Filovirus Infections: Experiences from Kikwit and Durba, Democratic Republic of Congo

摘要

In this paper we present some of the unpublished observations during the Kikwit Ebola and the Durba Marburg epidemic. Recently we learned that the reservoir of the Ebola virus could be bats (1) and how the Ebola virus infects cells (2). Ebola virus can be through contact with blood and body fluids, but a very important public health questions remains incompletely answered: how do filoviruses enter the human body? During the 1995 Kikwit Ebola haemorrhagic fever (EHF) outbreak, a case control study was performed to determine risk factors for acquiring EHF by health care workers (HCW). In a multi-variant analysis the following risk factors were identified: unprotected contact with the blood of an EHF patient, the manipulation of a corpse and the contact with several EHF patients. Hand washing was protective. Only one nurse became infected after a needle stick trough her gloves when recapping a needle. Only two cases reported small wounds at the level of the hands as a possible entry point for the virus. One of the Italian nurses who became infected always worked with gloves, a mask and a blouse, but without goggles. She mentioned that she probably became infected by touching her eyes with a contaminated glove. One factor explaining the high transmission rate of filoviruses to health care workers could be the high viral load and the fact that filoviruses are causing an acute and aggressive disease characterised by bleeding, often very massive, vomiting and diarrhoea.