The 1995 Kikwit Ebola outbreak—Model of virus properties on system capacity and function: A lesson for future viral epidemics

Ryan C.W. Hall, MD, Richard C.W. Hall, MD

Abstract


The 1995 Kikwit Ebola outbreak in the Democratic Republic of the Congo is one of the first Ebola outbreaks to be treated in a hospital setting and is one of the most well-studied Ebola epidemics to have occurred to date. Many of the lessons learned from identifying, containing, and treating the epidemic are applicable to future viral outbreaks. This article looks at the characteristics of the Ebola virus and health system issues, which affected the healthcare providers’ ability to contain and treat the virus. It specifically examines factors such as the disease characteristics, surge capacity, supply issues, press involvement, and the involvement of voluntary organizations.

Keywords


Ebola, Hemorrhagic virus, Surge capacity

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References


Thacker PD: An Ebola epidemic simmers in Africa: In remote region, outbreak shows staying power. JAMA. 2003; 290: 317-319.

Georges AJ, Leroy EM, Renaut AA, et al.: Ebola hemorrhagic fever outbreaks in Gabon, 1994-1997: Epidemiologic and health control issues. J Infect Dis. 1999; 179(suppl 1): S65-S75.

Khan AS, Tshioko FK, Heymann DL, et al.: The reemergence of Ebola hemorrhagic fever, Democratic Republic of the Congo, 1995. Commission de Lutte contre les Epidemies a Kikwit. J Infect Dis. 1999; 179(suppl 1): S76-S86.

Sanchez A, Ksiazek TG, Rollin PE, et al.: Detection and molecular characterization of Ebola viruses causing disease in human and nonhuman primates. J Infect Dis. 1999; 179(suppl 1): S164-S169.

Chowell G, Hengartner NW, Castillo-Chavez C, et al.: The basic reproductive number of Ebola and the effects of public health measures: The cases of Congo and Uganda. J Theor Biol. 2004; 229: 119-126.

Crowcroft NS, Morgan D, Brown D: Viral haemorrhagic fevers in Europe—Effective control requires a co-ordinated response. Euro Surveill. 2002; 7: 31-32.

Bossi P, Tegnell A, Baka A, et al.: Task Force on Biological and Chemical Agent Threats, Public Health Directorate, European Commission, Luxembourg. Bichat guidelines for the clinical management of haemorrhagic fever viruses and bioterrorism-related haemorrhagic fever viruses. Euro Surveill. 2004; 9: E11-E12.

Campbell, A: The honourable: Spring of fear.Volume 1. The SARS Commission Executive Summary, Dec 2006.Available at http://www. sarscommission.ca/report/v1/html. Accessed March 25, 2007.

Heymann DL, Barakamfitiye D, Szczeniowski M, et al.: Ebola hemorrhagic fever: Lessons from Kikwit, Democratic Republic of the Congo. J Infect Dis. 1999; 179(suppl 1): S283-S286.

Kerstiens B, Matthys F: Interventions to control virus transmission during an outbreak of Ebola hemorrhagic fever: Experience from Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis. 1999; 179(suppl 1): S263-S267.

Guimard Y, Bwaka MA, Colebunders R, et al.: Organization of patient care during the Ebola hemorrhagic fever epidemic in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis. 1999; 179(suppl 1): S268-S273.

Bwaka MA, Bonnet MJ, Calain P, et al.: Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: Clinical observations in 103 patients. J Infect Dis. 1999; 179(suppl 1): S1-S7.

Dowell SF, Mukunu R, Ksiazek TG, et al.: Transmission of Ebola hemorrhagic fever: A study of risk factors in family members, Kikwit, Democratic Republic of the Congo, 1995. Commission de Lutte contre les Epidemies a Kikwit. J Infect Dis. 1999; 179(suppl 1): S87-S91.

De Roo A, Ado B, Rose B, et al.: Survey among survivors of the 1995 Ebola epidemic in Kikwit, Democratic Republic of Congo: Their feelings and experiences. Trop Med Int Health. 1998; 3: 883-885.

Leirs H, Mills JN, Krebs JW, et al.: Search for the Ebola virus reservoir in Kikwit, Democratic Republic of the Congo: Reflections on a vertebrate collection. J Infect Dis. 1999; 179(suppl 1): S155-S163.

Roels TH, Bloom AS, Buffington J, et al.: Ebola hemorrhagic fever, Kikwit, Democratic Republic of the Congo, 1995: Risk factors for patients without a reported exposure. J Infect Dis. 1999; 179(suppl 1): S92-S97.

Muyembe-Tamfum JJ, Kipasa M, Kiyungu C, et al.: Ebola outbreak in Kikwit, Democratic Republic of the Congo: Discovery and control measures. J Infect Dis. 1999; 179(suppl 1): S259-S262.

Tomori O, Bertolli J, Rollin PE, et al.: Serologic survey among hospital and health center workers during the Ebola hemorrhagic fever outbreak in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis. 1999; 179(suppl 1): S98-S101.

Hewlett BL, Hewlett BS: Providing care and facing death: Nursing during Ebola outbreaks in central Africa. J Transcult Nurs. 2005; 16: 289-297.

Mwanatambwe M, Yamada N, Arai S, et al.: Ebola hemorrhagic fever (EHF): Mechanism of transmission and pathogenicity. J Nippon Med Sch. 2001; 68: 370-375.

Nichol ST, Arikawa J, Kawaoka Y: Emerging viral diseases. Proc Natl Acad Sci USA. 2000; 97: 12411-12412.

Reed DS, Mohamadzadeh M: Status and challenges of filovirus vaccines. Vaccine. 2007; 25: 1923-1934.

Georges-Courbot MC, Sanchez A, Lu CY, et al.: Isolation and phylogenetic characterization of Ebola viruses causing different outbreaks in Gabon. Emerg Infect Dis. 1997; 3: 59-62.

Ebola haemorrhagic fever—Fact sheet revised in May 2004. Wkly Epidemiol Rec. 2004; 79: 435-439.

Outbreak(s) of Ebola haemorrhagic fever, Congo and Gabon, October 2001-July 2002. Wkly Epidemiol Rec. 2003; 78: 223-228.

Locsin RC, Matua AG: The lived experience of waiting-to-know: Ebola at Mbarara, Uganda—Hoping for life, anticipating death. J Adv Nurs. 2002; 37: 173-181.

Formenty P, Leroy EM, Epelboin A, et al.: Detection of Ebola virus in oral fluid specimens during outbreaks of Ebola virus hemorrhagic fever in the Republic of Congo. Clin Infect Dis. 2006; 42: 1521- 1526. Epub 2006 Apr 26.

Rodriguez LL, De Roo A, Guimard Y, et al.: Persistence and genetic stability of Ebola virus during the outbreak in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis. 1999; 179(suppl 1): S170-S176.

Rowe AK, Bertolli J, Khan AS, et al.: Clinical, virologic, and immunologic follow-up of convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic Republic of the Congo. Commission de Lutte contre les Epidemies a Kikwit. J Infect Dis. 1999; 179(suppl 1): S28-S35.

Geisbert TW, Jahrling PB: Exotic emerging viral diseases: Progress and challenges. Nat Med. 2004; 10(12 suppl): S110-S121. 31. Bray M: Defense against filoviruses used as biological weapons. Antiviral Res. 2003; 57: 53-60.

Hall RCW, Hall RCW, Chapman MJ: Effects of terrorist attacks on the elderly, Part 1: Medical complications of biological, chemical, nuclear and bombing attacks. Clin Geriatr. 2006; 14: 26-35.

Richards GA, Murphy S, Jobson R, et al.: Unexpected Ebola virus in a tertiary setting: Clinical and epidemiologic aspects. Crit Care Med. 2000; 28: 240-244.

Leroy EM, Kumulungui B, Pourrut X, et al.: Fruit bats as reservoirs of Ebola virus. Nature. 2005; 438: 575-576.

Biek R,Walsh PD, Leroy EM, et al.: Recent common ancestry of Ebola Zaire virus found in a bat reservoir. PLoS Pathog. 2006; 2: e90.

Busico KM, Marshall KL, Ksiazek TG, et al.: Prevalence of IgG antibodies to Ebola virus in individuals during an Ebola outbreak, Democratic Republic of the Congo, 1995. J Infect Dis. 1999; 179(suppl 1): S102-S107.

Mupapa K, Mukundu W, Bwaka MA, et al.: Ebola hemorrhagic fever and pregnancy. J Infect Dis. 1999; 179(suppl 1): S11-S12.

Hall RCW, Hall RCW: When the System is Overwhelmed: Protecting the Provider During Biodisaster. Montgomery, AL: Satellite Conference, University of Alabama Birmingham South Central Center for Public Health Preparedness/Alabama Department of Public Health/Tulane University School of Public Health, February 27, 2007. Available at http://www.adph.org/alphtn/. Accessed March 25, 2007.

Peters CJ, LeDuc JW: An introduction to Ebola: The virus and the disease. J Infect Dis. 1999; 179(suppl 1): ix-xvi. 40. Berggren RE, Curiel TJ: After the storm—Health care infrastructure in post-Katrina New Orleans. N Engl J Med. 2006; 354: 1549-1552.

Check E: Hurricane Katrina: Left behind. Nature. 2005; 437: 467.

Raggi P, Raggi J: Doctoring through Katrina: Dedicated to all the people who suffered during a natural disaster. Arch Intern Med. 2005; 165: 2458-2459.

Rice K, Colletti L, Hartman S, et al.: Learning from Katrina. Nursing. 2006; 36: 44-47.

Preston R: The Hot Zone. NY: Random House, 1994.




DOI: https://doi.org/10.5055/ajdm.2007.0035

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