Saturday, December 15, 2007


There is an Ebola Outbreak in Uganda. WHO reports that there have been 93 cases since early December, with 22 deaths so far. MSF sent teams from Barcelona and Switzerland to help with infection control. Kenya set up a tent at the border--just 3 km from our home-- to screen people entering the country from Uganda. We were called by a public health officer last week and rushed over, but it was a false alarm. I think I was the only disappointed member of the team. A case of Ebola! Now that would toot my horn.

Ebola is one of the filoviruses. It's clinical syndrome was detailed in The Hot Zone, a popular press description of the Ebola outbreak in monkeys in Virgina in 1989. I've read a few medical textbook descriptions of Ebola haemorrhagic fever which do not sound anywhere near as dramatic as the monkeys in the Hot Zone, who bled from every hole, crack, and crevice. Apparently the true clincal picture is much more akin to garden-variety septic shock, perhaps with a few scattered hematoma or petecaie thrown in. This leads me to wonder how a clinician practicing in Congo or Uganda would ever suspect ebola in the first place. Surely you can't go crying ebola over every fever, sore throat, headache and hypotension that walks into your waiting room.

According to Manson's Tropical Diseases, there have only been 20 or so Ebola outbreaks since the virus was first characterized in 1976. Manson says that primates probably are not the natural reservoir for filoviruses because they always get sick after infection, just like humans. A true natural host would have "latent infection," which means that the animal could harbor the virus without getting sick. There have been innoculation studies in bats that show asymptomatic viremia, which might indicate that bats are natural hosts. I guess I will stay away from bat infested caves if I ever get up to Uganda again.


Jenny Davidson said...

I'm with you on this - I mean, it's good if people aren't sick, but how could you resist the opportunity to help treat a case of Ebola?!?

(I found The Hot Zone a riveting read, but I guess I am not that surprised to find it somewhat overstated...)

nomad said...

There's no treatment, unfortunately. Health care workers can only offer "supportive care," which essentially means 'give IV fluids and keep your fingers crossed.' The mortality in ebola outbreaks is generally 50% or more! The expertise that CDC or who or msf offers is only in infection control: use of protective clothing, isolation, etc. to prevent transmission of the virus from the patient to the health care worker. But still, I'd like to see a case (especially through the visor of a space-suit, although apparently they aren't really essential for ebola protection).

Anonymous said...

hey beavis, did you say "crack" - uh.. huh huh...that's funny

audra said...

I'm pretty sure I got Ebola in Srikakulam. Or chikkingunniya. Or at least a really bad pharyngitis.
It sucked, and I'm glad you're healthy.
Thanks for blogging Nell, I love reading you!