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We don’t know how the Ebola outbreak started. That’s a problem.

What Ebola and hantavirus reveal about determining the source of an outbreak — and why it matters

In just 10 days over the summer of 1854, 500 people died of cholera in the Soho neighborhood of London. The city’s population had more than doubled to 2.3 million people in the first half of the 1800s, and its sewage system could not keep up. But the streams of human waste flowing into the street and seeping into the water supply were considered unconnected to the cholera crisis. The prevailing theory of the day was that bad air — miasma — caused illness.

The English physician John Snow thought differently. Five years before the outbreak he had suggested that the diarrheal disease was actually caused by a waterborne infection rather than miasma. He soon had a chance to test his theory, mapping the location of cholera-related deaths in Soho. Snow realized that the victims used one specific water pump on Broad Street, and he persuaded city officials to remove the pump’s handle to prevent anyone else from using it. With the source eliminated, the outbreak, which had already passed its peak, ended in days.

Though it took years for Snow’s theory to achieve widespread acceptance, his approach is central to modern epidemiology. Investigating the source of outbreaks can prevent new cases, but it also gives us a better understanding of diseases and helps manage public fear. Even when infections have stopped, outbreak investigations are useful to develop strategies for preventing — and, failing that, responding to — future outbreaks.

Two recent outbreaks have demonstrated the necessity — and the challenges — of such investigations, almost two centuries after Snow’s pioneering work. The first was the hantavirus outbreak that dominated headlines last month. Then, on May 17, the World Health Organization (WHO) declared a public health emergency of international concern, the highest level of global health alert, in response to an outbreak of the deadly hemorrhagic disease Ebola in the Democratic Republic of the Congo (DRC), which, as of June 2, had killed 62 people, with 363 confirmed cases. It’s the 17th Ebola outbreak in the DRC and one of the largest on record. It has spread to neighboring Uganda, where, as of June 4, there are 16 confirmed cases, one confirmed death, and one probable case and likely death.

The first confirmed case, a healthcare worker in Bunia, DRC, died on April 24, but the outbreak may have been spreading undetected since as early as January. Investigators haven’t identified patient zero — the index case — and still don’t know how this outbreak began. Abdou Sebushishe, a doctor working with the International Medical Corps in Goma, DRC, told CBS News that up to 20 percent of current patients are themselves healthcare workers. He estimated that it may be more than six months before the outbreak could be controlled, given that the disease is outpacing the current response.

Part of the challenge is that the current outbreak is caused by the Bundibugyo strain of Ebola, which is relatively uncommon and has a genome about 30 percent different from the Ebola viruses that usually spark outbreaks. Testing for more common variants didn’t pick up the Bundibugyo virus right away, and ongoing conflict in the DRC contributed to the delay and continues to make contact tracing difficult. Unlike other strains, the Bundibugyo virus has no approved therapeutics or vaccines.

In the past, researchers have had some success identifying the index case of Ebola outbreaks.........

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