New England Journal of Medicine
October 30, 2014 Vol. 371 No. 18
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Ebola Then and Now
Joel G. Breman, M.D., D.T.P.H., and Karl M. Johnson, M.D.
N Engl J Med 2014; 371:1663-1666October 30, 2014DOI: 10.1056/NEJMp1410540
[Excerpt]
In October 1976, the government of Zaire (now the Democratic Republic of Congo [DRC]) asked what was then the U.S. Center for Disease Control, where we worked, to join an international group of scientists in elucidating and controlling an outbreak of an unusually lethal hemorrhagic fever. Just before we arrived in Zaire, our laboratory had used virologic and immunologic tests to identify the cause as a new filovirus, and we brought electron micrographs of the agent.1 In Zaire, we became, respectively, the chief of surveillance, epidemiology, and control and the scientific director of the International Commission for the Investigation and Control of Ebola Hemorrhagic Fever in Zaire.
The 2013–2014 outbreak of Ebola virus disease (EVD) has much in common with the 1976 outbreak. Both were caused by Zaire ebolavirus 2 and began in rural forest communities, where wild game is hunted for food (though no animal has been implicated as the trigger of these outbreaks). Severely ill patients came to provincial hospitals with systemic illness resembling malaria, typhoid, Lassa fever, yellow fever, or influenza. Unsuspecting hospital staff had contact with patients’ blood and body fluids, which amplified the outbreaks. Cases were exported to cities, and chains of transmission were established…