Ebola virus

Poor countries may lack the resources to prevent or minimise transmission

Twenty years ago Ebola virus first emerged in simultaneous outbreaks in Sudan1 and Zaire.2 Two subsequent outbreaks have occurred,3 4 but transmission among human populations has not been sustained. Despite substantial progress in our understanding of Ebola we have not identified its natural reservoir or the trigger for its re-emergence in new outbreaks in humans.

As the journal went to press, the World Health Organisation had reported 114 cases of Ebola infection and 79 deaths in a new outbreak centred in Kikwit, a rural town of 400000 situated in Bandundu Province, Zaire, 1000 km from the location of the 1976 outbreak in Zaire.5 A cordon sanitaire has been placed around the town, but some travellers have circumvented it. The few cases reported in nearby towns have so far been among already ill patients transferred from Kikwit to other hospitals. The index case, seen in early April, was a hospital laboratory worker presumed at first to have typhoid; subsequent cases were initially found among a surgical team and others who cared for the laboratory worker, with secondary spread to other health workers and to family members acting as carers. Two thirds of the deaths have been among health workers. Until the outbreak provoked a …