The 1995 Kikwit Ebola outbreak: lessons hospitals and physicians can apply to future viral epidemics.
OBJECTIVE
This article looks at lessons learned from the 1995 Kikwit Ebola outbreak and suggests how modern hospitals should apply these lessons to the next lethal viral epidemic that occurs.


METHODS
The 1995 Kikwit Ebola outbreak in the Democratic Republic of the Congo (formally Zaire) is one of the most well studied epidemics to have occurred to date. Many of the lessons learned from identifying, containing and treating that epidemic are applicable to future viral outbreaks, natural disasters and bioterrorist attacks. This is due to Ebola's highly contagious nature and high mortality rate.


RESULTS
When an outbreak occurs, it often produces fear in the community and causes the basic practice of medicine to be altered. Changes seen at Kikwit included limited physical examinations, hesitance to give intravenous medications and closure of supporting hospital facilities. The Kikwit Ebola outbreak also provided beneficial psychological insight into how patients, staff and the general community respond to a biological crisis and how this will affect physicians working in an epidemic.


CONCLUSIONS
General lessons from the outbreak include the importance of having simple, well-defined triage procedures; staff who are flexible and able to adapt to situations with unknowns; and the need to protect staff physically and emotionally to ensure a sustained effort to provide care.
Hall
Ryan C W
RC
Case Western Reserve University, Cleveland, OH 44106, USA. rcwh@att.net
Hall
Richard C W
RC
Chapman
Marcia J
MJ
D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo; D003906:Developing Countries; D004196:Disease Outbreaks / Q000517:prevention & control; D005239:Fear / Q000523:psychology; D006271:Health Facility Closure / Q000706:statistics & numerical data; D019142:Hemorrhagic Fever, Ebola / Q000401:mortality / Q000517:prevention & control / Q000523:psychology* / Q000635:transmission; D006760:Hospitalization; D006801:Humans; D055809:Illness Behavior; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control / Q000706:statistics & numerical data; D009723:Nurse-Patient Relations; D010356:Patient Isolation / Q000523:psychology; D010819:Physician's Role / Q000523:psychology*; D010817:Physician-Patient Relations; D016079:Refusal to Treat / Q000706:statistics & numerical data; D012066:Relief Work / Q000458:organization & administration; D013317:Strikes, Employee / Q000706:statistics & numerical data; D014218:Triage / Q000458:organization & administration
CMAJ. 2003 May 13;168(10):1245-51
12743065
Wkly Epidemiol Rec. 2003 Jun 27;78(26):223-8
15571171
J Infect Dis. 1999 Feb;179 Suppl 1:S1-7
9988155
Nursing. 2006 Apr;36(4):44-7
16582746
JAMA. 2003 Jul 16;290(3):317-9
12865357
Wkly Epidemiol Rec. 2004 Dec 3;79(49):435-9
15638356
Trop Med Int Health. 1998 Nov;3(11):883-5
9855400
J Infect Dis. 1999 Feb;179 Suppl 1:S259-62
9988192
CMAJ. 2004 Mar 2;170(5):811-2
14993176
Antiviral Res. 2003 Jan;57(1-2):53-60
12615303
CMAJ. 2004 Mar 2;170(5):793-8
14993174
J Adv Nurs. 2002 Jan;37(2):173-81
11851785
Vaccine. 2007 Mar 1;25(11):1923-34
17241710
Psychosom Med. 2004 Nov-Dec;66(6):938-42
15564361
Med Care. 2005 Jul;43(7):676-82
15970782
Psychol Med. 2004 Oct;34(7):1197-204
15697046
J Infect Dis. 1999 Feb;179 Suppl 1:S87-91
9988169
J Infect Dis. 1999 Feb;179 Suppl 1:S268-73
9988194
Clin Infect Dis. 2006 Jun 1;42(11):1521-6
16652308
J Clin Psychiatry. 2004 Aug;65(8):1120-7
15323599
J Infect Dis. 1999 Feb;179 Suppl 1:S98-101
9988171
Philos Trans R Soc Lond B Biol Sci. 2004 Jul 29;359(1447):1117-25
15306398
Nat Med. 2004 Dec;10(12 Suppl):S110-21
15577929
J Infect Dis. 1999 Feb;179 Suppl 1:S283-6
9988197
J Infect Dis. 1999 Feb;179 Suppl 1:ix-xvi
9988154
Occup Environ Med. 2005 Jul;62(7):473-7
15961624
J Infect Dis. 1999 Feb;179 Suppl 1:S263-7
9988193
Euro Surveill. 2004 Dec 15;9(12):E11-2
15677844
Eur J Emerg Med. 2005 Feb;12(1):13-8
15674079
Euro Surveill. 2002 Mar;7(3):31-2
12631941
J Infect Dis. 1999 Feb;179 Suppl 1:S92-7
9988170
Acad Emerg Med. 2005 Apr;12(4):322-8
15805323
Am J Disaster Med. 2007 Sep-Oct;2(5):270-6
18491842
J Infect Dis. 1999 Feb;179 Suppl 1:S18-23
9988160
Gen Hosp Psychiatry. 2005 Sep-Oct;27(5):352-8
16168796
J Transcult Nurs. 2005 Oct;16(4):289-97
16160191
J Infect Dis. 1999 Feb;179 Suppl 1:S155-63
9988179
Hong Kong Med J. 2004 Oct;10(5):325-30
15479961
Can J Nurs Res. 2006 Jun;38(2):42-54
16871849