Transmissions and Amplifications during an Ebola Outbreak

Name: Transmissions and Amplifications during an Ebola Outbreak
Uploaded: 2025-05-20
Duration: 13 min
Description: The lecture Transmissions and Amplifications during an Ebola Outbreak by Jean-Jacques Muyembe-Tamfum, MD, PhD is from the course Ebola.

by Jean-Jacques Muyembe-Tamfum, MD, PhD

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00:01 I will give you some examples of these. Amplification during the Ebola outbreak in 1995 in Kikwit. We receive, the alert of, an outbreak causing a several community deaths, including healthcare workers and Italian nurses who works in the hospital. And, , but the disease started in January, and the epidemic was not, detected for three months. The first cases were detected in a small hospital of 150 beds called Kikwit Hospital 2, followed by a large spread of, the of the infection At the Kikwit General Hospital with 300 beds. Healthcare workers' contamination stopped when the hospital hygiene were improved and personal protective equipment arrived. We can say that this outbreak was detected because of the nosocomial transmission, the transmission of the Ebola virus among healthcare workers. Otherwise, we did not have an Ebola outbreak. So the amplification in the hospital was the first signal for us to say that this outbreak is Ebola. We know also that, , Ebola can infect wild animals. And the first the first proof of this. The first evidence was given by, , the outbreak. We call that, the episodic of Ebola in the Tai forest in Cote d'Ivoire in 1994, where a lot of chimpanzees were dead because of Ebola. And a scientist, who conducted autopsy was infected by the virus, but he survived. And in 1996, children of the village of Geburtswanne in Gabon were infected after handling the meat of chimpanzees found dead in the forest. So Ebola can infect both han and non-han primates. Bushmeat in Gabon were the most at risk factor of Ebola outbreak in Gabon and also in Congo Brazzaville. But most cases in DRC, we have no links with the consption of bushmeat. And also our last in the the Mueka Ebola outbreak in the Democratic Republic of Congo. It was in Mueka. We found also links between bats consption and Ebola outbreak. For the community amplification of Ebola infection, we know that the traditional mortuary toilet without gloves and disinfectant. This is a most important risk factors. Touching and kissing the corpse is a cultural expression of love in Africa. Why the Ebola virus remain contagious, even on the skin of the deceased patient. And also collection of relics like hair, nail, cloth ing from the course to send to the village. Thus, they will promote the spread of the Ebola virus outside the epicenter of the outbreak. The source of contamination during the Ebola outbreak, we can give for the example of of yambuku. This was the first Ebola virus in the world. We don't know the index case and the source of infection is unknown. During the outbreak of Nza ra in Sudan in 1976, the index case was not known. And also the source of contamination and kikwit, the source of the index case was a charcoal maker, but the source of infection was not known. Only we know the source of infection and the index case. , in case of Mayibout 2 and during the outbreak of Booué in Gabon in 1998. And, for Uganda, mostly with Ebola Sudan, we don't know the cause of, the source, the cause of infection. We don't know. But in Gabon and, during the outbreak in Gabon in 2002, in Congo-Brazzaville, the source, the index case where the hunters and the source of infection were the dead gorilla found in the, in the forest. And, what about the relation of human epidemics and epizootics? If we see that the outbreak of 1989 to 1989, we have epizootics of cynomolgus monkeys. This was in the laboratory of, Reston in Virginia. But the Reston was not a pathogen for humans. And the same observation occurred in 1992 and in 1996. But in 1994, there was a chimpanzees epidemic, as I said, in the Tai Forest in Ivory Coast. And also chimpanzee was the cause of the outbreak in Mayibout 2 . So one chimpanzee was found dead in the forest and, in 2001, 2002. There was also an epizootic Gorilla in Gabon and also in Boma in Congo-Brazzaville. So Ebola Zaire can kill non-human primates, but Ebola Sudan, we have no relationship with epizootic in Sudan and in Uganda. So, here I want to to say that sometimes epizootic can precede the outbreak in humans. So what we are doing now is to, to give a good information to the hunters, not to handle chimpanzees or gorilla found that in the, in the forest. Okay. So, let us see, what is the chain of transmission during the outbreak? I can say that there is a moderating rule played by the village. When the infection is in the village, infection tended to stop on its own once introduced into a village. That is the example of outbreaks in DRC, the first outbreak in 1976. During this outbreak, 55 villages were affected. Only 17 villages has one case, and 18 when two has 2 to 5 cases and the outbreak stopped. I n Kikwit in 1995, we have 25 villages affected. Only 15 has one case and ten has 2 to 5 cases. And the outbreak stopped. It means that if the virus is introduced in a village, there is no amplification. Most of the time the outbreak will stop spontaneously. And also, the case of the chain of transmission of a village in Gabon. So we have a hunter who was infected is the index case. And this index case will infect, two brothers, and one of them will die. And the outbreak stopped. And? But when? When the virus is introduced in a hospital. This is Makokou hospital. It is the district hospital in Gabon. There is an amplification. And as you see here, the chain of transmission is long compared to the chain of transmission in the village of Ekata. So this is why we are saying that the hospital is a place of Ebola amplification. When this hospital has very low standard of hygiene and a lack of disinfectant, of glove, of running water. What we propose at that time, because handshaking is very important in, in Africa. It is a sign of, of love in the community and so on. And also during Ebola, handshaking is a risk factor for the transmission of Ebola. So we propose this kind of, of shaking, elbow by elbow, as you see here. And this also was used, recently, during the Covid, Covid pandemic. And also washing hands is very important, very important. Like having, disinfectant. So , in washing, we promote these, these, action in the community, during, Ebola outbreaks in our country. So this is, also transmitted during the Ebola outbreak in West Africa in 2013 and 2016.

About the Lecture

The lecture Transmissions and Amplifications during an Ebola Outbreak by Jean-Jacques Muyembe-Tamfum, MD, PhD is from the course Ebola.

Included Quiz Questions

What role did nosocomial transmission play in the 1995 Kikwit Ebola outbreak?

It served as the first signal for outbreak detection after healthcare workers became infected
It was completely prevented by early implementation of isolation protocols
It only occurred after community transmission had already been controlled
It was limited to a single healthcare facility without further spread
It resulted from airborne transmission in poorly ventilated hospital rooms

How does Ebola transmission differ between village and hospital settings?

Villages show self-limiting spread with most having only 1-5 cases, while hospitals demonstrate amplification with long transmission chains
Villages have higher transmission rates due to closer family contact patterns
Hospitals have better containment due to medical supervision and isolation
Both settings show identical transmission patterns and outbreak duration
Villages require more aggressive intervention strategies than hospitals

What is the relationship between epizootics in non-human primates and human Ebola outbreaks?

Epizootics can precede human outbreaks, as seen with chimpanzee deaths in Tai Forest and gorilla deaths in Gabon
Epizootics only occur after human outbreaks have already been established
There is no documented relationship between animal and human Ebola cases
Epizootics are limited to laboratory settings and do not affect wild populations
Animal outbreaks only involve fruit bats and never affect primates

Which traditional practices contribute most significantly to Ebola transmission amplification in affected communities?

Traditional mortuary rituals including touching and kissing corpses, and collection of relics from deceased patients
Large wedding celebrations and community festivals with dancing
Shared cooking utensils and communal eating arrangements
Traditional healing practices using herbal remedies
Religious ceremonies involving group singing and prayer

What evidence supports the role of bushmeat in Ebola transmission?

Children in Gabon were infected after handling meat from dead chimpanzees, and links were found between bat consumption and outbreaks in DRC
All Ebola outbreaks in Central Africa have been directly linked to bushmeat consumption
Bushmeat transmission only occurs through cooked meat consumption
Only certain species of antelopes carry the Ebola virus
Bushmeat transmission requires direct blood contact during animal slaughter

What community-based prevention measures were successfully implemented during Ebola outbreaks?

Modified greeting practices using elbow-to-elbow contact instead of handshaking and enhanced hand hygiene with disinfectants
Complete isolation of all suspected cases in designated quarantine facilities
Mass vaccination campaigns using experimental Ebola vaccines
Elimination of all traditional funeral practices and immediate cremation
Mandatory wearing of full personal protective equipment by all community members

Author of lecture Transmissions and Amplifications during an Ebola Outbreak

Jean-Jacques Muyembe-Tamfum, MD, PhD

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