Name: History of all known Ebola and Marburg virus outbreaks year virus location # sick # dead description of outbreak 1967 Marburg Germany & 32 7 (21%) lab workers handling Ugandan monkeys Yugoslavia 1975 Marburg South Africa 3 1 (33%) a man who traveled to Zimbabwe, his friend, and his hospital nurse 1976 Ebola Zaire Zaire (DRC) 318 280 Yambuku Province; spread by contaminated (88%) needles in hospitals 1976 Ebola Sudan Sudan 284 151 first case went to hospital, then it spread among (53%) patients & workers 1977 Ebola Zaire Zaire (DRC) 1 1 (100%) diagnosed post-mortem in Tandala 1979 Ebola Sudan Sudan 34 22 (65%) recurrence of 1976 outbreak in same village in Sudan (Nzara) 1980 Marburg Kenya 2 1 (50%) a man who visited Kitum Cave, and his doctor 1987 Marburg Kenya 1 1 (100%) a boy who visited Kitum Cave 1989 Ebola USA 0 0 (0%) sick monkeys in quarantine in VA, TX, PA Reston from Philippines. 4 people developed antibodies, but none got sick. Virus airborne!! 1990 Ebola USA 0 0 (0%) sick monkeys in quarantine in VA & TX from Reston Philippines. 4 people developed antibodies, none sick 1992 Ebola Italy 0 0 (0%) sick monkeys in quarantine in Sienna from Reston same facility in Philippines. No humans infected. 1994 Ebola Zaire Gabon 52 31 (60%) gold miners in rain forest mine. At first thought to be yellow fever. Diagnosed as Ebola in 1995. 1994 Ebola Ivory Cote D’Ivoire 1 0 (0%) scientist doing autopsy on wild chimpanzee got Coast sick. 1995 Ebola Ivory Liberia 1 0 (0%) a warrior chief living in the bush, diagnosed Coast after he recovered. 1995 Ebola Zaire Democratic 315 250 Kikwit outbreak (Nova video) spread in Rep. of Congo (81%) hospital and in families. 1996 Ebola Zaire Gabon 37 21 (57%) 19 people butchered & ate a dead chimp they found. disease spread to their families 1996 Ebola Zaire Gabon 60 45 (75%) index case was a hunter. Disease spread by close contact with sick. 1996 Ebola Zaire South Africa 2 1 (50%) A doctor treating Ebola patients in Gabon got sick, & his nurse died 1996 Ebola USA 0 0 (0%) quarantined monkeys in TX from Philippines. Reston No humans infected. 1996 Ebola Philippines 0 0 (0%) monkey export facility. No humans infected. Reston 1998- Marburg Democratic 154 128 workers in a gold mine 2000 Rep. of Congo (83%) 2000- Ebola Sudan Uganda 425 224 Occurred in 3 districts. Infection spread at 2001 (53%) funerals, in families, and in medical caregivers 2001- Ebola Zaire Gabon & 122 96 (79%) Outbreak occurred in border area. 2002 Congo 2002- Ebola Zaire Congo 143 128 villagers stoned 4 people to death for “casting a 2003 (89%) spell” on the sick 2003 Ebola Zaire Congo 35 29 (83%) hunters ate infected boar meat 2004 Ebola Sudan Sudan 17 7 (41%) fast UN response kept # sick low 2004- Marburg Angola 374 329 Uige Province; mainly children at first, then 2005 (88%) family members & funeral attendees. Also spread through needle re-use. 2007 Ebola Zaire Democratic 264 187 Remote area; complicated by simultaneous Rep. of Congo (71%) dysentery outbreak 2007 Marburg Uganda 2 1 (50%) Workers in a gold & lead mine 2007- Ebola Uganda 149 37 (25%) Appearance of new strain; not yet named 2008 2008 Marburg Netherlands 1 1 (100%) A woman recently back from trip to Uganda. Died on 10th day. 2008 Ebola Philippines 0 0 (0%) First known incidence of ebola in domesticated Reston animals (pigs) There have also been 3 needlestick accidents involving Ebola in laboratories: 1976 in England, survived; 2004 in Maryland, USA, survivied; 2004 in Russia, died (data gathered from cdc.gov, the Special Pathogens branch of the Centers for Disease Control & Prevention website, and from who.int, the World Health Organization (UN agency) website.) Fill in this table! Disease First discovered Total # sick Total # dead Overall death rate (%) Marburg Ebola Zaire Ebola Sudan Ebola Ivory Coast Ebola Reston To calculate overall death rate, divide # of dead by # of sick Write the total number of deaths below the country’s name. If an outbreak occurred in 2 countries at once, put half the dead in each country’s list (as an estimate). Angola Congo Cote Democratic Republic of Congo Gabon Germany Italy D’Ivoire (aka Zaire, depending on year) Kenya Liberia Netherlands Philippines South Sudan Uganda United States Yugoslavia Africa Information on hemorrhagic fevers: Incubation period (time between infection and first symptoms): 2-21 days Sudden onset of abrupt illness Early symptoms: high fever, headache, joint & muscle aches, sore throat, weakness, fatigue Later symptoms: rash, vomiting (sometimes blood), diarrhea (sometimes bloody), stomach pain, chest pain, shock In some patients: hiccups, internal hemorrhage, multiple organ failure, bleeding from multiple orifices, blindness, death Most deaths occur within 2 weeks of first symptoms, with no strong immune response present. Treatment: There is no vaccine and no cure. Supportive therapy is the only treatment (fluid replacement, balancing electrolytes, maintaining oxygen and blood pressure, and treating any complicating infections). Spread of disease: through close personal contact, contact with blood, secretions, and other body fluids, medical care without the use of gloves, masks, and gowns. All versions of Ebola and Marburg have shown the ability to aerosolize and spread through the air in laboratory conditions, but this has never been documented in a real-world setting, except in the case of Ebola Reston, which affects monkeys but not people. The reservoir species, of the Ebola virus was discovered in November, 2005. Small amounts of viral RNA were found in 3 species of fruit bat: Hypsignathus monstrosus, Epomops franqueti, and Myonycteris torquata. None of these bats showed any symptoms of disease, suggesting that these animals may be the long-term host of Ebola between outbreaks in primates and humans. Questions: 1. Look over the list titled “Description of Outbreak”. Do you notice any patterns to how the index case (first patient) became infected? 2. Who tends to get sick from the index case? 3. If you were educating people on how to prevent the spread of Ebola or Marburg, what would you emphasize? 4. It has been said that the speed at which Ebola and Marburg viruses kill people is actually helpful in preventing a worldwide pandemic. Does this make sense? Can you explain why this could be? Color-code this map of the world by country. Leave blank any country which has never had an outbreak. For countries which have had outbreaks, color them based on the number of deaths: 0 = blue 1-5 = green 100-199 = yellow 200-350 = orange > 800 = red You can find the names of the countries on the classroom map, in an atlas, or on the internet.