Ebola is back in Africa. It?s one of the most deadly viral diseases known and can incubate for up to three weeks before flu-like symptoms set in. It then starts attacking internal organs, causing bloody diarrhea and vomiting. Within two weeks, the victim usually is dead from massive blood loss. There is no cure. But the virus usually kills its victims faster than it can spread, so it doesn?t spread too far.

The Ebola death toll in West Africa is now 24, the World Health Organization says. The latest fatality occurred in Republic of Congo, where seven people have now died. The disease has killed 17 people in neighboring Gabon.

WHO says 33 cases have been confirmed, including those who died. They include 20 cases in Gabon and 13 in villages in Republic of Congo that are close to the border. Fifteen more suspected cases in Gabon are being investigated, and medical experts are monitoring 214 people in Gabon and 34 others in Republic of Congo who may have had contact with those infected with the disease.

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In 1994 there were 44 cases in Gabon, in gold-panning camps in the rain forest; 63 percent died. It was initially thought to be yellow fever, but was identified as Ebola in 1995.

In 1996 there were 37 cases; 57 percent died. Nineteen people were infected after eating a chimpanzee found dead in the forest.

In 1996-97 there were 60 cases and 75 percent died. The initial victim was a hunter who lived in a forest camp. Disease spread by close contact with infected persons. A dead chimpanzee found in the forest at the time was determined to be infected with Ebola.

In 2001-02, 20 cases have been discovered in Gabon, with 12 in the neighboring Republic of Congo; 72 percent have died so far.

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But the story of Ebola is greater than the statistics. John Otolany has seen the fifth member of his family die of Ebola, including his 5 year-old nephew and oldest son. ?I can?t cry any more,? he says. ?If I do, everything will fall apart.? Otolany?s sister, a nurse, was the first in the family to die. She caught the disease from a patient. Ebola is transmitted through bodily fluids and can be passed by a simple handshake.

This is the fourth time this rare, highly contagious form of hemorrhagic fever has struck Ogooue Ivindo, a remote, northeastern province inhabited by Pygmies and other hunter tribes and researchers are struggling to explain why. Villagers blame everything from plants and monkeys to politics and vampires.

Twenty-four people have died so far in the region, and the outbreak has caused panic. The sick refuse to go to the town?s crumbling medical center, afraid they will be told they have the disease and must be isolated from all human contact. Health workers refuse to treat patients. Those with money send their wives and children away for safety. ?People cross the street to avoid me,? Otolany says. ?I smell of death.?

More than 800 people have died of Ebola since it was first identified in 1976 in western Sudan and in a nearby region of Congo, according to the World Health Organization. Outbreaks are often years and hundreds of miles apart. The disease last struck in Uganda, killing 224 people last year.

Death tolls have been lower in the Ogooue Ivindo region of Gabon, the only place in the world where outbreaks have occurred repeatedly. When Ebola last struck the thinly populated province in 1996-97, it killed 45 of the 60 people infected.

Ebola is believed to be carried by some animals and insects that live with the virus in Africa?s vast rain forests. But researchers have been unable to pin down the cause, in part because of the variety of wildlife. Most outbreaks begin with the introduction of the virus into a single human, who then spreads the disease in a community. But researchers say this time there is evidence of at least two independent transfers in Gabon and one in Republic of Congo. This suggests there are a high number of the virus? natural hosts in the area.

Suspicion has focused on primates. Gabon?s outbreaks have all been accompanied by reports of unusually high numbers of dead chimpanzees, gorillas and other animals. A 1996 case was traced to hunters who skinned and chopped a chimpanzee found dead in the forest. But researchers say primates are unlikely to be natural hosts, since they too become sick and die.

Otolany, like many others in the region, is angry that authorities did not act sooner. The outbreak was only officially confirmed Dec. 11, and health officials say their efforts were hampered by a critical lack of resources and experienced personnel. Protective equipment, including gloves and face masks, had to be flown in from the capital. Blood samples had to be sent 370 miles south to a laboratory in Franceville. Phone lines are erratic, and the provincial health authority owns just one vehicle.

?We should have had the material in place, as we know Ogooue Ivindo is a region susceptible to outbreaks,? says provincial health director Prosper Abessolo Mengue. Next time, he hopes, things will be different.

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