The International Committee on Scientific and Technical Coordination, supported by the team of the World Health Organization (WHO) in Zaire, reports today that the epidemic of Ebola haemorrhagic fever is coming under control. The number of cases detected since the beginning of the epidemic remains unchanged, except for cases occurring between January and March 1995 which have been identified in retrospect.

The latest figures indicate a total of 160 confirmed or suspected cases, distributed geographically as follows: 138 in Kikwit, 14 in Mosango, 3 in Bulungu, 2 in Imbongo and 1 each in Mukala and Dua. There have been 121 deaths in all, which gives a case fatality rate of 76%. All cases were in the Province of Bandundu. The average age of patients was 37, the youngest being 3 months old and the oldest 71 years of age. Only five patients were under 16.

It should be noted that only six new cases have been reported since 18 May 1995, which allows the specialists to affirm that the acute phase of the epidemic is over and that transmission now has been greatly reduced, if not completely halted. The new cases were expected because of the length of the incubation period, which still covers a number of persons who became infected before the arrival of the WHO team.

The specialists on the ground will have two main tasks over the next few days: to strengthen health facilities and to commence research activities to understand better the disease.

THE EBOLA EPIDEMIC IN ZAIRE: INTERNATIONAL AID INCREASES

After last week's meeting of donors in Geneva, the number of countries offering aid to the World Health Organization (WHO) to combat Ebola haemorrhagic fever in Zaire is increasing by the day. Over US$ 2 million have been promised to or received by WHO.

Italy set the tone at the beginning of the crisis by supplying equipment to the value of US$ 100 000, mainly in the form of medical kits. Ireland contributed US$ 30 000, Sweden put a team of specialists at the disposal of WHO, and Belgium lent a C-130 military transport plane to convey the medical aid.

As regards promised financial aid to support the continued activity of the WHO team in Zaire, Italy with a contribution of US$ 650 000, Japan with US$ 150 000 and Norway with US$ 100 000 have between them undertaken to provide almost US$ 1 million. At the request of WHO, Sweden is to take charge of all logistic support for the operation, including provision of protective material for health personnel, the equivalent of contributing approximately US$ 900 000.

The Sasakawa Memorial Health Foundation has pledged US$ 1 million. This sum will also be devoted to longer term control of emerging diseases, as will the large contribution from Italy.

Alerted by the media coverage of the epidemic, nongovernmental organizations and private companies have also offered WHO their services to help contain the Ebola epidemic and forestall similar outbreaks in the future.

The WHO team has made a detailed evaluation of its medium-term requirements, which can be broken down as follows: US$ 200 000 for logistics over the next six months, US$ 500 000 to strengthen health infrastructure in the region, and US$ 500 000 for research. Research is becoming more important now that the epidemic seems to be levelling out somewhat, though it has not yet been stopped.

In the long run, of course, local surveillance capacity must be systematically strengthened, hospital facilities must be improved, and virological research must be undertaken in order to cope with any periodic resurgence of the Ebola virus in the future.

Press Release WHO/38

22 May 1995

RESEARCHERS SEEK SOURCE OF EBOLA EPIDEMIC

The International Committee on Scientific and Technical Coordination, supported by the team of experts of the World Health Organization (WHO) in Zaire, said today that there were no new cases of Ebola haemorrhagic fever and no increase in deaths since the previous update issued on 21 May 1995. One duplicated case has been discounted, giving a revised total of 136 cases and 101 deaths.

The epidemic remains stable. As the team in Kikwit is attempting to get a better idea about the severity of the expected fourth generation of cases in the epidemic, research activities are beginning which will provide answers to questions such as the clinical spectrum of disease caused by infection by the Ebola virus, the factors which cause its transmission, and who is at most risk of becoming infected.

Active surveillance continues to provide information that may lead to a possible source of the epidemic. A previous chain of deaths within one household, which appears to have begun in late December 1994, is now being linked with other cases of haemorrhagic disease and death similar to Ebola haemorrhagic fever, which passed in generations with two to three week intervals throughout January, February and March 1995.

The active surveillance team is meeting twice daily to piece together all the information, which at present seems to lead back to a middle-aged male forest worker who was an early, or possibly the first, case in this epidemic. Three Zairean veterinarians along with members of the International Commission will go to the forest site where this possible first case worked preparing charcoal. They will trap animals, insects and rodents, including bats, in search of a possible reservoir for the Ebola virus in nature.

Associated with the present epidemic, which appears to have been amplified in both Kikwit 2 Hospital and Kikwit General Hospital, there seem to be at least four offshoot parallel chains of disease and death, probably transmitted from person to person, by close contact with bodily secretions of the sick or the dead. These offshoot chains may be more close to the natural history of the disease in nature; that is, the virus enters man from some vector in nature, and causes a small outbreak of disease which, if not amplified by non-sterile techniques in health facilities, ends spontaneously after several generations of disease.

Hypotheses such as this and others will be studied by the International Commission as research activities intensify in an attempt to obtain information necessary to prevent future epidemics.

Press Release WHO/37

21 May 1995

EBOLA EPIDEMIC IN ZAIRE: MORE CASES AND DEATHS REPORTED

The International Committee on Scientific and Technical Coordination, supported by the team of experts of the World Health Organization (WHO) in Zaire, said today that the number of suspected cases of Ebola haemorrhagic fever reported since the beginning of the epidemic is now 137 including 101 deaths, which represents an increase of 9 cases and 4 deaths compared to the previous update issued yesterday, 20 May 1995.

During the course of active surveillance, several chains of deaths, one involving seven out of 12 persons living in the same household, have been identified which were traced retrospectively as far back as late December 1994. The presence of at least one patient with haemorrhagic disease in late December has been confirmed by a physician from Kikwit General Hospital, where the records are at present being examined for further confirmation of this case and perhaps others.

Four more Zairean national physicians from Kinshasa are expected to have further training in high-security self protection and to take up work in isolation wards for Ebola haemorrhagic fever patients early next week. Sanitary kits containing material for health workers' protection have been distributed to the physicians and nurses who took part in the regional surveillance training yesterday. They are to return to their posts where they will again be in daily radio contact beginning tomorrow morning.

The scientific research team of the international committee will meet later today to finalize their research agenda so that research activities can be included in routine patient care and active surveillance. A small field laboratory has been established which has the capacity to detect antibodies associated with recent Ebola virus infection. This laboratory will be strengthened and used in the upcoming research activities to understand better the disease.

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/35

19 May 1995

According to the International Committee on Scientific and Technical Coordination, supported by the team of experts of the World Health Organization (WHO), the cumulative total of suspected cases in the current outbreak of Ebola haemorrhagic fever in Zaire now stands at 124, among whom 89 (72%) have died. The epidemiological investigation in the city of Kikwit and the surrounding villages in the Bandundu Region continues.

Most of the cases and deaths presently being recorded, and which are being added to the daily cumulative total since case finding activities have begun, are actually cases and deaths which have occurred earlier in the epidemic.

The epidemic is presently somewhere between its third and fourth generation of cases. The first generation of cases appears to have been spouses, other relatives and close friends of those infected at Kikwit General and Kikwit 2 hospitals who were infected either during patient care or preparation of bodies for burial. Prior to this time cases appear to have been sporadic, though this remains to be verified. Persons in the second and third generation were other relatives and friends of those in previous generations who became infected in the same manner. A fourth generation of cases is expected among persons who are already in the incubation period.

Based on observations beginning 15 May by active surveillance teams, it is felt that house to house transmission is being minimized, and that intra-house transmission should constitute most of the transmission which may be noted in the fourth generation.

The above description is for the epidemic in Kikwit which represents 92% of all suspect cases. Outside Kikwit, in a 200 kilometer radius one additional small focus of tranmission with second generation cases has occurred and is under regular surveillance, while seven sites (Mbongi added today) are potential sites for transmission where patients from the Kikwit epidemic centre have gone to prior to their death.

The WHO and the Government of Zaire are organizing today a humanitarian mission to the border between the two provinces of Kinshasa and Bandundu at the village of Mongata. An estimated 300 cars and an average of 3000 people have been stopped at the border for about a week because of fears that the potential Ebola outbreak in the Kinshasa area could spread to the capital Kinshasa. This is a result of a misunderstanding of quarantine measures put in place by the Government. After extensive consultations with the international committee of technical and scientific co-ordination, which is leading the fight against the Ebola outbreak, the Government has issued new instructions. Acting on advice from WHO, quarantine measures will be concentrated on hospitals, health centres and places where someone has died from Ebola or there have been suspected cases. This will take the form of increased medical supervision.

The relief effort mounted today includes delivery of food, water and medical supplies. In addition, medical teams will examine those people currently on the border between the two provinces for any sign of sickness. After this examination, those who show no symptoms of any infectious diseases will be allowed to continue their journey; those that do will be placed under medical supervision.

The number of cases of Ebola haemorrhagic fever in the Kikwit area of Zaire now stands at 114 from the previous total of 101, and the number of deaths at 79 from 77, the WHO team of experts reported today. Unlike previous totals, the number of cases includes those that are suspected as well as those confirmed, and covers those found in hospitals, health centres and the surrounding community.

The latest data from the WHO team shows that the mean age of cases is 35 years, with a range from two to 71 years. Only three cases have been under the age of 15. Fifty-two per cent of the cases have been male, and the 79 deaths represent 69% of all cases.

Members of the team are continuing to investigate the potential spread of the epidemic in six villages in the immediate area of Kikwit where it is known that people with Ebola haemorrhagic fever have died after returning there from Kikwit hospitals. The villages are Kindinga, Kinsoni, Nsi-Moloongo, Beyasala, Yassa Bonga and Vanga.

By visiting households where a death has occurred, health workers are able to offer families advice on reducing the risks of infection, and at the same time are able to gain information about how many individuals may be incubating the disease. This information in turn helps epidemiologists estimate how the epidemic will progress in the next two or three weeks.

The team reported that only a few people a day are being admitted with suspected Ebola symptoms to hospital in Kikwit. There were only three such admissions on Wednesday 17 May.

While no case of Ebola haemorrhagic fever has been confirmed in any other country as a result of the current epidemic, WHO said in a note to health and quarantine administrations that it would appreciate being informed immediately of any suspect cases arriving on their territory, and of the measures which have been taken regarding these cases. Such information should be addressed to: Division of Communicable Disease (CDS), WHO, Geneva, at fax number (41 22)

791 41 98 or e-mail Torrigianig@WHO.CH, or telex 415416 attention CDS.

Press Release WHO/33

17 May 1995

WHO TEAM IN ZAIRE REPORTS FURTHER RISE IN EBOLA CASES

The WHO team of experts in Zaire reported today that the number of cases of Ebola haemorrhagic fever has risen to 101 from the previous total of 84 cases, which included 77 deaths. No new figure for deaths is yet available, but the death rate in the epidemic is approximately 75%.

The major means of transmission appears to be close and unprotected patient contact or preparation of the dead for burial, unlike the first outbreak of Ebola haemorrhagic fever in Zaire in 1976, which in addition to close contact, was transmitted by unsterilized needles and syringes in a small rural hospital.

The first case at Kikwit General Hospital in the current epidemic concerned a 36 year-old male laboratory worker who underwent an abdominal operation at the hospital on 10 April 1995. He died on 14 April from a massive intra-abdominal haemorrhage. Medical personnel who took care of this patient, either in the operating theatre or in hospital wards, became ill a few days later. A total of three operating theatre nurses and two nurse anaesthetists became ill, as well as ward nurses and other hospital workers. Approximately, 73% of the first 70 patients in the epidemic appear to have been health workers and among them the case fatality rate has been high. It is understood that the Mother Superior of a group of nursing sisters, three of whom are known to have died, has also developed the disease.

One of the cases was transferred from Kikwit General Hospital to Mosango Hospital, about 100 kilometres to the west, where transmission through unprotected patient contact also occurred. Another case was admitted to Yassa Bonga Hospital about 150 kilometres west of Kikwit, where no further cases have occurred to date. People with Ebola haemorrhagic fever which originated in Kikwit have returned to six villages in the immediate area of Kikwit during illness, and have died there.

The locations are Kibinga, Kinsomi, Nsi-Moloomgo, Beyasala, Yassa-Bonga and Vanga. Many of these locations remain potential sites of infection because contacts of those who died are still within the three week incubation period.

The WHO team said it would probably announce a considerable increase in cases from Kikwit by Friday 19 May because the new numbers would reflect individuals identified during recent case tracing in addition to those registered as hospital patients. Before today, all cases reported by WHO have been hospital patients. All known patients who left hospital have been traced and their households placed under medical and epidemiological surveillance. The team is now looking for cases of infection among people at health centres in and around Kikwit.

A C-130 military aircraft provided by the Belgian Government is due to arrive in Kikwit today with supplies donated by the Italian Government. These amount to 8,600 kilos of health equipment including hypodermic needles, syringes, protective clothing and WHO emergency medical kits, which contain medicines for a wide range of medical conditions, and are sufficient to last for three months.

The Minister of Health of Zaire, the ambassadors of three countries and the WHO country representative in Zaire were scheduled to visit Kikwit today.

The team reported that because regular flights from Kinshasa to Kikwit have been disrupted, it has become extremely difficult for the WHO team and others fighting the epidemic to maintain essential communications with Kinshasa. The alternatives to air travel are a two-day journey by road or a six-day journey by river.

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.

Press Release WHO/31, 15 May 1995

EBOLA EPIDEMIC IN ZAIRE: CASES CONTINUE TO RISE

The World Health Organization's (WHO) team of experts in Zaire reported today new figures in the Ebola virus epidemic and expects the number to increase even more during the coming weeks. The team has recorded 4 new cases and 17 more deaths caused by the virus bringing to 84 the total number of cases and to 77 the number of deaths.

Based on hospital data, the number of cases has quadrupled every 10 to 12 days for the last three weeks. Having begun to actively trace new cases and contacts of people infected by the virus in the community the team is now investigating rumours of 34 additional cases and 15 deaths notified to the Zairean health authorities.

WHO experts expect a significant increase in cases during the next two or three weeks among people who are incubating the disease, after having been exposed to it during the care of relatives or neighbours with haemorrhagic fever. The team is also concerned by the fact that people do not want to go to hospital, knowing that the epidemic started there.

Professor Tamfum Muyembe, the Head of the International Committee on Scientific and Technical Coordination of the fight against the epidemic, has noted however, that an important and encouraging sign is that the population is better informed, thanks to a health education campaign and knows how to protect itself against the infection, by avoiding any close contact with patients or the bodies of those who have died. This allows the hope that transmission will soon be interrupted even if, in the meantime, the number of cases continues to rise. The campaign was launched by the Ministry of Health throughout Kikwit and surrounding villages.

Based on the findings to date in the environs of Kikwit, members of the International Committee established by WHO experts, will begin tracing possible new cases in the area of Masongo, where five deaths were reported last week and where there are probably a certain number of people incubating the infection. The Committee has had the collaboration of 22 medical students trained by the Ministry of Health in active case finding.

Press Release WHO/29 14 May 1995 20:00 Geneva Time

Zaire Ebola Epidemic - Update

The World Health Organization (WHO) team in Kikwit, Zaire has reported three new cases and two deaths in the city from Ebola. This brings the total number of cases to 79 and the total number of deaths from the disease to 59.

There is still no confirmation of new cases outside the town of Kikwit. However, a more accurate picture should become available during coming days when regional teams being active tracing of patients and those who have come into contact with infected people tomorrow, Monday 15 May.

Until now surveillance of cases has been by daily contact with 11 health centres in Kikwit and daily radio contact with 15 centres in a 150 kilometre radius of the city. Active tracing should reveal if there have been any deaths in the community and how many cases there may be outside hospitals and health centres.

It has been confirmed that the strain of Ebola involved in the current outbreak is the same strain as that which caused previous epidemics in Zaire in the late 1970s.

Press Release WHO/28 - 13 May 1995 - 20:00 Geneva Time)

UPDATE ON THE EPIDEMIC IN ZAIRE

The World Health Organization (WHO) team of experts sent to Zaire provided updated information on the outbreak of Ebola fever in the area around Kikwit.

Eleven new cases and nine deaths were reported this afternoon, all in the hospitals in Kikwit. This brings to 76 the total number of cases and to 57 the number of registered deaths since the beginning of the epidemic. No new cases were registered today in Mosango nor in Yassa Bonga.

Rumours of other possible cases are being investigated. This search will permit the WHO team to get a better understanding of the spread of the disease to other people brought on by patients who earlier had fled from city hospitals. The total of cases and deaths could increase as a result of these investigations.

Patient care in the hospitals is now under control. All are now in rooms that have been cleaned and sterilized. Hosptial personnnel are wearing gowns, gloves, masks and protective shoes. The nurses from the eleven peripheral health posts around Kikwik are being trained in the care and handling of patients in case it is needed in the future.

One Swiss and one French doctor are caring for patients in Kikwit's General Hospital. This has helped to reassure not only the patients but also the local medical community. The hospital has access to potable water and electricity, which is contributing significantly to improving conditions.

The bodies of the epidemic's victims are regularly picked up by the Red Cross of Zaire, which is also taking care of their burial.

Four teams have been formed from the experts sent by WHO, the CDC in Atlanta and the Institut Pasteur in Paris to take on repsonsiblity for patient care, hygiene, epidemiological surveillance and research. The research teams will not begin to meet until the epidemic is under control.

The immediate priority for the WHO team is to stop the epidemic and make sure that patients are well taken care of, while encouraging people in local communities who may have become contaminated to go to the hospitals as soon as possible.

Press Release WHO/27

13 May 1995

WHO EXPERT TEAM GIVES NEW DETAILS OF EBOLA OUTBREAK IN ZAIRE

A more detailed breakdown of the numbers of cases and deaths in the Ebola outbreak was provided today by the team of WHO experts who are investigating the epidemic and supporting the Zairean health authorities.

Of the 48 people now known to have died in the outbreak, 42 were in the city of Kikwit, five were in Mosango, and one was in Yassa Bonga. Another 17 people are in hospital with Ebola fever, all but one of whom are in Kikwit, the other being in Mosango.

Tomorrow, the WHO team members will begin to trace contacts of those who have died or become ill as part of a surveillance operation. This will help explain how far the epidemic has spread since the first case occurred. According to the WHO team, this was in late March or early April. Active tracing of contacts will also identify additional cases and ensure that those individuals get medical attention more quickly.

The investigation so far indicates that no new case has been detected in Yassa Bonga during the last three weeks. The WHO experts are providing health workers in Kikwit with advice on sterile techniques, the use of protective clothing and other aspects of sanitation and hygiene to reduce the risks of transmission of the virus. This is of great importance because almost two thirds of the deaths so far - 63 per cent - have been among hospital workers.

The WHO team has expressed the need for extra logistical support, including vehicles to help in the investigation and control of the outbreak.

Press Release WHA/15 12 May 1995

WHO TEAM IN ZAIRE REPORTS NEW CASES AND MORE DEATHS IN EBOLA OUTBREAK

New figures provided by the WHO team of experts in Zaire today show that 48 people are now known to have died in the Ebola virus outbreak, with another 17 hospitalized with symptoms of the disease.

The figures are an update of the 27 deaths and 22 cases recorded by yesterday. The numbers are expected to increase further as the investigation of the epidemic progresses. Almost two thirds of the deaths - 63 percent - have been among hospital workers. The increase in deaths does not involve any new locations other than those already identified, and is understood to refer mainly to Kikwit, the city at the centre of the outbreak.

Reporting from there by telephone to WHO headquarters in Geneva, a senior member of the team said: "The population is generally calm, but afraid, and is getting help from the health authorities".

He said health workers were touring Kikwit with megaphones advising people go to the General Hospital if they had symptoms of the disease. Relatives of victims were being advised not to use traditional methods of cleaning and preparing bodies for burial as these methods could increase the risks of transmitting the Ebola virus. Red Cross workers were helping to bury the dead. Most of the victims are adults, but a few children have also died.

The team has established daily contact with eleven peripheral health posts outside of the city, who had not reported any increase in the number of deaths. Some quarantine restrictions are apparently still in place, with a road block some 190 kilometres west of Kikwit on the main route to the capital, Kinshasa. Protective clothing - one-piece sterile smocks - provided by a hospital in Geneva has been distributed among health workers involved in the outbreak.

Press Release WHA/13 12 May 1995

WHO TEAM IN FURTHER EFFORTS TO CONTROL

EBOLA VIRUS OUTBREAK IN ZAIRE

The experts are hopeful that the outbreak will be limited to the general area where cases have been reported in three towns in Bandundu province. In a telephone report this morning, the WHO team of experts said there was no increase in the number of cases since the previous day.

They have recorded 27 deaths and 22 hospitalized cases related to Ebola, and no new locations of cases other than those in Kikwit, Mosango and Yassa Bonga. WHO intends to issue a daily bulletin of information on cases.

The WHO team is working with health officials of the Government of Zaire and with other nongovernmental organizations such as the International Federation of Red Cross and Red Crescent Societies and Médecins sans Frontières Belgique. One priority is the detection and surveillance of cases, and the tracing of contacts of those cases. Members of the public who suspect they may have Ebola infection are being encouraged to seek medical attention, and WHO is providing advice on the care and management of Ebola patients.

WHO headquarters in Geneva is recommending that no special measures be instituted with respect to aircraft passengers or crew arriving in other countries from Zaire. In advice aimed particularly towards health authorities and airlines, WHO says that persons with the Ebola virus become infectious to others only when they are extremely ill and are already haemorrhaging or 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" WHO says. "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 practical from other passengers and crew. Aircrews as a routine should advise ground staff at the destination if they have severely ill passengers aboard. Health or quarantine authorities should arrange for the isolation of these passengers for initial clinical screening for Ebola".

Press Release WHA/11 11 May 1995

WHO TEAM IN ZAIRE SENDS FIRST REPORT ON EBOLA VIRUS OUTBREAK

The World Health Organization's team of experts investigating the Ebola virus outbreak in Zaire reported tonight that 27 people have died and 22 others are hospitalized, many of them in terminal stages of illness. The majority of the total of 49 cases are health workers. A third Italian nursing sister died of the disease today, according to the WHO team in a telephone report from Zaire to WHO headquarters in Geneva.

Cases have been identified in four separate hospital locations. One is at Kikwit General Hospital, the centre of the outbreak, the second is another hospital in Kikwit, the third is a hospital in Mosango, about 100 kilometres from Kikwit, and the fourth a hospital in Yassa Bonga, about 250 kilometres from Kikwit. The pattern is of infectious patients being transferred to these hospitals from the 350-bed Kikwit General Hospital where most of the initial cases appear to have occurred.

Rapid and effective detection and surveillance of cases by Zairean scientists and public experts is now underway, with the full cooperation of the Government of Zaire and nongovernmental organizations. Transmission of the virus through close contact is continuing to occur. Within the total of 49 cases, six new ones were recorded on 9 May and two more on 10 May. Up to six new probable cases are presenting each day to Kikwit General Hospital, which has been closed to all but suspect and clinically-confirmed cases.

The WHO team already in Kikwit is being reinforced by several more experts who will arrive on 11 and 12 May. Apart from quarantine restrictions at Kikwit General Hospital, there is no other quarantine measure in Kikwit and the policy among health workers is to encourage people who suspect they are infected to come to hospitals for treatment. Médecins sans Frontières Belgique is playing an important role in setting up care facilities for patients, providing incentives for them to come for treatment.

Schools in Kikwit have been closed, but the airport remains open. In all four areas where cases have occurred and in neighbouring villages, public health advice messages are being broadcast with the use of megaphones by Zairean health workers.

The Zaire Red Cross has assumed responsibility for immediate and safe burial of cases.

Press Release WHA/10, 11 May 1995

EBOLA VIRUS CONFIRMED IN FATAL ZAÏRE OUTBREAK

The World health Organization confirmed today that the Ebola virus is implicated in the outbreak of haemorrhagic fever in Zaïre which has caused at least 59 deaths. The confirmation is based on the results of laboratory tests of specimens taken from patients in Zaïre, and sent to the WHO Collaborating Centre for Reference and Research at the Centers for Disease Control (CDC) in Atlanta, Georgia, USA.

A WHO team of experts has arrived in Kikwit, the city at the centre of the outbreak, some 300 kilometres east of the capital, Kinshasa. The experts found the 350-bed city hospital abandoned but for about 20 ill patients. In view of the dispersal of patients and staff from the hospital, WHO believes that more cases of Ebola disease will occur in the vicinity. The WHO team has also reports of about 20 suspected cases in a second hospital, about 100 kilometres south of Kikwit, which received one of the patients from Kikwit.

Dr Ralph Henderson, an Assistant Director-General at WHO, said "Given that many patients have left the Kikwit hospital, we must expect some additional transmission of the disease. However, we believe this will be limited to people who are in prolonged intimate contact with sufferers of the disease. It is unlikely that this outbreak will have implications for Zaïre as a whole or for international travel."

He said that two relatives of an Italian nursing sister who died in the outbreak had returned to Italy from Zaïre and were under close medical surveillance, but were showing no symptoms of infection.

The WHO team is made up of about ten experts from WHO, from CDC Atlanta, from the Pasteur Institute in Paris, France, and from the National Institute for Virology in Johannesburg, South Africa. At the request of the Government of Zaïre, they are investigating the outbreak and assisting in efforts to contain it, as well as advising local health officials on the care and management of patients. WHO is also providing sterile gowns and other equipment for medical staff in Kikwit.

Ebola virus was first identified in 1976 in Zaïre. Ebola disease, a form of haemorrhagic fever, is a very rare but highly fatal infection which has had mortality rates as high as 80%. The only reported outbreaks were in Zaïre and Sudan in 1976 and 1979.

Symptoms of the disease include the sudden onset of fever, followed by vomiting and diarrhoea. The primary mode of transmission of the virus is contact with contaminated blood, secretions or body fluids. Contaminated needles and syringes were a cause of transmission in previous cases in Zaïre. The virus is not easily transmitted however, and requires intimate contact with an infected person, such as close nursing contact, or with contaminated materials.