With the recent Ebola epidemic in West Africa reviving interest in the first outbreak of the deadly hemorrhagic fever 40 years ago, scientists led by Joel Breman, MD, DTPH, FIDSA, of the Fogarty International Center at the National Institutes of Health (NIH) have released a report highlighting lessons learned from the smaller, more quickly contained 1976 outbreak.1

“Key to diagnosis in 1976 was the relatively quick clinical recognition of a severe, possibly new disease by national authorities,” according to Breman and his coauthors. “International notification and specimen provision occurred within 5 weeks from onset of the first cases; this did not occur in the 2013–2016 epidemic, when the delay was over 3 months.”

The report, published in the Journal of Infectious Diseases, identifies an adult male who was hospitalized in late August 1976 at Yambuku Mission Hospital in the Democratic Republic of Congo (DRC)—known as Zaire at the time—as the first Ebola patient. It describes how “several dozen patients . . . developed a similar febrile hemorrhagic syndrome and died in about 1 week, as did many of their contacts.”

A month after “patient zero” was hospitalized, blood taken from a Belgian midwife-nun who had contracted the virus was sent to Belgium for analysis. Within days of the nun’s death, the area where the outbreak was occurring was placed under quarantine, and Yambuku Hospital was shut down on the advice of health officials.

In total, there were 318 cases of Ebola and 280 deaths in the 1976 outbreak, which lasted less than 11 weeks. In the recent West African outbreak, there were 11,310 deaths out of nearly 29,000 cases, and the epidemic lasted more than 2 years—almost 10 times as long as in 1976. The death rate in 1976—88%—was much higher than in the recent outbreak in Liberia, Guinea, and Sierra Leone—around 50%.

The report also tries to settle the debate over who “discovered” the Ebola virus in 1976. Local Zairean, Belgian, and French doctors and health officials were the first to see and assess patients in Yambuku, while the Institute of Tropical Medicine in Antwerp, Belgium, received the first Ebola specimens and recovered what they called “a Marburg-like virus.” However, it was the US Centers for Disease Control and Prevention (CDC) that identified and recognized a new, unknown virus that fulfilled the criteria for discovery of a new virus, according to the report.

Researchers give specific credit to Patricia Webb, MD, James Lange, PhD, and Karl Johnson, MD, of CDC’s special pathogens branch.

As for what carried the virus into DRC in the first place, investigators in Zaire determined at the time by questioning community leaders, people recovering from Ebola, and the families of 1976 victims about their contact with animals, that bats were not the vector. However, in the 40 years since the first Ebola outbreak, fruit bats have been found to be probable reservoirs for filoviruses—the type that causes Ebola—and the Ebola genome and antibodies have been found in bat and rodent species in East and West Africa.

More extensive preparations, including improved screening capabilities, are needed to detect and manage future outbreaks promptly, the scientists recommend. According to NIH, primary prevention through strengthened prediction models, detection, response, control mechanisms, and international cooperation and coordination are essential for all countries in Africa and elsewhere where Ebola and new and reemergent pathogens are sure to surface again.

For more information, visit the Fogarty International Center.


  1. Breman JG, Heymann DL, Lloyd G, et al. Discovery and description of Ebola Zaire virus in 1976 and relevance to the West African epidemic during 2013–2016. J Infect Dis. Posted online June 29, 2016; doi: 10.1093/infdis/jiw207.