World Health Organization. In humans, the disease is spread through contact with infected bodily fluids leading to haemorrhagic fever (World Health Organization [WHO], 2015). Has data issue: false 2 0 obj It . By clicking "Allow All" you agree to the storing of cookies on your device to enhance site navigation, Hostname: page-component-75b8448494-spc8s General introduction into the Ebola virus biology and disease. In: Knipe DM, Howley PM, editors. [24]Report of an International Commission. 18 March 2020. https://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03535.x/full Disease outbreak news. https://www.who.int/emergencies/situations/Ebola-2019-drc-. As a transmittable disease, progression of the virus had been thought to be linked to higher probabilities of transmission, and therefore safety of persons in contact with infected patients was in question (Yamin et al., 2015). Neagu M, Calina D, Docea AO, Constantin C, Filippini T, Vinceti M, Drakoulis N, Poulas K, Nikolouzakis TK, Spandidos DA, Tsatsakis A. J Cell Mol Med. , The WHO declares an outbreak is over when no confirmed or probable cases are detected for a period of 42 days (i.e., twice the maximum incubation period) since the last potential exposure to the last case occurred; however, WHO recommends heightened surveillance and response activities during the 42-day period and for at least 6 months after. 2020 Feb 20;6(1):13. doi: 10.1038/s41572-020-0147-3. The most recent outbreak of 2014 has set the alarm bell ringing across the globe for increased focus, funding, research, and development toward the control and management of this emerging viral communicable disease that has a potential pandemic threat. About three hundred people in each of the two nations were infected with the virus, resulting in a mortality rate of 88% in Zaire, and 53% in Sudan (Bulletin of the WHO 1978). How soon after exposure do symptoms appear? Ebola haemorrhagic fever in Zaire, 1976. Updates to the zoonotic niche map of Ebola virus disease in Africa. A directory of local health departments is located at, Visit the VDH website that contains information on Ebola virus disease at, Visit the Centers for Disease Control and Prevention website at. Supportive care and management of complications are mainstays of treatment. 2021 May;25(10):4523-4533. doi: 10.1111/jcmm.16462. In class we got a chance to discuss Ebola in the US and in Africa. What is the treatment for Ebola virus disease? % It most commonly affects people and nonhuman primates, such as monkeys, chimpanzees, and gorillas. Eastaugh, Lin S. Feb 2021 [internet publication]. Smither, Sophie J. For any urgent enquiries please contact our customer services team who are ready to help with any problems. [33]World Health Organization. * A suspected case (evaluated by a clinician) or person who died from suspected EVD and had an epidemiological link to a confirmed case (but was not tested and did not have laboratory confirmation of the disease) becomes PROBABLE. Although the latter species was also a suspected cause of a deadly outbreak in pigs in the People's Republic of China and the Philippines, experiments have shown that it does not cause disease in porcine populations. Philadelphia: Lippincott Williams & Wilkins; 2006. pp. Ebola - Democratic Republic of the Congo. },}2}yb Ebola health update:north Kivu/Ituri, DRC, 2018-2020. Ebola in Freetown area, Sierra Leone - a case study of 581 patients. Elife. Ebola virus disease fact sheet. doi: 10.1371/journal.pone.0179356. Those vertices are "agent," "host," and "environment." Care of people with Ebola is difficult and varied due to the highly infectious and often fatal nature of the disease. National Library of Medicine Treatment for EVD also consists of supportive care and relief of symptoms. "useRatesEcommerce": false xna%b83EtbQ,@.%dWg8Ci%aI$\7_wo>|r)oo7xy!RH"dsy{q&|/~h'n31;@.>aP19z2"rphVh0lGmY3/KlH1ZC0L^[`|C4ryDpX{exve&X$o+@Plp{An22P03R_2kP#PO-r7_Dn~+ZV0YVVv~U~i[eQxyn; -DBF)%9"v! https://www.cdc.gov/amd/stories/ebola.html. Originally, Ebola had never touched the United States until September of 2014. Metrovi, Tomislav. https://www.who.int/publications/m/item/who-recommended-criteria-for-declaring-the-end-of-the-ebola-virus-disease-outbreak, UK Health Security Agency: ebola and Marburg haemorrhagic fevers - outbreaks and case locations Wash hands often with soap and water or an alcohol-based hand sanitizer. https://www.who.int/emergencies/disease-outbreak-news/item/2021-DON325, 2020: the eleventh outbreak in the DRC started on June 1, 2020 in the quateur province and was declared over on November 18, 2020, with a total of 130 cases and 55 deaths (case fatality rate 42%). https://www.who.int/emergencies/disease-outbreak-news/item/2021-DON328, 2021: the twelfth outbreak in the DRC started on February 7, 2021 in the North Kivu province and was declared over on May 3, 2021, with a total of 12 cases and 6 deaths (case fatality rate 50%). The lack of IPC training lead to health care workers being 100 times more likely than the general population to contract Ebola (Ratnayake et al. Ebola virus disease Guinea. Infect Dis Poverty. This infection sparks a chain of events that can quickly transform a small illness into an epidemic. There are four different strains of the Ebola virus that cause disease in people: Ebola virus (Zaire ebolavirus); Sudan virus (Sudan ebolavirus); Ta Forest virus (Ta Forest ebolavirus, formerly Cte dIvoire ebolavirus); and Bundibugyo virus (Bundibugyo ebolavirus). 1. Bookshelf Still, pigs can act as an amplifying host, thus potential transmission routes need to be further addressed. 2019 Sep 29;6(1):435-458. doi: 10.1146/annurev-virology-092818-015708. endobj * A probable or suspected case becomes CONFIRMED when a sample from that person tests positive for EVD in laboratory. https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease, 2014-2016: the worlds largest outbreak started in the DRC in 2014 and finished in 2016, with over 28,000 cases and 11,000 deaths (case fatality rate 46%). Keywords: burial practices, communicable disease, emerging disease, environment, epidemiology, infection, public health, risk exposure, surveillance, transmission, Suggested Citation: Epidemiological Triangle The agent factors of the disease include five genus viruses, Zaire Ebola virus, Bundibugyo Ebola virus, Sudan Ebola virus, Reston Ebola virus, and Tai Forest Ebola virus (Kaur, Sachdeva, Jha, & Sulania, 2017). https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease. 1, 2 Due to its epidemiological presentation pattern, impact on public health, resources necessary for its management and control, as well as the need for a The presence of the Zaire ebolavirus in naturally infected fruit bats was first documented when viral RNA and antibodies were detected in three different bat species of the Pteropodidae family: Hypsignathus monstrosus, Epomops franqueti, and Myonycteris torquata. official website and that any information you provide is encrypted Over 19,000 cases were reported by December 2014 and of those, 7,518 lost their lives. doi: 10.7554/eLife.16412. Fill out the Epidemiological Triangle for the current Ebola outbreak. If EVD is suspected based on the persons symptoms and exposure to Ebola virus, such as having close contact with an Ebola-infected person, he or she should be isolated (separated from other people) immediately and the local health department should be notified. sharing sensitive information, make sure youre on a federal Opens in new window, Use of this content is subject to our disclaimer. Dec 2021 [internet publication]. Ebola Virus Disease (EVD) is the international health emergency paradigm due to its epidemiological presentation pattern, impact on public health, resources necessary for its control, and need for a national and international response. It is transmitted by means of contact with infected blood, mucous membranes, semen and other secretions, therefore being skin lesions and sexual contact significant ways of transmission (Boulton, 2014). ), Marburg and Ebola virus infections in laboratory non-human primates: a literature review, Ebola: The Natural and Human History of a Deadly Virus, Ebola virus disease in southern Sudan: hospital dissemination and intrafamilial spread, Isolation and partial characterization of a new strain of Ebola virus, Ebola hemorrhagic fever: Tandala, Zaire, 1977-1978, The reemergence of Ebola hemorrhagic fever, Democratic Republic of the Congo, 1995, Emergence of divergent Zaire Ebola virus strains in Democratic Republic of the Congo in 2007 and 2008, Ebola Virus Disease in the Democratic Republic of Congo, Ebola hemorrhagic fever outbreaks in Gabon, 1994-1997: epidemiologic and health control issues, Outbreak(s) of Ebola hemorrhagic fever, Congo and Gabon, October 2001-July, US Centers for Disease Control and Prevention, Outbreak of Ebola Hemorrhagic Fever - Uganda, August 2000-January 2001, Outbreak of Ebola hemorrhagic fever, Uganda, August 2000-January 2001, Filovirus outbreak detection and surveillance: lessons from Bundibugyo, Reemerging Sudan Ebola Virus Disease in Uganda, 2011, Managing Ebola from rural to urban slum settings: experiences from Uganda. Outbreaks of EVD have occurred in those areas. HHS Vulnerability Disclosure, Help Here we review key epidemiological data from past Ebola outbreaks and carry out a comparative . <>>> Fortunately, a pharmaceutical company. The ebola virus took the world by storm after it was carried to the United States and spread by people who had visited West Africa. Such an idea was supported by experimental studies in African plants and animals that resulted in the transmission of the Zaire Ebola virus to African fruit and insectivorous bats, although a conclusive link could not be established. Ebola virus disease in West Africa: the first 9 months of the epidemic and forward projections. Abstract Ebola virus disease (EVD) is one of the most virulent pathogens among viral hemorrhagic fevers affecting economically deprived countries of the world with reported case fatality rates of up to 90% due to multi-organ failure and severe bleeding complications. Click on the Sign button and create an e-signature. https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON398. Polish Academy of Sciences & Jagiellonian University Medical College. https://www.who.int/emergencies/disease-outbreak-news/item/2021-DON351. Suggested Citation, Maidan Garhischool of social sciencesNew Delhi, 110068India, Subscribe to this fee journal for more curated articles on this topic, International Institutions: Transnational Networks eJournal, Political Economy - Development: Health eJournal, We use cookies to help provide and enhance our service and tailor content. Epub 2022 Apr 6. Nobody had any. https://www.who.int/emergencies/situations/Ebola-2019-drc-, 2018: small outbreak in the DRC with 54 cases and 33 deaths (case fatality rate 61%).[2]World Health Organization. When healthcare workers became infected colleges became frightened further reducing community trust in the healthcare system. %PDF-1.5 Mar 2019 [internet publication]. Bookshelf Potluri R, Kumar A, Oriol-Mathieu V, Van Effelterre T, Metz L, Bhandari H. BMC Infect Dis. Ladak, Reese Jalal CDC Emergency Operations Center activated, CDC deployments surge. Ebola was first recognized in 1976 as the cause of outbreaks of disease in the Democratic Republic of the Congo (then known as Zaire) and in Sudan. News-Medical.Net provides this medical information service in accordance The West Africa Ebola virus (species Zaire ebolavirus) outbreak is the largest in history with sustained transmission in multiple countries.Guinea, Sierra Leone, and Liberia have been the most heavily affected. Aug 2022 [internet publication]. Nat Rev Dis Primers. https://www.nejm.org/doi/full/10.1056/NEJMc1413685 Although observed modes of transmission mainly include direct contact and contaminated staff, high case fatality ratio and frequent contacts among individuals in developed countries are among determinants which may lead to the development of the EVD outbreak. Ebola virus disease (EVD) is one of the most virulent pathogens among viral hemorrhagic fevers affecting economically deprived countries of the world with reported case fatality rates of up to 90% due to multiorgan failure and severe bleeding complications. Ebola Virus Disease: Rapid Diagnosis and Timely Case Reporting are Critical to the Early Response for Outbreak Control. Most human infections during outbreaks usually occur by direct contact with infected patients or cadavers. Ansumana R, Jacobsen KH, Idris M, et al. 2021. between patient and physician/doctor and the medical advice they may provide. Ebola disease caused by Sudan ebolavirus Uganda. More info. In 2014, a total of 20, 206 cases and 7,905 deaths were reported to have occurred in up to eight countries worldwide. Various objects (for example needles and syringes) contaminated with infected bodily fluids represent a threat as well; therefore, they should be properly sterilized. Symptoms of EVD include fever, severe headache, muscle or joint pain, weakness, fatigue, sore throat, loss of appetite, diarrhea, vomiting, abdominal (stomach) pain, and, in some cases, unexplained hemorrhage (bleeding or bruising). Disclaimer. Emerg Infect Dis. Avoid contact with bats and nonhuman primates or blood, fluids and raw meat prepared from these animals (bushmeat) or meat from an unknown source. Ebola virus disease Guinea. Arwady MA, Bawo L, Hunter JC, Massaquoi M, Matanock A, Dahn B, Ayscue P, Nyenswah T, Forrester JD, Hensley LE, Monroe B, Schoepp RJ, Chen TH, Schaecher KE, George T, Rouse E, Schafer IJ, Pillai SK, De Cock KM. 2022. 7t-P?xBwP%|byhU3F{7Ou6 `yl9]#| %P=mYRKQ>SZU,?z66.G\hT@w}vt*P -9AcJ"guP". 6TU*tV[Nw ~MqO\ !x0[".1@CIkeRq&g85Htl@(_%F 1$`(:6R.||w,(Q_N\`pn/ n (CGCM]/NT`Z`Dl''#m@J?IdC!Gk,2R@:IEgs1:bT S-4IkmYi)k4Ng4q>@MaQ$ CHAPTER 2 - Retrospective studies conducted by WHO staff and Guinean health officials identified the index case . The Ebola-Zaire subtype is the most lethal variant. In this study, the new epidemiological features and prevalence trends for EVD in Guinea, Liberia, and Sierra Leone are described. Nov 2020[internet publication]. Ebola Virus Disease (EVD) is a serious, often fatal disease caused by the Ebolavirus, a virus of the Filoviridae family, capable of infecting multiple species of primates, including humans. [6]Roddy P, Howard N, Van Kerkhove MD, et al. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052986 The Epidemiologic Triangle is a model that scientists have developed for studying health problems. 2011 Jul;17(7):964-76. https://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03535.x/full, http://www.ncbi.nlm.nih.gov/pubmed/21722250?tool=bestpractice.com. The number cases for this current year so far is 9,936; 4,877 have been killed by this disease. This sickness can be treatable, early care is very important with rehydration, symptomatic treatment can improve survival rates. Contact Tracing: Barriers and Facilitators. 8600 Rockville Pike FOIA and transmitted securely. The virus first transmitted to humans from wild animals and spread even more to the human race by close contact. Ebola virus disease fact sheet. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052986, http://www.ncbi.nlm.nih.gov/pubmed/23285243?tool=bestpractice.com. "Ebola Virus Epidemiology". Bull World Health Organ. Jun 2021 [internet publication]. Could Ebola virus be used for bioterrorism? Retrospective observational study of 38 outbreaks of Ebola disease occurred from 1976 through 2019, excluding laboratory accidents. 2022: the fourteenth outbreak in the DRC started on April 23, 2022 in the quateur province and was declared over on July 4, 2022, with a total of 5 cases and 5 deaths (case fatality rate 100%). Spread to Nigeria and Senegal, CDC teams . January 2023 [internet publication]. 2022 Dec;11(1):1635-1646. doi: 10.1080/22221751.2022.2086072. This is the first FDA-approved vaccine for Ebola virus disease caused by one strain of the Ebola virus (species Zaire ebolavirus). Characteristic burial ceremonies where mourners have direct contact with the body of the deceased can also represent an important path of transmission. With additional efforts and protocols instituted by organizations such as the Center for Disease Control and Prevention, the virus began to fall until the present day. Ebola virus disease (EVD) is one of the most virulent pathogens among viral hemorrhagic fevers affecting economically deprived countries of the world with reported case fatality rates of up to 90% due to multi-organ failure and severe bleeding complications. Many of these symptoms are also present with other more common diseases, such as malaria and typhoid fever. [37]World Health Organization. Unable to load your collection due to an error, Unable to load your delegates due to an error. Mar 2020 [internet publication]. Symptoms of EVD include fever, severe headache, muscle or joint pain, weakness, fatigue, sore throat, loss of appetite, diarrhea, vomiting, abdominal (stomach) pain, and, in some cases, unexplained hemorrhage (bleeding or bruising). The best way to understand the epidemiologic triangle is to see how epidemiologists use it to explain the spread of existing diseases. Be sure the info you fill in Epidemiologic Triangle For Ebola is updated and correct. PLoS One. Aug 2022 [internet publication]. jR06%oX^qTOHYs"F$+QI$G&Eem]Km^a*S3sFcz_ 1&. 1). Spread of the potential health crisis known as Ebola can be decelerated by understanding it, learning how to treat it, and quarantining. Bethesda, MD 20894, Web Policies These particular monoclonal antibodies bind to part of the Ebola viruss surface to prevent the virus from entering a persons cells. Owned and operated by AZoNetwork, 2000-2023. MeSH Once in humans, Ebola can spread efficiently in the community through human-to-human transmission. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> https://www.news-medical.net/health/Ebola-Virus-Epidemiology.aspx. World Health Organization. Origins of the 2014 Ebola epidemic. Epub 2021 Mar 18. The complex and unprecedented Ebola epidemic ongoing in West Africa has highlighted the need to review the epidemiological characteristics of Ebola Virus Disease (EVD) as well as our current understanding of the transmission dynamics and the effect of control interventions against Ebola transmission. Accessibility Back to basics in COVID-19: Antigens and antibodies-Completing the puzzle. The Epidemiological Presentation Pattern of Ebola Virus Unit for Research in Emergency and Disaster, Faculty of Medicine, University of Oviedo, Oviedo, Spain, Centre for Research on Health Care in Disasters, Karolinska Institutet, Stockholm, Sweden, https://doi.org/10.1017/S1049023X20000333, Get access to the full version of this content by using one of the access options below. Image Credit: Valeniker / Shutterstock.com. He enjoys contributing back to the community. The first presumed fatality was in Guinea in December 2013 [], and the first cases in Sierra Leone were detected in May 2014 [].Initial transmissions in Sierra Leone were concentrated . The objective of this work is to study the evolution and progression of the epidemiological presentation profile of Ebola disease outbreaks since its discovery in 1976 to the present, and to explore the possible reasons for this evolution from different perspectives. How can Ebola virus disease be prevented? The most common species of Ebola virus responsible for outbreaks is the Zaire ebolavirus, the second most common species being the Sudan ebolavirus. Feature Flags: { <> This means that health care workers should be encouraged to document and report those they think have been exposed and their contacts. WHO recommended criteria for declaring the end of the Ebola virusdisease. Populations at risk have increased (P = .024) and the geographical extent of Ebola outbreaks has grown (P = .004). The triad consists of an external agent, a susceptible host, and an environment that brings the host and agent together. Render date: 2023-04-29T22:21:14.756Z Leroy EM, Gonzalez JP, Baize S. Ebola and Marburg haemorrhagic fever viruses: major scientific advances, but a relatively minor public health threat for Africa. Flight 822 was where it all began. In 2014 the United States was hit with a force far more deadly and dangerous than many threats received. https://www.who.int/emergencies/disease-outbreak-news/item/2021-DON328. on this website is designed to support, not to replace the relationship [4]Leroy EM, Gonzalez JP, Baize S. Ebola and Marburg haemorrhagic fever viruses: major scientific advances, but a relatively minor public health threat for Africa. N Engl J Med. Ebola virus disease (EVD) is an often deadly illness caused by the Ebola virus. If you have concerns about EVD, contact your healthcare provider. [35]World Health Organization. [26]Centers for Disease Control and Prevention. In this episode of omg OMx, Bruker's science-driven podcast, Kate Stumpo interviews Daniel Hornburg, the VP of Proteomics at Seer, as they discuss the innovative technologies in plasma proteomics. Ebola virus disease (EVD) is a deadly zoonotic disease caused by the Ebola virus. Ebola hemorrhagic fever is considered a classic zoonotic disease with the persistence of the Ebola virus in a reservoir species. Published online by Cambridge University Press: May 2021 [internet publication]. World Health Organization. People become infected with Ebola virus through contact with infected wild animals or contact with blood or body fluids (urine, feces, saliva, sweat, vomit, breast milk, and semen) of infected humans. Trop J Med Res 2017;20:1-9, Available at SSRN: If you need immediate assistance, call 877-SSRNHelp (877 777 6435) in the United States, or +1 212 448 2500 outside of the United States, 8:30AM to 6:00PM U.S. Eastern, Monday - Friday. There has been a change in the epidemiological profile of the Ebola outbreaks from 1976 through 2019 with an increase in the geographical extent of the outbreaks and the population at risk, as well as a significant decrease in the outbreaks case fatality rate. An increase in the frequency of EVD outbreaks across decades was There are several steps to take to prevent EVD when living in or traveling to an area with EVD: The FDA approved the Ebola vaccine rVSV-ZEBOV (called Ervebo) on December 19, 2019. It is important to note that the airborne transmission of Ebola has not been documented, which is comparable to how other respiratory viruses such as the severe acute respiratory coronavirus 2 (SARS-CoV-2) are spread. In 2014, an Ebola epidemic spread from Africa to other continents, becoming a pandemic. AFROs regional director, Dr. Luis Sambo, called for greater epidemiological aid and implementation of the IHRs alert system requirements. Jul 2022 [internet publication]. The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical. January 2023 [internet publication]. National Library of Medicine There is no FDA-authorized treatment for the three other strains of the Ebola virus that cause disease in people. Training for outbreak response through the Global Outbreak Alert and Response Network. 2022 Jul;112(7):1025-1033. doi: 10.2105/AJPH.2022.306842. However, bats are frequent residents in equatorial Africa, where they are even hunted for food. In Central Africa, for the last three years outbursts have been recognized every year, the most recent of which proceeded in the Republic of the Congo with the amount of victims more than 125, according to the World Health Organization (Ebola. Sanchez A, Geisbert TW, Feldmann H. Filoviridae: Marburg and Ebola viruses. The evolution of Ebola virus disease outbreaks. Ding, Yu You can read their DAILY Situation Summary. endobj CDC Issues Level 3 travel Warnings for West Africa. To learn more, visit Recent outbreaks of animal-borne emerging infectious diseases have likely been precipitated by a complex interplay of changing ecological, epidemiological and socio-economic factors. The emerging diagnostic technologies, rapid viral characterization, geospatial mapping of EVD transmission, and new treatments and vaccines are discussed. Your feedback has been submitted successfully. The epidemiology of human pathogenic filovirus is reviewed in this paper considering the most relevant facts. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a rare but severe, often fatal illness in humans. There have been advances in the detection and management capacity of outbreaks, and the notification time to the WHO has been reduced. 4 0 obj analyse site usage and support us in providing free open access scientific content. Since then, frequent outbreaks have occurred in Central and Western Africa. Mar 2020 [internet publication]. There was considerable difference in the ability of health care services to deal with infectious diseases due to scarcity in supplies and training. [36]World Health Organization. "7b8= n4k7yRRQM>)/@I3X^s+}p-0+f9Gzw3MP:I&hRtqik pulo8jy@fia\evQ r8Xd`wf3tGB}OxCu,t^&V1VM/a'x(=O&)%kRYe8hCgU9Dq}! Do ketogenic diets elevate low-density lipoprotein cholesterol levels? Unable to load your collection due to an error, Unable to load your delegates due to an error. Roddy P, Howard N, Van Kerkhove MD, et al. Ebola disease caused by Sudan ebolavirus Uganda. endobj It has also been responsible for smaller outbreaks in the DRC since then. https://www.nytimes.com/interactive/2014/07/31/world/africa/ebola-virus-outbreak-qa.html. Although the virus is not transmitted via food or water, and the proper cooking of foods should inactivate infectious particles, ingestion of contaminated food may represent a possible route of exposure in natural infections. Federal government websites often end in .gov or .mil. Am J Public Health. Still, successful isolation of the Marburg virus from the cave-dwelling species of the fruit bat Rousettus aegyptiacus lends support to the proposed idea of bats as a reservoir species for all filoviruses. As each country must strengthen its preparedness and response system to prevent eventual Ebola outbreaks in the future, adequate knowledge about the ecology and transmission of this disease is of the uttermost importance.
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