A 39-year-old freelance cameraman returned to Germany on Aug 1, 1999, from Abidjan, Côte d’Ivoire, where he had spent 2 weeks working in Comoé National Park in the northeast of the country. He started feeling unwell on the final part of his journey and went to a hospital in Frankfurt/Oder the same day. He had a sudden onset of fever with a temperature over 39 C and chills, general malaise, and weakness. Subsequently, he had muscle and joint pains, headache, abdominal discomfort, nausea, and one bout of haematemesis. Laboratory results showed impaired coagulation status with thrombocytopenia (1 0 71 09/L), low prothrombin (25%), and prolonged partial thromboplastin time (PTT; 44 s). Initially, renal function was unaffected and electrolytes were normal. Haemoglobin, leucocyte count, and erythrocyte sedimentation rate were normal. C-reactive protein was 2· 8 mg/L. Aspartate and alanine aminotransferase concentrations were raised (22 538 U/L, 8732 U/L) and so was bilirubin (45 mol/L), suggesting acute liver failure. Ultrasonography of the liver showed a hyperdense, slightly enlarged organ with signs of fatty degeneration. A chest radiograph on admission was normal. He was suspected to have a viral haemorrhagic fever and was air-lifted to a specialised infectious diseases unit on the third day of his illness. On arrival at the unit, his symptoms were worse. He was fully oriented, febrile (39· 2 C), had enanthema of his palate, conjunctival injection with discrete jaundice, petechiae on both arms with multiple sites of mosquito bites, and an enlarged liver without splenomegaly. His previous medical history was unremarkable. He had taken mefloquine for malaria prophylaxis. During his stay in the Côte d’Ivoire he was well. He stated that he had been immunised against yellow fever in 1993. Because of his travel history, clinical features, and laboratory results, he was diagnosed as having a viral haemorrhagic fever, possibly highly contagious, and transferred to a negativeair-pressure isolation unit. 1 The patient’s wife and another man travelling with him were quarantined at home and in hospital respectively. People who had close contact with him were identified and all possible contacts on his airline flights were traced. Malaria was excluded by repeated