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Y lo bueno es bueno, y lo malo, malo. Mala, muy mala es una de las cuatro. Y Sarah es buena, muy buena y sufriente: hija de una bruja buena es, de todas, la que tiene poder innato, ya que su madre muri. Lirio fue, probablemente, una de las otras brujas del c. Con lo del bien y el mal, lo oscuro- feo- malo y lo claro- bonito- bueno, el tema pierde casi toda su fuerza, que podr.
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Ebola Virus Haemorrhagic Fever. THE EPIDEMIOLOGY OF EBOLA HAEMORRHAGIC FEVER IN ZAIRE, 1. J. G. VAN NIEUWENHOVE (5), J.
B. VAN DER GROEN (2), P. A. Center for Disease Control, Atlanta, Georgia, 3. USA. 2. Commissariat de la Sant. Institut Pasteur, Paris, France. South African Institute of Medical Research, Johannesburg, South Africa. INTRODUCTIONThe epidemiological investigations attempted to describe the outbreak of Ebola haemorrhagic fever (Eb. HF) by its distribution in time, in geography and amongst persons. Factors related to spread were also studied. These included possible modes of transmission, the incubation period, secondary attack rates and related risk factors. Serological surveys were undertaken to find evidence of prior Ebola virus disease in the area and asymptomatic infections occurring during the epidemic The cause of the epidemic (1)was searched for by attempts to find the index case and evidence of Ebola virus in some animal and insects (2). DESCRIPTION OF THE EPIDEMIC AREAThe epidemic focus was in north- central Zaire. It was located in and near the Yambuku Mission, in the Yandongi collectivity (country) of the Bumba Zone of the Equateur Region (Figure 1). This collectivity has about 3. Bumba Zone has about 2. Half of the population is less than 1. Over 7. 5% of the population lives in forest villages of less than 5 0. The area forms part of the Zaire river basin and is essentially tropical rainforest. The Zaire river forms the southern boundary of the zone and effectively separates geographically the most northern sectors from the remainder of the country. The major ethnic group is Budza and Lingala is the principal language. Traditionally, the people are hunters and have contact with a wide variety of wild animals. Cash crops are palm oil, rice, some coffee and cocoa. Ebola virus disease (EVD), also known as Ebola hemorrhagic fever (EHF) or simply Ebola, is a viral hemorrhagic fever of humans and other primates caused by ebolaviruses. It was the first Bee Gees single to feature Barry's falsetto exclusively as the lead vocal. Malaria, filariasis, measles, pneumonia, amoebiasis, bacillary dysentery and goitre are common. There is some poorly controlled movement of palm oil, rice and other staples out of the Equateur into the Central African Empire and the Sudan. These are exchanged for luxury items such as cloth, utensils, transistor radios and other implements of modern technology. The mission was established in 1. Belgian missionaries near Yambuku, a small isolated village 1. Bumba, the administrative capital of the zone. The mission developed a large local following over the next four decades and was involved in education, agricultural development, animal raising, social service and health programmes, as well as religious activities. By 1. 97. 6, before the epidemic, the hospital had 1. Zairian paramedical assistant. Included in the medical staff were three Belgian nursing nuns. The hospital outpatient department drew its clientele essentially from the Yandongi collectivity population, but others from within and even outside the Bumba zone were attracted by the relatively good supply of medicines. Between 6 0. 00 and 1. Five syringes and needles were issued to the nursing staff each morning for use at the outpatient department, the prenatal clinic and the inpatient wards. These syringes and needles were sometimes rinsed between patients in a pan of warm water. At the end of the day they were sometimes boiled. The surgical theatre had its own ample supply of instruments, syringes and needles which were kept separately. DEFINITIONS AND METHODSA probable case of Eb. HF was a person living in the epidemic area who died after one or more days with two or more of the following symptoms and signs, occurring between 1 September and 5 November 1. Ebola virus infection and clinically could not be assigned another diagnosis. A proven case of Eb. HF was a person from whom Ebola virus was isolated or visualized by electron microscopy or who had a fluorescent antibody (IFA) titer of at least 1: 6. Ebola virus within three weeks after onset of symptoms. An Ebola virus infection was deemed to have occurred in persons who had a similar IFA antibody titer, but who reported no illness during the period 3. August to 1. 5 November 1. A possible case was a person with at least 2. Eb. HF within the previous 3 weeks. These cases were treated with antimalarial drugs, antibiotics and antipyretics to exclude diseases common to the area. Persons reporting such symptoms retrospectively were bled and their sera were tested for Ebola virus antibodies. Any case of fever with bleeding, regardless of outcome, reported to the Ministry of Health (MOH) from any part of Zaire was also regarded as a possible case and every effort was made to establish a diagnosis by virological or pathological means. Infants born to probable cases of Eb. HF were called neonatal cases if they died within 2. A primary contact was any person having direct face- to- face contact with a probable or a proven case (sleeping in the same room, sharing meals, caring for patients, preparing a cadaver for burial, touching the body at a funeral, etc.). Contact was required from two days prior to onset of symptoms to death or clinical recovery of the patient. The surveillance interval for primary contacts was 2. Secondary contacts were persons having face- to- face contact with a primary contact. Case investigations were performed by six physician- led teams working with nurseinterpreters and standardized pre- coded forms. The forms had questions on clinical as well as on epidemiological features. Controls were chosen from the same village as a probable case. They were matched as far as possible with cases by sex and age and a member of the same family was chosen if available. One part of the study was done in a restricted zone of 2. Yambuku before the six teams began. A family was defined as persons using the same kitchen, claiming the same person as the family head, living in contiguous dwellings and sleeping in the village during the time an active case occurred in the family unit. A case was considered to have acquired his disease by injection if, in the three weeks preceding symptom onset, he received an injection by any medical practitioner in the epidemic area and had no primary contact with a probable or proven case. Person- to- person transmission was designated when a probable case had face- to- face contact with another case within three weeks prior to symptom onset without history of injection receipt. Transmission was classified as both possible if the case had both an injection and face- toface contact with another case within three weeks of symptom onset and one transmission type was not likely by history. Hospital records were reviewed for the period January 1. October 1. 97. 7. Outpatient records were not kept. One village with a high attack- rate was studied in greater depth to gain better insight into transmission patterns and subclinical infection. An investigative team mapped every house in the village and censused all cases occurring during the epidemic and remaining residents. Sera were drawn from as many residents as possible. Serum specimens were taken from family and non- family primary contacts who reported febrile illness during the epidemic, and were possible cases, from other residents of 8 villages where cases occurred, and from residents of 4 villages near the epidemic area where no cases occurred. These were screened for Ebola virus indirect immunofluorescent antibodies (IFA) using a method previously described (4) . RESULTSTime. The first known case, a 4. Yambuku Mission school, came to the Mission hospital on 2. August 1. 97. 6 with a febrile illness felt due to malaria. He was given an injection of chloroquine at the dispensary. The fever dropped and remained normal over the next four days but rose to 3. The typical syndrome evolved from that day and he died on 8 September with severe haemorrhage. From I September to 2. October there were 3. Figure 2). Date of symptom onset was not available for about 1. Place. Fifty- five villages of less than 5,0. All infected villages in the epidemic area were within 6. Yambuku. This area includes about 1. The larger towns of Abumombazi and Bumba, about 1. Kinshasa, 1 1. 00 km to the south- west. The large majority of affected villages were along roads running east and west of Yambuku, along which were located more villages than the north- south road. Forty- three of 7. Yandongi collectivity were affected. This collectivity had an attack rate of 8. The epidemic spread relatively slowly in the epidemic area. Within the first two weeks after onset of the epidemic cases were occurring no further than 3. Yambuku. Almost another two weeks passed before a sick nursing sister was evacuated to Kinshasa. The mean duration of active disease was 2. At the Yambuku Mission Hospital, where all staff members contacted patients or instruments used for treating patients, 1. Person. All ages and both sexes were affected. Females predominated, mainly in the age groups 5- 1. Table 1). Age- sex specific attack rates, using Yandongi collectivity population as denominator, shows adult females with the highest attack rates (Figure 3). Convalescents were all adults, except for one child of 8 years of age. Fig. 2 Cases of Ebola Hemorrhagic Fever, by day of onset, Equateur Region, Zaire, Africa, Sept. TABLE 1. AGE AND SEX DISTRIBUTION OF Eb. HF CASES, ZAIRE, 1. Male. Female. Total. Agen%n%n%Newborn & Infant. Unknown. 20. 6. 30. Total. 14. 14. 4. Fig. 3 Attack rates of Ebola Haemorrhagic Fever by age and sex, Yandongi collectivity, Bumba Zone, Equateur Region, Zaire, 1. Mortality, Two hundred and eighty persons died during the epidemic, a death- to- case ratio of 8. Transmission. Types of spread. For 8. 5 of 3. 18 cases the only risk factor elicited was receipt of one or more injections compared to controls (Table 2). These were almost all given at the outpatient service or on the general medical wards at the Yambuku mission hospital. Less than 1% of the controls had contact with the hospital during the epidemic (p 0. History of injection receipt away from the Yambuku mission hospital occurred in only 2 instances. One case had an injection at the dispensary in Kwa. Aux deux colombes est un film r. Auberge Aux Deux Colombes. AUX 2 C Location salle des f Location de salle AUX DEUX COLOMBES.Situ. Salle de mariage, soir Animalerie aux deux colombes, Saint-Lin–Laurentides. 2 792 mentions J’aime . Animalerie et Boutique Animalerie aux deux colombes, Saint-Lin, QC. Animalerie et Boutique Directed by Sacha Guitry. 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