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N Engl J Med. 2014 Nov 27;371(22):2083-91. doi: 10.1056/NEJMoa1411099. Epub 2014 Oct 15.

Ebola virus disease in the Democratic Republic of Congo.

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From the Centre International de Recherches Médicales de Franceville, World Health Organization (WHO) Collaborating Center, Franceville, Gabon (G.D.M., N.B., I.L., E.M.L.); Ministry of Health (B.K.I., F.K.), Institut National de Recherche Biomédicale (J.K., P.M.K., J.-J.T.M.), and the WHO (V.M., J.C.), Kinshasa, Democratic Republic of Congo; Centre National de la Recherche Scientifique, Unité Epidémiologie et Physiopathologie des Virus Oncogènes (CNRS UMR3569) (N.B.), Eco-anthropologie et Ethnobiologie, UMR 7206 CNRS-MNHN (A.E.), and Institut Pasteur, Unité de Recherche et d'Expertise Environnement et Risques Infectieux, Cellule d'Intervention Biologique d'Urgence (J.-C.M.), Paris, and Institut de Recherche pour le Développement, Unité Maladies Infectieuses et Vecteurs Ecologie, Genetique, Evolution et Controle IRD 224-CNRS 5290-UM1-UM2, Montpellier (E.M.L.) - all in France; Public Health Agency of Canada, Winnipeg (G.K.); and the WHO, Geneva (E.B., S.B., P.F., L.G.-A., J.-M.O.-B., C.D.).



The seventh reported outbreak of Ebola virus disease (EVD) in the equatorial African country of the Democratic Republic of Congo (DRC) began on July 26, 2014, as another large EVD epidemic continued to spread in West Africa. Simultaneous reports of EVD in equatorial and West Africa raised the question of whether the two outbreaks were linked.


We obtained data from patients in the DRC, using the standard World Health Organization clinical-investigation form for viral hemorrhagic fevers. Patients were classified as having suspected, probable, or confirmed EVD or a non-EVD illness. Blood samples were obtained for polymerase-chain-reaction-based diagnosis, viral isolation, sequencing, and phylogenetic analysis.


The outbreak began in Inkanamongo village in the vicinity of Boende town in Équateur province and has been confined to that province. A total of 69 suspected, probable, or confirmed cases were reported between July 26 and October 7, 2014, including 8 cases among health care workers, with 49 deaths. As of October 7, there have been approximately six generations of cases of EVD since the outbreak began. The reported weekly case incidence peaked in the weeks of August 17 and 24 and has since fallen sharply. Genome sequencing revealed Ebola virus (EBOV, Zaire species) as the cause of this outbreak. A coding-complete genome sequence of EBOV that was isolated during this outbreak showed 99.2% identity with the most closely related variant from the 1995 outbreak in Kikwit in the DRC and 96.8% identity to EBOV variants that are currently circulating in West Africa.


The current EVD outbreak in the DRC has clinical and epidemiologic characteristics that are similar to those of previous EVD outbreaks in equatorial Africa. The causal agent is a local EBOV variant, and this outbreak has a zoonotic origin different from that in the 2014 epidemic in West Africa. (Funded by the Centre International de Recherches Médicales de Franceville and others.).

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