The Hunt for Ebola
A CDC team races to Uganda just days after an outbreak of the killer virus to try to pinpoint exactly how it is transmitted to humans
- By Joshua Hammer
- Smithsonian magazine, November 2012, Subscribe
(Page 3 of 4)
The quick reaction by the health authorities may have prevented the outbreak from spiraling out of control. Health workers fanned out to villages and methodically tracked down everyone who had close contact with the family in which nine had died. Those showing Ebola-like symptoms were given blood tests, and, if they tested positive, were immediately isolated and given supportive treatment. Four hundred and seven people were ultimately identified as “contacts” of confirmed and suspected Ebola cases; all were monitored by surveillance teams for 21 days. The investigators also worked their way backward and identified the “index patient,” Winnie Mbabazi, although they were unable to solve the essential mystery: How had Mbabazi acquired the virus?
Jonathan Towner is the head of the virus host ecology section of the CDC’s Special Pathogens Branch. He specializes in the search for viral “reservoirs”—passive carriers of pathogenic organisms that occasionally leap into human beings. Towner earned his reputation investigating Marburg, a bleeding fever that can be 80 percent lethal in humans. The virus got its name from Marburg, Germany, where the first case appeared in 1967. Workers were accidentally exposed to tissues of infected African green monkeys at an industrial laboratory; 32 people became infected and seven died. Virologists eliminated the monkeys as the primary source of Marburg, because they, like humans, die quickly once exposed to the virus. “If the virus kills the host instantly, it’s not going to be able to perpetuate itself,” Towner explained, as we sat on the patio of the Hotel Starlight. “It has to adapt to its host environment, without killing the animal. Think of it as a process taking thousands of years, with the virus evolving along with the species.”
Between 1998 and 2000, a Marburg outbreak killed 128 workers at a gold mine in Congo. Seven years later, two more gold miners died at the Kitaka mine in Uganda. In 2008, a Dutch tourist who had visited a cave in Uganda became ill and died after returning to the Netherlands. Towner and other scientists captured hundreds of Egyptian fruit bats (Rousettus aegyptiacus) in the mines and found that many were riddled with Marburg. “Every time we’ve captured decent numbers of these bats, and looked for the virus, we’ve found it,” he says. A bat bite, contact with bat urine or feces, or contact with an infected monkey—which often acts as the “amplification host” in virus transmissions to humans—were all possible means of infection, says Towner.
Ebola is considered a “sister virus” to Marburg, both in the family of filoviridae that biologists believe have existed for millennia. They have similar genetic structures and cause nearly identical symptoms, including external bleeding in the most severe cases. “Marburg is one of the strongest arguments that bats are the reservoir for Ebola,” said Towner.
We were back at the Hotel Starlight in Karaguuza after spending the morning hunting for bats. The team had bagged more than 50 of them in two abandoned houses and was now preparing to dissect them in a makeshift screened-in lab beneath a tarp in the rear courtyard of the hotel. There, tucked out of sight so as not to disturb the other guests, the group set up an assembly line. Luke Nyakarahuka, the Ugandan health ministry epidemiologist, placed the bats one by one in a sealed plastic bag along with two tea strainers filled with isoflurane, a powerful anesthetic. The bats beat their wings for a few seconds, then stopped moving. It took about a minute to euthanize them. Then Nyakarahuka passed them on to other members of the team, who drew their blood, measured them, tagged them, plucked out their organs, and stored their carcasses and other material in liquid nitrogen for shipment to the CDC.
For Towner and the others, the hope is not only that they will find the Ebola virus, but also that they will shed light on how the pathogen is transmitted from bat to human. “If the kidneys are blazing hot, then the Ebola might be coming out in urine. If it’s the salivary glands, maybe it’s coming out in saliva,” I was told by the CDC’s Brian Amman. Testing of the Marburg virus carriers hasn’t indicated much, he says. “We’ve found the virus only in the liver and spleen, two body filters where you’d expect to find it.” Amman said that if research conclusively found that Ethiopian epauletted fruit bats carried Ebola, it might catalyze an HIV/AIDs-type awareness campaign aimed at minimizing contacts between bats and humans. It might also lead to the boarding up of the many abandoned and half-built houses in rural Africa that serve as bat roosting places and breeding grounds. “Some people here might say, ‘Let’s kill them all,’” said Amman. “But that would be destroying a valuable ecological resource. Our aim is to mitigate the interaction.”
None of the virus hunters had any expectation that a vaccine against Ebola was imminent. The drug development process takes an average of 15 years and costs billions of dollars. Pharmaceutical companies are reluctant to expend those resources to combat a virus that has killed about 1,080 people in 30 years or so. So far, nearly all Ebola vaccine research has been funded by the U.S. government to combat potential bioterrorist attacks. The Army Medical Research Institute of Infectious Diseases in Fort Detrick, Maryland, recently tested an experimental vaccine made from virus-like particles on guinea pigs and monkeys, and reported promising results. Several biodefense contractors have initiated small-scale safety trials with human volunteers, who are not exposed to the Ebola virus. But most virologists say that an effective vaccine is many years away.
In late August, four weeks after Ebola was confirmed, I visited Kagadi Hospital, a tidy compound of tile- and tin-roofed one-story buildings on a hill overlooking the town. I dipped my shoes into a tub of disinfectant at the front gate. Posters on the walls of the administration building and the general wards listed symptoms of Ebola—“sudden onset of high fever...body rash, blood spots in the eyes, blood in the vomit...bleeding from the nose”—and instructed people to avoid eating monkey meat and to make certain to wrap the corpses of victims in infection-resistant polyethylene bags. Cordoned off by an orange plastic fence in the rear courtyard was the “high-risk” ward, where Ebola patients are kept in isolation and attended by masked, gloved, biohazard-suited health workers. “If you were on the other side of the orange tape, you would have to be wearing an astronaut suit,” a physician from Doctors Without Borders told me.
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Comments (2)
Your virus is not high, but low. Look for desiccated animals with bacteria, then rehydrate the bacteria and you will find the virus hiding inside.
Posted by Matthew on October 29,2012 | 05:39 PM
I always enjoy reading Mr. Hammer's articles, even on a disturbing topic such as the Ebola virus. Thank you.
Posted by C. Gray on October 28,2012 | 12:21 AM