Amiga ISO Collection/AmigaDemoCD2.iso/ASCII/TEXTE/MISC/ebola.txt

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@BEGIN_FILE_ID.DIZ
 UPDATE--ZAIRE EBOLA OUTBREAK
@END_FILE_ID.DIZ

   CDC has received reports from the Government of Zaire and the World
   Health Organization (WHO) of illness consistent with viral hemorrhagic
   fever in Kikwit, Zaire. Laboratory tests performed at CDC confirms the
   presence of Ebola infection in specimens from some of the ill persons
   in Kikwit. The strain isolated is closely related to the strain that
   caused Ebola disease in Zaire in 1976. The number of cases and
   fatalities are unknown. There have been reports of possible viral
   hemorrhagic fever in other locations outside Kikwit, however, these
   reports have not been substantiated. Three CDC investigators are in
   route to Zaire to participate as members of the WHO and government of
   Zaire team investigating the outbreak.

   At present, CDC believes the potential for introduction of Ebola
   outside of Zaire is low. The impacted area is remote and infrequently
   visited, and there is no direct air service between the United States
   and Zaire. However, public health officials and clinicians should be
   aware of the signs and symptoms of viral hemorrhagic fever, should
   question persons with suspected viral hemorrhagic fever about recent
   travel to Africa and should assure proper isolation if Ebola infection
   is suspected and contact local/state health officials.

   Ebola disease is usually characterized by the sudden onset of fever,
   malaise, myalgia, and headache followed by vomiting and diarrhea.
   Persons infected with the virus may suffer massive internal
   hemorrhaging which may lead to severe organ failure. Transmission
   usually occurs by direct contact with infected blood or other bodily
   secretions. Transmission in hospitals and other health care settings
   due to contaminated needles and syringes has also been documented.

   Ebola disease was first recognized in Sudan and Zaire in 1976. In
   those outbreaks over 600 people became ill and over 400 people died. A
   second outbreak also occurred in Sudan in 1979. In 1989, an episode
   involving the importation of non-human primates with a strain of
   Ebola, not thought to produce illness in humans, occurred in suburban
   Washington, D.C. In 1995, a case of Ebola disease was documented in a
   primate researcher working in Cote D'Ivoire.

   For updated information on the outbreak contact: Thomas Prentiss,
   9-011-41-22-791-3221, or Christopher Powell, 9-011-41-22-791-2888 at
   the World Health Organization, Geneva, Switzerland

==============================================================================

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Centers for Disease Control and Prevention (CDC)
Atlanta, Georgia  30333


In reply, address CDC                      May 12, 1995
Refer to:  NCID:DQ

ADVISORY MEMORANDUM No. 111

SUBJECT: Ebola Virus Hemorrhagic Fever - Zaire

The Government of Zaire and the World Health Organization have reported
an unusual outbreak of Ebola virus hemorrhagic fever in Kikwit,
(approximately 250 miles southeast of Kinshasa)  and the surrounding
areas within Bandundu Province, Zaire.  The incubation period (time
before symptoms appear) for Ebola virus hemorrhagic fever may range
from 2-21 days.  The average is approximately 1 week.  The illness is
characterized by an abrupt onset of fever and headache.  Continued fever,
headache, general malaise, muscle aches, joint pain, and sore throat are
commonly followed by vomiting, diarrhea and abdominal pain.  A transient,
measles-like skin rash, that subsequently becomes scaly, often appears at
the end of the first week of illness.  Persons infected with the virus may
sufferinternal hemorrhaging, severe organ failure and death.

The disease is primarily transmitted by contaminated injections and close
personal contact with severely ill patients.  Transmission usually occurs
by direct contact with infected blood, secretions, organs or semen.
Otherwise, the risk of infection is believed to be very low.  Persons in
the incubation period are not considered to be a significant risk to
those around them.

Travelers to Zaire are at low risk of acquiring the disease under normal
circumstances.  To eliminate the risks, travelers should avoid the Ebola
virus areas described above.  Travelers in Zaire should contact the U.S.
Embassy for further information after arrival in Kinshasa.

For future updates of this advisory, you may call CDC International
Travelers' Voice Information Service at (404)332- 4559 press 1, then
press 4, and listen for the outbreak menu for Zaire or you may call the
CDC Fax Information Service at [phone] and request document #221009.

All recipient health departments, travel agencies, airlines, and shipping
companies should notify prospective travelers of the recommendations in
this advisory.



Brian Mahy, Ph.D.                             Charles R. McCance
Director                                      Director
Division of Viral aDivision of Quarantine
Rickettsial DiseasNational Center for
National Center for                            Infectious Diseases
Infectious Diseases

==============================================================================

EBOLA VIRUS HEMORRHAGIC FEVER: GENERAL INFORMATION

What are viral hemorrhagic fevers?

   Viral hemorrhagic fevers are a group of diseases caused by viruses
   from four distinct families of viruses: filoviruses, arenaviruses,
   flaviviruses, and bunyaviruses. The usual hosts for most of these
   viruses are rodents or arthropods (such as ticks and mosquitoes). In
   some cases, such as Ebola virus, the natural host for the virus is
   unknown. All forms of viral hemorrhagic fever begin with fever and
   muscle aches. Depending on the particular virus, the disease can
   progress until the patient becomes very ill with respiratory problems,
   severe bleeding, kidney problems, and shock. The severity of viral
   hemorrhagic fever can range from a relatively mild illness to death.

What is Ebola virus?

   The Ebola virus is a member of a family of RNA viruses known as
   filoviruses. When magnified several thousand times by an electron
   microscope, these viruses have the appearance of long filaments or
   threads. Ebola virus was discovered in 1976 and was named for a river
   in Zaire, Africa, where it was first detected.

Ebola virus hemorrhagic fever: How common is it?

   Until recently, only three outbreaks of Ebola hemorrhagic fever among
   people had been reported. The first two outbreaks were in 1976: one in
   Zaire and one in western Sudan. These were large outbreaks, resulting
   in more than 550 cases and 340 deaths. The third outbreak, in 1979 in
   Sudan, was smaller, with 34 cases and 22 fatalities. During each of
   these outbreaks, a majority of cases occurred in hospital settings
   under the challenging conditions of the developing world. These
   conditions, including a lack of adequate medical supplies and the
   frequent reusing of needles and syringes, played a major role in the
   spread of disease. The outbreaks were quickly controlled when
   appropriate medical supplies and equipment were made available and
   quarantine procedures were used.

   The source of the Ebola virus in nature remains unknown. In an attempt
   to identify the source, investigators tested thousands of specimens
   from animals captured near the outbreak areas, but their efforts were
   unsuccessful. Monkeys, like humans, appear to be susceptible to
   infection and may serve as a source of virus if infected.

What do we know about the recent outbreak of Ebola virus infection?

   The recent Ebola virus outbreak is centered in Kikwit, Zaire. (Kikwit
   is a city of 400,000 located 400 kilometers east of Kinshasa, the
   capital of Zaire.) The outbreak appears to have started with a patient
   who had surgery in Kikwit on April 10, 1995. Members of the surgical
   team then developed symptoms similar to those of a viral hemorrhagic
   fever disease. Ebola hemorrhagic fever was suspected by a Belgium
   physician who reported the disease to the Zairian government. At the
   request of Zairian health officials, medical teams from CDC, the World
   Health Organization, and from Belgium, France, and South Africa are
   collaborating to investigate and control the outbreak in Zaire.

What are the symptoms of Ebola hemorrhagic fever?

   Symptoms of Ebola hemorrhagic fever begin 4 to 16 days after
   infection. Persons develop fever, chills, headaches, muscle aches, and
   loss of appetite. As the disease progresses, vomiting, diarrhea,
   abdominal pain, sore throat, and chest pain can occur. The blood fails
   to clot and patients may bleed from injection sites as well as into
   the gastrointestinal tract, skin, and internal organs.

How is the Ebola virus spread from person to person?

   Ebola virus is spread through close personal contact with a person who
   is very ill with the disease. In previous outbreaks, person-to-person
   spread frequently occurred among hospital care workers or family
   members who were caring for an ill person infected with Ebola virus.
   Transmission of the virus has also occurred as a result of hypodermic
   needles being reused in the treatment of patients. Reusing needles is
   a common practice in developing countries, such as Zaire and Sudan,
   where the health care system is underfinanced. Medical facilities in
   the United States do not reuse needles.

   Ebola virus can also be spread from person to person through sexual
   contact. Close personal contact with persons who are infected but show
   no signs of active disease is very unlikely to result in infection.
   Patients who have recovered from an illness caused by Ebola virus do
   not pose a serious risk for spreading the infection. However, the
   virus may be present in the genital secres of such persons for a
   brief period after their recovery, and therefore it is possible they
   can spread the virus through sexual contact.

How is Ebola hemorrhagic fever diagnosed?

   A diagnosis is made by detection of Ebola antigens, antibody, or
   genetic material, or by culture of the virus from these sources.
   Diagnostic tests are usually performed on clinical specimens that have
   been treated to inactivate (kill) the virus. Research on Ebola virus
   must be done in a special high-containment laboratory to protect
   scientists working with infected tissues.

How will health officials control the outbreak?

   Previous outbreaks of Ebola hemorrhagic fever have been limited. These
   outbreaks were successfully controlled through the isolation of sick
   persons in a place requiring the wearing of mask, gown, and gloves;
   careful sterilization of needles and syringes; and proper disposal of
   waste and corpses.

How do hospital personnel isolate an ill person?

   Hospital personnel isolate ill persons through a method called
   "barrier technique." Barrier technique includes the following actions:
   1) doctors and nurses wear gowns, mask, gloves, and goggles when
   caring for patients; 2) the patient's visitors are restricted; 3)
   disposable materials are removed from the room and burned after use;
   4) all reusable materials are sterilized before reuse; and 5) since
   the virus is easily destroyed by disinfectants, all hard surfaces are
   cleaned with a sanitizing solution.

Are persons in the United States at risk?

   Persons in the United States are at risk only if they have had close
   personal contact with patients in Zaire who are infected with Ebola
   virus. There are no reports that infected persons have left the
   country of Zaire. The Zairian government has quarantined all persons
   in the affected areas and restrictemovement of persons in and out of
   these areas. Any persons who wish to travel to Zaire are encouraged to
   contact the U.S. State Department (202-647-5225) for travel
   advisories.

   What is CDC's role in the outbreak investigation?

   CDC has sent three medical scientists to Zaire to assist with the
   investigation. They will provide advice and assistance in helping to
   control the outbreak and prevent additional cases, collect specimens
   for diagnostic testing, study the cnical course of the disease in
   ill persons, and look for others who may have been in contact with
   the infected individuals. They will also be instruct the hospital
   staff in Zaire about how to limit the spread of the disease. Efforts
   will also made to find the source of the infection.
   CDC also has a role in educating the U.S. public about this outbreak
   and about the potential threat of emerging infectious diseases. For
   the next several days, CDC will issue press releases and will inform
   the state health departments about any updates on the disease outbreak
   Zaire.

==============================================================================

   Press Release WHO/36 20 May 1995 EBOLA EPIDEMIC IN ZAIRE : UPDATE ON
   FIGURES

   The international Committee on Scientific and Technical Coordination,
   supported by the team of experts of the World Health Organization
   (WHO) in Zaire, informed today that the number of cases of Ebola
   haemorrhagic fever reported from the beginning of the epidemic is now
   128, including 97 deaths, which represents an increase of 4 cases and
   8 deaths, compared to the previous update issued yesterday. Epidemic
   control continues in Kikwit with the same two major strategies:
   epidemiological surveillance to identify all cases and deaths in order
   to isolate patients and bury the dead under safe conditions; and
   improvement of conditions at the Kikwit General Hospital, in order to
   enhance patients' confidence so that they will show up to hospital for
   care.

   At the same time, a team from WHO and the Government of Sweden has
   started medium and long term needs assessments in the region of
   Bandudu in order to strengthen and sustain the health infrastructure
   and surveillance activities.

   On 19 May 1995, as a preliminary medium term activity, 52 physicians
   from all hospitals and health facilities in the region, who are
   currently participating in surveillance and case finding activities,
   were provided with one day training in surveillance, patient
   management and control measures, such as patients isolation.

   A new update on the Ebola haemorrhagic fever epidemic is expected to
   be published tomorrow, Sunday 21 May 1995.

==============================================================================

   Press Release WHO/32 17 May 1995

EBOLA HAEMORRHAGIC FEVER: ADVICE TO TRAVELLERS

   In the wake of the universal media coverage, the current outbreak of
   the Ebola haemorrhagic fever in south-western Zaire is raising
   questions of travellers' safety. Given the unlikelihood of any patient
   with Ebola haemorrhagic fever travelling from the country, the World
   Health Organization (WHO) does not recommend that any special measures
   be instituted with respect to aircraft or the general travelling
   public arriving from Zaire.

   A very small number of individuals (principally health care workers
   and journalists) will be returning to their home countries after
   having been in known contact with Ebola patients in Zaire. Unless
   these passengers are obviously ill, no travel restrictions are
   required, but such persons are advised to inform health/quarantine
   officials at their destination of their exposure history and where
   they may be contacted during the incubation period of the disease. If
   they fall ill during this period, they should seek immediate care and
   notify the health/quarantine authorities of this fact.

   Other passengers leaving Zaire are advised to notify a doctor
   immediately if an illness develops during a period of three weeks from
   the departure date. In particular, any fever should be reported at
   once and the physician informed that the patient has travelled from
   Zaire. The incubation period for Ebola haemorrhagic fever is up to 21
   days. Persons with Ebola become infectious for others only when they
   are extremely ill and are already haemorrhaging (bleeding). It is
   highly unlikely that such persons would try to travel on an
   international flight, and unlikely that they would be permitted to
   board if they did try. If on board, they would represent a hazard to
   members of the crew and any passengers who had direct contact with the
   patient's blood. Such passengers should be placed as far as is
   practical from other passengers and crew. Aircrews, as a routine,
   should advise ground staff at their destination if they have severely
   ill passengers on board. Health and/or quarantine authorities should
   arrange for the isolation of these passengers for initial clinical
   screening for Ebola. Passengers and crew who had close prolonged
   contact with the patient (e.g. passengers sitting in an adjoining seat
   but not across the aisle or in front or behind unless specific contact
   occurred, or crew providing care) should be advised of the hazard and,
   on arrival, be placed under surveillance (e.g. active contact
   maintained by telephone or visit). Others in the aircraft should be
   advised of the hazard and told to contact a physician if they become
   ill.


==============================================================================

EBOLA HAEMORRHAGIC FEVER

   Clinical picture: A severe viral illness, usually characterized by
   sudden onset with weakness, fever, muscle pain, headache and sore
   throat, followed by vomiting, diarrhea, rash, limited kidney and
   liver involvement, and both internal and external bleeding. Ebola
   infections end in death from 50% to nearly 90% of those clinically
   ill. Incubation period is 2 to 21 days.

   Diagnosis is by specialized laboratory tests (not commercially
   available) to detect specific antigen or antibody and/or isolation of
   the virus. Laboratory studies present an extreme biohazard and should
   be conducted only under high containment conditions.

   Therapy: No specific treatment or vaccine exists. Severe cases require
   intensive supportive care. Patients are frequently dehydrated and need
   intravenous fluids.

   Occurrence and reservoir: Ebola disease was first recognized in the
   western equatorial province of the Sudan and the nearby region of
   Zaire in 1976; a second outbreak occurred in the same area in Sudan in
   1979. The reservoir of Ebola is unknown despite extensive studies.
   Ebola-related filoviruses were isolated from cynomolgus monkeys
   (Macacca fascicularis) imported into the United States of America
   from the Philippines in 1989; many of these monkeys died, and at least
   four persons were infected, although none suffered clinical illness.
   Transmission of Ebola virus is person-to-person by direct contact with
   infected blood, secretions, organs or semen. Hospital acquired
   infections have been frequent, and many health care workers have been
   infected while attending patients. In the 1976 Zairean epidemic all
   Ebola cases linked to contaminated syringes and needles died.
   Transmission through semen may occur up to 7 weeks after clinical
   recovery as has been the case with Marburg haemorrhagic fever.

   Containment: Suspected patients should be isolated from other
   patients. Strict barrier nursing techniques should be practised. All
   hospital personnel should be briefed on the nature of the disease and
   the routes of transmission. Particular emphasis should be placed on
   high risk nursing procedures such as placing intravenous lines,
   handling of blood and secretions, catheters and suction.

   Hospital staff should have individual gowns, gloves and masks. Gloves
   and masks must not be reused unless disinfected.

   Fatal cases should be promptly buried or cremated.

   Contacts: As the primary mode of person-to-person transmission is
   contact with contaminated blood, secretion or body fluids, any person
   who has had close physical contact with patients should be put under
   strict surveillance (twice daily body temperature checks; in case of
   temperature >38.3 C (101 F), hospitalize immediately in strict
   isolation). Casual contacts should be placed on alert and asked to
   report any fever. All surveillance should be continued for three weeks
   after the date of the last contact. Hospital personnel who come into
   close contact with patients or contaminated materials without
   barrier nursing attire must be considered exposed and put under close,
   supervised surveillance.

==============================================================================

DR. FREDERICK A. MURPHY TALKS ABOUT THE EBOLA VIRUS
An Interview by Sean Henahan, Access Excellence

The book "The Hot Zone" and the film "Outbreak" have seized the
public's imagination and brought into focus many issues regarding
the very real threats posed by new and emerging diseases. In this
interview we talk with Frederick A. Murphy, D.V.M., Ph.D., Dean of
School of Veterinary Medicine, UC Davis.

At the time of the 'Reston incident', Dr. Murphy was the director of
the National Center for Infectious Diseases at the CDC in Atlanta.
Dr. Murphy is considered one of the world authorities on viruses. He
was the first one to look at Ebola virus 'face-to-face' in the
electron microscope. Dr. Murphy appears in "The Hot Zone" and his
now famous photo of the Ebola virus appears in the film "Outbreak".

Note: Dr. Murphy has also provided an extensive bibliography and
three excellent electron micrographs to accompany this interview.


Q: The book "The Hot Zone" and more recently the film "Outbreak"
have brought public attention to the reality of emerging viruses and
potentially disastrous epidemics. It can be difficult to tell fact
from fiction with these kind of sources. I'd like to ask some
questions gathered from high school science teachers and students
all over the country to clarify some of the issues raised by this
book and this movie.

A: The public response to the book and the film has been phenomenal.
Half of the posts for a virology conference on the Internet I look
at are about the Ebola virus. I myself have had innumerable calls
from the press and other media people. By the way, I want to say
hello to the Access Excellence people and say I had a great time
down at Genentech last summer when I spoke on the subject of new and
emerging diseases.

Q: Please explain how Ebola and the other filoviruses are classified
and how they are related to other known viruses?

A: The viruses are classified in the family 'Filoviridae', with one
genus, 'Filovirus'. There are four known viruses. We have Marburg
virus and three Ebola viruses: Zaire, Sudan and Reston. Marburg and
Ebola are distinguished by their length when purified. In the
unpurified state you get all different lengths of these worm-like
virions. When they are purified, the infectivity is associated with
a particular particle length, which is slightly different between
the Marburg and Ebola, but all of the Ebola viruses are the same
length.

Q: Considering how similar the Ebola viruses are, how are they
differentiated?

A: They are very close. First of all, there is a very small
serologic difference among the Ebola viruses which can help
distinguish them. Second, there are sequence differences which can
be determined using the tools of molecular biology.

Q: What have we learned about the Ebola genome, and what remains to
be learned?

A: Ebola Zaire has been completely sequenced and Ebola Reston is
nearly completed. The gene order of these viruses reaffirms their
independence as a family. Also, some ancient conserved sequences
along with the gene order, i.e. the layout of the genes along the
RNA molecule, put the family 'Filoviridae' into an order, the only
order in virology, 'Mononegavirales' This emphasizes the ancient
phylogenetic connection between three families- 'Filoviridae',
'Paramyxoviridae' (measles, mumps) and 'Rhabdoviridae' (rabies).
There is no connection with HIV.

Q: Let's talk about the pathogenicity of Ebola. How does Ebola virus
infect humans?

A: In Zaire and Sudan, Ebola virus was spread by close contact and
dirty needles. The center of the epidemic in Zaire involved a
missionary hospital where needles and syringes were re-used without
sterilization. Most of the staff of that hospital got sick and died.
There were secondary cases involving people taking care of sick
people or preparing bodies for burial, but the virus essentially
shut down after that epidemic peaked.

There is something of a misconception that Ebola virus can infect
just about any cell. In fact, the virus has a very specific tropism
for liver cells and cells of the reticuloendothelial system, e.g.
macrophages. Massive destruction of the liver is a hallmark feature
of Ebola Zaire, Ebola Sudan, and Ebola Reston (the latter in monkeys
only).

Q: Ebola Zaire is said to kill nine of ten people infected. What
about the surviving one person? Is anything known about natural
resistance to this virus?

A: Starting with Marburg in 1967, there was one fellow who tested
positive for the virus 30 days post-infection. In fact the virus was
detected in his semen, and there was a case of sexual transmission
in that circumstance. Another patient had virus in the vitreous of
his eye for more than 30 days. But eventually the virus died out
within these people without killing them. Ebola too is not
persistently carried in the blood and appears to be self limiting in
the surviving patient.

Q: Given that there are some signs of natural immunity to Marburg
and Ebola Zaire, and that the monkey workers were not killed after
exposure to Ebola Reston, does this give us any possible approaches
to vaccine development? Both the measles and rubella vaccines were
based on attenuated viruses.

A: No, I don't think so. I don't think we would know how to select a
stable, safe attenuated virus. The kind of research needed to
develop a modified live virus vaccine simply could not be done given
the scope of the problem. That is, you only have a few people
working in labs who would need to be vaccinated, and you might want
a vaccine stockpile in the event of an epidemic, but these are not
the scale of circumstances where we could afford to develop a
vaccine. A killed vaccine is much simpler to develop, but so far
this has not worked with Ebola virus.

Q: On Oct 13, 1976 you prepared a specimen from an African patient
with hemorrhagic fever and suddenly realized it might be deadly
serious. Can you tell us what you were thinking at that time?

A: When I put the specimen in the electron microscope, I was sure it
was Marburg. I had worked on Marburg in 1967 and 1968 and had done a
project on experimental Marburg infection in monkeys. The specimen
had come back from Zaire to the CDC in Atlanta in less than optimal
condition, with the tubes in the box broken. Anyone else would have
taken a look and put the whole box in the autoclave, but Dr.
Patricia Webb, wearing gloves, gown and mask, squeezed a few drops
of fluid out of the cotton surrounding the broken tubes. That was
the material the virus was isolated from. It was placed in tissue
culture (monkey kidney cells) for a couple of days then I got a drop
of the tissue culture fluid and prepared a specimen for the electron
microscope. When I saw what I was sure was Marburg, I shut the
electron microscope down and went back to the room in which I had
prepared the specimen. This was in the days when hoods were a lot
more primitive. I "cloroxed the hell" out of the place where I had
done the preparation and carried my discard pan with gown and gloves
etc. to the autoclave and ran it. Then I went back to the microscope
and called Karl Johnson and Patricia Webb to take a look. I shot a
cassette of pictures and with wet negatives, not good for the
enlarger and I made prints which were available within minutes. I
carried these dripping prints to the office of the Director of the
CDC. It was very dramatic.

Q: Then later when Fort Detrick called and said they thought they
had found Ebola in Virginia, what was your reaction?

A: The way it is stated in "The Hot Zone", General Russell suggested
I didn't believe him. In fact, I took it very seriously. General
Russell himself had enough experience to recognize Ebola when he saw
it. With Marburg 67, it was monkeys that brought the virus to
Europe. In 1976 we had no idea where the virus came from, so when he
said he had Ebola in monkeys I sure believed him. We went to Fort
Detrick the next day.

Q: There are a number of issues concerning the response to an
epidemic raised by both "The Hot Zone" and "Outbreak". How well did
these describe the interaction of the various agencies?

A: The movie Outbreak created some false impressions. The law in our
country gives the responsibility for epidemic management to state
health departments, with these agencies calling CDC when
need help. CDC has no authority to go into a state except by
invitation. The Army could be called in by a state health
department, but to my knowledge this never has happened.

In the Reston incident, the Virginia Health department and the CDC
took over the human health side of the episode and the Army, at the
request of the monkey import company, took over the animal side. It
turned out after lots of surveillance of animal caretakers and their
families that there was no human disease, but there was plenty of
monkey disease. The Army's role involved depopulating the monkey
colony. So the movie Outbreak, where the Army takes over, is rather
fictional.

Q: Has the Reston incident changed the way monkeys are imported and
housed?

A: There were a series of CDC investigations after the Reston
episode. There walso a complete embargo on the importation of
monkeys for about a year. The CDC then relicensed importers, denying
licenses to those that did not have propfacilities and staff
training. So I would say there has been significant improvement in
this area. Countries that used to export monkeys are also getting
out of that business. primarily for species preservation reasons.

The use of captive bred monkeys is absolutely the trend. The goal is
or complete reliance on domestic breeding. We have to stretch the
definition a bit, since there is a huge captive breeding colony on a
small Caribbean island.

Q: Did anyone every figure out how an African Ebola virus ended up
in a monkey from the Philippines?

A: No. That's a very good question. We still have no idea where
Ebola lives in nature. It was not possible to do field studies in
the Philippines because of a civil war going on in the area they
came from. Some studies in Africa tried to trace Marburg and
Ebola, but nothing has ever been found.

Q: Are budget cuts affecting the ability of the CDC and other
agencies to respond to epidemic outbreaks?

A: Yes. The Army program at USAMRID has been cut quite a bit. Over
the past few years the CDC's programs for dealing with infectious
diseases have been nibbled to death by inflation. The budgets are
the same in today's dollars as they were 12 years ago. In effect
these programs have lost half of their purchasing power, while at
the same we've seen an explosion in AIDS and other infectious
diseases.

Q: Such as Hantavirus?

A: Yes, hantavirus is a good example. The same people from CDC and
the Army who worked on the new Hantavirus outbreak previously worked
on Ebola. It is a small, wonderful group of dedicated people. They
really have had their budgets whacked. And then with the emergence
of one disease problem after another, this has really stretched them
beyond the breaking point.

Q: Can you give us an update on the Hantavirus situation?

A: It is amazing how quickly the virus was characterized after the
first outbreak in the Four Corners area. The virus is transmitted by
breathing dried dust that contains the virus (from the dried feces,
urine and saliva of the mouse vector, 'Peromyscus maniculatus'). The
virus could not be grown, so everything was done by molecular
biological means. The first clue came with the observation of some
cross serology with known hantaviruses. Everything else was done by
PCR and partial sequencing. Six months later they were able to make
an isolate. Since then four different variants of the virus have
been isolated from more than 100 people. It still has a mortality
rate above 50% and has been seen from California to the East Coast
and Florida. It is incredible that this set of variant viruses was
present all along and no one knew it. Although we know the vector,
we also know that controlling this vector, mice, is virtually
impossible.

We have a similar problem now in California, with all the rains. The
mosquitoes that carry Western equine encephalitis and St. Louis
encephalitis are resistant to virtually every licensed insecticide.

We could have a re-emergence of these virus diseases this summer.

The most important mosquito-born disease in the world today is
dengue. This disease is emerging now in all the big cities of the
Caribbean and tropical and sub-tropical America. If you get lots of
dengue and multiple serotypes in an area, you get dengue hemorrhagic
fever. Uncomplicated dengue infection, called breakbone fever, is
like influenza, with all people recovering. But dengue hemorrhagic
fever, usually seen in children, is deadly. Symptoms include fever,
shock, hemorrhaging from the nose and mouth, respiratory distress
and, in some cases, death.

Q: Back to the CDC. What do public health agencies need in order to
fight epidemics?

A: The things they need are hard to come by. The National Academy of
Sciences, the Institute of Medicine and the CDC have published plans
on what is needed to control new and emerging diseases better. The
plans focuses on better surveillance, better laboratory diagnostics,
better communication and better education. The plans are very good,
but the timing is terrible, since budgets are so tight, and from
what I read in the papers, budgets will get much worse.

Q: There have been complaints at the vast inaccuracies and dubious
details in the film Outbreak. What did you think of this film?

A: I did see the movie. In fact, in return for the use of the
electron micrographs of the virus, Warner Bros. gave us tickets to
the premiere in Sacramento. I thought the early scenes in the
biosafety level 1,2,3, and 4 labs looked pretty accurate. After that
it became fictional, and I enjoyed it as fiction. We know a virus
can't kill someone in an hour. The making of the antisera in a day
was ludicrous. I think all bug movies have a problem, since once
they unleash the bug, there is the problem of resolving the crisis.
Like in the film, 'The Andromeda Strain', the only way to resolve
the story was to have the bug mutate to become harmless. The real
world is not so simple. Fourteen years into the AIDS epidemic and we
still don't have a vaccine or decent drugs.

Q: The CDC is one of two places in the world with remaining
specimens of smallpox virus. Both the CDC specimens and the Russian
specimens were scheduled for destruction, but have gained a
reprieve. Should they be saved?

A: The collections of smallpox specimens at these places are fairly
large. CDC has about 500 strains of the virus. It is highly
contained in a freezer that is never opened. The WHO also visited
the Russian facility and certifiits safety.

I was originally in favor of the destruction of these specimens.
This was for political reasons, rather than scientific ones. I
thought publicity surrounding its destruction would remind
people that we had done something very good. However, within the
last two years several different strains of the smallpox virus have
been completely sequenced. Some really interesting genes have been
found, which may contribute to the understanding of the
pathogenicity and natural history of other viruses. So the current
consensus is that these kinds of genes must be preserved and
studied.

Q: Last question. Any advice for some one considering a career in
virology?

A: There are several kinds of virologists. One kind of virologist is
a molecular biologist who studies the nature of the virus and how it
works. That is the world of molecular biology and cell biology.
Virology is also an infectious disease science in the hands of
physicians and veterinarians who take specialty training. Virology
also interfaces with other areas of biology that have to do with how
viruses are transmitted, such as entomology and mammology. The field
of virology also includes the whole world of public health and
preventive medicine.

The starting point for anyone interested in virology is the
undergraduate biology major. Then there is a fork in the road at
which the person chooses to seek a degree from a medical school or
veterinary school or to enter a Ph.D program in virology per se.
Either way you go, I can say "it's a wonderful life".

==============================================================================

                              DISEASE FIGHTS BACK

   Excerpted from The Economist, May 20, 1995.

   This is an excellent article which discusses viruses' mounting
   resistance to antibiotics. The complete article can be found on page
   15 of the May 20, 1995 issue of The Economist. Excerpts follow.
   _______________________________________________________________

Ebola is a terrifying illness. It kills quickly. Nine in every ten
of those who become infected die, and it is an especially hideous
death. Thanks to its speed and gruesomeness, this virus has
commanded front-page headlines all over the world in recent days.
Sleeping sickness -- which can be just as deadly and whose spread
across large parts of Zaire is virtually unchecked -- has commanded
no such attention. This is not so surprising: Ebola is new and
untreatable, sleeping sickness is old and treatable -- merely
untreated. The outbreak of Ebola in Kikwit has so far claimed about
100 victims; sleeping sickness kills 200,000 Zairois a year....

The problem humans have with germs is that they work by rules that
humans find hard to deal with, so different that before
Pasteur no one knew what they were. Germs are quick; humans are
slow. Germs have no thought for the future; humans plan. Germs have
no technologies; humans are consummate users of tools. Most
important, germs never give up. Humans do so all too readily.

For centuries staphylococcus bacteria made trivial wounds fatal
injuries. Then science came up with a tool to use against them:
penicillin. In 1952 staphylococcus bacteria were almost 100%
susceptible to penicillin, and the scourge became an irritant. By
1982, 90% of the strains had become resistant to the drug....

==============================================================================

Zaire sets checks to keep virus from Kinshasa
 (c) 1995 Copyright the News & Observer Publishing Co.
 (c) 1995 Reuter Information Service

   KINSHASA (May 22, 1995 - 11:30) - Zaire, whose capital has been spared
   by the Ebola virus, has introduced checks at unexpected spots on roads
   into Kinshasa to screen for the deadly disease.

   With the death toll topping 100, World Health Organisation spokesman
   said Ebola death toll passes 100; outbreak may have started as early as
   December.

   Sammy Chumfong said on Monday that the random checks replaced a failed
   attempt to stop all travel to the capital from the virus-stricken
   province of Bandundu.

   "The screening posts are dotted everywhere for purposes of random
   testing. We don't want people to know where they are, so they don't
   try to avoid them," he told Reuters.

   "There's really nothing else we can do," he said, adding: "After doing
   a number of tests we concluded that keeping people at the frontier
   (between the province and the area around the capital) was not really
   the solution."

   Medical experts in Kikwit, at the heart of the epidemic which was at
   first was mostly confined to doctors and nurses at Kikwit General
   Hospital, expect a clearer picture to emerge this week of the impact
   one general population.

   Medical teams based in Kikwit, 500 km (300 miles) from Kinshasa, have
   been scouring outlying villages for Ebola cases and burying bodies --
   often abanded by frightened relatives.

   The virus, which is contracted by contact with blood or bodily fluids,
   kills by causing uncontrollable bleeding. There is no known vaccine or
   cure.

   It resurfaced in March when a man died of it in Kikwit hospital but
   the WHO, which is spearheading the fight against the disease, spoke of
   cases in the area as far back as December.

   The WHO in Geneva put the death toll by Sunday at 101 from 137 cases
   -- up from 97 deaths by Saturday.

   Kinshasa, where no cases have been reported, went to work as normal on
   Monday. In the bustling streets and markets, it appeared like any
   other Monday, but thoughts of the virus were at the back of many
   people's minds. Some talked about it, others joked.

   Graphic posters on walls, public buildings and bus stops spelled out
   the dangers of touching anyone showing symptoms of the disease, which
   can kill up to nine out of 10 victims. In Kikwit, posters were also on
   taxis.

   Trucks from Bandundu Province, which provides almost half Kinshasa's
   food, clattered into the capital and its markets throughout the night.

   Kinshasa went without fresh supplies of food last week after the
   authorities set up roadblocks on the main highway from Bandundu and
   the east, preventing trucks and travellers reaching the city.

   They lifted the blockade on Saturday, fearing angry scenes or worse
   from several thousands travellers and truck drivers marooned at a
   roadblock 150 km (90 miles) from the capital.

   The outbreak in Zaire has had repercussions throughout the region and
   Kenyan tourism industry officials appealed on Monday for overseas
   visitors not to cancel their holidays in the East African country.
   "We would like to tell the world there is no outbreak of this disease
   in Kenya at all," Colonel Joe Nguru, chief executive of the Kenya
   Association of Tour Operators told Reuters in the Kenyan capital
   Nairobi.

==============================================================================

                   EBOLA RECOMMENDED READING LIST

   "Outbreak of Fear" Newsweek, May 22, 1995

   "Viral hemorrhagic fever in southern Sudan and Northern Zaire" by
   Bowen et al., Lancet, vol. 1, pp 571-573 (1977)

   "Management of patients with suspected viral hemorrhagic fever,"
   CDC-Morbidity and Mortality Weekly Report, Supp. 37/S-3, pp 1-16
   (1988)

   "Update: Ebola-related filovirus infection in nonhuman primates and
   interim guidelines for handling nonhuman primates during transit and
   quarantine," CDC- Morbidity and Mortality Weekly Report, vol. 39, pp
   22-4 & 29-30 (1990)

   "Biosafety in Microbiological and Biomedical Laboratories" by the
   CDC/NIH, HHS Publication No.CDC-1993, 3rd Edition

   "Epidemiologic investigation of Marburg virus disease, Southern
   Africa, 1975" by Conrad, et al., Am. J.Trop. Med. Hyg., vol. 27, pp
   1210-1215 (1978)

   "Molecular biology and evolution of filoviruses" by Feldmann et al.,
   Arch.Virol (supp), vol. 7, pp 81-100 (1993)

   "Association of Ebola-related Reston virus particles and antigen with
   tissue lesions of monkeys imported to the United States" by Geisbert
   et al., J. Comp. Path., vol. 106, pp 137-152 (1992)

   "Preliminary Report: isolation of Ebola virus from monkeys imported to
   USA" by Jahrling et al., Lancet, vol. 335, pp 502-05 (1990)

   "Isolation and partial characterization of a new virus causing acute
   hemorrhagic fever in Zaire" by Johnson, et al., Lancet, vol. 1, pp
   569-571 (1977)

   "Agent of disease contracted from green monkeys" by Kissling et al.,
   Science, vol. 160, pp 888-890 (1968)

   "Infectious Diseases" by Frederick A. Murphy, Avances in Virus
   Research, vol. 43.

   Pathology of Ebola virus infection" by F.A. Murphy, Ebola Virus
   Hemorrhagic fever (ed. by Pattyn, Elsevier/North Holland, Amsterdam),
   pp 37-42 (1978)

   "Marburg virus morphology and taxonomy" by F.A. Murphy, Ebola Virus
    Hemorrhagic fever (ed. by Pattyn, Elsevier/North Holland, Amsterdam),
    pp 61-82 (1978).

   "Marburg virus infection in monkeys" by Murphy et al. Lab. invest.,
    '71, vol. 24, pp 279-291 (1971)

   "Filoviruses as Emerging Pathogens" by C.J. Peters et al., Seminars
    in Virology, vol. 5, pp 147-154 (1994)

    "Filoviruses" by C.J. Peters et al., Chapt.15 in Emerging Viruses (ed.
    by S. Morse, Oxford University Press, New York), pp 159-75 (1991)
    Richard Preston. Esquire. July/August 1993.

    "The Hot Zone." Scientific American, vol. 271, pp 114 (Nov. 1994).
    Richard Preston. The Hot Zone

    David Quammen. "You Can Run: Emerging viruses in the global village"
    Discover Apr 1994.

    "Sequence analysis of the Ebola virus genome: organization, genetic
    elements, and comparison with Marburg" by Sanchez et al., Virus Res.,
    vol. 29, pp 215-240 (1993).

    Zinsser. MICROBIOLOGY, 20th ed. pages 1031-1033. (has a section on
    Ebola and about 10 references-books, journal articles, and WHO
    bulletins)

    The TV newsmagazine 48 Hrs did a show on ebola and hanta virus called
    "Into the Danger Zone"

    "The Apocalypse Bug" - May 14, 1995 on CNN



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