London School of Hygiene & Tropical Medicine

With the recent Ebola epidemic in West Africa reviving interest in the first outbreak of the virus 40 years ago, a new report highlighting the lessons learned from the smaller, more quickly contained 1976 outbreak has been published in the Journal of Infectious Diseases.

The article was co-authored by scientists involved in investigating the first outbreak, including lead author Dr Joel Breman of the Fogarty International Center at the National Institutes of Health, and Professor Peter Piot and Professor David Heymann from the London School of Hygiene & Tropical Medicine.

The first known outbreak occurred in Zaire (now the Democratic Republic of Congo). In the new report the authors write that the "key to diagnosis in 1976 was the relatively quick clinical recognition of a severe, possibly new disease by national authorities… International notification and specimen provision occurred within five weeks from onset of the first cases; this did not occur in the 2013-2016 epidemic, when the delay was over three months."

The report also gives a timeline of events during the first outbreak and sets out the roles the experts played.

Local Zairean, Belgian and French doctors and health officials were the first to see and assess patients in Yambuku, Zaire. Blood specimens from a sick Belgian nun who had contracted the virus were sent to the laboratory of microbiology at the Institute of Tropical Medicine in Antwerp, where Piot worked as a research fellow together with Guido Van der Groen.

The ITM team were the first to isolate and observe the virus, which resembled the Marburg virus. The laboratory of Karl Johnson at the US Centers for Disease Control and Prevention (CDC) identified and recognised that this was a new, unknown virus that fulfilled the criteria for discovery of a new virus.

Peter Piot, Director of the School, and David Heymann, Professor of Infectious Disease Epidemiology, were part of the team that went to Zaire to investigate the first outbreak of Ebola, visiting the affected communities in order to discover how the virus was transmitted. At that time, Heymann was a medical epidemiologist in sub-Saharan Africa, on assignment from CDC. It was in Zaire that Karl Johnson suggested naming the new virus after a river (the Ebola river was chosen), rather than the Yambuku village, so as not to stigmatise the community.

Peter Piot said: "It was a privilege to be part of the team that worked on the first Ebola outbreak and to have played a role in its discovery. Our work helped shaped the world's knowledge of what was an unknown but deadly virus, something we can all be proud of.

"Reflecting on the 1976 outbreak offers clues to mistakes made during the most recent epidemic. For instance, even though there was less technology 40 years ago specimens of the virus were available two months faster than during the recent epidemic."

The authors say more extensive preparations, including improved screening capabilities, are needed to detect and manage future outbreaks promptly. Primary prevention through strengthened prediction models, detection, response, control mechanisms, and international cooperation and coordination are essential for all countries in Africa and elsewhere where Ebola and new and re-emergent pathogens are sure to surface again.

Peter Piot said: "There is no doubt that Ebola will return. We need to react more quickly, urgently develop an effective vaccine, and strengthen 'on the ground' local health systems to improve detection and containment of the virus."

In total, there were 318 cases of Ebola in 1976 and 280 deaths in an outbreak that lasted less than 11 weeks. In the recent West Africa outbreak, there were 11,310 deaths out of nearly 29,000 cases, and the epidemic lasted more than two years -- almost 10 times as long as in 1976. The death rate in 1976 - 88% - was much higher than in the recent outbreak in Liberia, Guinea and Sierra Leone - around 50%.

During the recent Ebola outbreak in West Africa, Professor Piot advised governments and international agencies on the response and was Chair of the World Health Organization (WHO) Ebola Science Committee. He also chaired the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine Independent Panel on the Global Response to Ebola, published in November 2015, which put forward 10 major reform proposals to prevent future such catastrophes.

David Heymann worked on two subsequent Ebola outbreaks in 1977 and 1995. He was involved in the recent Ebola response and was also an author on the Harvard-London School of Hygiene & Tropical Medicine report. He is currently Chair of WHO's Emergency Committee on Zika virus.

Publications

• Joel G. Breman, David L. Heymann, Graham Lloyd, Joseph B. McCormick. Malonga Miatudila, Frederick A. Murphy, Jean-Jacques Muyembé-Tamfun, Peter Piot, Jean-François Ruppol, Pierre Sureau, Guido van der Groen, Karl M. Johnson. Discovery and Description of Ebola Zaire Virus in 1976 and Relevance to the West African Epidemic During 2013-2016. Journal of Infectious Diseases. DOI: 10.1093/infdis/jiw207

Related links

• Independent panel of global experts calls for critical reforms to prevent future pandemics

Related publications:

• The Lancet, 12 March 1977 - the research teams coincided the publication of their findings in this edition:
  • K.M Johnson, J.V Lange, P.A Webb, F.A Murphy, Isolation and partial characterisation of a new virus causing acute hæmorrhagic fever in Zaire, The Lancet, DOI:10.1016/S0140-6736(77)92000-1
  • S. Pattyn, G.vander Groen, W. Jacob, P. Piot, G. Courteille, Isolation of Marburg-like virus from a case of hæmorrhagic fever in Zaire, The Lancet, Doi:10.1016/S0140-6736(77)92002-5
  • E.T.W. Bowen, G. Lloyd, W.J. Harris, G.S. Platt, A. Baskerville, E.E. Vella, Viral hæmorrhagic fever in southern Sudan and northern Zaire: Preliminary Studies on the Aetiological Agent, The Lancet. Doi:10.1016/S0140-6736(77)92001-3
• Bulletin of the World Health Organization, 1978 - includes a report of the investigation in Zaire