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The ebola virus epidemic in Zaire 1995 – KAMEDO-report 69

The Kamedo-reports are published by the Swedish Disaster Medicine Study Organisation (Kamedo), at the National Board of Health and Welfare. Observers study the medical, psychological, organisational and social aspects of disasters. The results, with a focus on experiences gained, are presented in the reports.

This report is entirely in Swedish. Only summary in English.


In May 10.1995 an appeal from Zaire reached the World Health Organization (WHO) about an epidemic outbreak of haemorrhagic fever in the city of Kikwit. The information was in the beginning fragmentary and contradictory.
Viral samples were sent to USA where they were rapidly identified as the Ebola virus, known to be responsible for earlier epidemics in the 1970:s. with a very high mortality rate. The transmission of the virus is partly unknown, however the spread through direct contact with blood is confirmed.
Several International Organizations arrived early at Kikwit in order to help the local health authorities to control the epidemic. These organisations did establish under the direction of WHO a well functioning collaboration with the local authorities.
An intensive epidemiologic mapping was performed and the propagation and the extent of the epidemic could rapidly be evaluated. The spread of the disease did probably occur as early as January 1995 but continued and remained at a small extent around the city of Kikwit. In April an infected patient was operated at Kikwit General Hospital causing an explosive spread of the disease.
A large number of other patients at the hospital were infected and approximately 50 hospital staff died due to Ebola fever. Not until then had the health authorities been aware of the outbreak of a serious epidemic.
When the epidemic ended in July 1995 a total of 316 cases were reported, 245 of these died (78%). Despite substantial action by different organisations there was no adequate care offered to the Ebola patients.
For this type of situation, most countries need to revise their preparedness but it is also necessary to find a better system for surveillance and reporting in the countries particularly affected. An international preparedness plan in order to provide efficient and safe help for these specific situations needs to be established.

Experience and conclusions

For Sweden The lessons learnt from the Ebola epidemic are almost applicable to the situation in developing countries. In Sweden or in any other developed country, Ebola cases or any other cases of haemorrhagic fever would create another type of problem and accordingly be handled differently. However, the epidemic had also important effects outside Zaire.
The Organisation for Control of Infectious Diseases in Sweden as well as the ones in other developed countries should together plan for actions to be implemented in different situations. It is important that all countries work according to the same instructions.
A system for protection of the personnel in laboratories and hospitals needs to be developed and it is necessary to establish regulations for quarantine and how to handle people travelling from the zone of an epidemic.
For the affected country There is a need for continuous surveillance in the regions where this type of disease may occur. If an outbreak can be detected early, the spread can be rapidly limited. If the basic level of hygiene in the health system and in the hospitals is improved the risk of an epidemic outbreak like the one in the Kikwit General Hospital will be reduced. The level of hygiene is dependent on the access of sterile needles, syringes and disposable gloves. However, the level of hygiene is also dependent on the ability to establish routines for treatment that will minimise the risks of blood contamination.
In the regions with a risk of an outbreak of haemorrhagic fever, special equipment should be stored and special preparedness plans should be carried out in order to adequately assist an affected hospital.
Personnel specially trained in hyegiene and also specially equipped with protective devices will be required.
For international relief organisations It is important that one organisation is chosen to coordinate all international specialists and the different relief organisations. The WHO is the appropriate candidate for that task. All dispatching of material and necessities should be coordinated through that organisation and the WHO should also act as the Mediator of the foreign assistance to the local authorities.
It is necessary to develop an international preparedness plan in order to rapidly assist an affected country or a region that has a possible outbreak of the disease. At the present time such a preparedness plan is under development at the WHO. There will be an advantage if the different organisations which take part in an action similar to the one in Zaire will agree in advance on their different responsibilities.
The personnel that arrive first in the zone of an outbreak should be equipped with adequate devices to protect themselves and the local personnel. Before sending material and specially trained personnel it is essential to send a small team in order to make a first survey. At the actual epidemic outbreak in Zaire, there was a large discrepancy between the first demands of material and the ones that were later sent from Sweden.
There is a great necessity for rapid and reliable diagnosis of these types of diseases. Diagnostic facilities should be available both at a central level e.g. WHO laboratory, and at more local level close to the hospitals concerned.
A plan for evacuation of health personal that are infected, or that have a suspicion of being infected, should be elaborated.
At the next epidemic outbreak the level of |ambition should be raised and the work should not only be limited to isolation of the sick patients but also include treatment and proper care of the sick. There are reasons to believe that simple therapeutic measures would change the prognosis considerably. A better care of the patients will also make it easier to convince infected or sick patients to seek hospital for care which will reduce the spread of the infection.
Equipment for communication like telephones, fax, e-mail, walkie-talkie is necessary to keep available and ready for use. If needed, a specialist in communication should be included in the staff. The selection of the personnel should be anticipated as the requirements for this type of missions are considerable. The personnel should be adequately vaccinated, they should have good knowledge of languages and former experience of missions in developing countries.

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Susannah Sigurdsson
+46 (0)75 247 30 00