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      Incubation Period of Ebola Hemorrhagic Virus Subtype Zaire

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          Abstract

          Objectives

          Ebola hemorrhagic fever has killed over 1300 people, mostly in equatorial Africa. There is still uncertainty about the natural reservoir of the virus and about some of the factors involved in disease transmission. Until now, a maximum incubation period of 21 days has been assumed.

          Methods

          We analyzed data collected during the Ebola outbreak (subtype Zaire) in Kikwit, Democratic Republic of the Congo, in 1995 using maximum likelihood inference and assuming a log-normally distributed incubation period.

          Results

          The mean incubation period was estimated to be 12.7 days (standard deviation 4.31 days), indicating that about 4.1% of patients may have incubation periods longer than 21 days.

          Conclusion

          If the risk of new cases is to be reduced to 1% then 25 days should be used when investigating the source of an outbreak, when determining the duration of surveillance for contacts, and when declaring the end of an outbreak.

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          The reemergence of Ebola hemorrhagic fever, Democratic Republic of the Congo, 1995. Commission de Lutte contre les Epidémies à Kikwit.

          A Khan, F. Tshioko, D. L. Heymann … (1999)
          In May 1995, an international team characterized and contained an outbreak of Ebola hemorrhagic fever (EHF) in Kikwit, Democratic Republic of the Congo. Active surveillance was instituted using several methods, including house-to-house search, review of hospital and dispensary logs, interview of health care personnel, retrospective contact tracing, and direct follow-up of suspect cases. In the field, a clinical case was defined as fever and hemorrhagic signs, fever plus contact with a case-patient, or fever plus at least 3 of 10 symptoms. A total of 315 cases of EHF, with an 81% case fatality, were identified, excluding 10 clinical cases with negative laboratory results. The earliest documented case-patient had onset on 6 January, and the last case-patient died on 16 July. Eighty cases (25%) occurred among health care workers. Two individuals may have been the source of infection for >50 cases. The outbreak was terminated by the initiation of barrier-nursing techniques, health education efforts, and rapid identification of cases.
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            Exotic emerging viral diseases: progress and challenges.

            Thomas W. Geisbert, Peter B. Jahrling (2004)
            The agents causing viral hemorrhagic fever (VHF) are a taxonomically diverse group of viruses that may share commonalities in the process whereby they produce systemic and frequently fatal disease. Significant progress has been made in understanding the biology of the Ebola virus, one of the best known examples. This knowledge has guided our thinking about other VHF agents, including Marburg, Lassa, the South American arenaviruses, yellow fever, Crimean-Congo and Rift Valley fever viruses. Comparisons among VHFs show that a common pathogenic feature is their ability to disable the host immune response by attacking and manipulating the cells that initiate the antiviral response. Of equal importance, these comparisons highlight critical gaps in our knowledge of these pathogens.
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              Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients.

              Mpia A. Bwaka, Marie‐José Bonnet, Philippe Calain … (1999)
              During the 1995 outbreak of Ebola hemorrhagic fever in the Democratic Republic of the Congo, a series of 103 cases (one-third of the total number of cases) had clinical symptoms and signs accurately recorded by medical workers, mainly in the setting of the urban hospital in Kikwit. Clinical diagnosis was confirmed retrospectively in cases for which serum samples were available (n = 63, 61% of the cases). The disease began unspecifically with fever, asthenia, diarrhea, headaches, myalgia, arthralgia, vomiting, and abdominal pain. Early inconsistent signs and symptoms included conjunctival injection, sore throat, and rash. Overall, bleeding signs were observed in <45% of the cases. Typically, terminally ill patients presented with obtundation, anuria, shock, tachypnea, and normothermia. Late manifestations, most frequently arthralgia and ocular diseases, occurred in convalescent patients. This series is the most extensive number of cases of Ebola hemorrhagic fever observed during an outbreak.
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                Author and article information

                Contributors
                Martin Eichner
                Journal
                Journal ID (nlm-ta): Osong Public Health Res Perspect
                Title: Osong Public Health and Research Perspectives
                ISSN (Print): 2210-9099
                ISSN (Electronic): 2233-6052
                Publication date PMC-release: 12 April 2011
                Publication date (Electronic): 12 April 2011
                Publication date (Print): June 2011
                Volume: 2
                Issue: 1
                Pages: 3-7
                Affiliations
                [a ]Department of Medical Biometry, University of Tübingen, Tübingen, Germany
                [b ]Centers for Disease Control and Prevention, Atlanta, Georgia, USA
                Author notes
                [∗ ]Corresponding author. martin.eichner@ 123456uni-tuebingen.de
                Article
                Publisher ID: S2210-9099(11)00002-6
                DOI: 10.1016/j.phrp.2011.04.001
                PMC ID: 3766904
                PubMed ID: 24159443
                SO-VID: b59ff982-2168-414d-ab65-394c303624b7
                Copyright © © 2011 Published by Elsevier B.V. on behalf of Korea Centers for Disease Control and Prevention.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 February 2011
                Date accepted : 2 May 2011
                Categories
                Subject: Invited Original Article

                Keywords: disease outbreaks/prevention & control,ebola/epidemiology,ebola hemorrhagic fever,ebola/prevention & control,statistical models
                Data availability:
                Keywords: disease outbreaks/prevention & control, ebola/epidemiology, ebola hemorrhagic fever, ebola/prevention & control, statistical models

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