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Something is going on in Uganda, and it is causing health care workers to flee in panic.

First, some background on the current outbreak, from Reuters:

Death-toll rises from Uganda's Ebola outbreak
Sat Dec 1, 2007 10:43 AM ET
By Francis Kwera

KAMPALA (Reuters) - Two more Ugandans have died of a new strain of the deadly Ebola virus in an outbreak near the border with Democratic Republic of Congo, bringing the death-toll to 18, health officials said on Saturday.

"We have had two more deaths in the last 24 hours, and the disease continues to spread," Sam Zaramba, the Ugandan Health Ministry's director of health services, told Reuters.

Zaramba said World Health Organization (WHO) officials had teamed up with local experts to draw up a strategy to contain the outbreak of the hemorrhagic fever in the western Bundibugyo region. More than 50 people are also infected.

"We have set up isolation wards where all those who have been diagnosed with Ebola have been quarantined, and are being monitored closely," Zaramba added.

Genetic analysis of samples taken from some of the victims shows it is a previously unknown type of Ebola, making it the fifth strain, U.S. and Ugandan health officials say.

Ebola can cause internal and external bleeding. Victims often die of shock, but symptoms can be vague, including fever, muscle pain and nausea. It is known to infect humans, chimpanzees and gorillas.

Uganda was last hit by an epidemic of Ebola in 2000, when 425 people caught it and just over half of them died.

An outbreak in neighboring Congo this year infected up to 264 people, killing 187, the World Health Organization says.

But samples had tested negative.

(Writing by Andrew Cawthorne; Editing by Michael Winfrey)

http://today.reuters.com/news/articlenews.aspx?type=healthNews&storyid=2007-12-01T154333Z_01_L0114732_RTRUKOC_0_US-UGANDA-EBOLA.xml

Now, we get the "boots on the ground" view, from FOCUS Information Agency:

Kampala. Several dozen medics and support staff have fled western Uganda after their coworkers became infected with the Ebola virus in an outbreak that has already killed 18 people, officials said Saturday.
Ugandan officials clamped a quarantine on the Bundibugyo region and appealed for help in dealing with the outbreak of Ebola, a contagious disease that kills up to 90 percent of those infected, AFP reported.
However efforts to contain the outbreak, which began in September but was definitively identified as Ebola only last week, have been hampered by medical personnel becoming infected and others fleeing.
"We have a shortage of health workers and we need more because those who were there on the ground have been infected: two doctors, a medical officer and a nurse," said Sam Zaramba, the country's top government physician.
"Health workers are terribly afraid. They have abandoned patients in health units for fear of being infected," a government official told the state-owned New Vision newspaper.

There is a theory among microbiologists -- not much more than that, but a theory nonetheless -- that in order for a lethal disease to proliferate, it must reduce its lethality in order to spread more easily. We have discussed this time and again regarding the case fatality rate for H5N1. We have discussed this on this Blogsite. Could there be some kind of counterbalance in Nature, a biological "haggling session" that allows diseases to become more widespread in exchange for a reduction in lethality?

If these forces are at work in Uganda today, they may have produced a mutation that is less deadly yet much more easily transmitted. With the apparently easy transfer of what I will christen Ebola Uganda to health care workers, enough to cause a stampede out of the affected region, we should be very concerned.

Easy transfer? Since the outbreak was discovered in September, health care officials originally suspected Marburg virus, a hemorrhagic cousin of Ebola, they would have used protocols similar to those of Ebola. They are or should not be surprised by the diagnosis of Ebola, since much of sub-Saharan Africa has seen outbreaks over the years. 

So what would cause them to flee in panic?  How about Ebola that defies protocols and may actually be airborne or transmitted by asymptomatic human carriers?

I found a nifty, short description of the four previously known strains of Ebola from the Website of one Bret Russell (http://www.brettrussell.com/personal/what_strains_exist_.html 

• Ebola Zaire - The virus discovered in Zaire in 1976 - the first known occurrence of the Ebola Virus.
   
• Ebola Sudan - Initially discovered in western Sudan in 1976. This type of Ebola virus resurfaced again in 1979 in Sudan.
   
• Ebola Reston - This is the variation of the Ebola virus discovered in the African monkeys imported to the United States. This particular type is not believed to cause health problems in Humans.
   
• Ebola Tai - This is the most recently discovered type of the Ebola virus. Discovered in 1995 on the Ivory Coast of West Africa, in the Tai Forest. A Swiss researcher was the first infected human, but survived the infection.

Ebolas Zaire, Sudan, and Tai cause illness in humans as well as primates (monkeys). Ebola Reston does not cause illness in humans, but does cause illness in monkeys. Ebola Reston is suspected to be airborne (transmitted by the air) where the other strains are not transmitted by air. As for their structure, they are all quite similar in (string-like) shape, but have different gene sequences in places, and therefore different properties.

Note that Ebola Reston is named after the city of Reston, Virginia -- site of the book "The Hot Zone."  Its origin appears to be from the Philippines, since that is where the imported infected monkeys came from.

While trolling the Internet on the subject of potential airborne transmission of Ebola, I found an interesting article from a biology student at Bryn Mawr University Jennifer L. Wilson. Ms. Wilson writes:    

Secondly, one must consider epidemiological factors. For a major epidemic of the virus, conditions include: " Presence of the animal or insect vectors, whatever they may be, in proximity to a human population; 1) exposure of even a single infected human to others, by traveling from a remote setting, to a population center after exposure to a vector and/or reservoir in that remote setting; 2) deficient sanitation and hygiene among the population (lack of clean water supplies, sewage disposal & treatment, etc.) which increases the chance of bodily fluid contact (e.g., contact with fresh sewage containing wastes from Ebola victims); 3) decreased immune response in members of the population, whether from malnutrition or other disease burdens, especially AIDS; 4) social customs which increase bodily fluid contact between people (e.g., burial customs, multiple-partner sex); 5) inadequate public health infrastructure (hospitals, staff, equipment - e.g., enough syringes to prevent their re-use, isolation facilities, barrier supplies); 6) lack of awareness of the disease and its symptoms among the population; 7) access to transportation systems; 8) poor communications infrastructure, resulting in delays in medical response and public notification & education; 9) the mutation of Ebola so that a strain that is dangerous to humans becomes airborne." (12) While the last condition is currently not an issue, it is also the most grave of the conditions, and would allow an epidemic of the Ebola virus to reoccur in vast proportions. Furthermore, it may be assumed that airborne transmission is the best possible trait for the virus, as a mutation of this degree would ensure its continued evolution and progression.

Many Ebola researchers believe that apes are simply a short-term vector of the disease, and that the ultimate host is unknown but could be something along the lines of a tick or other small, pesky insect.  Otherwise, they postulate, how could Ebola ever continue to exist?  If apes die from Ebola (and certain African gorillas are now in danger of extinction because of Ebola), then how could they possibly be the long-term host?

So, while trolling the Net, you can imagine my surprise as I came across a Website dedicated to the Bible Code.  I am fascinated by such attempts to prove prophecy, so I throw this in just to entertain and enlighten.  Anyway, a gentleman found this passage at the intersection of a few Hebrew letters:

It may indicate a major Ebola epidemic in year 2007-2010.... The next two matrices are from a -300,000 to 300,000 Old Testament search for ARTHROPOD and EBOLA, since Arthropods are the family of animal life that includes ticks, mites, spiders, and insects, which are possible Ebola vectors. So we will try to see if an Arthropod is the Ebola vector host.

God, I love this stuff. The Website is located at: http://www.angelfire.com/zine2/Number666/KingJames10.html

Turning back to science, I found a 2003 Powerpoint from one Risha Patel, hosted by the University of Southern California (Go Trojans!).  Patel's presentation also mentions possible permanent reservoirs of Ebola, including bats, plants, arthropods.  Patel further writes that the "Wide range of potential reservoirs makes identification more difficult." Further trolling confirms the potential for insects and bats to transmit Ebola and Marburg. And just this past August, researchers at the Centers for Disease Control and Prevention (CDC), Atlanta, GA, and the Centre International de Recherches Médicales de Franceville (CIRMF) and the Institut de Recherche pour le Développement, Franceville, Gabon, confirmed the presence of Marburg in African fruit bats, so one vector has now been proven. 

Patel's presentation can be viewed at: bioweb.usc.edu/courses/2003-spring/documents/bisc419-r.patel.ppt .

Question of the Millennium: If Reston Ebola can be considered airborne, even though it only impacts apes, could a new, previously undetected strain of Ebola "go airborne and become a flyer?" 

Stranger things have happened.

Giving the "other side" an opportunity to weigh in, I deliver the rebuttal: An article from Probe, the Columbia University journal. Titled "Airborne Ebola? A theory that won't fly," the article's author, David R. Zimmerman, is an adjunct professor at the Columbia Graduate School of Journalism and is the editor of Probe, a newsletter of science and media criticism.  He writes:

Popular culture has a recurrent fascination with doomsday pathogens. Michael Crichton's The Andromeda Strain was a classic incarnation of this scary scenario.... In Richard Preston's book The Hot Zone and the film "Outbreak," we're frightened by real viruses, specifically Ebola.... The ostensibly responsible media are not immune to the temptation to stir these fears. In a May 12 editorial, the New York Times declared: "A modest genetic change might enable Ebola to spread rapidly through the air..."

That very same day, in the news section, Times reporter Lawrence K. Altman, M.D., handled the matter more soberly. Reporting from the Centers for Disease Control and Prevention in Atlanta, he wrote, "The deadly Ebola virus continues to spread in Zaire, chiefly affecting health care workers... [It] apparently spread initially among [doctors] and nurses who operated on a patient in Kikwit." Dr. Altman, an infectious-disease specialist who once worked at the CDC, added, "Transmission presumably was through contaminated blood..."

Can a bloodborne or body fluid-borne virus be transformed by a single mutation into an airborne agent (a "flyer"), as the scare scenarios imply? It's conceivable. But it's "probably unlikely," according to virologist Beth Levine, M.D. , director of virology research in the infectious diseases division at Columbia University's College of Physicians and Surgeons. "Single amino acid mutations can change the tropism [the residential preference] of a virus" in some experimental situations, Dr. Levine says, "but there haven't been any examples of such mutations actually occurring in nature, changing a virus from a bloodborne or bodily fluid route of transmission to a respiratory route."

So, says Dr. Levine, "The media's claim is not totally without scientific basis. But there are no precedents for it, and it's unlikely.

"I think it's irresponsible to raise that concern," she added, "because in general viruses are very well-adapted to their milieu­­and they don't just suddenly change their environment." Will this kind of level-headed assessment quell media hysteria? Stay tuned.

Indeed, stay tuned. 

Finally, from Florida1, the founder and president of FluTrackers:  A Lancet journal article from 2000, presenting very persuasive evidence that there are human asymptomatic carriers of Ebola.  There are people who apparently are immune from the effects of the worst disease you can think of. 

The Lancet 2000; 355:2210-2215
DOI:10.1016/S0140-6736(00)02405-3

Human asymptomatic Ebola infection and strong inflammatory responseDr EM Leroy DVM a , S Baize PhD a, VE Volchkov PhD b, SP Fisher-Hoch MD c, M-C Georges-Courbot MD a, J Lansoud-Soukate PhD a, M Capron PhD d, P Debré MD e, JB McCormick and AJ Georges MD a

SummaryBackground

Ebola virus is one of the most virulent pathogens, killing a very high proportion of patients within 5–7 days. Two outbreaks of fulminating haemorrhagic fever occurred in northern Gabon in 1996, with a 70% case-fatality rate. During both outbreaks we identified some individuals in direct contact with sick patients who never developed symptoms. We aimed to determine whether these individuals were indeed infected with Ebola virus, and how they maintained asymptomatic status.
MethodsBlood was collected from 24 close contacts of symptomatic patients. These asymptomatic individuals were sampled 2, 3, or 4 times during a 1-month period after the first exposure to symptomatic patients. Serum samples were analysed for the presence of Ebola antigens, virus-specific IgM and IgG (by ELISA and western blot), and different cytokines and chemokines. RNA was extracted from peripheral blood mononuclear cells, and reverse-transcriptase-PCR assays were done to amplify RNA of Ebola virus. PCR products were then sequenced.

Findings
11 of 24 asymptomatic individuals developed both IgM and IgG responses to Ebola antigens, indicating viral infection. Western-blot analysis showed that IgG responses were directed to nucleoprotein and viral protein of 40 kDa. The glycoprotein and viral protein of 24 kDa genes showed no nucleotide differences between symptomatic and asymptomatic individuals. Asymptomatic individuals had a strong inflammatory response characterised by high circulating concentrations of cytokines and chemokines.

Interpretation
This study showed that asymptomatic, replicative Ebola infection can and does occur in human beings. The lack of genetic differences between symptomatic and asymptomatic individuals suggest that asymptomatic Ebola infection did not result from viral mutations.

Elucidation of the factors related to the genesis of the strong inflammatory response occurring early during the infectious process in these asymptomatic individuals could increase our understanding of the disease. (bold Sharon's).

Airborne?  Or asymptomatic?  Whatever the situation, or the cause, the situation is rapidly devolving in Uganda.  Now MSF, home to Ebola worker Zoe Young, has been called in.  We will see what transpires.