In a follow-up to the Ebola fever epidemic, the Director-General of the World Health Organization, Dr Hiroshi Nakajima, arrives in Zaire tonight on a fact-finding mission which includes a visit to Kikwit, the centre of the epidemic.

Dr Nakajima, who is being accompanied on the four-day visit to Zaire by the WHO Regional Director for Africa, Dr Ebrahim Samba, travels to Kikwit on Saturday 1 July, after meetings scheduled with the President, the Prime Minister, the Health Minister and other senior officials of the Government of Zaire. He will visit the two hospitals in Kikwit which treated the first Ebola cases, and meet members of the International Committee on Scientific and Technical Coordination which was set up to combat the epidemic.

According to the Committee's latest figures, there has been a total of 296 suspected or confirmed cases of Ebola haemorrhagic fever in the Kikwit area, of whom 232 are known to have died.

Dr Nakajima said: "WHO believes the acute phase of the epidemic is over, but concern remains about the risk of sporadic transmission of the virus in the community, and about transmission in health facilities if adequate isolation and barrier nursing procedures do not continue to be enforced".

Before the epidemic can officially be declared at an end, a period equal to twice the maximum incubation period of the disease - that is, 42 days - will need to have passed from the date of recovery or burial of the last case, with no new cases identified through active searching.

"WHO is certain that the main peak of the epidemic has been contained, and anticipates a few more cases before the epidemic comes to an end, mainly those who were infected within the preceding three weeks", Dr Nakajima said. "It is of crucial importance that an undiagnosed case does not become again the cause of amplification of the epidemic in a hospital setting, and extreme attention to ensuring that health workers are using barrier nursing techniques and respecting universal precautions is a priority".

Dr Nakajima said WHO had prepared a plan of action that will run from 1 July until 31 December 1995. The priorities of the plan are to:

- ensure the containment of the epidemic;

- better understand the Ebola virus epidemiology and its clinical manifestations;

- ensure overall administrative, technical and scientific coordination of the International Committee in Kikwit;

- strengthen national response to potentially epidemic diseases.

An important purpose of Dr Nakajima's visit is to try to reinforce the need for stronger infrastructure in Zaire to prevent and control any further outbreaks of Ebola and other infectious diseases. This will require efforts at a national level with the assistance of the international community.

Dr Nakajima's visit will also underline the need for a global surveillance network to detect, assess and respond to outbreaks of new and re-emerging diseases in different parts of the world.

WHO has been able to assert its leading role in controlling the Ebola epidemic by providing staff from its African Regional Office in Brazzaville and from its headquarters in Geneva. On Sunday 7 May, WHO headquarters was notified by the Regional Office that there was a suspected Ebola haemorrhagic fever outbreak in Zaire. Two days later, on 9 May, staff from Brazzaville and Geneva left for Zaire, arriving on 10 May, and were joined from 12 - 14 May by an international team which included staff from the Centres for Disease Control in Atlanta, Georgia, the Institut Pasteur in Paris, and the National Institute for Virology in Sandringham, South Africa.

 One of the first tasks of the team was to assess the situation and to provide direct patient care at Kikwit General Hospital, the centre of the outbreak. Measures were taken to establish acceptable standards of hygiene, disinfection and protection of hospital staff, care of patients, and safe disposal and burial of those who had died from the disease. Active surveillance of cases and tracing of contacts were then established, both in Kikwit and surrounding villages. It became apparent that Ebola cases had been present in the region since January 1995, but had not been recognized as such. These measures are estimated to have saved hundreds of lives.

The International Scientific and Technical Committee, supported by the team from the World Health Organization (WHO) in Zaire, reported today a slight increase in the number of cases of Ebola haemorrhagic fever. In addition to the cases that occurred between January and March 1995, which are still being reported retrospectively, some new cases have been reported in the last few days.

The latest total is 280 confirmed or suspected cases, including 220 deaths, since the start of the epidemic. Thirteen new cases, 10 of them now in hospital in Kikwit, have been reported since 9 June 1995. These are people who, having been in contact with patients, have reached the end of incubation period of the disease and represent the expected fifth wave of the epidemic. None are health workers, the group which suffered most at the start of the epidemic.

All the new reported cases are in Kikwit. WHO specialists expect that there will be a certain number of new cases, though they still maintain that the acute phase of the epidemic has passed. This slight increase in the number of cases does, however, show that vigilance, as well as epidemiological surveillance, must be maintained.

Regional surveillance still covers 21 villages where patients stayed or through which they passed on the way home from hospital to their own villages. Twenty Zairian medical students are helping with this surveillance, trying to trace any cases of infection.

In order to cope with these, and any other cases that might occur, the International Scientific and Technical Committee is improving health facilities and conducting research, especially to locate the animal "reservoirs" that might harbour the Ebola virus in between epidemics.

COMBATING THE EBOLA EPIDEMIC IN ZAIRE:

A MODEL OF INTERNATIONAL COLLABORATION

The work done in Zaire since the beginning of May by the International Scientific and Technical Committee for control of the epidemic of Ebola haemorrhagic fever, under the chairmanship of Professor Muyembe, from Kinshasa University, has been a model of effective international collaboration, say officials of the World Health Organization (WHO).

The team sent by WHO (Headquarters and Regional Office for Africa), which has been working in situ since 10 May 1995, was joined quickly by specialists from other institutions and organizations, whose work has done much to stop the epidemic.

The Centers for Disease Control and Prevention (CDC), Atlanta, United States of America, have helped with patients' care, training in protection against infection and in epidemiological surveillance. In addition, they have identified and begun work on priority areas of research, especially into possible animal reservoirs of the virus.

Médecins Sans Frontières (Belgium) has helped improve sanitation and isolation procedures at Kikwit General Hospital and in regional health facilities. MSF Belgium has also helped with training in barrier protection, epidemiological surveillance, and distribution of emergency medical kits to health centres.

The Institute of Tropical Medicine, Antwerp (Belgium) has overseen to the training of health personnel in the transfer of patients from emergency departments to isolation units, and has taken part in study of the epidemic and in epidemiological monitoring.

The Pasteur Institute, Paris (France) has concentrated on study of the epidemic and on epidemiological monitoring.

The team of Swedish specialists has taken charge of assessing material needs and medium-term planning, as well as planning and strengthening of sanitation and hygiene in the health centres.

South African virology laboratories have provided the means to carry out blood and antibody tests on patients. They have also taken part in ecological studies with a view to try to identify any animal reservoirs of the virus, and in clinical pathology research.

The Federation of Red Cross and Red Crescent Societies has made an evaluation of needs in Kikwit and contributed resources to meet them, and has helped with monitoring in Kinshasa, the capital of Zaire.

The animal research team gets to work

Now that the acute phase of the Ebola haemorrhagic fever epidemic appears to be over, the International Scientific and Technical Committee is turning, as was intended, towards research. A WHO team of eight specialists which is to conduct ecological research to identify any animal reservoir, has just arrived in Kikwit and will start work before the end of the rainy season.

The team consists of five scientists from CDC, Atlanta (three epidemiologists, one zoologist specializing in vertebrate animals and a medical entomologist); two specialists from the United States Army, and a research scientist at the University of Antwerp who specializes in small mammals and arthropods.

WHO Press Release 42

1 June 1995

The International Committee on Scientific and Technical Coordination, supported by the team of the World Health Organization (WHO) in Zaire, confirmed today that the acute phase of the Ebola haemorrhagic fever epidemic is over. The number of cases detected since the beginning of the epidemic is still increasing but almost exclusively due to cases occurring between January and March 1995 which are now being identified after careful investigations.

The latest figures indicate a total of 211 confirmed or suspected cases with 164 deaths, which gives a fatality rate of about 75%. All cases without exception were in the province of Bandundu and all rumours of cases elsewhere, including in Kinshasa, have proved unfounded. New rumours from four or five villages around Kikwit are under investigation, but there were no new hospital admissions, in the last three days.

Specialists are still expecting a number of new cases in persons currently in the incubation period, but transmission seems now to be completely halted.

Priority is now given to strengthening of health facilities and to research activities. Specialists from the Centers for Disease Control in Atlanta, USA, are expected in Kikwit as well as a US Army team which will try to identify animal reservoirs of the virus. Their aim is to enlarge scientific knowledge of the disease in order to prevent further outbreaks of the Ebola haemorrhagic fever.