.e,i+i,
inte'rins res.onsi%le +or ,ell a)#esion to t#e interC,ell(lar str(,t(re, an) )a$a'e to t#e
li/er, -#i,# lea)s to ,oa'(lo.at#*!
T#e $e)i,al #istor*, es.e,iall* tra/el an) -or& #istor* alon' -it# e=.os(re to -il)li+e
are i$.ortant to s(s.e,t t#e )ia'nosis o+ EV"!
T#e )ia'nosis is ,on+ir$e) %* isolatin' t#e /ir(s, )ete,tin' its RNA or .roteins, or
)ete,tin' anti%o)ies a'ainst t#e /ir(s in a .ersonLs %loo)! Isolatin' t#e /ir(s %* ,ell
,(lt(re, )ete,tin' t#e /iral RNA %* .ol*$erase ,#ain rea,tion 0?CR1 an) )ete,tin'
.roteins %* enG*$eClin&e) i$$(nosor%ent assa* 0ELISA1 is e++e,ti/e earl* an) in t#ose
-#o #a/e )ie) +ro$ t#e )isease! "ete,tin' anti%o)ies a'ainst t#e /ir(s is e++e,ti/e late in
t#e )isease an) in t#ose -#o re,o/er! No- less t#an 207 an) )ro..in'!
"(rin' an o(t%rea&, /ir(s isolation is o+ten not +easi%le! T#e $ost ,o$$on )ia'nosti,
$et#o)s are t#ere+ore real ti$e ?CR an) ELISA )ete,tion o+ .roteins, -#i,# ,an %e
.er+or$e) in +iel) or $o%ile #os.itals!;4D< 8ilo/irions ,an %e seen an) i)enti+ie) in ,ell
,(lt(re %* ele,tron $i,ros,o.* )(e to t#eir (ni:(e +ila$ento(s s#a.es, %(t ele,tron
$i,ros,o.* ,annot tell t#e )i++eren,e %et-een t#e /ario(s +ilo/ir(ses )es.ite t#ere %ein'
so$e len't# )i++eren,es!
T#e 'enera E%ola/ir(s an) 9ar%(r'/ir(s -ere ori'inall* ,lassi+ie) as t#e s.e,ies o+ t#e
no-Co%solete 8ilo/ir(s 'en(s!
In 9ar,# 1226, t#e Verte%rate Vir(s S(%,o$$ittee .ro.ose) in t#e International
Co$$ittee on Ta=ono$* o+ Vir(ses 0ICTV1 to ,#an'e t#e 8ilo/ir(s 'en(s to t#e
8ilo/iri)ae +a$il* -it# t-o s.e,i+i, 'eneraA E%olaCli&e /ir(ses an) 9ar%(r'Cli&e
/ir(ses! T#is .ro.osal -as i$.le$ente) in as#in'ton, "C on A.ril 2001 an) in ?aris
on F(l* 2002!
In 2000, anot#er .ro.osal -as $a)e in as#in'ton, "!C!, to ,#an'e t#e NCli&e /ir(sesN
to NC/ir(sN res(ltin' in to)a*Ls E%ola/ir(s an) 9ar%(r'/ir(s! Yo( ,an ,#an,e na$es all
*o( li&e %(t $(tations -ill #a..en an) a ne- na$e is not $(,# (se to an*one -#en t#e
.atient is %lee)in' o(t an) #is or #er &i)ne*s are t(rnin' to $(s#!
Rates o+ 'eneti, ,#an'e are 100 ti$es slo-er t#an in+l(enGa A in #($ans, %(t on t#e
sa$e $a'nit()e as t#ose o+ #e.atitis B! E=tra.olatin' %a,&-ar)s (sin' t#ese rates
in)i,ates t#at E%ola/ir(s an) 9ar%(r'/ir(s )i/er'e) se/eral t#o(san) *ears a'o!
Ho-e/er, .aleo/ir(ses 0'eno$i, +ossils1 o+ +ilo/ir(ses 08ilo/iri)ae1 +o(n) in $a$$als
in)i,ate t#at t#e +a$il* itsel+ is at least tens o+ $illions o+ *ears ol)!
8ossiliGe) /ir(ses t#at are ,losel* relate) to e%ola/ir(ses #a/e %een +o(n) in t#e
'eno$e o+ t#e C#inese #a$ster!
T#e s*$.to$s o+ EV" are si$ilar to t#ose o+ 9ar%(r' /ir(s )isease!
It ,an also easil* %e ,on+(se) -it# $an* ot#er )iseases ,o$$on in E:(atorial A+ri,a
s(,# as ot#er /iral #e$orr#a'i, +e/ers, +al,i.ar($ $alaria, t*.#oi) +e/er, s#i'ellosis,
ri,&ettsial )iseases s(,# as t*.#(s, ,#olera, 'ra$Cne'ati/e se.ti,e$ia, %orreliosis s(,#
as rela.sin' +e/er or EHEC enteritis!
Ot#er in+e,tio(s )iseases t#at s#o(l) %e in,l()e) in t#e )i++erential )ia'nosis in,l()e t#e
+ollo-in'A le.tos.irosis, s,r(% t*.#(s, .la'(e, P +e/er, ,an)i)iasis, #isto.las$osis,
tr*.anoso$iasis, /is,eral leis#$aniasis, #e$orr#a'i, s$all.o=, $easles, an) +(l$inant
/iral #e.atitis!
NonCin+e,tio(s )iseases t#at ,an %e ,on+(se) -it# EV" are a,(te .ro$*elo,*ti,
le(&e$ia, #e$ol*ti, (re$i, s*n)ro$e, sna&e en/eno$ation, ,lottin' +a,tor
)e+i,ien,ies5.latelet )isor)ers, t#ro$%oti, t#ro$%o,*to.eni, .(r.(ra, #ere)itar*
#e$orr#a'i, telan'ie,tasia, Ka-asa&i )isease, an) e/en -ar+arin .oisonin'!K
E%ola /ir(ses are ,onta'io(s, -it# .re/ention .re)o$inantl* in/ol/in' %e#a/ior
,#an'es, .ro.er +(ll %o)* .ersonal .rote,ti/e e:(i.$ent, an) )isin+e,tion!
Te,#ni:(es to a/oi) in+e,tion in/ol/e not ,onta,tin' in+e,te) %loo) or se,retions,
in,l()in' +ro$ t#ose -#o are )ea)!
T#is in/ol/es s(s.e,tin' an) )ia'nosin' t#e )isease earl* an) (sin' stan)ar)
.re,a(tions +or all .atients in t#e #ealt#,are settin'!
Re,o$$en)e) $eas(res -#en ,arin' +or t#ose -#o are in+e,te) in,l()eA -earin'
.rote,ti/e ,lot#in' in,l()in'A $as&s, 'lo/es, 'o-ns an) 'o''les, e:(i.$ent steriliGation
an) isolatin' t#e$!Han) -as#in' is i$.ortant %(t ,an %e )i++i,(lt in areas -ere t#ere is
not e/en eno('# -ater +or )rin&in'! An* in+e,te) areas t#at is a -ar Gone in A+ri,a t#e
ris& is 'reat to an*one! It -ill s.rea) an) +ast!
"(e to la,& o+ .ro.er e:(i.$ent an) #*'ieni, .ra,ti,es, lar'eCs,ale e.i)e$i,s #a/e
o,,(re) $ostl* in .oor, isolate) areas -it#o(t $o)ern #os.itals or -ellCe)(,ate)
$e)i,al sta++!
Tra)itional %(rial rit(als, es.e,iall* t#ose re:(irin' e$%al$in' o+ %o)ies, s#o(l) %e
)is,o(ra'e) or $o)i+ie)!
Airline ,re-s -#o +l* to areas o+ t#ese areas o+ t#e -orl) are ta('#t to i)enti+* E%ola
an) are to isolate an*one -#o #as s*$.to$s! B(t li&e I sa*, .i's -ill also +l*K
P(arantine, also &no-n as en+or,e) isolation, is (s(all* e++e,ti/e in )e,reasin' s.rea)!
Eo/ern$ents o+ten :(arantine areas -#ere t#e )isease is o,,(rrin' or t#ose -#o $a*
%e in+e,te)!
In t#e Unite) States t#e la- allo-s :(arantine o+ t#ose in+e,te) -it# E%ola!
T#e la,& o+ roa)s an) trans.ortation $a* #el. slo- t#e )isease in A+ri,a! "(rin' t#e
2014 o(t%rea& Li%eria ,lose) s,#ools!
No /a,,ine is ,(rrentl* a/aila%le +or #($ans!
T#e $ost .ro$isin' ,an)i)ates are "NA /a,,ines or /a,,ines )eri/e) +ro$
a)eno/ir(ses, /esi,(lar sto$atitis In)iana /ir(s 0VSIV1 or +ilo/ir(sCli&e .arti,les
0VL?s1 %e,a(se t#ese ,an)i)ates ,o(l) .rote,t non#($an .ri$ates +ro$ e%ola/ir(sC
in)(,e) )isease! "NA /a,,ines, a)eno/ir(sC%ase) /a,,ines, an) VSIVC%ase) /a,,ines
#a/e entere) ,lini,al trials!
Va,,ines #a/e .rote,te) non#($an .ri$ates! I$$(niGation ta&es si= $ont#s, -#i,#
i$.e)es t#e ,o(nterCe.i)e$i, (se o+ t#e /a,,ines! Sear,#in' +or a :(i,&er onset o+
e++e,ti/eness, in 200D a /a,,ine (sin' an a)eno/iral 0A"V1 /e,tor ,arr*in' t#e E%ola
s.i&e .rotein -as teste) on ,ra%Ceatin' $a,a:(es! T-ent*Cei'#t )a*s later t#e* -ere
,#allen'e) -it# t#e /ir(s an) re$aine) resistant!
A /a,,ine %ase) on atten(ate) re,o$%inant /esi,(lar sto$atitis /ir(s 0VSV1 /e,tor
,arr*in' eit#er t#e E%ola 'l*,o.rotein or t#e 9ar%(r' 'l*,o.rotein in 200B .rote,te)
non#($an .ri$ates, o.enin' ,lini,al trials in #($ans!
T#e st()* %* O,to%er ,o$.lete) t#e +irst #($an trial, o/er t#ree $ont#s 'i/in' t#ree
/a,,inations sa+el* in)(,in' an i$$(ne res.onse! In)i/i)(als +or a *ear -ere +ollo-e),
an), in 2004, a st()* testin' a +asterCa,tin', sin'leCs#ot /a,,ine %e'an@ t#is ne- st()*
-as ,o$.lete) in 2006!
Tr*in' t#e /a,,ine on a strain o+ E%ola t#at $ore rese$%les t#e one t#at in+e,ts #($ans
is t#e ne=t ste.! As lon' at it )oes not $(tate %e+ore t#en an) I #a/e no )o(%t t#at t#e
9e)i,al Co$.anies -ill (se %la,& '(inia .i's an) $a&e $one* %i' ti$e!
Tr* testin' a -#ite .o.(lation in E(ro.e $a* -ell ,ase anot#er -ee -ar an) t#e* &no-
t#is! Tr(st $e, in A+ri,a i+ *o( )ie o(tsi)e a to-n or ,it* )(e to $e)ial tests -#o ,ares>K
Not so$e o+ t#e $e)i,al ,o$.aines, not t#e tr(steeLs! Not t#e s#are #ol)ers t#at is +or
s(re %e,a(se t#e* -ant res(lts, res(lts t#at -ill sell!
0Vi,ti$, 2D001, $ale, a'e) 20, %la,&, .ai) Q100! "ie)!1 9one* tal&sK
On 4 "e,e$%er 2011, t#e )e/elo.$ent o+ a s(,,ess+(l /a,,ine a'ainst E%ola +or $i,e
-as re.orte)! Unli&e t#e .re)e,essors, it ,an %e +reeGeC)rie) an) t#(s store) +or lon'
.erio)s in -ait +or an o(t%rea&! All t#e -orl) $i,e o+ all s.e,ies are no- /er* #a..*K
An e=.eri$ental /a,,ine $a)e %* resear,#ers at Cana)aLs national la%orator* in
inni.e' -as (se) in 2002 to .reCe$.ti/el* treat a Eer$an s,ientist -#o $i'#t #a/e
%een in+e,te) )(rin' a la% a,,i)ent! Ho-e/er, a,t(al EBOV in+e,tion ,o(l) ne/er %e
)e$onstrate) -it#o(t a )o(%t!
E=.eri$entall*, re,o$%inant /esi,(lar sto$atitis In)iana /ir(s 0VSIV1 e=.ressin' t#e
'l*,o.rotein o+ EBOV or SU"V #as %een (se) s(,,ess+(ll* in non#($an .ri$ate
$o)els as .ostCe=.os(re .ro.#*la=is! E%ola /ir(ses are orl) Healt# Or'aniGation
Ris& Ero(. 4 .at#o'ens, re:(irin' %iosa+et* le/el 4Ce:(i/alent ,ontain$ent!
La%orator* resear,#ers $(st %e .ro.erl* traine) in BSLC4 .ra,ti,es an) -ear .ro.er
.ersonal .rote,ti/e e:(i.$ent!
No e%ola/ir(sCs.e,i+i, treat$ent e=ists!
Treat$ent is .ri$aril* s(..orti/e in nat(re an) in,l()es $ini$iGin' in/asi/e
.ro,e)(res, %alan,in' +l(i)s an) ele,trol*tes to ,o(nter )e#*)ration, a)$inistration o+
anti,oa'(lants earl* in in+e,tion to .re/ent or ,ontrol )isse$inate) intra/as,(lar
,oa'(lation, a)$inistration o+ .ro,oa'(lants late in in+e,tion to ,ontrol #e$orr#a'in',
$aintainin' o=*'en le/els, .ain $ana'e$ent, an) a)$inistration o+ anti%ioti,s or
anti$*,oti,s to treat se,on)ar* in+e,tions!
Earl* treat$ent $a* in,rease t#e ,#an,e o+ s(r/i/al!
T#e )isease #as a #i'# $ortalit* rateA o+ten %et-een B0 .er,ent an) 20 .er,ent!
I+ an in+e,te) .erson s(r/i/es, re,o/er* $a* %e :(i,& an) ,o$.lete! ?rolon'e) ,ases are
o+ten ,o$.li,ate) %* t#e o,,(rren,e o+ lon' ter$ .ro%le$s, s(,# as in+la$$ation o+ t#e
testi,les, Hoint .ains, $(s,le .ains, s&in .eelin', or #air loss! E*e s*$.to$s, s(,# as
li'#t sensiti/it*, e=,ess tearin', iritis, iri)o,*,litis, ,#oroi)itis an) %lin)ness #a/e also
%een )es,ri%e)!
EBOV an) SU"V $a* %e a%le to .ersist in t#e se$en o+ so$e s(r/i/ors +or (. to se/en
-ee&s, -#i,# ,o(l) 'i/e rise to in+e,tions an) )isease /ia se=(al inter,o(rse!
T#is is -#ere in 1234 ,on+(sion arose %et-een HIV an) AI"S %(t I -ill ,o$e %a,& to
t#at later!
T#e )isease t*.i,all* o,,(rs in o(t%rea&s in tro.i,al re'ions o+ S(%CSa#aran A+ri,a!
Bet-een 1234, -#en it -as +irst i)enti+ie), t#ro('# 201D, +e-er t#an 1,000 .eo.le .er
*ear #a/e %een in+e,te)!
T#e lar'est o(t%rea& to )ate is t#e on'oin' 2014 est A+ri,a E%ola o(t%rea&, -#i,# is
a++e,tin' E(inea, Sierra Leone, an) Li%eria!
As o+ F(l* 2014 $ore t#an 1D20 ,ases #a/e %een i)enti+ie)!E%ola o(t%rea&s #a/e %een
restri,te) to A+ri,a, -it# t#e e=,e.tion o+ Reston e%ola/ir(s!
T#e International Co$$ittee on Ta=ono$* o+ Vir(ses ,(rrentl* re,o'niGes +o(r s.e,ies
o+ t#e E%olaA Maire /ir(s 0MEBOV1, S()an e%ola/ir(s 0SEBOV1, Reston e%ola/ir(s
0REBOV1, an) CRte )LI/oire e%ola/ir(s 0CIEBOV1!
One a))itional s.e,ies or t*.e o+ E%ola is o+ten re,o'niGe) %* t#e orl) Healt#
Or'aniGation 0HO1 an) Centers +or "isease Control an) ?re/ention 0C"C1 as
B(n)i%('*o e%ola/ir(s 0B"BV1 or E%olaCB(n)i%('*o, +ollo-in' t#e o(t%rea& in
U'an)a in 2003!
Trans$ission %et-een nat(ral reser/oirs an) #($ans is rare, an) o(t%rea&s are o+ten
tra,ea%le to a sin'le in)e= ,ase -#ere an in)i/i)(al #as #an)le) t#e ,ar,ass o+ a 'orilla,
,#i$.anGee, or )(i&er!
T#e /ir(s t#en s.rea)s .ersonCtoC.erson, es.e,iall* -it#in +a$ilies, #os.itals, an)
)(rin' so$e $ort(ar* rit(als -#ere ,onta,t a$on' in)i/i)(als %e,o$es $ore li&el*!
Be+ore o(t%rea&s are ,on+ir$e) in areas o+ -ea& s(r/eillan,e on t#e lo,al or re'ional
le/els, E%ola is o+ten $ista&en +or $alaria, t*.#oi) +e/er, )*senter*, in+l(enGa, or
/ario(s %a,terial in+e,tions -#i,# $a* %e en)e$i, to t#e re'ion! Learnin' +ro$ +aile)
res.onses, s(,# as t#at to t#e 2000 U'an)a o(t%rea&, .(%li, #ealt# $eas(res in,l()in'
t#e HOLs Elo%al O(t%rea& an) Res.onse Net-or& -ere instit(te) in areas at #i'#
ris&! 8iel) la%oratories -ere esta%lis#e) in or)er to ,on+ir$ ,ases, instea) o+ s#i..in'
sa$.les to So(t# A+ri,a!
T#e Unite) States Centers +or "isease Control an) ?re/ention S.e,ial ?at#o'ens
Bran,# ,#arter to st()* #i'#l* in+e,tio(s /ir(ses, $an* ,a(sin' #e$orr#a'i, +e/ers, #as
#istori,all* en)o-e) it to ,losel* +ollo- E%ola o(t%rea&s!;6< Co$.ilin' s,ienti+i,
Ho(rnals an) .(%li, #ealt# anno(n,e$ents, t#e +ollo-in' list is +ro$ Kno-n Cases an)
O(t%rea&s o+ E%ola He$orr#a'i, 8e/er, in C#ronolo'i,al Or)er!
1234 Maire 0"e$o,rati, Re.(%li, o+ Con'o1 MEBOV D16 260 667
O,,(rre) in Ya$%(&( an) s(rro(n)in' area! "isease -as s.rea) %* ,lose
.ersonal ,onta,t an) %* (se o+ ,onta$inate) nee)les an) s*rin'es in #os.itals5,lini,s!
T#is o(t%rea& -as t#e +irst re,o'nition o+ t#e )isease!
1234 S()an SEBOV 264 1B1 BD7 O,,(rre) in NGara, 9ari)i an)
t#e s(rro(n)in' area! "isease -as s.rea) $ainl* t#ro('# ,lose .ersonal ,onta,t -it#in
#os.itals! 9an* $e)i,al ,are .ersonnel -ere in+e,te)!;11<
1233 Maire 0"e$o,rati, Re.(%li, o+ Con'o1 MEBOV 1 1 1007
Note) retroa,ti/el* in t#e /illa'e o+ Tan)ala!
1232 S()an SEBOV D4 22 4B7 O,,(rre) in NGara, 9ari)i!
Re,(rrent o(t%rea& at t#e sa$e site as t#e 1234 S()an e.i)e$i,!
1262 USA REBOV 0 0 07 REBOV -as intro)(,e) into
:(arantine +a,ilities in Vir'inia an) ?enns*l/ania %* $on&e*s i$.orte) +ro$ t#e
?#ili..ines!
1220 USA REBOV 4 0as*$.to$ati,1 0 07 REBOV -as intro)(,e)
on,e a'ain into :(arantine +a,ilities in Vir'inia an) Te=as %* $on&e*s i$.orte) +ro$
t#e ?#ili..ines! 8o(r #($ans )e/elo.e) anti%o)ies %(t )i) not 'et si,&!
1262I1220 ?#ili..ines REBOV D 0as*$.to$ati,1 0 07 Hi'#
$ortalit* a$on' ,*no$ol'(s $a,a:(es in a .ri$ate +a,ilit* res.onsi%le +or e=.ortin'
ani$als in t#e USA!;14< T#ree -or&ers in t#e ani$al +a,ilit* )e/elo.e) anti%o)ies %(t
)i) not 'et si,&!
1222 Ital* REBOV 0 0 07 REBOV -as intro)(,e) into
:(arantine +a,ilities in Siena %* $on&e*s i$.orte) +ro$ t#e sa$e e=.ort +a,ilit* in t#e
?#ili..ines t#at -as in/ol/e) in t#e e.iso)es in t#e Unite) States! No #($ans -ere
in+e,te)!
1224 Ea%on MEBOV B2 D1 407 O,,(rre) in 9S&o(&a an) ot#er
'ol)C$inin' ,a$.s )ee. in t#e rain +orest! Initiall* t#o('#t to %e *ello- +e/er@ i)enti+ie)
as E%ola #e$orr#a'i, +e/er in 122B!
1224 I/or* Coast CIEBOV 1 0 07 S,ientist %e,a$e ill a+ter
,on)(,tin' an ne,ro.s* on a -il) ,#i$.anGee in t#e Tai 8orest! T#e .atient -as treate)
in S-itGerlan)!
122B Maire 0"e$o,rati, Re.(%li, o+ Con'o1 MEBOV D1B 2B0 327
O,,(rre) in Ki&-it an) s(rro(n)in' area! Tra,e) to in)e= ,aseC.atient -#o
-or&e) in +orest a)Hoinin' t#e ,it*! E.i)e$i, s.rea) t#ro('# +a$ilies an) #os.itals!
1224 FanIA.r Ea%on MEBOV D3 21 B37 O,,(rre) in
9a*i%o(t area! A ,#i$.anGee +o(n) )ea) in t#e +orest -as eaten %* .eo.le #(ntin' +or
+oo)! Nineteen .eo.le -#o -ere in/ol/e) in t#e %(t,#er* o+ t#e ani$al %e,a$e ill@ ot#er
,ases o,,(rre) in +a$il* $e$%ers!
1224I1223 F(lIFan Ea%on MEBOV 40 4B 3B7 O,,(rre) in
Boo(S area -it# trans.ort o+ .atients to Li%re/ille! In)e= ,aseC.atient -as a #(nter -#o
li/e) in a +orest ,a$.! "isease -as s.rea) %* ,lose ,onta,t -it# in+e,te) .ersons! A )ea)
,#i$.anGee +o(n) in t#e +orest at t#e ti$e -as )eter$ine) to %e in+e,te)!
1224 So(t# A+ri,a MEBOV 2 1 B07 A $e)i,al .ro+essional tra/ele)
+ro$ Ea%on to Fo#annes%(r', So(t# A+ri,a, a+ter #a/in' treate) E%ola /ir(sCin+e,te)
.atients an) t#(s #a/in' %een e=.ose) to t#e /ir(s! He -as #os.italiGe), an) a n(rse
-#o too& ,are o+ #i$ %e,a$e in+e,te) an) )ie)!
1224 USA REBOV 0 0 07 REBOV -as intro)(,e) into a
:(arantine +a,ilit* in Te=as %* $on&e*s i$.orte) +ro$ t#e ?#ili..ines! No #($an
in+e,tions -ere i)enti+ie)! T#e ?#ili..ines is t#ere+ore a #i'# ris& area an) s(s.e,t!
1224 ?#ili..ines REBOV 0 0 07 REBOV -as i)enti+ie) in a
$on&e* e=.ort +a,ilit* in t#e ?#ili..ines! No #($an in+e,tions -ere i)enti+ie)!
2000I2001 U'an)a SEBOV 42B 224 BD7 O,,(rre) in E(l(,
9asin)i, an) 9%arara )istri,ts o+ U'an)a! T#e t#ree $ost i$.ortant ris&s asso,iate)
-it# E%ola /ir(s in+e,tion -ere atten)in' +(nerals o+ E%ola #e$orr#a'i, +e/er ,aseC
.atients, #a/in' ,onta,t -it# ,aseC.atients in oneLs +a$il*, an) .ro/i)in' $e)i,al ,are
to E%ola ,aseC.atients -it#o(t (sin' a)e:(ate .ersonal .rote,ti/e $eas(res!
2001I2002 O,tI9ar Ea%on MEBOV 4B BD 627 O(t%rea&
o,,(rre) o/er t#e %or)er o+ Ea%on an) t#e Re.(%li, o+ t#e Con'o!
2001I2002 O,tI9ar Re.(%li, o+ Con'o MEBOV B3 4D 3B7
O(t%rea& o,,(rre) o/er t#e %or)er o+ Ea%on an) t#e Re.(%li, o+ t#e Con'o!
T#is -as t#e +irst ti$e t#at E%ola #e$orr#a'i, +e/er -as re.orte) in t#e Re.(%li, o+ t#e
Con'o! UK ,(,&ooLs -inter in t#e Con'oK
2002I200D "e,IA.r Re.(%li, o+ Con'o MEBOV 14D 126 207 O(t%rea&
o,,(rre) in t#e )istri,ts o+ 9%o$o an) KSllS in C(/ette O(est "S.arte$ent!
200D No/I"e, Re.(%li, o+ Con'o MEBOV DB 22 6D7 O(t%rea&
o,,(rre) in 9%o$o an) 9%an)Ga /illa'es lo,ate) in 9%o$o )istri,t, C(/ette O(est
"S.arte$ent!
2004 S()an SEBOV 13 3 417 O(t%rea& o,,(rre) in Ya$%io
,o(nt* in estern E:(atoria o+ so(t#ern S()an! T#is o(t%rea& -as ,on,(rrent -it# an
o(t%rea& o+ $easles in t#e sa$e area, an) se/eral s(s.e,te) EH8 ,ases -ere later
re,lassi+ie) as $easles ,ases!
2003 "e$o,rati, Re.(%li, o+ Con'o MEBOV 244 163 317 O(t%rea&
o,,(rre) in KasaiCO,,i)ental ?ro/in,e! T#e o(t%rea& -as )e,lare) o/er on No/e$%er
20! Last ,on+ir$e) ,ase on O,to%er 4 an) last )eat# on O,to%er 10!
2003I2006 "e,IFan U'an)a B"BV 142 D3 2B7 O(t%rea&
o,,(rre) in B(n)i%('*o "istri,t in -estern U'an)a! 8irst re.orte) o,,(rren,e o+ a ne-
strain!
2006 No/ ?#ili..ines REBOV 4 0as*$.to$ati,1 0 07 O(t%rea&
in t#e ?#ili..ines an) t#e +irst &no-n o,,(rren,e o+ REBOV in .i's! Strain ,losel*
si$ilar to earlier strains! Si= -or&ers +ro$ t#e .i' +ar$ an) sla('#ter#o(se )e/elo.e)
anti%o)ies %(t )i) not %e,o$e si,&!
2006I2002 "e,I8e% "e$o,rati, Re.(%li, o+ Con'o MEBOV D2 14 4B7
O(t%rea& o,,(rre) in t#e 9-e&a an) L(e%o #ealt# Gones o+ t#e ?ro/in,e o+
KasaiCO,,i)ental!;DD<
2012 F(nIA(' U'an)a SEBOV 24 13 317 O(t%rea&
o,,(rre) in t#e Ki%aale "istri,t!
2012 F(nINo/ "e$o,rati, Re.(%li, o+ Con'o B"BV 33 D4 437
O(t%rea& o,,(rre) in ?ro/in,e Orientale!
2014 E(inea
Li%eria
Sierra Leone MEBOV 1440 624 B3!D7 O(t%rea& is ,(rrentl* on'oin'
in so(t#eastern E(inea, in,l()in' t#e ,a.ital Cona&r* an) t#e nei'#%o(rin' ,o(ntries
o+ Sierra Leone an) Li%eria!
As o+ D0 A('(st 2003, 10D .eo.le 0100 a)(lts an) t#ree ,#il)ren1 -ere in+e,te) %* a
s(s.e,te) #e$orr#a'i, +e/er o(t%rea& in t#e /illa'e o+ Ka$.(n'(, "e$o,rati,
Re.(%li, o+ t#e Con'o! T#e o(t%rea& starte) a+ter t#e +(nerals o+ t-o /illa'e ,#ie+s, an)
213 .eo.le in +o(r /illa'es +ell ill! T#e orl) Healt# Or'aniGation sent a tea$ to ta&e
%loo) sa$.les +or anal*sis an) ,on+ir$e) t#at $an* o+ t#e ,ases -ere t#e res(lt o+
E%ola/ir(s!T#e Con'oLs last $aHor E%ola e.i)e$i, &ille) 24B .eo.le in 122B in Ki&-it,
a%o(t 200 $iles 0D20 &$1 +ro$ t#e so(r,e o+ t#e A('(st 2003 o(t%rea&!
On D0 No/e$%er 2003, t#e U'an)a 9inistr* o+ Healt# ,on+ir$e) an o(t%rea& o+ E%ola
in t#e B(n)i%('*o "istri,t! A+ter ,on+ir$ation o+ sa$.les teste) %* t#e Unite) States
National Re+eren,e La%oratories an) t#e Centers +or "isease Control, t#e orl) Healt#
Or'aniGation ,on+ir$e) t#e .resen,e o+ a ne- s.e,ies o+ E%ola/ir(s, -#i,# -as
tentati/el* na$e) B(n)i%('*o! T#e e.i)e$i, ,a$e to an o++i,ial en) on 20 8e%r(ar*
2006! #ile it laste), 142 ,ases o+ t#is ne- strain -ere re.orte), an) D3 o+ t#ose le) to
)eat#s!
An International S*$.osi($ to e=.lore t#e en/iron$ent an) +ilo/ir(s, ,ell s*ste$ an)
+ilo/ir(s intera,tion, an) +ilo/ir(s treat$ent an) .re/ention -as #el) at Centre C(lt(rel
8ranTais, Li%re/ille, Ea%on, )(rin' 9ar,# 2006!T#e /ir(s a..eare) in so(t#ern Kasai
O,,i)ental on 23 No/e$%er 2006,;63< an) %loo) an) stool sa$.les -ere sent to
la%oratories in Ea%on an) So(t# A+ri,a +or i)enti+i,ation!
On 2B "e,e$%er 2006, it -as re.orte) t#at t#e E%ola /ir(s #a) &ille) 2 an) in+e,te) 21
.eo.le in t#e estern Kasai .ro/in,e o+ t#e "e$o,rati, Re.(%li, o+ Con'o! On 22
"e,e$%er, "o,tors it#o(t Bor)ers re.orte) 11 )eat#s in t#e sa$e area, statin' t#at a
+(rt#er 24 ,ases -ere %ein' treate)! In Fan(ar* 2002, An'ola ,lose) )o-n .art o+ its
%or)er -it# t#e "e$o,rati, Re.(%li, o+ Con'o to .re/ent t#e s.rea) o+ t#e o(t%rea&!
On 12 9ar,# 2002, an (ni)enti+ie) 4BC*earCol) s,ientist +ro$ Eer$an* a,,i)entall*
.ri,&e) #er +in'er -it# a nee)le (se) to inHe,t E%ola into la% $i,e! S#e -as 'i/en an
e=.eri$ental /a,,ine ne/er %e+ore (se) on #($ans! Sin,e t#e .ea& .erio) +or an
o(t%rea& )(rin' t#e 21C)a* E%ola in,(%ation .erio) #a) .asse) as o+ 2 A.ril 2002, s#e
#a) %een )e,lare) #ealt#* an) sa+e! It re$ains (n,lear -#et#er or not s#e -as e/er
a,t(all* in+e,te) -it# t#e /ir(s!
In 9a* 2011, a 12C*earCol) 'irl in U'an)a )ie) +ro$ E%ola 0S()an s(%s.e,ies1! No
+(rt#er ,ases -ere re,or)e)! T#at )oes not $ean t#e /ir(s -as not a,ti/e in A+ri,a an)
in t#e %(s# %(rial -o(l) #a/e %een :(i,& or not at all!
EBOLA THE ISSUES 2014


It is -it#o(t )o(%t, t#at t#e NHS in t#e UK or t#e Healt# Boar)s in Irelan) ,o(l) in +a,t
,o.e -it# e/en a s$all o(t%rea& o+ t#e E%ola Vir(s )(e to its ,(t %a,&s, la,& o+ traine) sta++!
T#at )oes not $ean t#at t#e* -o(l) not tr*, %(t t#e s.rea) o+ t#is /ir(s an) ot#ers li&e it into
t#e $a$$al an) ot#er ani$al .o.(lations a,ross t#e UK an) Irelan) ,o(l) ,a(se $aHor
.ro%le$s in )ealin' -it# it! "is.osal o+ t#e #($an )ea) an) ani$als -o(l) #a/e to %e
,re$ation on a lar'e s,ale an) i+ t#e /ir(s too& a +oot#ol) t#in& o+ t#e 8oot an) 9o(t# o(t%rea&
an) t#e +ires an) s$o&e t#at -ere seen! T#at o+ ,o(rse is a %lea& o(tloo& %(t e/en a s$all lo,al
o(t%rea& -o(l) nee) +ast ,re$ation o+ t#e )ea)!
Co$.assion is one t#in' an) +or $ost o+ (s t#at is -#at $a&es (s #($an %(t st(.it* is anot#er
an) -e ,are $ore a%o(t ani$als o+ all sorts t#an -e )o a%o(t .eo.le an) e/en s$(''le ani$als
into t#e UK an) Irelan), ali/e or )ea), %(s# $eat is a 'oo) e=a$.le!
As ti$e 'oes on e$i'ration +ro$ a++e,te) areas in A+ri,a nee)s to %e .(t on #ol) an) a $(,#
ti'#ter Bor)er Controls in +or,e! As it stan)s, t#ese are not -or&in' an) -it# o/er B00,000
$issin' .eo.le -e )o #a/e a $aHor .ro%le$ no- an) in t#e +(t(re! Care-or&ers, n(rses an)
)o,tor are all at #i'# ris& i+ t#e* are -or&in' -it# t#e A+ri,ian o(t%rea&s o+ E%ola an) I a$ o+
t#e in+or$e) o.inion t#at $an* -ill in +a,t 'et t#e /ir(s an) )ie!
T#e /e,tors o+ t#e /ir(s in A+ri,a are %loo) s.illa'e an) ,onta,t, all %o)* +l(i)s, .ossi%le
se=(al inter,o(rse in t#e earl* sta'es, %reast +ee)in' %* in+e,te) $ot#ers, %itin' an)
+l*in' inse,ts t#at +ee) on in+e,te) %loo) an) +l(i)s, +r(it %ats, +a$il* $e$%ers ,onta,t
-it# t#e )ea) .erson %e+ore an) )(rin' a +(neral, rats, $i,e an) ot#er ro)ents in an
in+e,te) area, all %(s# $eat in an in+e,te) are, ,ats, )o's an) s$all ,arino/ores t#at
#a/e e=,ess to in+e,te) %loo), %o)* +l(i)s, in+e,te) %(s# $eat 08r(it %ats1, an) (rine
an) )ro..in's o+ t#e sa$e!
S#o(l) E%ola rea,# t#e Britis# Isles, Irelan) or E(ro.e t#en t#is is a $(,# #i'#er
ris& to t#e #($an an) so$e ani$al s.e,ies an) it is /er* )o(%t+(l t#at In+e,tion
Controls at .resent in .la,e -ill not -or&! Hos.itals at .resent are )oin' t#eir %est %(t
still +i'#tin' a #ar) %attle -it# ot#er in+e,tions a,ross t#e %oar)!
So$e #os.itals #a/e a /er* .oor re,or) o+ In+e,tion Control as it is an) i+ .eo.le t#in&
t#at an isolation -ar) is 'oin' to sa/e t#e )a* it -onLt %e,a(se it -ill %e isolation
#os.itals t#at -ill %e nee)e)! T#e )ea) no $atter -#at reli'ion t#e* are nee) to %e
,re$ate) an) +ast!
Ronnie Carleton A('(st 2014

Related Interests