A prospective, randomized, double-blind, concurrent, placebo-controlled clinical trial of intravenous ribavirin (loading dose of 33 mg/kg, 16 mg/kg every 6 h for 4 days, and 8 mg/kg every 8 h for 3 days) was conducted in 242 patients with serologically confirmed hemorrhagic fever with renal syndrome (HFRS) in the People's Republic of China. Mortality was significantly reduced (sevenfold decrease in risk) among ribavirin-treated patients, when comparisons were adjusted for baseline risk estimators of mortality (P = .01; two-tailed). HFRS typically consists of five consecutive but frequently overlapping clinical phases. Only occurrence of oliguric phase and hemorrhage was associated with severity of clinical disease in the placebo group. Ribavirin therapy also resulted in a significant reduction in the risk of entering the oliguric phase and experiencing hemorrhage. The only ribavirin-related side effect was a well-recognized, fully reversible anemia after completion of therapy.

No abstract

From October to December 1977, an extensive epizootic occurred in Egypt resulting in abortions and increased mortality in domestic animals, and severe clinical disease with fatalities in man. Rift Valley Fever (RVF) virus was isolated and identified as the causative agent. In humans, acute febrile, encephalitic, ocular and fatal haemorrhagic diseases were documented as resulting from RVF virus infection. A retrospective serological survey indicated RVF was recently introduced into the area. The 1977 epizootic extensively involved five Governorates. In the summer and autumn of 1978, epizootic RVF reappeared in Egypt and spread to previously uninfected areas. Virological, serological and epidemiological studies, and factors related to the spread of RVF are discussed.

Epidemiological factors related to the introduction, spread and maintenance of Rift Valley fever (RVF) virus were studied during the 1977-78 epizootic in Egypt, Culex pipiens is the most ubiquitous and prevalent mosquito species in the Nile Valley and Delta. Isolation of RVF virus from unengorged C. pipiens, and demonstration of laboratory transmission of the virus by this species, strongly implicate it as the chief vector in Egypt. Virus transmission to man also occurs by contamination when handling infected meat and by inhaling natural virus aerosols. Wild rodents apparently do not serve as RVF virus reservoirs. Domestic sheep, cattle, buffaloes, camels, goats, donkeys and dogs act as amplifying hosts. Over 30% of the camels sampled at the southern border of Egypt were serologically positive for antibodies to RVF virus and it appears likely that the virus was introduced into Egypt, either by these animals or by other vehicles from the south.