Ebola outbreak of 1995

Epidemic

Date: April-May, 1995

Place: Kitwit, near Kinshasa, Zaire (now Democratic Republic of the Congo)

Result: 245 dead, 50 infected

Gaspard Menga died on January 13, 1995, in Kitwit General Hospital. For a week he struggled against some unknown enemy, suffering a soaring fever, headaches, horrible stomach pains, uncontrollable hiccups, and massive bleeding—blood in his vomit, diarrhea, nose, and ears. Bebe, Philemond, and Bibolo Menga all died in a similar manner within weeks of preparing Gaspard’s body for burial, the preparation being a traditional procedure that involved washing the corpse. Philemond’s nineteen-year-old daughter Veronique also died in the same manner, having helped care for her ailing father.

Of 23 members of the extended Menga-Nseke family, 13 perished because of the Ebola virus between January 6 and March 9, 1995. Four of them died in Kitwit General Hospital, which means the deadly virus probably lurked in the hospital for more than two months—perhaps mistaken for shigellosis, a common bacterial disease—before erupting in mid-April when surgery on an infected laboratory technician named Kimfumu spread Ebola to a dozen doctors and nurses. Kimfumu was a thirty-six-year-old laboratory technician who was responsible for collecting blood samples from suspected shigellosis cases. Kimfumu became ill, and his stomach was distended; the physicians thought he had an intestinal perforation caused by typhus. They operated twice. During the first operation, the physicians could not find any perforation, but they did remove Kimfumu’s inflamed appendix on April 10, 1995. When Kimfumu’s stomach remained severely distended, they operated again. This time when they opened the abdomen, they were horrified to see huge pools of blood—uncontrollable hemorrhaging from every organ. Kimfumu died, and soon, one after another, members of the two surgical teams that had operated on the man also died. The dead included four anesthesiologists, four doctors, two nurses, and two Italian nuns.

Symptoms and Spread of Ebola Virus. Symptoms of Ebola hemorrhagic fever (EHF) begin four to sixteen days after infection. Victims 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 infection sites, as well as into the gastrointestinal tract, skin, and internal organs.

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 infected person. Transmission of the virus also has 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. “The major means of transmission appears to be close and unprotected patient contact or preparation of the dead for burial,” said a World Health Organization (WHO) statement.

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 secretions of such persons for a brief period after their recovery, and therefore it is possible they can spread the virus through sexual contact.

Epidemic Site and Sanitary Conditions. Kitwit, a community of between 250,000 and 400,000 people, is located about 260 miles (400 kilometers) northeast of Kinshasa, the capitol of Zaire, now the Democratic Republic of the Congo. Kitwit, really no more than a huge village without running water, a sewage system, or electricity, became filled with fear. As of May 20, 1995, Ebola had infected 155 people and killed 97. Most of the fear in Kitwit was directed at the hospital, where the gruesome illness with mysterious origins spread slowly, doctors believed, unnoticed for months until magnified by nonsterile practices. These practices and conditions, including a lack of adequate medical supplies and the frequent reuse of needles and syringes, played a major role in the spread of disease. The outbreak was quickly controlled when appropriate medical supplies and equipment were made available and quarantine procedures were used. The same was true for earlier outbreaks of Ebola.

Birth of the Epidemic. The Mengas’ experience, like the other chains of transmission, seem to show that Ebola initially simmered in Kitwit, spreading within families for two to three months. It exploded into an epidemic in mid-April of 1995 in the hospital. In all chains of transmission the virus seems to have hit hardest in the first rounds of spreading, waning in transmissibility and virulence over time, eventually burning itself out.

Early in the epidemic a nurse at the Mosango Mission Hospital became infected tending a patient who had fled Kitwit, a ninety-minute drive from Mosango. The nurse died after particularly acute hemorrhaging. The terrified staff disinfected and scrubbed the room, burned the bed linens, and sealed the chamber for two weeks. Fifteen days after the nurse died, a young woman with an unrelated problem was placed in the room, Mosango physicians said. She contracted Ebola and died. Her only contact with the virus, scientists said, was the mattress upon which she had lain.

Physicians in Kitwit General Hospital were in a state of panic. Their patients were dying despite antibiotic therapy, and the medical staff and nuns were falling victim to the mysterious ailment as well. A tentative diagnosis of shigellosis—a bacterial disease that normally had a 30 percent fatality rate but should have been curable with antibiotics—was assigned to the crisis. The fatality rate from Ebola proved to be in the vicinity of 90 percent.

Aid from Belgium and Elsewhere. A Zairean doctor who arrived in Kitwit in mid-April radioed an urgent message to a contact in Brussels requesting ciproflaxin, one of the most powerful and expensive antibiotics on the market. The doctor also mentioned in his message to Brussels that the cases in Kitwit reminded him of an epidemic he had seen in 1976 in Yambuktu, Zaire, the country’s first Ebola outbreak. Money was not available for the antibiotic, but the contact passed the message on to Antwerp’s Institute of Tropical Medicine. The word Ebola stood out for an official of the Institute of Tropical Medicine who had been involved in the 1976 Ebola outbreak in Zaire. He told the Brussels contact to tell the Zairean doctor to send blood and tissue samples immediately. The samples arrived in Antwerp on May 6, 1995, but were quickly sent to the American Centers for Disease Control (CDC) in Atlanta. If it was Ebola, the official at the Institute of Tropical Medicine and officials from the World Health Organization (WHO) agreed, then it should be handled in the most secure facility available. Physicians from both the CDC and the WHO were dispatched to Kitwit, and a physician and a team of two volunteers arrived from Médecins sans Frontières (MSF, or Doctors Without Borders).

Physicians and Volunteers Arrive. On May 10, 1995, the CDC physician, an American epidemiologist, arrived at the Kitwit General Hospital and surveyed the situation. He recalled that “[t]here was blood everywhere. Blood on the mattresses, the floors, the walls. Vomit, diarrhea . . . wards were full of Ebola cases. [Non-Ebola] patients and their families were milling around, wandering in and out. There was lots of exposure.” The women mourners sat on a slab of concrete walkway that led from the wards, which were full of Ebola patients, to the morgue. Family after family sat on the walkway, rocking and wailing near the morgue.

Dr. Barbara Kierstein from MSF later said that the hospital was in a sorry state and the patients were in a sorrier state. The Kitwit General Hospital staff had no protection, and they had not been paid for risking their lives. So Kierstein and her team decided to focus on hospital sanitation and establishment of an isolation ward. On Thursday, May 11, 1995, Kierstein and her team began hooking up the hospital’s ancient water system but gave up after realizing that all the pipes were blocked and rusted. Instead, they set up a plastic rainwater collection and filtration system. A thin, plastic wall was set up, isolating a ward for Ebola patients. The doctors dispensed gloves and masks to the hospital staff.

Supplies and the End of Quarantine. On Saturday, May 13, 1995, Kierstein decided that additional help was needed, and she and her team spent Saturday morning listing essential supplies, using a satellite telephone to pass the list to Brussels. The request was to send respirator masks, latex gloves, protective gowns, disinfectant, hospital linens and plastic mattress covers, plastic aprons, basic cleaning supplies, water pumps and filters, galoshes, and tents. Kierstein commented that she had seen many African countries, and, even compared to others, the conditions at Kitwit General Hospital were shocking. She further stated that the only thing the hospital staff had to work with was their brains. For twenty-six days, however, the brains and dedication of the on-site rescue teams—as well as the numerous Zairean volunteers and medical workers—continued to be their main weapon. The supplies did not begin arriving in suitable amounts until May 27, 1995.

Meanwhile, Zairean officials had quarantined the Kitwit area. The quarantine was lifted on Sunday, May 21, 1995, so as to allow long-awaited food deliveries to reach Kinshasa. The road between Kitwit and Kinshasa carries much of the capital’s food, grown in the fertile Bandundu region where Kitwit is located. Compulsory health checks continued on road travelers from Kitwit to Kinshasa until the number of recorded deaths remained static at 245. The road health checks ceased on Tuesday, June 6, 1995. The final count was 245 deaths recorded out of 315 people known to have been infected.

Even as a long-term investigation strategy was being prepared that would reveal the entire history of Kitwit’s epidemic, officials in Zaire said that bloody diarrhea had broken out elsewhere in Kitwit’s province of Bandundu. In an area 470 miles north of Kitwit, in a town called Tendjuna, 25 people had died from the ailment. Experts initially assigned a diagnosis of shigellosis to the illness.

Researchers have begun to get a handle on the Ebola virus’s high pathogenicity. Research work at the University of Michigan Medical Center in Ann Arbor reports results suggesting that the virus uses different versions of the same glycoprotein—a protein with sugar groups attached—to wage a two-pronged attack on the body. One glycoprotein, secreted by the virus, seems to paralyze the immune system response that should fight it off, while the other, which stays bound to Ebola, homes in on the endothelial cells lining the interior of blood vessels, helping the virus to infect and damage them.

It seems that as Ebola invades and subverts the cells’ genetic machinery to make more of itself, it also damages the endothelial cells, making blood vessels leaky and weak. The patient first bleeds and then goes into shock as failing blood pressure leaves the circulatory systems unable to pump blood to vital organs. Long before their immune systems can mount an antibody response—a process that can take weeks—most Ebola victims bleed to death. If confirmed in infected animals and humans, the findings suggest that these glycoproteins could be targets for anti-Ebola vaccines as well as for drugs that treat Ebola infections. A vaccine has been developed that works in monkeys, but human trials have not yet proved successful.

Bibliography

Centers for Disease Control and Prevention. “Outbreak of Ebola Viral Hemorrhagic Fever—Zaire, 1995.” Morbidity and Mortality Weekly Report 44 (1995): 381-382.

‗‗‗‗‗‗‗. “Update: Outbreak of Ebola Viral Hemorrhagic Fever—Zaire, 1995.” Morbidity and Mortality Weekly Report 44 (1995): 399.

Cowley, Geoffrey. “Outbreak of Fear.” Newsweek 125 (May 22, 1995): 48.

“Ebola’s Lethal Secrets.” Discovery Magazine 19, no. 1 (July 1, 1998): 24.

Klenk, Hans-Dieter, ed. Marburg and Ebola Viruses. New York: Springer, 1999.

Murphy, Frederick A., and Clarence J. Peters. “Ebola Virus: Where Does It Come from and Where Is It Going?” In Emerging Infections, edited by Richard M. Krause. San Diego, Calif.: Academic Press, 1998.

Regis, Ed. Virus Ground Zero: Stalking the Killer Viruses with the Centers for Disease Control. New York: Pocket Books, 1996.

Smith, Tara C. Ebola. Philadelphia: Chelsea House, 2006.