Abstract: The Hot Zone is a best-selling 1994 non-fiction bio-thriller by Richard Preston about the origins and incidents involving viral hemorrhagic fevers, particularly ebolaviruses and marburgviruses. The basis of the book was Preston's 1992 New Yorker article "Crisis in the Hot Zone".
The filoviruses Ebola virus (EBOV), Sudan virus (SUDV), Marburg virus (MARV), and Ravn virus (RAVV) are Biosafety Level 4 agents. Biosafety Level 4 agents are extremely dangerous to humans because they are very infectious, have a high case-fatality rate, and there are no known prophylactics, treatments, or cures. Along with describing the history of the diseases caused by these two Central African diseases, Ebola virus disease (EVD) and Marburg virus disease (MVD), Preston describes an incident in which a relative of Ebola virus named Reston virus (RESTV), which was the result of a mutation in the Ebola virus. Its name is derived from Reston, Virginia, nonhuman primate quarantine facility less than fifteen miles (24 km) away from Washington, DC, because it was where they found it. The original Reston, VA, facility located at 1946 Isaac Newton Square was torn down sometime between 1995 and 1998.
The book is in four sections:
1. "The Shadow of Mount Elgon" delves into the history of filoviruses, as well as speculation about the origins of AIDS. Preston accounts the story of "Charles Monet" (a pseudonym), who might have caught MARV from visiting Kitum Cave on Mount Elgon in Kenya. The author describes in great detail the progression of the disease, from the initial headache and backache, to the final stage in which Monet's internal organs fail and he "bleeds out" (i.e., hemorrhages extensively) in a waiting room in a Nairobi hospital. This part also introduces a young promising physician who becomes infected with MARV while treating Monet. Nancy Jaax's story is told. Viruses, and biosafety levels and procedures are described. The EVD outbreaks caused by EBOV and its cousin, Sudan virus (SUDV) are mentioned. Preston talks to the man who named Ebola virus.
2. "The Monkey House" The discovery of Reston virus virus among imported monkeys in Reston, Virginia, and the following actions taken by the U.S. Army and Center for Disease Control.
3. "Smashdown" is more on the Reston epizootic, which involved a strain of the virus that does not affect humans but which easily spreads by air, and is very similar to its cousin the Ebola virus.
4. "Kitum Cave" The author visits the cave that is the suspected home of the natural host animal that Ebola lives inside of.
The book starts with "Charles Monet" visiting Kitum Cave during a camping trip to Mount Elgon in Central Africa. Not long after, he begins to suffer from a number of symptoms, including vomiting, diarrhea and red eye. He is soon taken to Nairobi Hospital for treatment, but his condition deteriorates further and he goes into a coma while in the waiting room. He dies, but not before a Doctor named Shem Musoke, attempting to insert a laryngoscope, is infected by exposure to Charles' blood and vomit. Musoke is one of the few to become symptomatic from a filovirus and survive. This particular filovirus is called Marburg virus.
Dr. Nancy Jaax had been promoted to work in the Level 4 Biosafety containment area at USAMRIID, and is assigned to research Ebola virus. While preparing food for her family at home, she cuts her right hand. Later, while working on a dead, EBOV-infected monkey, one of the gloves on the hand with the open wound tears, and she is almost exposed to contaminated blood, but does not get infected. Meanwhile, Peter Cardinal, a ten-year-old, visits Kitum Cave, gets infected with a MARV relative, Ravn virus (RAVV), and does not survive this infection. Nurse Mayinga is also infected by a nun and elects to visit Nairobi Hospital for treatment, where she succumbs to the disease. A CDC team arrives to collect samples of the virus for study.
In Reston, Virginia, less than fifteen miles (24 km) away from Washington, DC, a company called Hazelton Research once operated a quarantine center for monkeys that were destined for laboratories. In October 1989, when an unusually high number of their monkeys began to die, their veterinarian decided to send some samples to Fort Detrick (USAMRIID) for study. At the time, it was believed that the virus was Simian hemorrhagic fever virus, a viral hemorrhagic fever harmless to humans but almost always fatal to other primates (see zoonosis). Early during the testing process in biosafety level 3, when one of the flasks appeared to be contaminated with harmless pseudomonas bacterium, two USAMRIID scientists exposed themselves to the virus by wafting the flask. When they eventually tested the samples with known Level 4 agents, only EBOV reacted with the unknown samples. They decided not to tell anyone about their exposure, but they did secretly test their blood every day. After one of the monkey house staff members becomes ill with nausea and violent vomiting, USAMRIID is given permission to send in a team to euthanize all the monkeys at the facility and collect tissue samples. They later determine that, while the virus is terrifyingly lethal to monkeys, humans can be infected with it without any health effects at all. This virus is now known as Reston virus (RESTV).
Finally, the author himself goes into Africa to explore Kitum Cave. On the way, he discusses the role of AIDS in the present, as the highway they were on, sometimes called the "AIDS Highway," or the "Kinshasa Highway" was where it first appeared. Equipped with a Hazmat suit,
he enters the cave and finds a large number of animals, one of which
might be the virus carrier. At the conclusion of the book, he travels to
the quarantine facility in Reston. The building there was abandoned and
deteriorating. He concludes the book by saying EBOV will be back (Wikipedia, 2012).