Ebola fever

from Wikipedia, the free encyclopedia
Classification according to ICD-10
A98.4 Ebola virus disease
ICD-10 online (WHO version 2019)

Ebola fever , according to ICD-10 Ebola virus disease , is an infectious disease that is caused by viruses of the genus Ebolavirus . The name goes back to the Ebola River in the Democratic Republic of the Congo , near which these viruses caused the first well-known major outbreak in 1976. From 2014 to 2016 the world's worst Ebola fever epidemic to date occurred in West Africa . The second-worst outbreak historically so far, the Ebola fever epidemic, has raged in eastern Congo and Uganda since 2018 .

Ebola fever is a zoonosis and is fatal in around 25 to 90 percent of all cases, depending on the type of virus, with the average mortality rate being 50 percent. As a therapy, measures to combat or alleviate individual symptoms of the disease have so far been available. For prophylaxis are vaccines used. In Germany , Austria , Switzerland and in many other countries there is an obligation to report suspected Ebola virus disease, direct or indirect pathogen detection, onset of the disease, hemorrhagic disease or death from the Ebola virus disease. According to the Animal Health Act (TierGesG), notification of monkeys is mandatory in Germany .

root cause

Electron microscope image of Ebola virus
Electron microscope image of an Ebola virus

There are five species in the genus Ebolavirus : Zaire Ebolavirus ( EBOV ), Sudan Ebolavirus (SUDV), Reston Ebolavirus (RESTV), Taï Forest Ebolavirus (TAFV, formerly Ivory Coast or Côte-d'Ivoire- Ebolavirus) and Bundibugyo Ebolavirus (BDBV). With the exception of the Reston Ebola virus, all four other types cause high fever above 38.5 ° C in connection with bleeding ( hemorrhagic fever ) in humans . The mortality ( lethality ) of the sick from Ebola is 50 to 90% in the case of EBOV, 41 to 65% in the case of SUDV and 25 and 36% in the two known outbreaks of BDBV. In the case of the TAFV and RESTV, none of the few proven cases of illness are dead. The World Health Organization (WHO) gives a case fatality rate of around 50%, with a range of 25 to 90% for past outbreaks. The Robert Koch Institute names a lethality of 30 to 90% depending on the virus species. Due to the high mortality and risk of infection, the pathogen is classified in the highest risk group  4 according to the Biological Agents Ordinance (only the virus species RESTV is assigned to risk group 2).

The natural reservoir of the virus - the reservoir host - is so far unknown. However, there is evidence to suggest that Egyptian bats might be the main host . Recently, researchers from the could the Center International de Recherches Médicales de Franceville in Gabon either virus fragments or viral antibodies in itself is not diseased six bats species detected. These were the flying foxes species Epomops franqueti , hammerhead ( Hypsignathus monstrosus ), narrow collar bat ( Myonycteris torquata ) Micropteropus pusillus and Egyptian fruit bat ( Rousettus aegyptiacus ) and the bat Angola free-tailed bat Pug condylurus from an area where previously chimpanzees and gorillas died of Ebola virus disease. In parts of West and Central Africa, these animals are consumed as " bush meat ". With regard to this raw meat, unprotected contact and consumption are not recommended.

The Reston subtype causes the disease in the macaque monkey genus . However, no disease triggering in humans has yet been established.

Disease emergence

transmission

The pathogen can be transmitted to humans from sick people (through body fluids ), from animals (including the regionally common “bush meat” ) and from contaminated objects. In principle, these routes of infection can be reliably switched off primarily by disinfecting objects and avoiding “bush meat”, and secondarily by isolating the sick and protective clothing for caring relatives and medical staff. However, the necessary requirements are not met in all areas.

Factors of pathogenesis

In the context of the Ebola virus epidemic from 2014 to 2016 in West Africa , the possibility was also considered that an infected person might travel to Europe, for example, and only become ill there. The Robert Koch Institute (RKI) has named important factors that are important in the pathogenesis . The flow chart used for this is intended to help medical staff to quickly identify a justified suspicion of an imported Ebola case. Similar summaries have also been used by the Centers for Disease Control and Prevention (CDC).

Accordingly, it is a justified suspicion if

  • the patient has a fever of more than 38.5 ° C or has an elevated temperature with accompanying symptoms such as diarrhea, nausea, vomiting or hemorrhages (see symptoms )

and in the 21 days before the onset of the disease

  • Has had contact with a person who was infected with Ebola, suspected of being sick or who died of the infection, although contact with the person may have different exposure risks,

or

  • had professional contact with Ebola viruses, material containing pathogens or infected animals, the contact may have been in Germany or abroad,

or

  • Contact with certain animals that can transmit the Ebola virus ( fruit bats , bats , primates ), or contact with their excretions in an area in Africa affected by Ebola outbreaks or contact with bushmeat from these areas.

incubation period

Various information has been published with regard to the incubation period . In general, it is given as 2 to 21 days, most often it is 8-10 days. In 3% of all cases it is 22–42 days, the WHO does not make any statements about 2%.

Clinical manifestations

In many patients, two clinical phases of the disease can be distinguished, between which the symptoms subside over 24 to 48 hours ( remission ). In the first phase, symptoms appear as if the flu is beginning , the second phase is characterized by hemorrhagic fever .

After the incubation period, flu-like symptoms appear, with fever , chills , headache and muscle pain , as well as nausea and vomiting or even diarrhea . Other symptoms that were documented during the epidemic in Mosango (Democratic Republic of the Congo) in 1995 are weakness , pain in the abdomen , loss of appetite , joint pain , reddening of the mucous membranes in the oral cavity , difficulty swallowing and conjunctivitis . In addition, dizziness , sore throats and edema were documented as symptoms during the 2014 epidemic at Kenema State Hospital (Sierra Leone) . A rash develops in around a quarter to half of patients. After a few days of symptomatic illness, some patients have bleeding. These are mostly limited to skin bleeding such as petechiae , ecchymosis , conjunctival bleeding (bleeding in the conjunctiva of the eye) or bleeding after needle pricks , such as with injections .

The documentation of the symptoms of Ebola fever patients in the Kenema State Hospital in Sierra Leone during the 2014 epidemic enables statements to be made about the frequency of symptoms, but it should be noted that only the data from 44 patients were recorded. According to this, many sufferers have fever (89% of patients), headache (80%), weakness (66%), dizziness (60%) and diarrhea (51%). Less common symptoms are abdominal pain (40%), sore throat (34%), vomiting (34%), and conjunctivitis (31%). Bleeding was documented in only one patient, so hemorrhagic symptoms are considered rare for the 2014 epidemic. However, these cannot be ruled out for the remaining 43 patients, as the logging was limited.

The second phase of the disease is characterized by hemorrhagic fever , a high fever of> 38.5 ° C combined with bleeding. In this later and more severe course of the disease, the patients show bleeding from the mucous membranes , mainly from the gastrointestinal tract , but also from other organs, e.g. B. the kidney , which manifests itself in bloody stool and urine . The patients show shock and circulatory collapse . The impairment of the kidneys leads to oliguria and ultimately to kidney failure . Also on neuropsychiatric abnormalities were reported at the onset of 1995, seizures ( convulsions ) and delirium diagnosed. Confusion and hearing loss were also reported during the 2014 epidemic . If the course is fatal, death is caused by a form of septic shock with multiple organ failure . Damage ( necrosis ) to various organ systems can be detected by autopsies , without usually being able to determine a single pathological change as the cause of death.

Investigation methods

Clinically, the appearance of an Ebola infection cannot be clearly differentiated from an infection with the Marburg virus or other viruses that cause hemorrhagic fever.

diagnosis

The virus can only be proven beyond doubt by laboratory diagnostics in the blood , urine or saliva . Reverse transcriptase PCR has established itself as the standard procedure , in which very few virus copies are sufficient for reliable detection. Detection of the special antibodies is also possible, but these are often only formed in the later course of the disease, so their absence cannot be used as a criterion for excluding an acute infection. Ebola viruses may only be dealt with in high-security laboratories of protection level 4 .

Differential diagnosis

In the differential diagnosis , other tropical diseases , which can also be expressed by fever, must be excluded. This is often the case with malaria . Furthermore, it must be clarified whether it is not a case of virally caused hemorrhagic fever beyond Ebola. These are, for example, dengue fever (caused by the dengue virus ), yellow fever (caused by the yellow fever virus ), Crimean-Congo fever (caused by the Crimean-Congo hemorrhagic fever virus ), Lassa fever (caused by the Lassa Virus ), Marburg fever (caused by the Marburg virus) or infectious diseases caused by hantaviruses or the hepatitis A virus . Bacterial diseases must be excluded, such as typhoid fever , plague , rickettsial disease , meningococcal - sepsis or other forms of sepsis, leptospirosis , dysentery or hemorrhagic forms of relapsing fever .

treatment

therapy

To treat one is symptomatic therapy performed. In the early stages there are isolated successes with convalescent serum . An effective antiviral agent is not yet known, ribavirin has no effect against filoviruses . Isolating the patient is very important to prevent infection of medical staff or other patients. Symptomatic therapy includes intensive medical care, which focuses on measures to reduce fever , compensate for fluid and electrolyte loss and regulate the glucose balance .

In the course of the Ebola epidemic in 2014, two US infected people were treated with an experimental antibody for the first time . The name of the unapproved drug from San Diego- based Mapp Biopharmaceutical is ZMapp . It was successfully tested on a few monkeys and showed significant improvements within a few hours in the two Americans.

In addition to vaccinations, drugs that have not yet been established in the treatment of Ebola fever have been used experimentally therapeutically in the treatment of Ebola fever since 2018 in eastern Congo, accompanied by clinical studies . Four drug therapies are used. Two are medicated with antibodies and the other two are treated with antiviral drugs. In July 2019 it was not yet possible to estimate how well these new therapies would work, as no reliable figures were yet available on how many patients were treated and what the outcome or survival rates were in the respective treated patients.

Rhesus monkeys and macaques infected with Ebola virus were able to up to 5 days after infection by using stable ribonucleic acid molecules, so-called small interfering, directed against the L protein of RNA polymerase , virus protein 24 and virus protein 35 of the Ebola virus RNA (siRNA), can be saved. Of the 3 rhesus monkeys treated with siRNA, 2 survived, and all of the 7 macaques survived.

Treatment facilities

Isolation device for Ebola infected people in Zaire in 1976

The following German clinics have special isolation wards for highly infectious patients:

In Austria, the Kaiser-Franz-Josef-Spital in Vienna has a special isolation ward.

As part of the 2014 Ebola epidemic, infected people were treated at the UKE in Hamburg , at the University Hospital in Frankfurt am Main and at the St. Georg Hospital in Leipzig . According to the University Clinic in Hamburg-Eppendorf, up to six patients can be treated there at the same time in the special isolation ward. 50 nurses and 30 doctors were trained to look after an infected Senegalese laboratory worker. The Frankfurt clinic also stated that it could accept up to six patients at the same time in the special isolation ward.

Prospect of healing

forecast

Ebola fever is often fatal. The death rate varied between 25 and 90% depending on the outbreak and virus variant (see cause ). A laboratory predictor is the amount of virus RNA detected in the blood by PCR . In patients who eventually died of the disease, it was a factor of 100 (around 2 log levels) higher. In the Zaire Ebola virus species , it has been shown that survivors of the virus have a well-regulated immune response to the virus, while fatalities have a deficient immune response with overactivation of macrophages and monocytes . Interleukin-1β (IL-1β) and interleukin-6 (IL-6) have been identified as markers for survival . Interleukin-10 (IL-10), IL1RA and neopterin could be identified as markers for a deficient immune response . In terms of clinical symptoms, the occurrence of fever and the level of body temperature are not suitable for predicting the course of the disease.

Temporal course

During the 2014 epidemic, data on the time course of the disease were recorded at the Kenema State Hospital in Sierra Leone. This is a small group of patients, depending on the type of recording time between 39 and 63 patients. The information is given as the mean plus or minus standard error . According to this, 5.7 ± 0.5 days passed from the appearance of the first symptoms to admission or admission to the hospital. In patients in whom the Ebola virus disease was fatal, there were 9.8 ± 0.7 days between the onset of symptoms and death. In the patients who survived the disease, 21.3 ± 2.6 days elapsed between the onset of symptoms and hospital discharge.

Secondary diseases

If the disease is survived, complications can arise during convalescence - psychoses , myelitis (inflammation of the spinal cord), hepatitis (inflammation of the liver) and uveitis ( inflammation of the iris) have been described. The inflammation of the spinal cord can in turn lead to paraplegia .

Prevention and control measures

Preventive measures during treatment

In addition to the treatment of infected patients, cleaning and disinfection measures must also be used to prevent transmission through contaminated objects and surfaces. This is to protect the medical staff or relatives. For the disinfection of surfaces as well as for hand disinfection, the Robert Koch Institute recommends agents with the effect range “limited virucidal ” or “virucidal”. Lists of suitable disinfectants are available from the RKI or the Association for Applied Hygiene (VAH). In the event of possible contact with the virus, post-exposure prophylaxis (PEP) measures to disinfect skin and mucous membranes are necessary. According to the RKI, the German-Austrian guidelines for HIV- PEP should be followed. The medical staff must also have personal protective equipment (see Transmission of the Ebola virus ).

Dealing with sick people and suspects

In the case of patients who may have Ebola virus disease, it should be checked immediately whether there is a justified suspicion (see section Factors of Pathogenesis ). The Robert Koch Institute recommends leaving the patient in the current environment until the decision is made, other people (medical staff or relatives) should keep a minimum distance of one meter or wear protective clothing. As soon as it is clear that the suspected case is justified, the patient should be isolated in a treatment center set up for this purpose. The infection must be confirmed by laboratory diagnostics. If the patient's condition requires immediate treatment, he or she may be admitted to a standard care hospital, observing the rules of barrier nursing . The principle of “Barrier Nursing” is to observe three zones when dealing with highly contagious pathogens. The patient is treated in the first area; protective clothing must be worn here. The room or ward can only be entered via a lock area. In this second zone, the protective clothing is decontaminated after leaving the treatment room in order to avoid infections. In the third area, the medical staff is supported. If you are fit for transport, you should try to move to a competence and treatment center.

Furthermore, all contact persons must be found who had direct contact with the sick person or who came into contact with infectious material from the sick person. The health department determines the contact persons and assesses their exposure risk . According to the German Infection Protection Act (IfSG), monitoring ( Section 29 IfSG) or quarantine ( Section 30 IfSG) can be ordered. These protective measures ( Section 28 IfSG) are intended to prevent the spread of communicable diseases. They represent an interference with the basic rights laid down in the Basic Law for the Federal Republic of Germany (e.g. freedom of the person ). According to the recommendations of the RKI, contact persons should be 21 Days (incubation period) are monitored regularly for clinical symptoms (especially fever) or unspecific symptoms. If this is the case, the measures described for justified suspicious cases apply.

Measures in the area

The patient's environment must be disinfected when an Ebola fever is confirmed; this applies, for example, to the person's home or areas in which the treatment took place. The legal basis in Germany for these "special measures" is § 17 IfSG. The RKI does not currently have any recommendations for dealing with pets of those suffering from Ebola. For the USA, recommendations were published by the CDC as part of the 2014 Ebola virus epidemic. In the case of the nurse who was infected in Spain in October 2014, her dog was killed as a precaution.

The Robert Koch Institute has published a leaflet with detailed information on disinfection measures in the event of a justified suspicion of Ebola. Among other things, it also describes laundry disinfection. Disposable garments should be used during patient treatment. This, as well as clothes and other laundry of the patient that may be contaminated is to an appropriate waste disposal are fed.

All waste that arises in the care of a justified suspicion of Ebola virus disease must be inactivated by professional waste disposal. In addition to the Infection Protection Act, the provisions of the Biological Agents Ordinance (BioStoffV) must also be observed, in particular the protective measures for protection levels 2, 3 and 4 specified in Appendix II BioStoffV . These protective measures are not directly prescribed for health service facilities, but the employer must select suitable measures from them in order to protect employees and other people ( Section 11 BioStoffV). Usually, contaminated solid and liquid waste must be inactivated by physical or chemical processes before final disposal ( Appendix II 1 of the BioStoffV ).

In the USA, it was calculated that an American hospital generates waste per patient with a volume of eight drums with a capacity of 55 gallons per day. That corresponds to about 2 m³.

Action in the event of death

RKI recommendations also exist in the event that someone suffering from Ebola fever dies. If an autopsy is required, it should only be carried out under conditions of protection level 4 by specially qualified personnel. The corpse is placed in a liquid-tight plastic cover, which is placed in a lockable and externally disinfected coffin. It must be stored in a secure and appropriately marked area, preferably a cold room. The undertakers must be informed about the risk of infection in the event of unprotected contact with the corpse. A cremation (cremation) is recommended.

immunity

A serological examination of 4,349 people in Gabon shows a high prevalence of antibodies against the virus species Zaire Ebola virus (formerly ZEBOV, currently abbreviated as EBOV). Blood samples were examined using the ELISA method, and immunoglobulin G (IgG) directed against EBOV was detected in 15.3% of the samples . Further studies show that there is a humoral and a cellular immune response . The people examined live both in areas in which there have already been outbreaks of Ebola and in areas in which no illnesses have been registered to date. One conclusion of the study is that they gained immunity through exposure to the virus without being diagnosed with the infectious disease Ebola. Contact with wild animals as a host is one possibility for contact with the Ebola virus, but does not explain the high prevalence. Instead, it is assumed that the persons have fruits that are in the saliva of the corresponding animals, such as. B. bats were contaminated , came into contact with the virus. The study does not answer the question of whether a person who has survived Ebola fever is at least immune to the infection-causing Ebola virus species.

vaccination

Number of vaccinations with the rVSV-ZEBOV vaccine in Eastern Congo from 2018

The development of Ebola vaccines has been underway since 2012 at the latest ; some have even proven themselves in animal experiments when given two to three days after infection and have cured them. In the meantime one of them, VSV-EBOV , has also been provisionally approved in Europe.

As of September 2014, a vaccine against the Ebola virus was tested for tolerability in twenty healthy volunteers by the United States' National Institutes of Health . The vaccine consists of a chimpanzee - adenovirus , the addition genetically an Ebola virus protein was implanted, one immune response is triggered. Chimpanzee adenovirus was chosen as the vehicle for Ebola virus protein because it does not normally cause disease in humans. The vaccine was developed by the Swiss-Italian biotech company Okairos, which was acquired by the pharmaceutical company GlaxoSmithKline in 2013 .

A vaccine is also being developed in Canada . The experimental preparation called VSV-EBOV, a preparation from the vesicular stomatitis virus with Ebola antigens , was developed in the state Canadian National Microbiology Laboratory and has already been successfully tested on monkeys. Tests on humans began in October 2014; in the trial phase, the drug will be administered to 40 healthy volunteers in the United States. The Canadian government also made the experimental vaccine available to the WHO.

At the end of 2016 it was reported that the active ingredient rVSV-ZEBOV from Merck, Sharp & Dohme was the first vaccine to be clinically tested effectively and safely, according to the WHO. The active ingredient was first used in Guinea towards the end of the Ebola fever epidemic that broke out in 2014. In the summer of 2018, there were renewed outbreaks of Ebola fever in the Democratic Republic of the Congo; As a result, the government started a vaccination campaign in which more than 28,000 people had been administered the active ingredient rVSV-ZEBOV by November 2018. The vaccine was shown to be highly effective according to accompanying studies. The effectiveness should be around 97 percent. In October 2019, the EMA's Committee for Medicinal Products for Human Use (CHMP) issued a recommendation for approval of the vaccine.

The active ingredient GamEvac-Combi, which was developed in Russia, was tested there in phase I / II studies on 83 healthy adults. Since August 2017, it has been administered to volunteers in Guinea in further clinical studies; in April 2018 there were more than 1,000 subjects.

research

Scientists at the USAMRIID succeeded in 2003, mice by injection of virus-like immunize particles. At the beginning of 2005, researchers led by Steven Jones and Heinz Feldmann ( University of Manitoba , Winnipeg , Canada) showed successful vaccination (active immunization) in crab-eating macaques ( Macaca fascicularis ) with an attenuated, live, recombinant vesicular stomatitis virus (VSV) that targets produces a so-called glycoprotein of the Zaire Ebolavirus strain "Kikwit" on its surface . It is now hoped that there will soon be a preventive vaccination option for humans too.

In 2010, US military researchers successfully tested a drug in monkeys that inhibits virus replication by attaching to the virus's RNA . 60% of the rhesus monkeys and 100% of the previously infected macaques survived .

In 2011, researchers at the Scripps Research Institute announced successes with an antibody they had developed. “Researchers have for the first time discovered an antibody that incapacitates the deadly Sudan strain of the Ebola virus.” The antibody prevents the virus from getting inside the cells. This opens up an opportunity to develop a vaccine against the disease, researchers report in the journal Nature Structural & Molecular Biology . "

The estrogen receptor modulators clomiphene and toremifene inhibit Ebola disease in infected mice. According to a study from 2014, the heart drug amiodarone prevents Ebola viruses from penetrating cells, at least in the test tube.

Experimental vaccines and drugs are e.g. B. ZMapp , VSV-EBOV , cAd3-ZEBOV , TKM-Ebola , Favipiravir , Brincidofovir , JK-05 , FGI-106 and BCX4430 .

outbreaks

Documented occurrence and epidemics of Ebola virus disease

  • Map of documented Ebola virus outbreaks in Africa (1976-2020)

  • Ebola virus epidemic in West Africa between April 2014 and July 2015 (including suspected cases); red diseases, black deaths

  • Ebola virus epidemic in 2018/19 in the provinces of North Kivu and Ituri in the Democratic Republic of the Congo; Total number of illnesses (blue) and deaths (red); Ministère de la Santé

year country Virus type cases dead Mortality in%
1976 Zaire (today: Democratic Republic of the Congo ) EBOV 318 280 88% Performed in Yambuku in the Mongala district in northern Zaire. The onset of the disease was brought about through close personal contact and the use of contaminated needles and syringes in hospitals and clinics.
1976 Sudan (today: South Sudan ) SUDV 284 151 53% Performed in Nzara and Maridi near Yambio . The disease was mainly spread through close physical contact in hospitals. Numerous health care workers have been infected.
1976 United Kingdom SUDV 1 0 0% Laboratory infection of a worker in Birmingham from a needle stick injury .
1977 Zaire (today: Democratic Republic of the Congo) EBOV 1 1 100% An outbreak has been reported in Tandala in southern Ubangi .
1979 Sudan (today: South Sudan) SUDV 34 22nd 65% Another outbreak in Nzara and Maridi near Yambio as in 1976.
1989 United States RESTV 0 0 0% Virus type has been detected in monkeys imported from the Philippines at quarantine facilities in Virginia and Pennsylvania.
1990 United States RESTV 4 (asymptomatic) 0 0% RESTV virus type was again detected in quarantine facilities in Virginia and Texas. Origin were imported monkeys from the Philippines. Four people developed antibodies but did not become ill.
1989-1990 Philippines RESTV 3 (asymptomatic) 0 0% High mortality among long-tailed macaques in a primate facility. The animals were intended for export to the USA. Three zookeepers developed antibodies but did not become ill.
1992 Italy RESTV 0 0 0% In the quarantine facility in Siena , the RESTV type was found in monkeys imported from the Philippines.
1994 Gabon EBOV 52 31 60% Performed in Mékouka and other gold workers' camps in the rainforest in the province of Ogooué-Ivindo . Originally viewed as yellow fever, it was identified as an Ebola outbreak in 1995.
1994 Ivory Coast TAFV 1 0 0% A scientist fell ill after an autopsy on a wild chimpanzee in Taï National Park . The patient was treated in Switzerland.
1995 Democratic Republic of Congo EBOV 315 254 81% Erupted in Kikwit and the surrounding area in Bandundu Province . After research, the outbreak took place among forest workers and an outbreak through relatives and in hospitals.
January-April 1996 Gabon EBOV 37 21st 57% Erupted in Mayibout in Minkébé National Park. A killed chimpanzee was eaten in the forest by people hunting for food. Nineteen people who were directly involved became ill. There were also other cases among family members.
July 1996 – January 1997 Gabon EBOV 60 45 75% Erupted in Booué and the surrounding area in the province of Ogooué-Ivindo and during patient transport to Libreville . Index patient was a hunter who lived in a forest camp. The disease was spread through close contact with infected people.
November 1996 South Africa EBOV 2 1 50% A medical professional traveled from Gabon to Johannesburg , South Africa, after treating an Ebola virus infected patient in Gabon and coming into contact with the virus. He was admitted to the hospital, whereupon a nurse became infected and died.
1996 United States RESTV 0 0 0% Virus type was detected in monkeys imported from the Philippines at quarantine facilities in Texas.
1996 Philippines RESTV 0 0 0% Virus type has been detected in monkeys that were intended for export to the United States.
1996 Russia EBOV 1 1 100% One death after contamination in the laboratory.
2000-2001 Uganda SUDV 425 224 53% Performed in Gulu , Masindi and Mbarara . The reason for the greater prevalence was inadequate protective measures at the funeral of patients infected with Ebola.
October 2001 – March 2002 Gabon EBOV 65 53 82% Outbreak on the border with the Democratic Republic of the Congo.
October 2001 – March 2002 Democratic Republic of Congo EBOV 57 43 75% Outbreak on the border with Gabon and for the first time in the Republic of the Congo.
December 2002 – April 2003 Democratic Republic of Congo EBOV 143 128 89% Outbreak in Mbomo and Kéllé in the Cuvette-Ouest department .
November-December 2003 Democratic Republic of Congo EBOV 35 29 83% Outbreak in Mbomo and the village of Mbandza in the Cuvette-Ouest department .
2004 Sudan (today: South Sudan ) SUDV 17th 7th 41% Outbreak in Yambio.
2004 Russia EBOV 1 1 100% One death after contamination in the laboratory.
2005 Democratic Republic of Congo EBOV 81 11 13% According to WHO, outbreak in Etoumbi and Mbomo.
May 2007 Democratic Republic of Congo EBOV 384 suspected cases 167 43% Outbreak in Kampungu , Democratic Republic of the Congo, according to WHO .
October 2007 Democratic Republic of Congo EBOV 264 187 71% Outbreak in Kasai-Occidental Province .
December 2007 – January 2008 Uganda BDBV 149 37 25% Outbreak in Bundibugyo District in western Uganda.
November 2008 Philippines RESTV 6 (asymptomatic) 0 0% First known occurrence of the Ebola type RESTV in pigs. Six workers at a pig farm and for processing slaughterhouse waste produced antibodies, but did not become ill.
December 2008 – February 2009 Democratic Republic of Congo EBOV 32 15th 47% Outbreak in Mweka and Luebo in Kasai-Occidental Province, according to WHO .
May 2011 Uganda SUDV 1 1 100% Outbreak in Ziroobwe in Luwero District , Uganda . Other sources give Bombo , Uganda (35 km north of Kampala ), 33 people were isolated as a precaution.
June – October 2012 Uganda SUDV 11 4th 36% Outbreak in Kibaale district , 11 cases of illness and four deaths have been laboratory-confirmed. The WHO reported 50 suspected cases. Other sources give 59 suspected cases, 24 people were isolated as a precaution.
June – November 2012 Democratic Republic of Congo BDBV 36 13 36% Outbreak in the Haut-Uele district of Orientale Province , Democratic Republic of the Congo. 36 cases of illness and 13 deaths were laboratory-confirmed. The WHO reported 46 cases of illness (14 of which were laboratory-confirmed) and 19 deaths (of which 6 were laboratory-confirmed).
November 2012 – January 2013 Uganda SUDV 6th 3 50% Outbreak in the Luwero district , six cases of illness and three deaths have been laboratory-confirmed.
February 2014-January 2016 Guinea , Liberia , Sierra Leone , Nigeria (until October 20, 2014), Senegal (until October 17, 2014), United States , Spain (until December 2, 2014), Mali
 EBOV 28,635 11,314 60% * Hemorrhagic fever outbreak since February 9, 2014 in Macenta and Guéckédou prefecture . According to WHO , Ministry of Health Guinea and Doctors Without Borders, advance to the capital Conakry as well as Sierra Leone and Liberia . The outbreak in Nigeria at the end of July 2014 could be traced back to a man who had traveled from Liberia; 20 cases of illness and 8 deaths were reported from the capital Lagos and Port Harcourt . The outbreak was declared over on October 20, 2014. In Senegal , at the end of August 2014, a case became known of a man who had immigrated from Guinea. In the absence of any other infections, the outbreak was declared over on October 17, 2014. At the end of September 2014 there was the first case in the USA (entered from Liberia, deceased). At the beginning of October 2014, the first infection in Spain and infections in the USA (infection when treating patients) became known. There were no further infections in Spain and the outbreak was declared over on December 2, 2014. At the end of October 2014, the first case in Mali (entered from Guinea, deceased) was reported.
* The mortality rate given relates to cases from Guinea, Liberia and Sierra Leone, where records can be used to trace whether the infected person died or was cured; this information is not available for the total number of reported infections or deaths.
August – November 2014 Democratic Republic of Congo EBOV, similar to the virus in Kikwit 1995 66 49 74% Outbreak in the province of Equateur . Outbreak of the disease independent of West Africa according to Health Minister Felix Kabange Numbi and WHO. Rapidly introduced preventive and control measures were able to contain this outbreak and on November 21, 2014 it was declared over.
May 2017 Democratic Republic of Congo 11 3 Outbreak in Bas-Uele Province .
May-July 2018 Democratic Republic of Congo 54 33 Two Ebola cases in Bikoro in the province of Equateur in northwestern Congo were confirmed on May 8, 2018. 33 deaths by August 4th.
(April) July 2018– Democratic Republic of the Congo, Uganda ZEBOV previously 3310


(As of March 29, 2020)

previously 2273
(as of March 29, 2020) 		> 68% Documented cases of illness from July 2018, but likely outbreak as early as April 2018; until May 2019 only in the provinces of Ituri , North Kivu of the Democratic Republic of the Congo; In June 2019, Ebola fever occurred for the first time in neighboring Uganda as part of the epidemic
June 2020– Democratic Republic of Congo previously 88
(as of August 16, 2020) 		so far 36
(as of August 16, 2020) 		Outbreak in the province of Equateur

Legend: BDBV: Bundibugyo Virus ( species Bundibugyo Ebolavirus ), EBOV: Ebola Virus (species Zaire Ebolavirus ), RESTV: Reston Virus (species Reston Ebolavirus ), SUDV: Sudan Virus (species Sudan Ebolavirus ) and TAFV: Taï Forest Virus (species Taï Forest Ebolavirus ), see also updated nomenclature of species in the genus Ebolavirus .

2014 epidemic in West Africa

  • CDC : Regional distribution of confirmed and suspicious cases of illness during the Ebola virus epidemic in West Africa 2014, presentation until September 14, 2014 (6 development steps)

  • Regional distribution of confirmed and suspected cases of illness in Guinea, Liberia and Sierra Leone, presentation from August 25 to October 12, 2014 (thereafter different, non-transferable classification).

  • Regional distribution of confirmed and suspected cases of illness in Guinea, Liberia and Sierra Leone, presentation from October 19, 2014 (previously different, non-transferrable classification).

  • Ebola virus epidemic in West Africa 2014, affected countries and number of infected people or number of deaths (including suspected cases)

The Ebola epidemic in West Africa first broke out in Guinea in the prefecture of Macenta and the prefecture of Guéckédou . According to the WHO and the Ministry of Health in Guinea, the capital Conakry was also affected; The focus of new cases increasingly shifted to Sierra Leone from July 2014 with 454 infected people. A treatment station in Telimélé in western Guinea has already been closed again.

In Liberia, on the other hand, illnesses were confirmed in seven districts, including in the capital Monrovia , where an Ebola treatment center made of tents will be set up to complement the existing hospitals by the end of July . A treatment center already exists in Foya in the Lofa district in the remote border area with Guinea, where MSF is also increasing its activities in Voinjama . In view of the outbreak, Liberia wants to close all borders with neighboring countries. Two airports and three other border points are excluded.

International aid measures got off to a slow start due to political and social problems. A large part of the population is the first flu-like symptoms and the infection poorly or not informed of the virus, so Infected will not be isolated soon enough and infect optionally other people. There is also great distrust of foreign medical teams and the domestic authorities, as there were rumors that helpers brought the virus into the country. The Red Cross broke off an aid operation after employees were threatened. A crisis meeting of the World Health Organization (WHO) in Ghana on July 2 and 3, 2014 was intended to get the participating states to officially recognize the epidemic and prevent it from spreading beyond national borders. In the meantime, for example, the government of Sierra Leone is threatening penalties if the sick are hidden. According to the WHO, an effective analysis and tracing of contacts with the sick (English: contact tracking ) as well as cross-border cooperation are necessary . However, the WHO did not issue any general travel restrictions. Liberia, on the other hand, was initially not even planning an awareness campaign.

A high survival rate of 63 percent in the treatment center of Donka Hospital in Conakry, where 59 confirmed Ebola patients have been treated since March 25, contrasts with the lower survival rate in rural areas: especially when medical help was sought late, as was the case Beginning of the epidemic in Guéckédou, there was a very small chance of survival. Treatment facilities were therefore set up mainly in the border area of ​​the three states away from the major centers, including in Kailahun , Koindu and Buedu in the Kailahun district . 200 local health workers were trained there.

In addition to the 786 diseases in West Africa (1093 in total) with 660 deaths (442 confirmed) that were confirmed in the laboratory on July 20, there are also further cases of Ebola and deaths to be added. The World Health Organization reports on it regularly in English (with a clear overview table).

According to media reports, two US infected people working in Africa were treated with an experimental serum that had previously only been tested on monkeys.

Subsequent examinations of blood samples from Sierra Leone, which had already been obtained between 2006 and 2008 for the purpose of diagnosing Lassa fever , revealed serological indications that Ebola infections had already occurred during these years but were not detected. The Food and Agriculture Organization of the United Nations (FAO) is now warning against eating bats , other wild animals and carcasses , as these can be carriers of the virus.

The Federal Foreign Office has advised against traveling to the areas since August 1, 2014. Since August 5, 2014, a formal travel warning has also been in effect for Liberia, Guinea and Sierra Leone. In the first week of August 2014, the first cases of infection became known in Nigeria , including a doctor . Two infected Americans were flown to the United States . The Spanish Air Force also evacuated a citizen.

On August 8, 2014, the WHO declared the epidemic an international health emergency. On August 14, 2014, the WHO stated that there were indications in the affected countries that the actual extent of the outbreak was far greater than the number of deaths and diseases indicated.

The WHO declared Liberia (January 2016), Sierra Leone and Guinea (end of 2015) to be ebola-free. According to the World Health Organization, 28,639 people fell ill with Ebola during the course of the epidemic, including suspected cases, of which 11,316 died.

Financial aid

On August 4, 2014, the World Bank announced that it would provide the affected countries Guinea, Liberia and Sierra Leone with emergency aid of up to US $ 200 million (EUR 149 million). Financial aid has also been promised by the African Development Bank (US $ 60 million) and the WHO (US $ 100 million).

The misappropriation of at least five million euros in Ebola funds resulted in considerable financial damage. According to a financial audit report, almost two million of the Red Cross donations were evaded by employees of the International Red Cross and Red Crescent Movement in Sierra Leone with the help of bank employees. Due to excessive prices for aid supplies and excessive personnel costs, around two million euros were lost in Liberia . One million euros was billed too much for customs clearance in Guinea . Further investigations were not yet completed in 2017.

Epidemic since 2018 in Central Africa

In 2018, the provinces of North Kivu and Ituri in the east of the Democratic Republic of the Congo experienced the second-most severe Ebola epidemic to date. The first confirmed case of the epidemic was recorded by the WHO in July 2018, although the first cases of the disease probably already occurred in April of that year in the town of Mabalako . The causative agent is the Zaire Ebola virus (ZEBOV). The area around the city of Beni was hit hardest in 2018 . As of January 1, 2019, 608 cases of illness and 368 deaths were documented; on March 24, 2019, 1009 cases of illness (944 confirmed, 65 probable) and 629 deaths (564 confirmed, 65 probable). At the beginning of May, 1,545 cases of illness and 1,019 deaths were counted. Among the sick are a relatively high percentage of women and children. By mid-May, on May 20, 2019, 1,847 cases of illness and 1,223 deaths had already been counted, which means an increase of over 300 cases of illness in 16 days. As of June 9, 2019, 2062 statistically recorded cases of illness (1968 confirmed, 94 probable) and 1390 deaths (1296 confirmed, 94 probable) were counted. 569 people survived the disease. The lethality (number of deaths / (deaths + recoveries) * 100%) was well over 70 percent.

In June 2019, the first case of illness was detected in neighboring Uganda .

A large-scale vaccination campaign has been running in eastern Congo since August 8, 2018 , during which (as of May 4, 2019) more than 110,000 people were vaccinated. Only the rVSV-ZEBOV vaccine from Merck is used. The vaccine was shown to be highly effective according to accompanying studies.

Due to the epidemic, the 2018 presidential and parliamentary elections in the Democratic Republic of the Congo were repeatedly postponed.

Financial aid

On December 10, 2019, the World Bank approved a $ 250 million project to fight pandemics, including Ebola, with which the Africa Centers for Disease Control and Prevention will set up laboratories, a health record system and emergency mechanisms .

Reporting requirement

In Germany, suspected illness, illness and death from virus- related haemorrhagic fever must be reported in accordance with Section 6 . In addition, according to this law, the direct or indirect detection of other pathogens of haemorrhagic fever is notifiable by name according to § 7 IfSG, provided that the evidence indicates an acute infection. In contrast to almost all other infections in the case of hemorrhagic fevers that can be transmitted from person to person, immediate isolation is mandatory for the sick person ( Section 30 (1) sentence 1 IfSG [quarantine], together with pulmonary plague ).

In Austria, virus- related hemorrhagic fever is also a notifiable disease in accordance with Section 1 (1) of the 1950 Epidemic Act . The reporting obligation relates to suspected cases, illnesses and deaths.

In Switzerland, in the event of clinical suspicion and consultation with a specialist in infectious diseases and the initiation of pathogen-specific laboratory diagnostics regarding Ebola fever, reporting is mandatory according to the Epidemics Act (EpG) in conjunction with the Epidemics Ordinance and Appendix 1 of the Ordinance of the FDHA on reporting of observations of communicable diseases in humans .

literature

  • Xiangguo Qiu, Gary Wong, et al. a .: Reversion of advanced Ebola virus disease in nonhuman primates with ZMapp. In: Nature , Volume 514, October 2, 2014, pp. 47-53, doi: 10.1038 / nature13777 .

Web links

Individual evidence

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  3. ↑ Ordinance on notifiable animal diseases in the version published on July 19, 2011 ( Federal Law Gazette I p. 1404 ), amended by Article 3 of the Ordinance of May 3, 2016 ( Federal Law Gazette I p. 1057 ) in conjunction with Section 4 of the Act for the prevention and control of animal diseases (Animal Health Act - TierGesG) of May 22, 2013 ( Federal Law Gazette I p. 1324 ), last amended by Article 8, Paragraph 12 of the law of December 3, 2015 ( Federal Law Gazette I, p. 2178 ).
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  143. ↑ WHO: Extent of the Ebola epidemic in West Africa clearly underestimated. ( Memento of the original from August 26, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. AFP (afp.com), August 15, 2014, accessed August 24, 2014. @1@ 2Template: Webachiv / IABot / www.afp.com
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