Ebola Infection: Same Disease, New Name

If you have been reading about the latest emergence of Ebola virus infection in Africa that has so far claimed over 140 lives you might have noticed something unusual. I’m not talking about the fact that the outbreak is occurring in Western Africa, a region that has not previously seen human cases of this disease. And I’m not talking about the fact that at least 50 cases have occurred in Conakry, the densely populated capital of Guinea.

The current outbreak in Western Africa marks the public debut of a “new” name for one of mankind’s most dreaded diseases. Goodbye, Ebola hemorrhagic fever. Hello, Ebola virus disease. For those of you with fond memories of Richard Preston books or Dustin Hoffman movies featuring horrific scenes of Ebola victims “bleeding out,” dropping hemorrhagic from the name of this virus may seem blasphemous.

In all seriousness, this change was a long time in coming. The media-fueled perception that Ebola virus infection invariably causes massive internal bleeding is inaccurate. Indeed, the entire class of viral hemorrhagic fevers, which have dramatically different epidemiological profiles and fatality rates and include everything from Ebola to Rift Valley fever to Lassa fever, makes little medical or scientific sense. For several years, the World Health Organization (WHO)’s International Classification of Diseases 10 (ICD-10), the international standard diagnostic tool for epidemiology, public health, and clinical purposes, has listed the disease caused by Ebola as Ebola virus disease. In a post on ProMED, virologist Dr. Jens Kuhn, author of Filoviruses: A Compendium of 40 Years of Epidemiological, Clinical, and Laboratory Studies (or as I like to call it Everything You Ever Wanted to Know About Ebola and Marburg But Were Afraid to Ask) wrote, “EHF [Ebola hemorrhagic fever] is certainly used a lot in the literature but mainly by people who do not get in touch with patients and simply don’t know any better (i.e. do not have to classify diseases according to existing legal frameworks and therefore don’t know that ICD-10 exists or how important it is). Also, the term “hemorrhagic fever” is always problematic, as its definition has not been updated since the 1960s and early 1970s (Gajdusek, Smorodintsev). Everybody seems to know what a viral hemorrhagic fever is, until you ask them and push for an answer.”

Despite having written the book on how to diagnose diseases, as late as 2012 WHO publicly referred to outbreaks of Ebola virus infections in Uganda as causing Ebola hemorrhagic fever. The current outbreak of Ebola virus in West Africa, which began in March 2014, is the first time that WHO has publicly referred to the disease as Ebola virus disease (EVD). While this name change unfortunately does not leave us any closer to a cure or treatment of this disease perhaps it marks one small step in controlling the fear and anxiety that seems to spread faster than the virus itself.