Alternative names back to top
Ebola hemorrhagic fever (Ebola fever), Marburg Hemorrhagic Fever, Crimean-Congo Hemorrhagic Fever

Organism
Ebola Virus, Marburg Virus, or Crimean-Congo Virus

Overview
Viral Hemorrhagic Fever is the name of a rare group of viral infections, including Ebola, Marburg, and the Crimean-Congo viruses, that cause similar symptoms and pathology. The first known case of the Crimean-Congo Hemorrhagic Fever was among Russian soldiers serving in the Crimea in 1944 and then among villagers living near the Congolese city of Kisangani in 1956. Not until 1969 were scientists able to isolate the single virus common to both. Ebola virus first emerged in two major disease outbreaks, which occurred almost simultaneously in Zaire and Sudan in 1976. Over 500 cases were reported, with mortality rates of 88% in Zaire and 53% in Sudan. The most recent Ebola outbreak occurred in Uganda between August 2000 to Jan 2001. It affected 425 individuals and killed 223 (53%). Marburg virus was first recognized in laboratory workers in Marburg, Germany, and Belgrade, Yugoslavia, simultaneously in 1967. These workers had been exposed to tissues and blood from African green monkeys (Cercopithecus aethiops ) imported from Uganda. There were 25 primary cases and six secondary cases in the outbreak. Seven of the primary cases died. Since then, sporadic, virologically confirmed Marburg disease cases have occurred in Zimbabwe, South Africa and Kenya.

All of the Hemorrhagic Fevers cause severe bleeding and a high fever and are often fatal. The incubation period appears to be 5-10 days, at which time the patient develops fatigue, malaise, headache, backache, vomiting, and diarrhea. Within a week, a raised (papular) rash appears over the entire body; the rash is often hemorrhagic (containing blood). The disease affects the capillaries in the body and causes excessive bleeding through the eyes, nose, mouth and gastrointestinal tract. Symptoms become increasingly severe and may include jaundice, inflammation of the pancreas, severe weight loss, delirium, shock, liver failure, massive hemorrhaging, and multi-organ dysfunction. Mortality is high, reaching 90%.

The largest outbreak of the highly contagious Crimean-Congo Virus in history was confirmed October 4, 2001, on Pakistan's frontier with Afghanistan. At least 75 people have caught the disease so far and eight have died. Evidence suggests the outbreak of Crimean-Congo Hemorrhagic Fever emanates from within Afghanistan, raising fears of an epidemic as thousands of refugees flee across the frontier into Pakistan. Dr Akhlaq Hussain, medical superintendent at the Pakistani hospital where most of the victims have been isolated in Quittel, Pakistan, said: "The first cases came in June. There were a number of deaths, but at first we did not know what was the cause." A number of blood samples were sent to Pakistan's national virology testing center in Islamabad and to South Africa's National Institute of Virology in Johannesburg, which confirmed the diagnosis of Crimean-Congo Hemorrhagic Fever. Although there have been a number of cases since, the outbreak at the Afghanistan-Pakistan border is the largest ever seen.

Carriers back to top
Viral Hemorrhagic Fever is transmitted by a tick, Hyaloma marginata, which thrives on sheep and cattle. Infected humans can spread the disease by blood, saliva or airborne droplets from sneezing.

Biological Weapons Use
Biological Weapons Use Viral Hemorrhagic Fever has been made into an aerosolized powder by the former Soviet Union Biopreparat that could be deployed as a biological weapon. It is believed that several nations now possess powdered biological weapons or have the capability to manufacture them, including Russia, Iraq, Iran, Syria, Libya, China, and North Korea. It is not known whether the most recent outbreak of Crimean-Congo Hemorrhagic Fever in Afghanistan is due to natural transmission or possibly due to a terrorist laboratory or manufacturing accident.

Toxicity back to top
Viral Hemorrhagic Fever causes a horrifying terrible death. In 1988, a Russian scientist named Nikolai Ustinov, working at the Biopreparat facility called Vector, accidentally pricked himself in the finger with a syringe that contained the Marburg virus. On about the fourth day, Ustinov developed a headache, and his eyes turned red. Tiny hemorrhages were occurring in them. He requested a laboratory notebook, and he began writing a diary in it, every day. He was a scientist, and he was determined to explain how he was dying. For a while, he maintained a small hope that he wouldn't die, but when his skin developed spontaneous bruises he understood what the future held. When Ustinov began to vomit blood and pass bloody black diarrhea, the doctor gave him transfusions, but as they put the blood into him it came out of his mouth and rectum. The final pages of Dr. Nikolai Ustinov's scientific journal are smeared with unclotted blood. His skin developed starlike hemorrhages in the underlayers. Incredibly -- the Vector scientists had never seen this -- he sweated blood directly from the pores of his skin, and left bloody fingerprints on the pages of his diary.

An autopsy was performed in the spacesuit morgue of the biocontainment hospital. If this was indeed the Popp strain of Marburg virus -- and who could say? -- it was incredibly lethal. It produced effects in the human body that were stunning, terrifying. Alibek says that a pathology team removed Ustinov's liver and his spleen. They sucked a quantity of his destroyed blood out of a leg vein using large syringes. They froze the blood and the body parts. They kept the Ustinov strain alive and continually replicating in the laboratories at Vector. They named the strain Variant U, after Ustinov, and they learned how to mass-produce it in simple bioreactors, flasks used for growing viruses. They dried Variant U, and processed it into an inhalable dust. The particles of Variant U were coated to protect them in the air so that they would drift for many miles.

In late 1990, Biopreparat researchers tested airborne Variant U on monkeys and other small animals in special explosion-test chambers at the Stepnagorsk plant. Marburg Variant U proved to be extremely potent in airborne form. They found that just one to five microscopic particles of Variant U lodged in the lungs of a monkey were almost guaranteed to make the animal crash, bleed, and die. With normal weapons-grade anthrax, in comparison, it takes about eight thousand spores lodged in the lungs to pretty much guarantee infection and death.

Contagiousness
Initial infection can arise from contact with infected animals or could be spread by airborne distribution like the common cold or flu virus. The Soviet's Biological research program produced both powdered Ebola and Marburg viruses for deployment as biological weapons either in a warhead or via aerosolized dissemination. Humans to human transmission of the virus can occur by direct contact with the blood and/or secretions of an infected person. This is why the virus has often been spread through the families and friends of infected persons: in the course of feeding, holding, or otherwise caring for them, family members and friends would come into close contact with such secretions. People can also be exposed to Ebola virus through contact with objects, such as needles, that have been contaminated with infected secretions.

Incubation back to top
Incubation The incubation period appears to be 5-10 days.

Symptoms back to top

Symptoms Early: