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| Boilerpipe Text | Ebola
Other names
Ebola haemorrhagic fever (EHF), Ebola virus disease (EBV)
Two nurses stand beside
Mayinga N'Seka
, a nurse with Ebola virus disease, during the
1976 outbreak in Zaire
(now the
Democratic Republic of the Congo
). N'Seka was treated, but ultimately died a few days later.
Pronunciation
[
1
]
Specialty
Infectious diseases
Symptoms
Fever
,
sore throat
,
muscle pain
,
headaches
,
diarrhoea
,
bleeding
[
2
]
[
3
]
Complications
Shock
from
fluid loss
[
4
]
Usual onset
2 days to 3 weeks after exposure
[
2
]
Causes
Ebolaviruses
spread by direct contact with the
blood
or
body fluid
of an
infected
person, or
contaminated
objects
[
2
]
Diagnostic method
Finding
ebolaviruses
, viral
RNA
, or
antibodies
in blood
[
2
]
Differential diagnosis
Other
viral haemorrhagic fevers
, such as
malaria
,
typhoid
,
cholera
, or
meningitis
[
2
]
Prevention
Coordinated medical services, careful handling of
bushmeat
[
2
]
Treatment
Supportive care
[
2
]
Medication
Atoltivimab/maftivimab/odesivimab
(INMAZEB)
Prognosis
25–90% mortality
[
2
]
Ebola
, also known as
Ebola virus disease
(
EVD
) and
Ebola hemorrhagic fever
(
EHF
), is a
zoonotic
viral hemorrhagic fever
in humans and other
primates
, caused by four of the six known
ebolaviruses
.
[
2
]
Symptoms typically start anywhere between two days and three weeks after infection.
[
5
]
The first symptoms are usually
fever
,
sore throat
,
muscle pain
, and
headaches
.
[
2
]
These are usually followed by
vomiting
,
diarrhoea
,
rash
,
hepatic
and
renal
dysfunction,
[
2
]
at which point some people begin to
bleed
both
internally
and externally.
[
2
]
The disease causes a mortality rate of anywhere between 25 and 90%, averaging out at approximately 50%.
[
2
]
The viral species involved and timing of treatment play a critical role in its prognosis. Death is often due to
shock from fluid loss
, and typically occurs between 6 and 16 days after the first symptoms appear.
[
4
]
The viruses have caused
intermittent outbreaks
in
Sub-Sahara Africa
since 1976 when the disease was first reported, with the largest one being the
2014 Western African epidemic
. They spread through direct contact with
body fluids
, such as
blood
from infected humans or other animals,
[
2
]
or from contact with items that have recently been contaminated with infected body fluids.
[
2
]
There have been no documented cases, either in nature or under laboratory conditions, of spread through the air between humans or other
primates
.
[
6
]
After recovering from Ebola,
semen
or
breast milk
may continue to carry the virus for anywhere between several weeks to several months.
[
2
]
[
7
]
[
8
]
Fruit bats
are believed to be the
natural host
of the viruses; they are able to spread the viruses without being affected by it.
[
2
]
The symptoms of Ebola may resemble those of several other diseases, including
malaria
,
cholera
,
typhoid fever
,
meningitis
and other viral hemorrhagic fevers.
[
2
]
Diagnosis is confirmed by testing blood samples for the presence of viral
RNA
, viral
antibodies
or the virus itself.
[
2
]
[
9
]
Control of outbreaks requires coordinated medical services and community engagement,
[
2
]
including rapid detection,
contact tracing
of those exposed, quick access to laboratory services, care for those infected, and proper disposal of the dead through
cremation
or burial.
[
2
]
[
10
]
Prevention measures involve wearing proper protective clothing and
washing hands
when in close proximity to patients and while handling potentially infected
bushmeat
, as well as thoroughly cooking bushmeat.
[
2
]
Two treatments (
atoltivimab/maftivimab/odesivimab
and
ansuvimab
) are associated with improved outcomes.
[
11
]
Early supportive care and treatment of symptoms increases the survival rate considerably compared to late start.
[
12
]
[
2
]
These include
oral rehydration therapy
(drinking slightly sweetened and salty water) or giving
intravenous fluids
, and treating symptoms.
[
2
]
An
Ebola vaccine
was approved by the US FDA in December 2019. In October 2020, atoltivimab/maftivimab/odesivimab (Inmazeb) was approved for medical use in the United States to treat the disease caused by
Zaire ebolavirus
.
[
13
]
Signs and symptoms
Signs and symptoms of Ebola
[
14
]
Onset
The length of time between exposure to the virus and the development of symptoms (
incubation period
) is between 2 and 21 days,
[
2
]
[
14
]
and usually between 4 and 10 days.
[
15
]
However, recent estimates based on mathematical models predict that around 5% of cases may take longer than 21 days to develop.
[
16
]
Symptoms usually begin with a sudden
influenza
-like stage characterised by
fatigue
,
fever
,
weakness
,
decreased appetite
,
muscular pain
,
joint pain
, headache, and sore throat.
[
2
]
[
15
]
[
17
]
[
18
]
The fever is usually higher than 38.3 °C (101 °F).
[
19
]
This is often followed by nausea, vomiting,
diarrhoea
, abdominal pain, and sometimes
hiccups
.
[
18
]
[
20
]
The combination of severe vomiting and diarrhoea often leads to severe
dehydration
.
[
21
]
Next,
shortness of breath
and
chest pain
may occur, along with
swelling
,
headaches
, and
confusion
.
[
18
]
In about half of the cases, the skin may develop a
maculopapular rash
, a flat red area covered with small bumps, five to seven days after symptoms begin.
[
15
]
[
19
]
Bleeding
In some cases, internal and external bleeding may occur.
[
2
]
This typically begins five to seven days after the first symptoms.
[
22
]
All infected people show some
decreased blood clotting
.
[
19
]
Bleeding from mucous membranes or from sites of needle punctures has been reported in 40–50% of cases.
[
23
]
This may cause
vomiting blood
,
coughing up of blood
, or
blood in stool
.
[
24
]
Bleeding into the skin may create
petechiae
,
purpura
,
ecchymoses
or
haematomas
(especially around needle injection sites).
[
25
]
Bleeding into the whites of the eyes
may also occur.
[
26
]
Heavy bleeding is uncommon; if it occurs, it is usually in the
gastrointestinal tract
.
[
27
]
The incidence of bleeding into the gastrointestinal tract was reported to be ~58% in the 2001 outbreak in Gabon,
[
21
]
but in the 2014–15 outbreak in the US it was ~18%,
[
28
]
possibly due to improved prevention of
disseminated intravascular coagulation
.
[
21
]
Recovery or death
Recovery may begin between seven and 14 days after first symptoms.
[
18
]
Death, if it occurs, follows typically six to sixteen days from first symptoms and is often due to
shock from fluid loss
.
[
4
]
In general, bleeding often indicates a worse outcome, and blood loss may result in death.
[
17
]
People are often in a
coma
near the end of life.
[
18
]
Those who survive often have ongoing muscular and joint pain,
liver inflammation
, and decreased hearing, and may have continued tiredness, continued weakness, decreased appetite, and difficulty returning to pre-illness weight.
[
18
]
[
29
]
Problems with vision may develop.
[
30
]
It is recommended that survivors wear condoms for at least twelve months after initial infection or until the semen of a male survivor tests negative for Ebolavirus on two separate occasions.
[
31
]
Survivors develop
antibodies
against Ebola that last at least 10 years, but it is unclear whether they are immune to additional infections.
[
32
]
Cause
EVD in humans is caused by four of six viruses of the genus
Ebolavirus
. The four are
Bundibugyo virus
(BDBV),
Sudan virus
(SUDV),
Taï Forest virus
(TAFV) and one simply called
Ebola virus
(EBOV, formerly Zaire Ebola virus).
[
33
]
EBOV, species
Zaire ebolavirus
, is the most dangerous of the known EVD-causing viruses, and is responsible for the largest number of outbreaks.
[
34
]
The fifth and sixth viruses,
Reston virus
(RESTV) and
Bombali virus
(BOMV),
[
35
]
are not thought to cause disease in humans, but have caused disease in other primates.
[
36
]
[
37
]
All six viruses are closely related to
marburgviruses
.
[
33
]
Virology
Electron micrograph
of an Ebola virus
virion
Ebolaviruses contain single-stranded, non-infectious
RNA
genomes
.
[
38
]
Ebolavirus
genomes contain seven
genes
including
3'-UTR
-
NP
-
VP35
-
VP40
-
GP
-
VP30
-
VP24
-
L
-
5'-UTR
.
[
25
]
[
39
]
The genomes of the five different ebolaviruses (BDBV, EBOV, RESTV, SUDV and TAFV) differ in
sequence
and the number and location of gene overlaps. As with all
filoviruses
, ebolavirus virions are filamentous particles that may appear in the shape of a shepherd's crook, of a "U" or of a "6," and they may be coiled, toroid or branched.
[
39
]
[
40
]
In general, Ebola virions are 80 nanometers (nm) in width and may be as long as 14,000 nm.
[
41
]
Their
life cycle
is thought to begin with a virion attaching to specific
cell-surface receptors
such as
C-type lectins
,
DC-SIGN
, or
integrins
, which is followed by fusion of the
viral envelope with cellular membranes
.
[
42
]
The virions taken up by the cell then travel to acidic
endosomes
and
lysosomes
where the viral envelope glycoprotein GP is cleaved.
[
42
]
This processing appears to allow the virus to bind to cellular proteins enabling it to fuse with internal cellular membranes and release the viral
nucleocapsid
.
[
42
]
The
Ebolavirus
structural glycoprotein (known as GP1,2) is responsible for the virus' ability to bind to and infect targeted cells.
[
43
]
The viral
RNA polymerase
, encoded by the
L
gene, partially uncoats the nucleocapsid and
transcribes
the genes into positive-strand
mRNAs
, which are then
translated
into structural and nonstructural proteins. The most abundant protein produced is the nucleoprotein, whose concentration in the host cell determines when L switches from gene transcription to genome replication. Replication of the viral genome results in full-length, positive-strand antigenomes that are, in turn, transcribed into genome copies of negative-strand virus progeny.
[
44
]
Newly synthesised structural proteins and genomes self-assemble and accumulate near the inside of the
cell membrane
. Virions
bud
off from the cell, gaining their envelopes from the cellular membrane from which they bud. The mature progeny particles then infect other cells to repeat the cycle. The genetics of the Ebola virus are difficult to study because of EBOV's virulent characteristics.
[
45
]
Initial case
Life cycles of the
Ebolavirus
Smoked
bushmeat
in
Ghana
. In Africa wild animals, including fruit bats, are hunted for food and are referred to as bushmeat.
[
46
]
[
47
]
In equatorial Africa human consumption of bushmeat has been linked to animal-to-human transmission of diseases, including Ebola.
[
48
]
Although it is not entirely clear how Ebola initially spreads from animals to humans, the spread is believed to involve direct contact with an infected wild animal or fruit bat.
[
49
]
Besides bats, other wild animals that are sometimes infected with EBOV include several species of monkeys such as
baboons
,
great apes
(
chimpanzees
and
gorillas
), and
duikers
(a species of
antelope
).
[
50
]
Animals may become infected when they eat fruit partially eaten by bats carrying the virus.
[
51
]
Fruit production, animal behavior and other factors may trigger outbreaks among animal populations.
[
51
]
Evidence indicates that both domestic dogs and pigs can also be infected with EBOV.
[
52
]
Dogs do not appear to develop symptoms when they carry the virus, and pigs appear to be able to transmit the virus to at least some primates.
[
52
]
Although some dogs in an area in which a human outbreak occurred had antibodies to EBOV, it is unclear whether they played a role in spreading the disease to people.
[
52
]
Areas undergoing
deforestation
are among the most likely places for outbreaks due to changes in the landscape bringing wildlife into closer contact with humans, including the
West African Ebola virus epidemic
.
[
53
]
[
54
]
Index cases of EVD have often been close to recently deforested lands.
[
55
]
[
56
]
Climate change may indirectly contribute to the rise in Ebola cases.
Extreme weather
events such as droughts, strong winds, thunderstorms, heat waves, floods, landslides, and shifting rainfall patterns can disrupt wildlife migration, pushing animals out of their natural habitats and nearer to human settlements.
[
57
]
For instance, a severe drought in Central Africa intensified
food insecurity
, leading some West African communities to hunt and consume infected animals such as bats, which likely fueled an Ebola outbreak.
[
58
]
Reservoir
The
natural reservoir
for Ebola has yet to be confirmed; however,
bats
are considered to be the most likely candidate.
[
59
]
Three types of fruit bats (
Hypsignathus monstrosus
,
Epomops franqueti
and
Myonycteris torquata
) were found to possibly carry the virus without getting sick.
[
60
]
As of 2013
, whether other animals are involved in its spread is not known.
[
52
]
Plants,
arthropods
,
rodents
, and birds have also been considered possible viral reservoirs.
[
2
]
[
21
]
Bats were known to roost in the cotton factory in which the
first cases
of the 1976 and 1979 outbreaks were observed, and they have also been implicated in Marburg virus infections in 1975 and 1980.
[
61
]
Of 24 plant and 19 vertebrate species experimentally inoculated with EBOV, only bats became infected.
[
62
]
The bats displayed no clinical signs of disease, which is considered evidence that these bats are a reservoir species of EBOV. In a 2002–2003 survey of 1,030 animals including 679 bats from
Gabon
and the
Republic of the Congo
, immunoglobulin G (IgG) immune defense molecules indicative of Ebola infection were found in three bat species; at various periods of study, between 2.2 and 22.6% of bats were found to contain both RNA sequences and IgG molecules indicating Ebola infection.
[
63
]
Antibodies against Zaire and Reston viruses have been found in fruit bats in
Bangladesh
, suggesting that these bats are also potential hosts of the virus and that the filoviruses are present in Asia.
[
64
]
Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians and
arthropods
sampled from regions of EBOV outbreaks, no Ebola virus was detected apart from some genetic traces found in six rodents (belonging to the species
Mus setulosus
and
Praomys
) and one
shrew
(
Sylvisorex ollula
) collected from the
Central African Republic
.
[
61
]
[
65
]
However, further research efforts have not confirmed rodents as a reservoir.
[
66
]
Traces of EBOV were detected in the carcasses of gorillas and chimpanzees during outbreaks in 2001 and 2003, which later became the source of human infections. However, the high rates of death in these species resulting from EBOV infection make it unlikely that these species represent a natural reservoir for the virus.
[
61
]
Transmission
An illustration of safe burial practices
It is believed that between people, Ebola disease spreads only by direct contact with the blood or other
body fluids
of a person who has developed symptoms of the disease.
[
67
]
[
68
]
[
69
]
Body fluids that may contain Ebola viruses include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and
semen
.
[
7
]
[
32
]
The WHO states that only people who are very sick are able to spread Ebola disease in
saliva
, and the virus has not been reported to be transmitted through sweat. Most people spread the virus through blood,
feces
and vomit.
[
70
]
Entry points for the virus include the nose, mouth, eyes, open wounds, cuts and abrasions.
[
32
]
Ebola may be spread through large
droplets
; however, this is believed to occur only when a person is very sick.
[
71
]
This contamination can happen if a person is splashed with droplets.
[
71
]
Contact with surfaces or objects contaminated by the virus, particularly needles and syringes, may also transmit the infection.
[
49
]
[
59
]
The virus is able to survive on objects for a few hours in a dried state, and can survive for a few days within body fluids outside of a person.
[
32
]
[
72
]
The Ebola virus may be able to persist for more than three months in the semen after recovery, which could lead to infections via
sexual intercourse
.
[
7
]
[
73
]
Virus persistence in semen for over a year has been recorded in a national screening programme.
[
74
]
Ebola may also occur in the breast milk of women after recovery, and it is not known when it is safe to breastfeed again.
[
8
]
The virus was also found in the eye of
one patient
, in 2014, two months after it was cleared from his blood.
[
75
]
Otherwise, people who have recovered are not infectious.
[
49
]
The potential for
widespread infections
in countries with medical systems capable of observing correct medical isolation procedures is considered low.
[
76
]
Usually when someone has symptoms of the disease, they are unable to travel without assistance.
[
77
]
Dead bodies remain infectious; thus, people handling human remains in practices such as traditional burial rituals or more modern processes such as
embalming
are at risk.
[
76
]
Of the cases of Ebola infections in Guinea during the 2014 outbreak, 69% are believed to have been contracted via unprotected (or unsuitably protected) contact with infected corpses during certain Guinean burial rituals.
[
78
]
[
79
]
Health-care workers treating people with Ebola are at greatest risk of infection.
[
49
]
The risk increases when they do not have appropriate protective clothing such as masks, gowns, gloves and eye protection; do not wear it properly; or handle contaminated clothing incorrectly.
[
49
]
This risk is particularly common in parts of Africa where the disease mostly occurs and health systems function poorly.
[
80
]
There has been transmission
in hospitals
in some African countries that reuse hypodermic needles.
[
81
]
[
82
]
Some health-care centres caring for people with the disease do not have running water.
[
83
]
In the United States the spread to two medical workers treating infected patients prompted criticism of inadequate training and procedures.
[
84
]
Human-to-human transmission of EBOV through the air has not been reported to occur during EVD outbreaks,
[
6
]
and airborne transmission has only been demonstrated in very strict laboratory conditions, and then only from pigs to
primates
, but not from primates to primates.
[
67
]
[
59
]
Spread of EBOV by water, or food other than bushmeat, has not been observed.
[
49
]
[
59
]
No spread by mosquitos or other insects has been reported.
[
49
]
Other possible methods of transmission are being studied.
[
72
]
Airborne transmission among humans is theoretically possible due to the presence of Ebola virus particles in saliva, which can be discharged into the air with a cough or sneeze, but observational data from previous epidemics suggests the actual risk of airborne transmission is low.
[
85
]
A number of studies examining airborne transmission broadly concluded that transmission from pigs to primates could happen without direct contact because, unlike humans and primates, pigs with EVD get very high ebolavirus concentrations in their lungs, and not their bloodstream.
[
86
]
Therefore, pigs with EVD can spread the disease through droplets in the air or on the ground when they sneeze or cough.
[
87
]
By contrast, humans and other primates accumulate the virus throughout their body and specifically in their blood, but not very much in their lungs.
[
87
]
It is believed that this is the reason researchers have observed pig to primate transmission without physical contact, but no evidence has been found of primates being infected without actual contact, even in experiments where infected and uninfected primates shared the same air.
[
86
]
[
87
]
Pathophysiology
Pathogenesis
schematic
Like other
filoviruses
, EBOV replicates very efficiently in many
cells
, producing large amounts of virus in
monocytes
,
macrophages
,
dendritic cells
and other cells including
liver cells
,
fibroblasts
, and
adrenal gland cells
.
[
88
]
Viral replication triggers
high levels of inflammatory chemical signals
and leads to a
septic state
.
[
29
]
EBOV is thought to infect humans through contact with mucous membranes or skin breaks.
[
67
]
After infection,
endothelial cells
(cells lining the inside of blood vessels), liver cells, and several types of immune cells such as
macrophages, monocytes
, and dendritic cells are the main targets of attack.
[
67
]
Following infection, immune cells carry the virus to nearby
lymph nodes
where further reproduction of the virus takes place.
[
67
]
From there the virus can enter the bloodstream and
lymphatic system
and spread throughout the body.
[
67
]
Macrophages are the first cells infected with the virus, and this infection results in
programmed cell death
.
[
41
]
Other types of
white blood cells
, such as
lymphocytes
, also undergo programmed cell death leading to an abnormally
low concentration of lymphocytes
in the blood.
[
67
]
This contributes to the weakened immune response seen in those infected with EBOV.
[
67
]
Endothelial cells may be infected within three days after exposure to the virus.
[
41
]
The breakdown of endothelial cells leading to
blood vessel
injury can be attributed to EBOV
glycoproteins
. This damage occurs due to the synthesis of Ebola virus
glycoprotein
(GP), which reduces the availability of specific
integrins
responsible for cell adhesion to the intercellular structure and causes liver damage, leading to
improper clotting
. The widespread
bleeding
that occurs in affected people causes
swelling
and
shock due to loss of blood volume
.
[
89
]
The
dysfunctional bleeding and clotting
commonly seen in EVD has been attributed to increased activation of the
extrinsic pathway
of the
coagulation cascade
due to excessive
tissue factor
production by macrophages and monocytes.
[
15
]
After infection, a secreted
glycoprotein
, small soluble glycoprotein (sGP or GP) is synthesised. EBOV replication overwhelms protein synthesis of infected cells and the host immune defences. The GP forms a
trimeric complex
, which tethers the virus to the endothelial cells. The sGP forms a
dimeric protein
that interferes with the signalling of
neutrophils
, another type of white blood cell. This enables the virus to evade the immune system by inhibiting early steps of neutrophil activation.
[
medical citation needed
]
Furthermore, the virus is capable of hijacking cellular metabolism. Studies have shown that Ebola virus-like particles can reprogram metabolism in both vascular and immune cells.
[
90
]
Immune system evasion
Filoviral infection also interferes with proper functioning of the
innate immune system
.
[
42
]
[
44
]
EBOV proteins blunt the human immune system's response to viral infections by interfering with the cells' ability to produce and respond to interferon proteins such as
interferon-alpha
,
interferon-beta
, and
interferon gamma
.
[
43
]
[
91
]
The VP24 and VP35 structural proteins of EBOV play a key role in this interference. When a cell is infected with EBOV, receptors located in the cell's
cytosol
(such as
RIG-I
and
MDA5
) or outside of the cytosol (such as
Toll-like receptor 3 (TLR3)
,
TLR7
,
TLR8
and
TLR9
) recognise
infectious molecules
associated with the virus.
[
43
]
On TLR activation, proteins including
interferon regulatory factor 3
and
interferon regulatory factor 7
trigger a signalling cascade that leads to the expression of
type 1 interferons
.
[
43
]
The type 1 interferons are then released and bind to the
IFNAR1
and
IFNAR2
receptors expressed on the surface of a neighbouring cell.
[
43
]
Once interferon has bound to its receptors on the neighbouring cell, the signalling proteins
STAT1
and
STAT2
are activated and move to the
cell's nucleus
.
[
43
]
This triggers the expression of
interferon-stimulated genes
, which code for proteins with antiviral properties.
[
43
]
EBOV's V24 protein blocks the production of these antiviral proteins by preventing the STAT1 signalling protein in the neighbouring cell from entering the nucleus.
[
43
]
The VP35 protein directly inhibits the production of interferon-beta.
[
91
]
By inhibiting these immune responses, EBOV may quickly spread throughout the body.
[
41
]
Diagnosis
When EVD is suspected, travel, work history, and exposure to wildlife are important factors with respect to further diagnostic efforts.
[
92
]
Laboratory testing
Possible non-specific laboratory indicators of EVD include a
low platelet count
; an initially
decreased white blood cell count
followed by an
increased white blood cell count
; elevated levels of the liver enzymes
alanine aminotransferase
(ALT) and
aspartate aminotransferase
(AST); and abnormalities in blood clotting often consistent with
disseminated intravascular coagulation
(DIC) such as a prolonged
prothrombin time
,
partial thromboplastin time
, and
bleeding time
.
[
93
]
Filovirions such as EBOV may be identified by their unique filamentous shapes in cell cultures examined with
electron microscopy
.
[
94
]
The specific diagnosis of EVD is confirmed by isolating the virus, detecting its
RNA
or proteins, or detecting
antibodies
against the virus in a person's blood.
[
95
]
Isolating the virus by
cell culture
, detecting the viral RNA by
polymerase chain reaction
(PCR)
[
9
]
[
15
]
and detecting proteins by
enzyme-linked immunosorbent assay
(ELISA) are methods best used in the early stages of the disease and also for detecting the virus in human remains.
[
9
]
[
95
]
Detecting antibodies against the virus is most reliable in the later stages of the disease and in those who recover.
[
95
]
IgM antibodies
are detectable two days after symptom onset and
IgG antibodies
can be detected six to 18 days after symptom onset.
[
15
]
During an outbreak, isolation of the virus with cell culture methods is often not feasible. In field or mobile hospitals, the most common and sensitive diagnostic methods are
real-time PCR
and ELISA.
[
96
]
In 2014, with new mobile testing facilities deployed in parts of Liberia, test results were obtained 3–5 hours after sample submission.
[
97
]
In 2015, a rapid antigen test which gives results in 15 minutes was approved for use by WHO.
[
98
]
It is able to confirm Ebola in 92% of those affected and rule it out in 85% of those not affected.
[
98
]
Differential diagnosis
Early symptoms of EVD may be similar to those of other diseases common in Africa, including
malaria
and
dengue fever
.
[
17
]
The symptoms are also similar to those of other viral haemorrhagic fevers such as
Marburg virus disease
,
Crimean–Congo haemorrhagic fever
, and
Lassa fever
.
[
99
]
[
100
]
The complete
differential diagnosis
is extensive and requires consideration of many other infectious diseases such as
typhoid fever
,
shigellosis
,
rickettsial diseases
,
cholera
,
sepsis
,
borreliosis
,
EHEC enteritis
,
leptospirosis
,
scrub typhus
,
plague
,
Q fever
,
candidiasis
,
histoplasmosis
,
trypanosomiasis
,
visceral
leishmaniasis
,
measles
, and
viral hepatitis
among others.
[
101
]
Non-infectious diseases that may result in symptoms similar to those of EVD include
acute promyelocytic leukaemia
,
haemolytic uraemic syndrome
,
snake envenomation
,
clotting factor
deficiencies/platelet disorders,
thrombotic thrombocytopenic purpura
,
hereditary haemorrhagic telangiectasia
,
Kawasaki disease
, and
warfarin
poisoning.
[
96
]
[
102
]
[
103
]
[
104
]
Prevention
Vaccines
An
Ebola vaccine
,
rVSV-ZEBOV
, was approved in the United States in December 2019.
[
105
]
It appears to be fully effective ten days after being given.
[
105
]
It was studied in Guinea between 2014 and 2016.
[
105
]
More than 100,000 people have been vaccinated against Ebola as of 2019
.
[
106
]
The WHO reported that approximately 345,000 people were given the vaccine during the
Kivu Ebola epidemic
from 2018 to 2020.
[
107
]
Infection control
VHF isolation precautions poster
Community awareness of the benefits on survival chances of admitting cases early is important for the infected and infection control
[
12
]
Caregivers
British woman wearing protective gear
People who care for those infected with Ebola should wear protective clothing including masks, gloves, gowns and goggles.
[
108
]
The U.S.
Centers for Disease Control
(CDC) recommend that the protective gear leaves no skin exposed.
[
109
]
These measures are also recommended for those who may handle objects contaminated by an infected person's body fluids.
[
110
]
In 2014, the CDC began recommending that medical personnel receive training on the proper suit-up and removal of
personal protective equipment
(PPE); in addition, a designated person, appropriately trained in biosafety, should be watching each step of these procedures to ensure they are done correctly.
[
109
]
In Sierra Leone, the typical training period for the use of such safety equipment lasts approximately 12 days.
[
111
]
In 2022 in Uganda, lighter personal protection equipment has become available as well as possibilities to monitor and communicate with patients from windows in the treatment tents until it is necessary to enter if e.g. a patient's oxygen levels drop.
[
12
]
Patients and household members
The infected person should be in
barrier-isolation
from other people.
[
108
]
All equipment, medical waste, patient waste and surfaces that may have come into contact with body fluids need to be
disinfected
.
[
110
]
During the 2014 outbreak, kits were put together to help families treat Ebola disease in their homes, which included protective clothing as well as
chlorine powder
and other cleaning supplies.
[
112
]
Education of caregivers in these techniques, and providing such barrier-separation supplies has been a priority of
Doctors Without Borders
.
[
113
]
Disinfection
Ebolaviruses can be
eliminated
with heat (heating for 30 to 60 minutes at 60 °C or boiling for five minutes). To
disinfect
surfaces, some lipid solvents such as some alcohol-based products, detergents, sodium hypochlorite (bleach) or
calcium hypochlorite
(bleaching powder), and other suitable disinfectants may be used at appropriate concentrations.
[
50
]
[
114
]
General population
Education of the general public about the risk factors for Ebola infection and of the protective measures individuals may take to prevent infection is recommended by the
World Health Organization
.
[
2
]
These measures include avoiding direct contact with infected people and regular
hand washing
using soap and water.
[
115
]
Bushmeat
Bushmeat
, an important source of protein in the diet of some Africans, should be handled and prepared with appropriate protective clothing and thoroughly cooked before consumption.
[
2
]
Some research suggests that an outbreak of Ebola disease in the wild animals used for consumption may result in a corresponding human outbreak. Since 2003, such animal outbreaks have been monitored to predict and prevent Ebola outbreaks in humans.
[
116
]
Corpses, burial
If a person with Ebola disease dies, direct contact with the body should be avoided.
[
108
]
Certain
burial rituals
, which may have included making various direct contacts with a dead body, require reformulation so that they consistently maintain a proper protective barrier between the dead body and the living.
[
110
]
[
117
]
[
118
]
Social anthropologists may help find alternatives to traditional rules for burials.
[
119
]
Transport, travel, contact
Transportation crews are instructed to follow a certain isolation procedure, should anyone exhibit symptoms resembling EVD.
[
120
]
As of August 2014
, the WHO does not consider travel bans to be useful in decreasing spread of the disease.
[
77
]
In October 2014, the CDC defined four risk levels used to determine the level of 21-day monitoring for symptoms and restrictions on public activities.
[
121
]
In the United States, the CDC recommends that restrictions on public activity, including travel restrictions, are not required for the following defined risk levels:
[
121
]
having been in a country with widespread Ebola disease transmission and having no known exposure (low risk); or having been in that country more than 21 days ago (no risk)
encounter with a person showing symptoms; but not within three feet of the person with Ebola without wearing PPE; and no direct contact with body fluids
having had brief skin contact with a person showing symptoms of Ebola disease when the person was believed to be not very contagious (low risk)
in countries without widespread Ebola disease transmission: direct contact with a person showing symptoms of the disease while wearing PPE (low risk)
contact with a person with Ebola disease before the person was showing symptoms (no risk).
The CDC recommends monitoring for the symptoms of Ebola disease for those both at "low risk" and at higher risk.
[
121
]
Laboratory
In laboratories where diagnostic testing is carried out,
biosafety level 4-equivalent containment
is required.
[
122
]
Laboratory researchers must be properly trained in BSL-4 practices and wear proper PPE.
[
122
]
Isolation
Isolation refers to separating those who are sick from those who are not.
Quarantine
refers to separating those who may have been exposed to a disease until they either show signs of the disease or are no longer at risk.
[
123
]
Quarantine, also known as enforced isolation, is usually effective in decreasing spread.
[
124
]
[
125
]
Governments often quarantine areas where the disease is occurring or individuals who may transmit the disease outside of an initial area.
[
126
]
In the United States, the law allows quarantine of those infected with ebolaviruses.
[
127
]
[
128
]
Contact tracing
Contact tracing
is considered important to contain an outbreak. It involves finding everyone who had close contact with infected individuals and monitoring them for signs of illness for 21 days. If any of these contacts comes down with the disease, they should be isolated, tested and treated. Then the process is repeated, tracing the contacts' contacts.
[
129
]
[
130
]
Management
As of 2019
two treatments (
atoltivimab/maftivimab/odesivimab
and
ansuvimab
) are associated with improved outcomes.
[
131
]
[
11
]
The U.S.
Food and Drug Administration
(FDA) advises people to be careful of advertisements making unverified or fraudulent claims of benefits supposedly gained from various anti-Ebola products.
[
132
]
[
133
]
In October 2020, the U.S.
Food and Drug Administration
(FDA) approved atoltivimab/maftivimab/odesivimab with an
indication
for the treatment of infection caused by
Zaire ebolavirus
.
[
13
]
Standard support
A hospital isolation ward in
Gulu, Uganda
, during the October 2000 outbreak
Treatment is primarily
supportive
in nature.
[
134
]
Early supportive care with rehydration and symptomatic treatment improves survival.
[
2
]
Rehydration may be via the
oral
or
intravenous
route.
[
134
]
These measures may include
pain management
, and treatment for
nausea
,
fever
, and
anxiety
.
[
134
]
The
World Health Organization
(WHO) recommends avoiding
aspirin
or
ibuprofen
for pain management, due to the risk of bleeding associated with these medications.
[
135
]
Blood products such as
packed red blood cells
,
platelets
, or
fresh frozen plasma
may also be used.
[
134
]
Other regulators of coagulation have also been tried including
heparin
in an effort to prevent
disseminated intravascular coagulation
and
clotting factors
to decrease bleeding.
[
134
]
Antimalarial medications
and
antibiotics
are often used before the diagnosis is confirmed,
[
134
]
though there is no evidence to suggest such treatment helps. Several
experimental treatments are being studied
.
[
136
]
Where hospital care is not possible, the WHO's guidelines for home care have been relatively successful. Recommendations include using towels soaked in a bleach solution when moving infected people or bodies and also applying bleach on stains. It is also recommended that the caregivers wash hands with bleach solutions and cover their mouth and nose with a cloth.
[
137
]
Intensive care
Intensive care
is often used in the developed world.
[
25
]
This may include maintaining blood volume and electrolytes (salts) balance as well as treating any bacterial infections that may develop.
[
25
]
Dialysis
may be needed for
kidney failure
, and
extracorporeal membrane oxygenation
may be used for lung dysfunction.
[
25
]
Prognosis
EVD has a
risk of death in those infected
of between 25% and 90%.
[
2
]
[
138
]
As of September 2014
, the average risk of death among those infected is 50%.
[
2
]
The highest risk of death was 90% in the 2002–2003
Republic of the Congo
outbreak.
[
139
]
Early admission significantly increases survival rates
[
12
]
Death, if it occurs, follows typically six to sixteen days after symptoms appear and is often due to
low blood pressure from fluid loss
.
[
4
]
Early supportive care to prevent dehydration may reduce the risk of death.
[
136
]
Post-Ebola virus syndrome
If an infected person survives, recovery may be quick and complete.
[
15
]
[
140
]
However, a large portion of survivors develop
post-Ebola virus syndrome
after the acute phase of the infection.
[
141
]
Prolonged cases are often complicated by the occurrence of long-term problems, such as
inflammation of the testicles
,
joint pains
, fatigue, hearing loss, mood and sleep disturbances,
muscular pain
, abdominal pain,
menstrual abnormalities
,
miscarriages
,
skin peeling
, or
hair loss
.
[
15
]
[
140
]
Inflammation and swelling of the uveal layer of the eye
is the most common eye complication in survivors of Ebola virus disease.
[
140
]
Eye symptoms, such as
light sensitivity
,
excess tearing
, and
vision loss
have been described.
[
142
]
Ebola can stay in some body parts like the eyes,
[
75
]
breasts, and testicles after infection.
[
7
]
[
143
]
Sexual transmission after recovery has been suspected.
[
144
]
[
145
]
If sexual transmission occurs following recovery, it is believed to be a rare event.
[
146
]
One case of a condition similar to
meningitis
has been reported many months after recovery, as of October 2015
.
[
147
]
Epidemiology
The disease typically occurs in outbreaks in tropical regions of
Sub-Saharan Africa
.
[
2
]
From 1976 (when it was first identified) through 2013, the WHO reported 2,387 confirmed cases with 1,590 overall fatalities.
[
2
]
[
148
]
The largest outbreak to date was the
Ebola virus epidemic in West Africa
, which caused a large number of deaths in
Guinea
,
Sierra Leone
, and
Liberia
.
[
149
]
[
150
]
1976
Sudan
Cotton factory in Nzara, South Sudan, where the first outbreak occurred
The first known outbreak of EVD was identified only after the fact. It occurred between June and November 1976, in
Nzara, South Sudan
[
33
]
[
151
]
(then part of
Sudan
), and was caused by
Sudan virus
(SUDV). The Sudan outbreak infected 284 people and killed 151. The first identifiable case in Sudan occurred on 27 June in a storekeeper in a cotton factory in
Nzara
, who was hospitalised on 30 June and died on 6 July.
[
25
]
[
152
]
Although the WHO medical staff involved in the Sudan outbreak knew that they were dealing with a heretofore unknown disease, the actual "positive identification" process and the naming of the virus did not occur until some months later in
Zaire
.
[
152
]
Zaire
A CDC worker incinerates medical waste from Ebola patients in Zaire in 1976.
On 26 August 1976, the second outbreak of EVD began in
Yambuku
, a small rural village in
Mongala District
in northern
Zaire
(now known as the
Democratic Republic of the Congo
).
[
153
]
[
154
]
This outbreak was caused by EBOV, formerly designated
Zaire ebolavirus
, a different member of the
genus
Ebolavirus
than in the first Sudan outbreak. The
first person infected with the disease
was the village school's headmaster
Mabalo Lokela
, who began displaying symptoms on 26 August 1976.
[
155
]
Lokela had returned from a trip to Northern Zaire near the border of the
Central African Republic
, after visiting the
Ebola River
between 12 and 22 August. He was originally believed to have
malaria
and was given
quinine
. However, his symptoms continued to worsen, and he was admitted to Yambuku Mission Hospital on 5 September. Lokela died on 8 September 14 days after he began displaying symptoms.
[
156
]
[
157
]
Soon after Lokela's death, others who had been in contact with him also died, and people in Yambuku began to panic. The country's Minister of Health and Zaire President
Mobutu Sese Seko
declared the entire region, including Yambuku and the country's capital,
Kinshasa
, a quarantine zone. No-one was permitted to enter or leave the area, and roads, waterways, and airfields were placed under
martial law
. Schools, businesses and social organisations were closed.
[
158
]
The initial response was led by Congolese doctors, including
Jean-Jacques Muyembe-Tamfum
, one of the discoverers of Ebola. Muyembe took a blood sample from a Belgian nun; this sample would eventually be used by
Peter Piot
to identify the previously unknown Ebola virus.
[
159
]
Muyembe was also the first scientist to come into direct contact with the disease and survive.
[
160
]
Researchers from the
Centers for Disease Control and Prevention
(CDC), including Piot, co-discoverer of Ebola, later arrived to assess the effects of the outbreak, observing that "the whole region was in panic."
[
161
]
[
162
]
[
163
]
Piot concluded that Belgian nuns had inadvertently started the epidemic by giving unnecessary vitamin injections to pregnant women without sterilizing the syringes and needles. The outbreak lasted 26 days and the quarantine lasted two weeks. Researchers speculated that the disease disappeared due to the precautions taken by locals, the quarantine of the area, and discontinuing of the injections.
[
158
]
During this outbreak, Ngoy Mushola recorded the first clinical description of EVD in
Yambuku
, where he wrote the following in his daily log: "The illness is characterised with a high temperature of about 39 °C (102 °F),
haematemesis
, diarrhoea with blood, retrosternal abdominal pain, prostration with 'heavy' articulations, and rapid evolution death after a mean of three days."
[
164
]
The virus responsible for the initial outbreak, first thought to be the
Marburg virus
, was later identified as a new type of virus related to the genus
Marburgvirus
. Virus strain samples isolated from both outbreaks were named "Ebola virus" after the
Ebola River
, near the first-identified viral outbreak site in Zaire.
[
25
]
Reports conflict about who initially coined the name: either Karl Johnson of the American CDC team
[
165
]
or Belgian researchers.
[
166
]
Subsequently, a number of other cases were reported, almost all centred on the Yambuku mission hospital or close contacts of another case.
[
155
]
In all, 318 cases and 280 deaths (an 88% fatality rate) occurred in Zaire.
[
167
]
Although the two outbreaks were at first believed connected, scientists later realised that they were caused by two distinct ebolaviruses, SUDV and EBOV.
[
154
]
1995–2014
Cases of Ebola fever in Africa since 1976
The second major outbreak occurred in Zaire (now the
Democratic Republic of the Congo
, DRC), in 1995, affecting 315 and killing 254.
[
2
]
In 2000,
Uganda
had an outbreak infecting 425 and killing 224; in this case, the Sudan virus was found to be the Ebola species responsible for the outbreak.
[
2
]
In 2003, an outbreak in the DRC infected 143 and killed 128, a 90% death rate, the highest of a
genus
Ebolavirus
outbreak to date.
[
168
]
In 2004, a Russian scientist died from Ebola after
sticking
herself with an infected needle.
[
169
]
Between April and August 2007, a fever epidemic
[
170
]
in a four-village region
[
171
]
of the DRC was confirmed in September to have been cases of Ebola.
[
172
]
Many people who attended the recent funeral of a local village chief died.
[
171
]
The 2007 outbreak eventually infected 264 individuals and killed 187.
[
2
]
On 30 November 2007, the Uganda Ministry of Health confirmed an outbreak of Ebola in the
Bundibugyo District
in Western Uganda. After confirming samples tested by the United States National Reference Laboratories and the Centers for Disease Control, the World Health Organization (WHO) confirmed the presence of a new species of
genus
Ebolavirus
, which was tentatively named Bundibugyo.
[
173
]
The WHO reported 149 cases of this new strain and 37 of those led to deaths.
[
2
]
The WHO confirmed two small outbreaks in Uganda in 2012, both caused by the Sudan variant. The first outbreak affected seven people, killing four, and the second affected 24, killing 17.
[
2
]
On 17 August 2012, the Ministry of Health of the DRC reported an outbreak of the Ebola-Bundibugyo variant
[
174
]
in the eastern region.
[
175
]
[
176
]
Other than its discovery in 2007, this was the only time that this variant has been identified as responsible for an outbreak. The WHO revealed that the virus had sickened 57 people and killed 29. The probable cause of the outbreak was tainted
bush meat
hunted by local villagers around the towns of
Isiro
and Viadana.
[
2
]
[
177
]
In 2014, an outbreak occurred in the DRC.
Genome-sequencing
showed that this outbreak was not related to the
2014–15 West Africa Ebola virus outbreak
, but was the same
EBOV
species, the Zaire species.
[
178
]
It began in August 2014, and was declared over in November with 66 cases and 49 deaths.
[
179
]
This was the 7th outbreak in the DRC, three of which occurred during the period when the country was known as
Zaire
.
[
180
]
2013–2016 West Africa
Cases and deaths from April 2014 to July 2015 during the
2013–2015 outbreak
In March 2014, the
World Health Organization
(WHO) reported a major Ebola outbreak in
Guinea
, a West African nation.
[
181
]
Researchers traced the outbreak to a one-year-old child who died in December 2013.
[
182
]
[
183
]
The disease rapidly spread to the neighbouring countries of
Liberia
and
Sierra Leone
. It was the largest Ebola outbreak ever documented, and the first recorded in the region.
[
181
]
On 8 August 2014, the WHO declared the epidemic an international public health emergency. Urging the world to offer aid to the affected regions, its Director-General said, "Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible."
[
184
]
By mid-August 2014,
Doctors Without Borders
reported the situation in Liberia's capital,
Monrovia
, was "catastrophic" and "deteriorating daily". They reported that fears of Ebola among staff members and patients had shut down much of the city's health system, leaving many people without medical treatment for other conditions.
[
185
]
In a 26 September statement, WHO said, "The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times. Never before in recorded history has a
biosafety level
four pathogen infected so many people so quickly, over such a broad geographical area, for so long."
[
186
]
Intense contact tracing and strict isolation largely prevented further spread of the disease in the countries that had imported cases.
It caused significant mortality, with a considerable
case fatality rate
.
[
187
]
[
188
]
[
189
]
[
note 1
]
By the end of the epidemic, 28,616 people had been infected; of these, 11,310 had died, for a case-fatality rate of 40%.
[
190
]
As of 8 May 2016
, 28,646 suspected cases and 11,323 deaths were reported;
[
191
]
[
192
]
however, the WHO said that these numbers may be underestimated.
[
193
]
Because they work closely with the body fluids of infected patients, healthcare workers were especially vulnerable to infection; in August 2014, the WHO reported that 10% of the dead were healthcare workers.
[
194
]
2014 Ebola virus epidemic in West Africa
In September 2014, it was estimated that the countries' capacity for treating Ebola patients was insufficient by the equivalent of 2,122 beds; by December there were a sufficient number of beds to treat and isolate all reported Ebola cases, although the uneven distribution of cases was causing serious shortfalls in some areas.
[
195
]
On 28 January 2015, the WHO reported that for the first time since the week ending 29 June 2014, there had been fewer than 100 new confirmed cases reported in a week in the three most-affected countries. The response to the epidemic then moved to a second phase, as the focus shifted from slowing transmission to ending the epidemic.
[
196
]
On 8 April 2015, the WHO reported only 30 confirmed cases, the lowest weekly total since the third week of May 2014.
[
197
]
On 29 December 2015, 42 days after the last person tested negative for a second time, Guinea was declared free of Ebola transmission.
[
198
]
At that time, a 90-day period of heightened surveillance was announced by that agency. "This is the first time that all three countries – Guinea, Liberia and Sierra Leone – have stopped the original chains of transmission ...", the organisation stated in a news release.
[
199
]
A new case was detected in Sierra Leone on 14 January 2016.
[
200
]
However, the outbreak was declared no longer an emergency on 29 March 2016.
[
201
]
2014 spread outside West Africa
On 19 September, Eric Duncan flew from his native Liberia to Texas; five days later he began showing symptoms and visited a hospital but was sent home. His condition worsened and he returned to the hospital on 28 September, where he died on 8 October. Health officials confirmed a diagnosis of Ebola on 30 September – the first case in the United States.
[
202
]
In early October, Teresa Romero, a 44-year-old Spanish nurse, contracted Ebola after caring for a priest who had been repatriated from West Africa. This was the first transmission of the virus to occur outside Africa.
[
203
]
Romero tested negative for the disease on 20 October, suggesting that she may have recovered from Ebola infection.
[
204
]
On 12 October, the
Centers for Disease Control and Prevention
(CDC) confirmed that a nurse in Texas,
Nina Pham
, who had treated Duncan tested positive for the Ebola virus, the first known case of transmission in the United States.
[
205
]
On 15 October, a second Texas health-care worker who had treated Duncan was confirmed to have the virus.
[
84
]
Both of these people recovered.
[
206
]
An unrelated case involved a doctor in New York City, who returned to the United States from Guinea after working with
Médecins Sans Frontières
and tested positive for Ebola on 23 October.
[
207
]
The person recovered and was discharged from
Bellevue Hospital
on 11 November.
[
206
]
On 24 December 2014, a laboratory in
Atlanta
, Georgia reported that a technician had been exposed to Ebola.
[
208
]
On 29 December 2014,
Pauline Cafferkey
, a British nurse who had just returned to
Glasgow
from Sierra Leone, was diagnosed with Ebola at Glasgow's
Gartnavel General Hospital
.
[
209
]
After initial treatment in Glasgow, she was transferred by air to
RAF Northolt
, then to the specialist
high-level isolation unit
at the
Royal Free Hospital
in
London
for longer-term treatment.
[
210
]
2017 Democratic Republic of the Congo
On 11 May 2017, the DRC Ministry of Public Health notified the WHO about an outbreak of Ebola. Four people died, and four people survived; five of these eight cases were laboratory-confirmed. A total of 583 contacts were monitored. On 2 July 2017, the WHO declared the end of the outbreak.
[
211
]
2018 Équateur province
On 14 May 2018, the World Health Organization reported that "the Democratic Republic of Congo reported 39 suspected, probable or confirmed cases of Ebola between 4 April and 13 May, including 19 deaths."
[
212
]
Some 393 people identified as contacts of Ebola patients were being followed up. The outbreak centred on the
Bikoro
, Iboko, and
Wangata
areas in
Equateur
province,
[
212
]
including in the large city of
Mbandaka
. The DRC Ministry of Public Health approved the use of an experimental vaccine.
[
213
]
[
214
]
[
215
]
On 13 May 2018, WHO Director-General
Tedros Adhanom Ghebreyesus
visited Bikoro.
[
216
]
Reports emerged that maps of the area were inaccurate, not so much hampering medical providers as
epidemiologists
and officials trying to assess the outbreak and containment efforts.
[
217
]
The 2018 outbreak in the DRC was declared over on 24 July 2018.
[
218
]
2018–2020 Kivu
On 1 August 2018, the world's 10th Ebola outbreak was declared in
North Kivu
province of the Democratic Republic of the Congo. It was the first Ebola outbreak in a military conflict zone, with thousands of refugees in the area.
[
219
]
[
220
]
By November 2018, nearly 200 Congolese had died of Ebola, about half of them from the city of
Beni
, where armed groups are fighting over the region's mineral wealth, impeding medical relief efforts.
[
221
]
By March 2019, this became the second largest Ebola outbreak ever recorded, with more than 1,000 cases and insecurity continuing to be the major resistance to providing an adequate response.
[
222
]
[
223
]
As of 4 June 2019
, the WHO reported 2025 confirmed and probable cases with 1357 deaths.
[
224
]
In June 2019, two people died of Ebola in neighbouring
Uganda
.
[
225
]
In July 2019, an infected man travelled to
Goma
, home to more than two million people.
[
226
]
One week later, on 17 July 2019, the WHO declared the Ebola outbreak a
global health emergency
, the fifth time such a declaration has been made by the organisation.
[
227
]
A government spokesman said that half of the Ebola cases are unidentified, and he added that the current outbreak could last up to three years.
[
228
]
On 25 June 2020, the second biggest EVD outbreak ever was declared over.
[
229
]
2020 Équateur province
On 1 June 2020, the Congolese health ministry announced a new DRC outbreak of Ebola in
Mbandaka
,
Équateur Province
, a region along the Congo River. Genome sequencing suggests that this outbreak, the 11th outbreak since the virus was first discovered in the country in 1976, is unrelated to the one in North Kivu Province or the previous outbreak in the same area in 2018. It was reported that six cases had been identified; four of the people had died. It is expected that more people will be identified as surveillance activities increase.
[
230
]
By 15 June the case count had increased to 17 with 11 deaths, with more than 2,500 people having been vaccinated.
[
231
]
The 11th EVD outbreak was officially declared over on 19 November 2020.
[
232
]
By the time the Équateur outbreak ended, it had 130 confirmed cases with 75 recoveries and 55 deaths.
2021
North Kivu
On 7 February 2021, the Congolese health ministry announced a new case of Ebola near Butembo, North Kivu detected a day before. The case was a 42-year-old woman who had symptoms of Ebola in Biena on 1 February 2021. A few days after, she died in a hospital in Butembo. The WHO said that more than 70 people with contact with the woman had been tracked.
[
233
]
[
234
]
On 11 February 2021, another woman who had contact with the previous woman died in the same town, and the number of traced contacts increased to 100.
[
235
]
A day after, a third case was detected in Butembo.
[
236
]
On 3 May 2021, the 12th EVD outbreak was declared over, resulting in 12 cases and six deaths.
[
237
]
[
238
]
Heightened surveillance will continue for 90 days after the declaration, in case of resurgence.
[
237
]
Guinea
In February 2021, Sakoba Keita, head of Guinea's national health agency confirmed that three people had died of Ebola in the south-eastern region near the city of Nzérékoré. A further five people also tested positive. Keita also confirmed more testing was underway, and attempts to trace and isolate further cases had begun.
[
239
]
On 14 February, the Guinean government declared an Ebola epidemic.
[
240
]
The outbreak may have started following reactivation of a
latent case
in a survivor of an earlier outbreak.
[
241
]
[
242
]
As of 4 May 2021, 23 cases were reported, with no new cases or deaths since 3 April 2021.
[
237
]
A 42-day countdown period was started on 8 May 2021, and on 19 June, the outbreak was declared over.
[
237
]
[
243
]
Ivory Coast
On 14 August 2021, The Ministry of Health of
Cote d’Ivoire
confirmed the country's first case of Ebola since 1994. This came after the Institut Pasteur in Cote d'Ivoire confirmed the Ebola Virus Disease in samples collected from a patient, who was hospitalized in the commercial capital of
Abidjan
, after arriving from Guinea.
[
244
]
However, on 31 August 2021, the WHO found that, after further tests in a laboratory in
Lyon
, the patient did not have Ebola. The cause of her disease is still being analyzed.
[
245
]
2022
On 23 April 2022, a case of Ebola was confirmed in the DRC in the Equateur province. The case was a 31-year-old man whose symptoms began on 5 April, but did not seek treatment for over a week. On 21 April, he was admitted to an Ebola treatment centre and died later that day.
[
246
]
By 24 May 2022, there were 5 recorded deaths in the DRC.
[
247
]
On 15 August, the fifth case was buried, and the outbreak was declared over, 42 days after, on 4 July 2022.
[
248
]
In September 2022,
Uganda reported 7 cases infected with the Ebola Sudan strain
,
[
249
]
but by mid-October the count had increased to 63.
[
250
]
In November 2022, the outbreak in Uganda continued — still without a vaccine.
[
12
]
On 10 January 2023, the outbreak was considered over after no new cases had been reported for 42 days; the outbreak killed nearly 80 people.
[
251
]
History
Ebola was first identified in 1976, in two simultaneous outbreaks, one in
Nzara
(a town in
South Sudan
) and the other in
Yambuku
(
the Democratic Republic of the Congo
), a village near the
Ebola River
, for which the disease was named.
[
2
]
Ebola outbreaks
occur intermittently in tropical regions of
sub-Saharan Africa
.
[
2
]
Between 1976 and 2012, according to the
World Health Organization
, there were 24 outbreaks of Ebola resulting in a total of
2,387 cases, and 1,590 deaths
.
[
2
]
[
148
]
The largest Ebola outbreak to date was an
epidemic in West Africa
from December 2013 to January 2016, with 28,646 cases and 11,323 deaths.
[
191
]
[
149
]
[
150
]
On 29 March 2016, it was declared to no longer be an emergency.
[
201
]
Other outbreaks in Africa began in the Democratic Republic of the Congo in May 2017,
[
252
]
[
253
]
and 2018.
[
254
]
[
218
]
In July 2019, the World Health Organization declared the Congo Ebola outbreak a
world health emergency
.
[
255
]
Society and culture
Weaponisation
Ebolavirus
is classified as a
biosafety level 4
agent, as well as a
Category A bioterrorism
agent by the Centers for Disease Control and Prevention.
[
88
]
[
256
]
It has the potential to be weaponised for use in
biological warfare
,
[
257
]
[
258
]
and was investigated by
Biopreparat
for such use, but might be difficult to prepare as a
weapon of mass destruction
because the virus becomes ineffective quickly in open air.
[
259
]
Fake emails pretending to be Ebola information from the WHO or the Mexican government have, in 2014, been misused to spread computer malware.
[
260
]
The BBC reported in 2015 that "North Korean state media has suggested the disease was created by the U.S. military as a biological weapon."
[
261
]
Displacement
Analysis of the 2014–2015 Ebola epidemic found that outbreaks can trigger displacement, as fear of infection, quarantine measures, lack of essential supplies, stigma, and violence around the response can lead people and even entire communities to flee their homes.
[
262
]
Literature
Richard Preston
's 1995
best-selling
book,
The Hot Zone
, dramatised the Ebola outbreak in Reston, Virginia.
[
263
]
[
264
]
[
265
]
William Close
's 1995
Ebola: A Documentary Novel of Its First Explosion
[
266
]
[
267
]
and 2002
Ebola: Through the Eyes of the People
focused on individuals' reactions to the 1976 Ebola outbreak in Zaire.
[
268
]
[
269
]
Tom Clancy
's 1996 novel,
Executive Orders
, involves a
Middle Eastern
terrorist attack on the United States using an airborne form of a deadly Ebola virus strain named "Ebola Mayinga" (see
Mayinga N'Seka
).
[
270
]
[
271
]
As the Ebola virus epidemic in West Africa developed in 2014, a number of popular self-published and well-reviewed books containing sensational and misleading information about the disease appeared in electronic and printed formats. The authors of some such books admitted that they lacked medical credentials and were not technically qualified to give medical advice. The World Health Organization and the United Nations stated that such misinformation had contributed to the spread of the disease.
[
272
]
Other animals
Wild animals
Ebola has a high mortality rate among primates.
[
273
]
Frequent outbreaks of Ebola may have resulted in the deaths of 5,000 gorillas.
[
274
]
Outbreaks of Ebola may have been responsible for an 88% decline in tracking indices of observed chimpanzee populations in the 420 km
2
Lossi Sanctuary between 2002 and 2003.
[
275
]
Transmission among chimpanzees through meat consumption constitutes a significant risk factor, whereas contact between the animals, such as touching dead bodies and grooming, is not.
[
276
]
Recovered gorilla carcasses have contained multiple Ebola virus strains, suggesting multiple introductions of the virus. Bodies decompose quickly and carcasses are not infectious after three to four days. Contact between gorilla groups is rare, suggesting that transmission among gorilla groups is unlikely, and that outbreaks result from transmission between viral reservoirs and animal populations.
[
275
]
Domestic animals
In 2012, it was demonstrated that the virus can travel without contact from pigs to nonhuman primates, although the same study failed to achieve transmission in that manner between primates.
[
52
]
[
87
]
Dogs may become infected with EBOV but not develop symptoms. Dogs in some parts of Africa
scavenge
for food, and they sometimes eat EBOV-infected animals and also the corpses of humans. A 2005 survey of dogs during an EBOV outbreak found that although they remain asymptomatic, about 32 percent of dogs closest to an outbreak showed a
seroprevalence
for EBOV versus nine percent of those farther away.
[
277
]
The authors concluded that there were "potential implications for preventing and controlling human outbreaks."
Reston virus
For more about the outbreak in Virginia, US, see
Reston virus
.
In late 1989, Hazelton Research Products' Reston Quarantine Unit in
Reston, Virginia
, had an outbreak of fatal illness amongst certain lab monkeys. This lab outbreak was initially diagnosed as
simian haemorrhagic fever virus
(SHFV) and occurred amongst a shipment of
crab-eating macaque
monkeys imported from the Philippines. Hazelton's veterinary pathologist in Reston sent tissue samples from dead animals to the
United States Army Medical Research Institute of Infectious Diseases
(USAMRIID) at
Fort Detrick, Maryland
, where an
ELISA
test indicated the antibodies present in the tissue were a response to Ebola virus and not SHFV.
[
278
]
An electron microscopist from USAMRIID discovered
filoviruses
similar in appearance, in crystalloid aggregates and as single filaments with a shepherd's hook, to Ebola in the tissue samples sent from Hazelton Research Products' Reston Quarantine Unit.
[
279
]
A
US Army
team headquartered at USAMRIID
euthanised
the surviving monkeys, and brought all the dead monkeys to Fort Detrick for study by the Army's veterinary pathologists and virologists, and eventual disposal under safe conditions.
[
278
]
Blood samples were taken from 178 animal handlers during the incident.
[
280
]
Of those, six animal handlers eventually
seroconverted
, including one who had cut himself with a bloody scalpel.
[
89
]
[
281
]
Despite its status as a
Level‑4
organism and its apparent
pathogenicity
in monkeys, when the handlers did not become ill, the CDC concluded that the virus had a very low pathogenicity to humans.
[
281
]
[
282
]
The Philippines and the United States had no previous cases of Ebola infection, and upon further isolation, researchers concluded it was another strain of Ebola, or a new filovirus of Asian origin, which they named
Reston ebolavirus
(RESTV) after the location of the incident.
[
278
]
Reston virus (RESTV) can be transmitted to pigs.
[
52
]
Since the initial outbreak it has since been found in nonhuman
primates
in Pennsylvania, Texas, and Italy,
[
283
]
where the virus had infected pigs.
[
284
]
According to the WHO, routine cleaning and disinfection of pig (or monkey) farms with
sodium hypochlorite
or
detergents
should be effective in inactivating the
Reston ebolavirus
. Pigs that have been infected with RESTV tend to show
symptoms
of the disease.
[
285
]
Research
Treatments
Researchers looking at slides of cultures of cells that make
monoclonal antibodies
. These are grown in a lab and the researchers are analyzing the products to select the most promising.
As of July 2015
, no medication has been proven safe and effective for treating Ebola. By the time the
Ebola virus epidemic in West Africa
began in 2013, there were at least nine different candidate treatments. Several trials were conducted in late 2014, and early 2015, but some were abandoned due to lack of efficacy or lack of people to study.
[
286
]
As of August 2019
, two experimental treatments known as
atoltivimab/maftivimab/odesivimab
and
ansuvimab
were found to be 90% effective.
[
287
]
[
288
]
[
289
]
Diagnostic tests
The diagnostic tests currently available require specialised equipment and highly trained personnel. Since there are few suitable testing centres in West Africa, this leads to delay in diagnosis.
[
290
]
On 29 November 2014, a new 15-minute Ebola test was reported that if successful, "not only gives patients a better chance of survival, but it prevents transmission of the virus to other people." The new equipment, about the size of a laptop and solar-powered, allows testing to be done in remote areas.
[
291
]
On 29 December 2014, the U.S.
Food and Drug Administration
(FDA) approved the LightMix Ebola Zaire
rRT-PCR
test for patients with symptoms of Ebola.
[
292
]
Disease models
Animal models and in particular non-human primates are being used to study different aspects of Ebola virus disease. Developments in
organ-on-a-chip
technology have led to a chip-based model for Ebola haemorrhagic syndrome.
[
293
]
See also
Bibliography of Ebola
Notes
^
The mortality (number of dead per number of healthy per time frame) recorded in Liberia up to 26 August 2014 was 70%.
[
189
]
However, due to the estimation method used, the estimated case fatality rate (70.8%) for this particular epidemic differs from the actual ratio between the number of deaths and the number of cases.
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articles related to Ebola; note these are general reading articles, they are not scientific peer-reviewed research articles. | ||||||||||||
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## Contents
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- [(Top)](https://en.wikipedia.org/wiki/Ebola)
- [1 Signs and symptoms](https://en.wikipedia.org/wiki/Ebola#Signs_and_symptoms)
Toggle Signs and symptoms subsection
- [1\.1 Onset](https://en.wikipedia.org/wiki/Ebola#Onset)
- [1\.2 Bleeding](https://en.wikipedia.org/wiki/Ebola#Bleeding)
- [1\.3 Recovery or death](https://en.wikipedia.org/wiki/Ebola#Recovery_or_death)
- [2 Cause](https://en.wikipedia.org/wiki/Ebola#Cause)
Toggle Cause subsection
- [2\.1 Virology](https://en.wikipedia.org/wiki/Ebola#Virology)
- [2\.2 Initial case](https://en.wikipedia.org/wiki/Ebola#Initial_case)
- [2\.3 Reservoir](https://en.wikipedia.org/wiki/Ebola#Reservoir)
- [3 Transmission](https://en.wikipedia.org/wiki/Ebola#Transmission)
- [4 Pathophysiology](https://en.wikipedia.org/wiki/Ebola#Pathophysiology)
Toggle Pathophysiology subsection
- [4\.1 Immune system evasion](https://en.wikipedia.org/wiki/Ebola#Immune_system_evasion)
- [5 Diagnosis](https://en.wikipedia.org/wiki/Ebola#Diagnosis)
Toggle Diagnosis subsection
- [5\.1 Laboratory testing](https://en.wikipedia.org/wiki/Ebola#Laboratory_testing)
- [5\.2 Differential diagnosis](https://en.wikipedia.org/wiki/Ebola#Differential_diagnosis)
- [6 Prevention](https://en.wikipedia.org/wiki/Ebola#Prevention)
Toggle Prevention subsection
- [6\.1 Vaccines](https://en.wikipedia.org/wiki/Ebola#Vaccines)
- [6\.2 Infection control](https://en.wikipedia.org/wiki/Ebola#Infection_control)
- [6\.2.1 Caregivers](https://en.wikipedia.org/wiki/Ebola#Caregivers)
- [6\.2.2 Patients and household members](https://en.wikipedia.org/wiki/Ebola#Patients_and_household_members)
- [6\.2.3 Disinfection](https://en.wikipedia.org/wiki/Ebola#Disinfection)
- [6\.2.4 General population](https://en.wikipedia.org/wiki/Ebola#General_population)
- [6\.2.5 Bushmeat](https://en.wikipedia.org/wiki/Ebola#Bushmeat)
- [6\.2.6 Corpses, burial](https://en.wikipedia.org/wiki/Ebola#Corpses,_burial)
- [6\.2.7 Transport, travel, contact](https://en.wikipedia.org/wiki/Ebola#Transport,_travel,_contact)
- [6\.2.8 Laboratory](https://en.wikipedia.org/wiki/Ebola#Laboratory)
- [6\.3 Isolation](https://en.wikipedia.org/wiki/Ebola#Isolation)
- [6\.4 Contact tracing](https://en.wikipedia.org/wiki/Ebola#Contact_tracing)
- [7 Management](https://en.wikipedia.org/wiki/Ebola#Management)
Toggle Management subsection
- [7\.1 Standard support](https://en.wikipedia.org/wiki/Ebola#Standard_support)
- [7\.2 Intensive care](https://en.wikipedia.org/wiki/Ebola#Intensive_care)
- [8 Prognosis](https://en.wikipedia.org/wiki/Ebola#Prognosis)
Toggle Prognosis subsection
- [8\.1 Post-Ebola virus syndrome](https://en.wikipedia.org/wiki/Ebola#Post-Ebola_virus_syndrome)
- [9 Epidemiology](https://en.wikipedia.org/wiki/Ebola#Epidemiology)
Toggle Epidemiology subsection
- [9\.1 1976](https://en.wikipedia.org/wiki/Ebola#1976)
- [9\.1.1 Sudan](https://en.wikipedia.org/wiki/Ebola#Sudan)
- [9\.1.2 Zaire](https://en.wikipedia.org/wiki/Ebola#Zaire)
- [9\.2 1995–2014](https://en.wikipedia.org/wiki/Ebola#1995%E2%80%932014)
- [9\.3 2013–2016 West Africa](https://en.wikipedia.org/wiki/Ebola#2013%E2%80%932016_West_Africa)
- [9\.3.1 2014 spread outside West Africa](https://en.wikipedia.org/wiki/Ebola#2014_spread_outside_West_Africa)
- [9\.4 2017 Democratic Republic of the Congo](https://en.wikipedia.org/wiki/Ebola#2017_Democratic_Republic_of_the_Congo)
- [9\.5 2018 Équateur province](https://en.wikipedia.org/wiki/Ebola#2018_%C3%89quateur_province)
- [9\.6 2018–2020 Kivu](https://en.wikipedia.org/wiki/Ebola#2018%E2%80%932020_Kivu)
- [9\.7 2020 Équateur province](https://en.wikipedia.org/wiki/Ebola#2020_%C3%89quateur_province)
- [9\.8 2021](https://en.wikipedia.org/wiki/Ebola#2021)
- [9\.8.1 North Kivu](https://en.wikipedia.org/wiki/Ebola#North_Kivu)
- [9\.8.2 Guinea](https://en.wikipedia.org/wiki/Ebola#Guinea)
- [9\.8.3 Ivory Coast](https://en.wikipedia.org/wiki/Ebola#Ivory_Coast)
- [9\.9 2022](https://en.wikipedia.org/wiki/Ebola#2022)
- [10 History](https://en.wikipedia.org/wiki/Ebola#History)
- [11 Society and culture](https://en.wikipedia.org/wiki/Ebola#Society_and_culture)
Toggle Society and culture subsection
- [11\.1 Weaponisation](https://en.wikipedia.org/wiki/Ebola#Weaponisation)
- [11\.2 Displacement](https://en.wikipedia.org/wiki/Ebola#Displacement)
- [11\.3 Literature](https://en.wikipedia.org/wiki/Ebola#Literature)
- [12 Other animals](https://en.wikipedia.org/wiki/Ebola#Other_animals)
Toggle Other animals subsection
- [12\.1 Wild animals](https://en.wikipedia.org/wiki/Ebola#Wild_animals)
- [12\.2 Domestic animals](https://en.wikipedia.org/wiki/Ebola#Domestic_animals)
- [12\.3 Reston virus](https://en.wikipedia.org/wiki/Ebola#Reston_virus)
- [13 Research](https://en.wikipedia.org/wiki/Ebola#Research)
Toggle Research subsection
- [13\.1 Treatments](https://en.wikipedia.org/wiki/Ebola#Treatments)
- [13\.2 Diagnostic tests](https://en.wikipedia.org/wiki/Ebola#Diagnostic_tests)
- [13\.3 Disease models](https://en.wikipedia.org/wiki/Ebola#Disease_models)
- [14 See also](https://en.wikipedia.org/wiki/Ebola#See_also)
- [15 Notes](https://en.wikipedia.org/wiki/Ebola#Notes)
- [16 References](https://en.wikipedia.org/wiki/Ebola#References)
Toggle References subsection
- [16\.1 Bibliography](https://en.wikipedia.org/wiki/Ebola#Bibliography)
- [17 Further reading](https://en.wikipedia.org/wiki/Ebola#Further_reading)
- [18 External links](https://en.wikipedia.org/wiki/Ebola#External_links)
Toggle the table of contents
# Ebola
135 languages
- [Afrikaans](https://af.wikipedia.org/wiki/Ebola "Ebola – Afrikaans")
- [Alemannisch](https://als.wikipedia.org/wiki/Ebolafieber "Ebolafieber – Alemannic")
- [አማርኛ](https://am.wikipedia.org/wiki/%E1%8A%A2%E1%89%A6%E1%88%8B "ኢቦላ – Amharic")
- [العربية](https://ar.wikipedia.org/wiki/%D9%85%D8%B1%D8%B6_%D9%81%D9%8A%D8%B1%D9%88%D8%B3_%D8%A5%D9%8A%D8%A8%D9%88%D9%84%D8%A7 "مرض فيروس إيبولا – Arabic")
- [مصرى](https://arz.wikipedia.org/wiki/%D9%85%D8%B1%D8%B6_%D9%81%D9%8A%D8%B1%D9%88%D8%B3_%D8%A7%D9%8A%D8%A8%D9%88%D9%84%D8%A7 "مرض فيروس ايبولا – Egyptian Arabic")
- [অসমীয়া](https://as.wikipedia.org/wiki/%E0%A6%87%E0%A6%AC%27%E0%A6%B2%E0%A6%BE_%E0%A6%AD%E0%A6%BE%E0%A6%87%E0%A7%B0%E0%A6%BE%E0%A6%9B_%E0%A7%B0%E0%A7%8B%E0%A6%97 "ইব'লা ভাইৰাছ ৰোগ – Assamese")
- [Asturianu](https://ast.wikipedia.org/wiki/Enfermed%C3%A1_pol_virus_del_%C3%89bola "Enfermedá pol virus del Ébola – Asturian")
- [Azərbaycanca](https://az.wikipedia.org/wiki/Ebola_virusu_x%C9%99st%C9%99liyi "Ebola virusu xəstəliyi – Azerbaijani")
- [Žemaitėška](https://bat-smg.wikipedia.org/wiki/Ebuola "Ebuola – Samogitian")
- [Беларуская](https://be.wikipedia.org/wiki/%D0%93%D0%B5%D0%BC%D0%B0%D1%80%D0%B0%D0%B3%D1%96%D1%87%D0%BD%D0%B0%D1%8F_%D0%BB%D1%96%D1%85%D0%B0%D0%BC%D0%B0%D0%BD%D0%BA%D0%B0_%D0%AD%D0%B1%D0%BE%D0%BB%D0%B0 "Гемарагічная ліхаманка Эбола – Belarusian")
- [Български](https://bg.wikipedia.org/wiki/%D0%95%D0%B1%D0%BE%D0%BB%D0%B0 "Ебола – Bulgarian")
- [Bamanankan](https://bm.wikipedia.org/wiki/Ebola_virisi_bana "Ebola virisi bana – Bambara")
- [বাংলা](https://bn.wikipedia.org/wiki/%E0%A6%87%E0%A6%AC%E0%A7%8B%E0%A6%B2%E0%A6%BE_%E0%A6%AD%E0%A6%BE%E0%A6%87%E0%A6%B0%E0%A6%BE%E0%A6%B8%E0%A6%9C%E0%A6%A8%E0%A6%BF%E0%A6%A4_%E0%A6%B0%E0%A7%8B%E0%A6%97 "ইবোলা ভাইরাসজনিত রোগ – Bangla")
- [Brezhoneg](https://br.wikipedia.org/wiki/Kle%C3%B1ved_viruz_Ebola "Kleñved viruz Ebola – Breton")
- [Bosanski](https://bs.wikipedia.org/wiki/Ebola_\(bolest\) "Ebola (bolest) – Bosnian")
- [Буряад](https://bxr.wikipedia.org/wiki/%D0%AD%D0%B1%D0%BE%D0%BB%D0%B0_%D0%B2%D0%B8%D1%80%D1%83%D1%81%D0%B0%D0%B9_%D2%AF%D0%B1%D1%88%D1%8D%D0%BD "Эбола вирусай үбшэн – Russia Buriat")
- [Català](https://ca.wikipedia.org/wiki/Febre_hemorr%C3%A0gica_de_l%27Ebola "Febre hemorràgica de l'Ebola – Catalan")
- [کوردی](https://ckb.wikipedia.org/wiki/%D9%86%DB%95%D8%AE%DB%86%D8%B4%DB%8C%DB%8C_%D8%A6%DB%8E%D8%A8%DB%86%D9%84%D8%A7 "نەخۆشیی ئێبۆلا – Central Kurdish")
- [Čeština](https://cs.wikipedia.org/wiki/Ebola "Ebola – Czech")
- [Cymraeg](https://cy.wikipedia.org/wiki/Clefyd_firaol_Ebola "Clefyd firaol Ebola – Welsh")
- [Dansk](https://da.wikipedia.org/wiki/Ebola "Ebola – Danish")
- [Dagbanli](https://dag.wikipedia.org/wiki/Ebola "Ebola – Dagbani")
- [Deutsch](https://de.wikipedia.org/wiki/Ebolafieber "Ebolafieber – German")
- [Thuɔŋjäŋ](https://din.wikipedia.org/wiki/Ebu%C9%94la "Ebuɔla – Dinka")
- [Eʋegbe](https://ee.wikipedia.org/wiki/Ebola_d%C9%94lele "Ebola dɔlele – Ewe")
- [Ελληνικά](https://el.wikipedia.org/wiki/%CE%91%CF%83%CE%B8%CE%AD%CE%BD%CE%B5%CE%B9%CE%B1_%CE%B9%CE%BF%CF%8D_%CE%88%CE%BC%CF%80%CE%BF%CE%BB%CE%B1 "Ασθένεια ιού Έμπολα – Greek")
- [Esperanto](https://eo.wikipedia.org/wiki/Ebola_malsano "Ebola malsano – Esperanto")
- [Español](https://es.wikipedia.org/wiki/Enfermedad_por_el_virus_del_%C3%89bola "Enfermedad por el virus del Ébola – Spanish")
- [Eesti](https://et.wikipedia.org/wiki/Ebola_viirushaigus "Ebola viirushaigus – Estonian")
- [Euskara](https://eu.wikipedia.org/wiki/Ebola_gaixotasun_biriko "Ebola gaixotasun biriko – Basque")
- [فارسی](https://fa.wikipedia.org/wiki/%D8%A8%DB%8C%D9%85%D8%A7%D8%B1%DB%8C_%D9%88%DB%8C%D8%B1%D9%88%D8%B3%DB%8C_%D8%A7%D8%A8%D9%88%D9%84%D8%A7 "بیماری ویروسی ابولا – Persian")
- [Fulfulde](https://ff.wikipedia.org/wiki/Ebola "Ebola – Fula")
- [Suomi](https://fi.wikipedia.org/wiki/Ebola "Ebola – Finnish")
- [Føroyskt](https://fo.wikipedia.org/wiki/Ebola "Ebola – Faroese")
- [Français](https://fr.wikipedia.org/wiki/Maladie_%C3%A0_virus_Ebola "Maladie à virus Ebola – French")
- [Galego](https://gl.wikipedia.org/wiki/%C3%89bola "Ébola – Galician")
- [Avañe'ẽ](https://gn.wikipedia.org/wiki/%C3%89bola_v%C3%ADru_mba%27asy "Ébola víru mba'asy – Guarani")
- [Ghanaian Pidgin](https://gpe.wikipedia.org/wiki/Ebola "Ebola – Ghanaian Pidgin")
- [Hausa](https://ha.wikipedia.org/wiki/%C6%98wayoyin_cuta_na_Ebola "Ƙwayoyin cuta na Ebola – Hausa")
- [עברית](https://he.wikipedia.org/wiki/%D7%90%D7%91%D7%95%D7%9C%D7%94 "אבולה – Hebrew")
- [हिन्दी](https://hi.wikipedia.org/wiki/%E0%A4%87%E0%A4%AC%E0%A5%8B%E0%A4%B2%E0%A4%BE_%E0%A4%B5%E0%A4%BE%E0%A4%AF%E0%A4%B0%E0%A4%B8_%E0%A4%B0%E0%A5%8B%E0%A4%97 "इबोला वायरस रोग – Hindi")
- [Hrvatski](https://hr.wikipedia.org/wiki/Ebola "Ebola – Croatian")
- [Kreyòl ayisyen](https://ht.wikipedia.org/wiki/Maladi_viris_Ebola "Maladi viris Ebola – Haitian Creole")
- [Magyar](https://hu.wikipedia.org/wiki/Ebola_\(betegs%C3%A9g\) "Ebola (betegség) – Hungarian")
- [Հայերեն](https://hy.wikipedia.org/wiki/%D4%B7%D5%A2%D5%B8%D5%AC%D5%A1_%D5%BE%D5%AB%D6%80%D5%B8%D6%82%D5%BD%D5%A1%D5%B5%D5%AB%D5%B6_%D5%B0%D5%AB%D5%BE%D5%A1%D5%B6%D5%A4%D5%B8%D6%82%D5%A9%D5%B5%D5%B8%D6%82%D5%B6 "Էբոլա վիրուսային հիվանդություն – Armenian")
- [Արեւմտահայերէն](https://hyw.wikipedia.org/wiki/%D4%BB%D5%BA%D5%B8%D5%AC%D5%A1_\(%D5%AA%D5%A1%D5%B0%D6%80%D5%A1%D5%B5%D5%AB%D5%B6_%D5%B0%D5%AB%D6%82%D5%A1%D5%B6%D5%A4%D5%B8%D6%82%D5%A9%D5%AB%D6%82%D5%B6\) "Իպոլա (ժահրային հիւանդութիւն) – Western Armenian")
- [Bahasa Indonesia](https://id.wikipedia.org/wiki/Penyakit_virus_Ebola "Penyakit virus Ebola – Indonesian")
- [Igbo](https://ig.wikipedia.org/wiki/Nje_%E1%BB%8Dr%E1%BB%8Ba_Ebola "Nje ọrịa Ebola – Igbo")
- [Italiano](https://it.wikipedia.org/wiki/Malattia_da_virus_Ebola "Malattia da virus Ebola – Italian")
- [日本語](https://ja.wikipedia.org/wiki/%E3%82%A8%E3%83%9C%E3%83%A9%E5%87%BA%E8%A1%80%E7%86%B1 "エボラ出血熱 – Japanese")
- [Jawa](https://jv.wikipedia.org/wiki/Panyakit_ebola "Panyakit ebola – Javanese")
- [Qaraqalpaqsha](https://kaa.wikipedia.org/wiki/Ebola_gemorragik_%C4%B1s%C4%B1tpas%C4%B1 "Ebola gemorragik ısıtpası – Kara-Kalpak")
- [Kabɩyɛ](https://kbp.wikipedia.org/wiki/Eeboolaa "Eeboolaa – Kabiye")
- [Қазақша](https://kk.wikipedia.org/wiki/%D0%AD%D0%B1%D0%BE%D0%BB%D0%B0_%D0%B0%D1%83%D1%80%D1%83%D1%8B "Эбола ауруы – Kazakh")
- [ភាសាខ្មែរ](https://km.wikipedia.org/wiki/%E1%9E%87%E1%9F%86%E1%9E%84%E1%9E%BA%E1%9E%A2%E1%9F%8A%E1%9E%B8%E1%9E%94%E1%9E%BC%E1%9E%A1%E1%9E%B6 "ជំងឺអ៊ីបូឡា – Khmer")
- [한국어](https://ko.wikipedia.org/wiki/%EC%97%90%EB%B3%BC%EB%9D%BC_%EC%B6%9C%ED%98%88%EC%97%B4 "에볼라 출혈열 – Korean")
- [کٲشُر](https://ks.wikipedia.org/wiki/%D8%A7%DB%8C%D8%A8%D9%88%D9%84%D8%A7 "ایبولا – Kashmiri")
- [Latina](https://la.wikipedia.org/wiki/Ebola_febris_haemorrhagica "Ebola febris haemorrhagica – Latin")
- [Luganda](https://lg.wikipedia.org/wiki/Ebola "Ebola – Ganda")
- [Limburgs](https://li.wikipedia.org/wiki/Ebola "Ebola – Limburgish")
- [Lingála](https://ln.wikipedia.org/wiki/Bokono_ya_Ebola "Bokono ya Ebola – Lingala")
- [ລາວ](https://lo.wikipedia.org/wiki/%E0%BA%AD%E0%BA%B5%E0%BB%82%E0%BA%9A%E0%BA%A5%E0%BA%B2 "ອີໂບລາ – Lao")
- [Lietuvių](https://lt.wikipedia.org/wiki/Ebolos_hemoragin%C4%97_kar%C5%A1tin%C4%97 "Ebolos hemoraginė karštinė – Lithuanian")
- [Latviešu](https://lv.wikipedia.org/wiki/Ebolas_v%C4%ABrusslim%C4%ABba "Ebolas vīrusslimība – Latvian")
- [मैथिली](https://mai.wikipedia.org/wiki/%E0%A4%87%E0%A4%AC%E0%A5%8B%E0%A4%B2%E0%A4%BE "इबोला – Maithili")
- [Malagasy](https://mg.wikipedia.org/wiki/Ebola "Ebola – Malagasy")
- [Македонски](https://mk.wikipedia.org/wiki/%D0%95%D0%B1%D0%BE%D0%BB%D0%B0 "Ебола – Macedonian")
- [മലയാളം](https://ml.wikipedia.org/wiki/%E0%B4%8E%E0%B4%AC%E0%B5%8B%E0%B4%B3 "എബോള – Malayalam")
- [Монгол](https://mn.wikipedia.org/wiki/%D0%AD%D0%B1%D0%BE%D0%BB%D0%B0 "Эбола – Mongolian")
- [मराठी](https://mr.wikipedia.org/wiki/%E0%A4%87%E0%A4%AC%E0%A5%8B%E0%A4%B2%E0%A4%BE "इबोला – Marathi")
- [Bahasa Melayu](https://ms.wikipedia.org/wiki/Penyakit_virus_Ebola "Penyakit virus Ebola – Malay")
- [မြန်မာဘာသာ](https://my.wikipedia.org/wiki/%E1%80%A1%E1%80%AE%E1%80%97%E1%80%AD%E1%80%AF%E1%80%9C%E1%80%AC_%E1%80%97%E1%80%AD%E1%80%AF%E1%80%84%E1%80%BA%E1%80%B8%E1%80%9B%E1%80%95%E1%80%BA%E1%80%85%E1%80%BA "အီဗိုလာ ဗိုင်းရပ်စ် – Burmese")
- [Nedersaksies](https://nds-nl.wikipedia.org/wiki/Ebola "Ebola – Low Saxon")
- [नेपाली](https://ne.wikipedia.org/wiki/%E0%A4%87%E0%A4%AC%E0%A5%8B%E0%A4%B2%E0%A4%BE "इबोला – Nepali")
- [Nederlands](https://nl.wikipedia.org/wiki/Ebola "Ebola – Dutch")
- [Norsk nynorsk](https://nn.wikipedia.org/wiki/Ebola "Ebola – Norwegian Nynorsk")
- [IsiNdebele seSewula](https://nr.wikipedia.org/wiki/Ubulwelwe_be-Ebola "Ubulwelwe be-Ebola – South Ndebele")
- [Sesotho sa Leboa](https://nso.wikipedia.org/wiki/Bolwet%C5%A1i_bja_baerase_ya_Ebola "Bolwetši bja baerase ya Ebola – Northern Sotho")
- [Chi-Chewa](https://ny.wikipedia.org/wiki/Matenda_a_Ebola "Matenda a Ebola – Nyanja")
- [Occitan](https://oc.wikipedia.org/wiki/Virus_Ebola "Virus Ebola – Occitan")
- [Oromoo](https://om.wikipedia.org/wiki/Dhibbee_vaayiirasii_Iboollaa "Dhibbee vaayiirasii Iboollaa – Oromo")
- [ଓଡ଼ିଆ](https://or.wikipedia.org/wiki/%E0%AC%87%E0%AC%AC%E0%AD%8B%E0%AC%B2%E0%AC%BE_%E0%AC%AD%E0%AD%82%E0%AC%A4%E0%AC%BE%E0%AC%A3%E0%AD%81_%E0%AC%B0%E0%AD%8B%E0%AC%97 "ଇବୋଲା ଭୂତାଣୁ ରୋଗ – Odia")
- [ਪੰਜਾਬੀ](https://pa.wikipedia.org/wiki/%E0%A8%87%E0%A8%AC%E0%A9%8B%E0%A8%B2%E0%A8%BE_%E0%A8%B5%E0%A8%BF%E0%A8%B8%E0%A8%BC%E0%A8%BE%E0%A8%A3%E0%A9%82_%E0%A8%B0%E0%A9%8B%E0%A8%97 "ਇਬੋਲਾ ਵਿਸ਼ਾਣੂ ਰੋਗ – Punjabi")
- [Papiamentu](https://pap.wikipedia.org/wiki/Ebola "Ebola – Papiamento")
- [Polski](https://pl.wikipedia.org/wiki/Gor%C4%85czka_krwotoczna_Ebola "Gorączka krwotoczna Ebola – Polish")
- [پښتو](https://ps.wikipedia.org/wiki/%D8%A7%DB%8C%D8%A8%D9%88%D9%84%D8%A7_%D9%86%D8%A7%D8%B1%D9%88%D8%BA%DB%8D "ایبولا ناروغۍ – Pashto")
- [Português](https://pt.wikipedia.org/wiki/Doen%C3%A7a_por_v%C3%ADrus_%C3%89bola "Doença por vírus Ébola – Portuguese")
- [Runa Simi](https://qu.wikipedia.org/wiki/Evola_virusmanta_unquyqa "Evola virusmanta unquyqa – Quechua")
- [ရခိုင်](https://rki.wikipedia.org/wiki/%E1%80%A1%E1%80%AE%E1%80%97%E1%80%AD%E1%80%AF%E1%80%9C%E1%80%AC%E1%80%97%E1%80%AD%E1%80%AF%E1%80%84%E1%80%BA%E1%80%B8%E1%80%9B%E1%80%95%E1%80%BA%E1%80%85%E1%80%BA "အီဗိုလာဗိုင်းရပ်စ် – Arakanese")
- [Romani čhib](https://rmy.wikipedia.org/wiki/Ebola "Ebola – Vlax Romani")
- [Ikirundi](https://rn.wikipedia.org/wiki/Ingwara_iterwa_n%E2%80%99umugera_wa_Ebola "Ingwara iterwa n’umugera wa Ebola – Rundi")
- [Română](https://ro.wikipedia.org/wiki/Boala_viral%C4%83_Ebola "Boala virală Ebola – Romanian")
- [Русский](https://ru.wikipedia.org/wiki/%D0%93%D0%B5%D0%BC%D0%BE%D1%80%D1%80%D0%B0%D0%B3%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B0%D1%8F_%D0%BB%D0%B8%D1%85%D0%BE%D1%80%D0%B0%D0%B4%D0%BA%D0%B0_%D0%AD%D0%B1%D0%BE%D0%BB%D0%B0 "Геморрагическая лихорадка Эбола – Russian")
- [Ikinyarwanda](https://rw.wikipedia.org/wiki/Indwara_ya_Ebola "Indwara ya Ebola – Kinyarwanda")
- [Саха тыла](https://sah.wikipedia.org/wiki/%D0%AD%D0%B1%D0%BE%D0%BB%D0%B0_%D0%B2%D0%B8%D1%80%D1%83%D1%81%D1%82%D0%B0%D0%B0%D1%85_%D1%8B%D0%B0%D1%80%D1%8B%D1%8B%D1%82%D0%B0 "Эбола вирустаах ыарыыта – Yakut")
- [Scots](https://sco.wikipedia.org/wiki/Ebola_virus_disease "Ebola virus disease – Scots")
- [Srpskohrvatski / српскохрватски](https://sh.wikipedia.org/wiki/Ebola "Ebola – Serbo-Croatian")
- [සිංහල](https://si.wikipedia.org/wiki/%E0%B6%89%E0%B6%B6%E0%B7%96%E0%B6%BD%E0%B7%8F_%E0%B7%80%E0%B7%9B%E0%B6%BB%E0%B7%83%E0%B7%8A_%E0%B6%BB%E0%B7%9D%E0%B6%9C%E0%B6%BA "ඉබූලා වෛරස් රෝගය – Sinhala")
- [Simple English](https://simple.wikipedia.org/wiki/Ebola_virus_disease "Ebola virus disease – Simple English")
- [Slovenčina](https://sk.wikipedia.org/wiki/Choroba_vyvolan%C3%A1_v%C3%ADrusom_Ebola "Choroba vyvolaná vírusom Ebola – Slovak")
- [Slovenščina](https://sl.wikipedia.org/wiki/Ebola "Ebola – Slovenian")
- [Anarâškielâ](https://smn.wikipedia.org/wiki/Ebola "Ebola – Inari Sami")
- [ChiShona](https://sn.wikipedia.org/wiki/Chirwere_cheEbola "Chirwere cheEbola – Shona")
- [Soomaaliga](https://so.wikipedia.org/wiki/Ebola_virus_disease "Ebola virus disease – Somali")
- [Српски / srpski](https://sr.wikipedia.org/wiki/%D0%95%D0%B1%D0%BE%D0%BB%D0%B0 "Ебола – Serbian")
- [SiSwati](https://ss.wikipedia.org/wiki/Ligciwane_lesifo_se-Ebola "Ligciwane lesifo se-Ebola – Swati")
- [Sesotho](https://st.wikipedia.org/wiki/Boloetse_ba_kokwanahloko_ya_Ebola "Boloetse ba kokwanahloko ya Ebola – Southern Sotho")
- [Sunda](https://su.wikipedia.org/wiki/Panyakit_virus_%C3%A9bola "Panyakit virus ébola – Sundanese")
- [Svenska](https://sv.wikipedia.org/wiki/Ebola "Ebola – Swedish")
- [Kiswahili](https://sw.wikipedia.org/wiki/Ebola "Ebola – Swahili")
- [தமிழ்](https://ta.wikipedia.org/wiki/%E0%AE%87%E0%AE%AA%E0%AF%8B%E0%AE%B2%E0%AE%BE_%E0%AE%A4%E0%AF%80%E0%AE%A8%E0%AF%81%E0%AE%A3%E0%AF%8D%E0%AE%AE_%E0%AE%A8%E0%AF%8B%E0%AE%AF%E0%AF%8D "இபோலா தீநுண்ம நோய் – Tamil")
- [ไทย](https://th.wikipedia.org/wiki/%E0%B9%82%E0%B8%A3%E0%B8%84%E0%B9%84%E0%B8%A7%E0%B8%A3%E0%B8%B1%E0%B8%AA%E0%B8%AD%E0%B8%B5%E0%B9%82%E0%B8%9A%E0%B8%A5%E0%B8%B2 "โรคไวรัสอีโบลา – Thai")
- [ትግርኛ](https://ti.wikipedia.org/wiki/%E1%88%95%E1%88%9B%E1%88%9D_%E1%89%AB%E1%8B%AD%E1%88%A8%E1%88%B5_%E1%8A%A2%E1%89%A6%E1%88%8B "ሕማም ቫይረስ ኢቦላ – Tigrinya")
- [Tagalog](https://tl.wikipedia.org/wiki/Sakit_na_Ebola "Sakit na Ebola – Tagalog")
- [Setswana](https://tn.wikipedia.org/wiki/Bolwetse_jwa_mogare_wa_Ebola "Bolwetse jwa mogare wa Ebola – Tswana")
- [Türkçe](https://tr.wikipedia.org/wiki/Ebola_vir%C3%BCs%C3%BC_hastal%C4%B1%C4%9F%C4%B1 "Ebola virüsü hastalığı – Turkish")
- [Xitsonga](https://ts.wikipedia.org/wiki/Xitsongwatsongwana_xa_vuvabyi_bya_Ebola "Xitsongwatsongwana xa vuvabyi bya Ebola – Tsonga")
- [Татарча / tatarça](https://tt.wikipedia.org/wiki/%D0%AD%D0%B1%D0%BE%D0%BB%D0%B0_%D0%B1%D0%B8%D0%B7%D0%B3%D3%99%D0%B3%D0%B5 "Эбола бизгәге – Tatar")
- [Twi](https://tw.wikipedia.org/wiki/Ebola_yare "Ebola yare – Twi")
- [ئۇيغۇرچە / Uyghurche](https://ug.wikipedia.org/wiki/%D8%A6%DB%90%D8%A8%D9%88%D9%84%D8%A7_%DB%8B%D9%89%D8%B1%DB%87%D8%B3%D9%89 "ئېبولا ۋىرۇسى – Uyghur")
- [Українська](https://uk.wikipedia.org/wiki/%D0%A5%D0%B2%D0%BE%D1%80%D0%BE%D0%B1%D0%B0,_%D1%8F%D0%BA%D1%83_%D1%81%D0%BF%D1%80%D0%B8%D1%87%D0%B8%D0%BD%D1%8E%D1%94_%D0%B2%D1%96%D1%80%D1%83%D1%81_%D0%95%D0%B1%D0%BE%D0%BB%D0%B0 "Хвороба, яку спричинює вірус Ебола – Ukrainian")
- [اردو](https://ur.wikipedia.org/wiki/%D8%A7%DB%8C%D8%A8%D9%88%D9%84%D8%A7_%D9%88%D8%A7%D8%A6%D8%B1%D8%B3_%D8%A8%DB%8C%D9%85%D8%A7%D8%B1%DB%8C "ایبولا وائرس بیماری – Urdu")
- [Oʻzbekcha / ўзбекча](https://uz.wikipedia.org/wiki/Ebola_gemorragik_isitmasi "Ebola gemorragik isitmasi – Uzbek")
- [Tshivenda](https://ve.wikipedia.org/wiki/Vhulwadze_ha_Vairasi_ya_Ebola "Vhulwadze ha Vairasi ya Ebola – Venda")
- [Tiếng Việt](https://vi.wikipedia.org/wiki/B%E1%BB%87nh_do_virus_Ebola "Bệnh do virus Ebola – Vietnamese")
- [Walon](https://wa.wikipedia.org/wiki/Five_Ebola "Five Ebola – Walloon")
- [Winaray](https://war.wikipedia.org/wiki/Sakit_nga_Ebola "Sakit nga Ebola – Waray")
- [Wolof](https://wo.wikipedia.org/wiki/J%C3%A0ngoroy_Ebola "Jàngoroy Ebola – Wolof")
- [吴语](https://wuu.wikipedia.org/wiki/%E5%9F%83%E5%8D%9A%E6%8B%89%E5%87%BA%E8%A1%80%E7%83%AD "埃博拉出血热 – Wu")
- [IsiXhosa](https://xh.wikipedia.org/wiki/Isifo_sentsholongwane_i-Ebola "Isifo sentsholongwane i-Ebola – Xhosa")
- [Yorùbá](https://yo.wikipedia.org/wiki/%C3%80r%C3%B9n_k%C3%B2k%C3%B2r%C3%B2_%C3%A0%C3%ACl%C3%A8foj%C3%BAr%C3%AD_af%C3%A0%C3%ACs%C3%A0n_Ebola "Àrùn kòkòrò àìlèfojúrí afàìsàn Ebola – Yoruba")
- [閩南語 / Bân-lâm-gí](https://zh-min-nan.wikipedia.org/wiki/Ebola_p%C4%93%E2%81%BF-to%CC%8Dk-p%C4%93%E2%81%BF "Ebola pēⁿ-to̍k-pēⁿ – Minnan")
- [粵語](https://zh-yue.wikipedia.org/wiki/%E4%BC%8A%E6%B3%A2%E6%8B%89%E5%87%BA%E8%A1%80%E7%86%B1 "伊波拉出血熱 – Cantonese")
- [中文](https://zh.wikipedia.org/wiki/%E5%9F%83%E5%8D%9A%E6%8B%89%E5%87%BA%E8%A1%80%E7%83%AD "埃博拉出血热 – Chinese")
- [IsiZulu](https://zu.wikipedia.org/wiki/Isifo_segciwane_le-Ebola "Isifo segciwane le-Ebola – Zulu")
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From Wikipedia, the free encyclopedia
Hemorrhagic fever caused by ebolaviruses
Medical condition
| Ebola | |
|---|---|
| Other names | Ebola haemorrhagic fever (EHF), Ebola virus disease (EBV) |
| [](https://en.wikipedia.org/wiki/File:7042_lores-Ebola-Zaire-CDC_Photo.jpg) | |
| Two nurses stand beside [Mayinga N'Seka](https://en.wikipedia.org/wiki/Mayinga_N%27Seka "Mayinga N'Seka"), a nurse with Ebola virus disease, during the [1976 outbreak in Zaire](https://en.wikipedia.org/wiki/1976_Zaire_Ebola_virus_outbreak "1976 Zaire Ebola virus outbreak") (now the [Democratic Republic of the Congo](https://en.wikipedia.org/wiki/Democratic_Republic_of_the_Congo "Democratic Republic of the Congo")). N'Seka was treated, but ultimately died a few days later. | |
| Pronunciation | [/iˈboʊlə/](https://en.wikipedia.org/wiki/Help:IPA/English "Help:IPA/English")[\[1\]](https://en.wikipedia.org/wiki/Ebola#cite_note-1) |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Infectious diseases](https://en.wikipedia.org/wiki/Infectious_diseases_\(medical_specialty\) "Infectious diseases (medical specialty)") [](https://www.wikidata.org/wiki/Q51993?uselang=en#P1995 "Edit this on Wikidata") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | [Fever](https://en.wikipedia.org/wiki/Fever "Fever"), [sore throat](https://en.wikipedia.org/wiki/Sore_throat "Sore throat"), [muscle pain](https://en.wikipedia.org/wiki/Muscle_pain "Muscle pain"), [headaches](https://en.wikipedia.org/wiki/Headaches "Headaches"), [diarrhoea](https://en.wikipedia.org/wiki/Diarrhoea "Diarrhoea"), [bleeding](https://en.wikipedia.org/wiki/Bleeding "Bleeding")[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[3\]](https://en.wikipedia.org/wiki/Ebola#cite_note-3) |
| [Complications](https://en.wikipedia.org/wiki/Complication_\(medicine\) "Complication (medicine)") | [Shock](https://en.wikipedia.org/wiki/Hypovolemic_shock "Hypovolemic shock") from [fluid loss](https://en.wikipedia.org/wiki/Fluid_loss "Fluid loss")[\[4\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ruz2014-4) |
| Usual onset | 2 days to 3 weeks after exposure[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") | [Ebolaviruses](https://en.wikipedia.org/wiki/Ebolavirus "Ebolavirus") spread by direct contact with the [blood](https://en.wikipedia.org/wiki/Blood "Blood") or [body fluid](https://en.wikipedia.org/wiki/Body_fluid "Body fluid") of an [infected](https://en.wikipedia.org/wiki/Infection "Infection") person, or [contaminated](https://en.wikipedia.org/wiki/Contaminated "Contaminated") objects[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| [Diagnostic method](https://en.wikipedia.org/wiki/Medical_diagnosis "Medical diagnosis") | Finding [ebolaviruses](https://en.wikipedia.org/wiki/Ebolaviruses "Ebolaviruses"), viral [RNA](https://en.wikipedia.org/wiki/RNA "RNA"), or [antibodies](https://en.wikipedia.org/wiki/Antibodies "Antibodies") in blood[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| [Differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") | Other [viral haemorrhagic fevers](https://en.wikipedia.org/wiki/Viral_haemorrhagic_fevers "Viral haemorrhagic fevers"), such as [malaria](https://en.wikipedia.org/wiki/Malaria "Malaria"), [typhoid](https://en.wikipedia.org/wiki/Typhoid "Typhoid"), [cholera](https://en.wikipedia.org/wiki/Cholera "Cholera"), or [meningitis](https://en.wikipedia.org/wiki/Meningitis "Meningitis")[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| Prevention | Coordinated medical services, careful handling of [bushmeat](https://en.wikipedia.org/wiki/Bushmeat "Bushmeat")[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| Treatment | [Supportive care](https://en.wikipedia.org/wiki/Supportive_care "Supportive care")[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| [Medication](https://en.wikipedia.org/wiki/Medication "Medication") | [Atoltivimab/maftivimab/odesivimab](https://en.wikipedia.org/wiki/Atoltivimab/maftivimab/odesivimab "Atoltivimab/maftivimab/odesivimab") (INMAZEB) |
| [Prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis") | 25–90% mortality[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
**Ebola**, also known as **Ebola virus disease** (**EVD**) and **Ebola hemorrhagic fever** (**EHF**), is a [zoonotic](https://en.wikipedia.org/wiki/Zoonosis "Zoonosis") [viral hemorrhagic fever](https://en.wikipedia.org/wiki/Viral_hemorrhagic_fever "Viral hemorrhagic fever") in humans and other [primates](https://en.wikipedia.org/wiki/Primate "Primate"), caused by four of the six known [ebolaviruses](https://en.wikipedia.org/wiki/Ebolavirus "Ebolavirus").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Symptoms typically start anywhere between two days and three weeks after infection.[\[5\]](https://en.wikipedia.org/wiki/Ebola#cite_note-5) The first symptoms are usually [fever](https://en.wikipedia.org/wiki/Fever "Fever"), [sore throat](https://en.wikipedia.org/wiki/Sore_throat "Sore throat"), [muscle pain](https://en.wikipedia.org/wiki/Myalgia "Myalgia"), and [headaches](https://en.wikipedia.org/wiki/Headache "Headache").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) These are usually followed by [vomiting](https://en.wikipedia.org/wiki/Vomiting "Vomiting"), [diarrhoea](https://en.wikipedia.org/wiki/Diarrhoea "Diarrhoea"), [rash](https://en.wikipedia.org/wiki/Rash "Rash"), [hepatic](https://en.wikipedia.org/wiki/Liver "Liver") and [renal](https://en.wikipedia.org/wiki/Kidney "Kidney") dysfunction,[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) at which point some people begin to [bleed](https://en.wikipedia.org/wiki/Bleeding "Bleeding") both [internally](https://en.wikipedia.org/wiki/Internal_bleeding "Internal bleeding") and externally.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) The disease causes a mortality rate of anywhere between 25 and 90%, averaging out at approximately 50%.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) The viral species involved and timing of treatment play a critical role in its prognosis. Death is often due to [shock from fluid loss](https://en.wikipedia.org/wiki/Hypovolemic_shock "Hypovolemic shock"), and typically occurs between 6 and 16 days after the first symptoms appear.[\[4\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ruz2014-4)
The viruses have caused [intermittent outbreaks](https://en.wikipedia.org/wiki/List_of_Ebola_outbreaks "List of Ebola outbreaks") in [Sub-Sahara Africa](https://en.wikipedia.org/wiki/Sub-Sahara_Africa "Sub-Sahara Africa") since 1976 when the disease was first reported, with the largest one being the [2014 Western African epidemic](https://en.wikipedia.org/wiki/Western_African_Ebola_epidemic "Western African Ebola epidemic"). They spread through direct contact with [body fluids](https://en.wikipedia.org/wiki/Body_fluid "Body fluid"), such as [blood](https://en.wikipedia.org/wiki/Blood "Blood") from infected humans or other animals,[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) or from contact with items that have recently been contaminated with infected body fluids.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) There have been no documented cases, either in nature or under laboratory conditions, of spread through the air between humans or other [primates](https://en.wikipedia.org/wiki/Primate "Primate").[\[6\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHOAir2014-6) After recovering from Ebola, [semen](https://en.wikipedia.org/wiki/Semen "Semen") or [breast milk](https://en.wikipedia.org/wiki/Breast_milk "Breast milk") may continue to carry the virus for anywhere between several weeks to several months.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[7\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cdc9months-7)[\[8\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCBreast2014-8) [Fruit bats](https://en.wikipedia.org/wiki/Megabat "Megabat") are believed to be the [natural host](https://en.wikipedia.org/wiki/Natural_host "Natural host") of the viruses; they are able to spread the viruses without being affected by it.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) The symptoms of Ebola may resemble those of several other diseases, including [malaria](https://en.wikipedia.org/wiki/Malaria "Malaria"), [cholera](https://en.wikipedia.org/wiki/Cholera "Cholera"), [typhoid fever](https://en.wikipedia.org/wiki/Typhoid_fever "Typhoid fever"), [meningitis](https://en.wikipedia.org/wiki/Meningitis "Meningitis") and other viral hemorrhagic fevers.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Diagnosis is confirmed by testing blood samples for the presence of viral [RNA](https://en.wikipedia.org/wiki/RNA "RNA"), viral [antibodies](https://en.wikipedia.org/wiki/Antibodies "Antibodies") or the virus itself.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[9\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Bro2016-9)
Control of outbreaks requires coordinated medical services and community engagement,[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) including rapid detection, [contact tracing](https://en.wikipedia.org/wiki/Contact_tracing "Contact tracing") of those exposed, quick access to laboratory services, care for those infected, and proper disposal of the dead through [cremation](https://en.wikipedia.org/wiki/Cremation "Cremation") or burial.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[10\]](https://en.wikipedia.org/wiki/Ebola#cite_note-10) Prevention measures involve wearing proper protective clothing and [washing hands](https://en.wikipedia.org/wiki/Washing_hands "Washing hands") when in close proximity to patients and while handling potentially infected [bushmeat](https://en.wikipedia.org/wiki/Bushmeat "Bushmeat"), as well as thoroughly cooking bushmeat.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Two treatments ([atoltivimab/maftivimab/odesivimab](https://en.wikipedia.org/wiki/Atoltivimab/maftivimab/odesivimab "Atoltivimab/maftivimab/odesivimab") and [ansuvimab](https://en.wikipedia.org/wiki/Ansuvimab "Ansuvimab")) are associated with improved outcomes.[\[11\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NIH2019Tx-11) Early supportive care and treatment of symptoms increases the survival rate considerably compared to late start.[\[12\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Guiliani_2022-12)[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) These include [oral rehydration therapy](https://en.wikipedia.org/wiki/Oral_rehydration_therapy "Oral rehydration therapy") (drinking slightly sweetened and salty water) or giving [intravenous fluids](https://en.wikipedia.org/wiki/Intravenous_fluids "Intravenous fluids"), and treating symptoms.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) An [Ebola vaccine](https://en.wikipedia.org/wiki/Ebola_vaccine "Ebola vaccine") was approved by the US FDA in December 2019. In October 2020, atoltivimab/maftivimab/odesivimab (Inmazeb) was approved for medical use in the United States to treat the disease caused by *Zaire ebolavirus*.[\[13\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA_PR-13)
## Signs and symptoms
[](https://en.wikipedia.org/wiki/File:Symptoms_of_ebola.png)
Signs and symptoms of Ebola[\[14\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014S-14)
### Onset
The length of time between exposure to the virus and the development of symptoms ([incubation period](https://en.wikipedia.org/wiki/Incubation_period "Incubation period")) is between 2 and 21 days,[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[14\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014S-14) and usually between 4 and 10 days.[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15) However, recent estimates based on mathematical models predict that around 5% of cases may take longer than 21 days to develop.[\[16\]](https://en.wikipedia.org/wiki/Ebola#cite_note-16)
Symptoms usually begin with a sudden [influenza](https://en.wikipedia.org/wiki/Influenza "Influenza")\-like stage characterised by [fatigue](https://en.wikipedia.org/wiki/Fatigue_\(medical\) "Fatigue (medical)"), [fever](https://en.wikipedia.org/wiki/Fever "Fever"), [weakness](https://en.wikipedia.org/wiki/Asthenia "Asthenia"), [decreased appetite](https://en.wikipedia.org/wiki/Anorexia_\(symptom\) "Anorexia (symptom)"), [muscular pain](https://en.wikipedia.org/wiki/Myalgia "Myalgia"), [joint pain](https://en.wikipedia.org/wiki/Arthralgia "Arthralgia"), headache, and sore throat.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15)[\[17\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gatherer_2014-17)[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18) The fever is usually higher than 38.3 °C (101 °F).[\[19\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2006-19) This is often followed by nausea, vomiting, [diarrhoea](https://en.wikipedia.org/wiki/Diarrhoea "Diarrhoea"), abdominal pain, and sometimes [hiccups](https://en.wikipedia.org/wiki/Hiccups "Hiccups").[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18)[\[20\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Brown2017-20) The combination of severe vomiting and diarrhoea often leads to severe [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration").[\[21\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Sharma2015-21) Next, [shortness of breath](https://en.wikipedia.org/wiki/Shortness_of_breath "Shortness of breath") and [chest pain](https://en.wikipedia.org/wiki/Chest_pain "Chest pain") may occur, along with [swelling](https://en.wikipedia.org/wiki/Oedema "Oedema"), [headaches](https://en.wikipedia.org/wiki/Headaches "Headaches"), and [confusion](https://en.wikipedia.org/wiki/Decreased_level_of_consciousness "Decreased level of consciousness").[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18) In about half of the cases, the skin may develop a [maculopapular rash](https://en.wikipedia.org/wiki/Maculopapular_rash "Maculopapular rash"), a flat red area covered with small bumps, five to seven days after symptoms begin.[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15)[\[19\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2006-19)
### Bleeding
In some cases, internal and external bleeding may occur.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) This typically begins five to seven days after the first symptoms.[\[22\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlwhqlibdoc.who.int-22) All infected people show some [decreased blood clotting](https://en.wikipedia.org/wiki/Bleeding_disorder "Bleeding disorder").[\[19\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2006-19) Bleeding from mucous membranes or from sites of needle punctures has been reported in 40–50% of cases.[\[23\]](https://en.wikipedia.org/wiki/Ebola#cite_note-23) This may cause [vomiting blood](https://en.wikipedia.org/wiki/Haematemesis "Haematemesis"), [coughing up of blood](https://en.wikipedia.org/wiki/Haemoptysis "Haemoptysis"), or [blood in stool](https://en.wikipedia.org/wiki/Blood_in_stool "Blood in stool").[\[24\]](https://en.wikipedia.org/wiki/Ebola#cite_note-24) Bleeding into the skin may create [petechiae](https://en.wikipedia.org/wiki/Petechia "Petechia"), [purpura](https://en.wikipedia.org/wiki/Purpura "Purpura"), [ecchymoses](https://en.wikipedia.org/wiki/Ecchymosis "Ecchymosis") or [haematomas](https://en.wikipedia.org/wiki/Haematoma "Haematoma") (especially around needle injection sites).[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25) [Bleeding into the whites of the eyes](https://en.wikipedia.org/wiki/Subconjunctival_haemorrhage "Subconjunctival haemorrhage") may also occur.[\[26\]](https://en.wikipedia.org/wiki/Ebola#cite_note-ShanthaEye2016-26) Heavy bleeding is uncommon; if it occurs, it is usually in the [gastrointestinal tract](https://en.wikipedia.org/wiki/Gastrointestinal_tract "Gastrointestinal tract").[\[27\]](https://en.wikipedia.org/wiki/Ebola#cite_note-West2014-27) The incidence of bleeding into the gastrointestinal tract was reported to be ~58% in the 2001 outbreak in Gabon,[\[21\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Sharma2015-21) but in the 2014–15 outbreak in the US it was ~18%,[\[28\]](https://en.wikipedia.org/wiki/Ebola#cite_note-28) possibly due to improved prevention of [disseminated intravascular coagulation](https://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation "Disseminated intravascular coagulation").[\[21\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Sharma2015-21)
### Recovery or death
Recovery may begin between seven and 14 days after first symptoms.[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18) Death, if it occurs, follows typically six to sixteen days from first symptoms and is often due to [shock from fluid loss](https://en.wikipedia.org/wiki/Hypovolemic_shock "Hypovolemic shock").[\[4\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ruz2014-4) In general, bleeding often indicates a worse outcome, and blood loss may result in death.[\[17\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gatherer_2014-17) People are often in a [coma](https://en.wikipedia.org/wiki/Coma "Coma") near the end of life.[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18)
Those who survive often have ongoing muscular and joint pain, [liver inflammation](https://en.wikipedia.org/wiki/Hepatitis "Hepatitis"), and decreased hearing, and may have continued tiredness, continued weakness, decreased appetite, and difficulty returning to pre-illness weight.[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18)[\[29\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Tosh2014-29) Problems with vision may develop.[\[30\]](https://en.wikipedia.org/wiki/Ebola#cite_note-30) It is recommended that survivors wear condoms for at least twelve months after initial infection or until the semen of a male survivor tests negative for Ebolavirus on two separate occasions.[\[31\]](https://en.wikipedia.org/wiki/Ebola#cite_note-31)
Survivors develop [antibodies](https://en.wikipedia.org/wiki/Antibodies "Antibodies") against Ebola that last at least 10 years, but it is unclear whether they are immune to additional infections.[\[32\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014QAT-32)
## Cause
EVD in humans is caused by four of six viruses of the genus *[Ebolavirus](https://en.wikipedia.org/wiki/Ebolavirus "Ebolavirus")*. The four are [Bundibugyo virus](https://en.wikipedia.org/wiki/Bundibugyo_virus "Bundibugyo virus") (BDBV), [Sudan virus](https://en.wikipedia.org/wiki/Sudan_virus "Sudan virus") (SUDV), [Taï Forest virus](https://en.wikipedia.org/wiki/Ta%C3%AF_Forest_virus "Taï Forest virus") (TAFV) and one simply called [Ebola virus](https://en.wikipedia.org/wiki/Ebola_virus "Ebola virus") (EBOV, formerly Zaire Ebola virus).[\[33\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2012-33) EBOV, species *[Zaire ebolavirus](https://en.wikipedia.org/wiki/Zaire_ebolavirus "Zaire ebolavirus")*, is the most dangerous of the known EVD-causing viruses, and is responsible for the largest number of outbreaks.[\[34\]](https://en.wikipedia.org/wiki/Ebola#cite_note-KuhnArch-34) The fifth and sixth viruses, [Reston virus](https://en.wikipedia.org/wiki/Reston_virus "Reston virus") (RESTV) and [Bombali virus](https://en.wikipedia.org/wiki/Bombali_ebolavirus "Bombali ebolavirus") (BOMV),[\[35\]](https://en.wikipedia.org/wiki/Ebola#cite_note-35) are not thought to cause disease in humans, but have caused disease in other primates.[\[36\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Spickler-36)[\[37\]](https://en.wikipedia.org/wiki/Ebola#cite_note-37) All six viruses are closely related to [marburgviruses](https://en.wikipedia.org/wiki/Marburgvirus "Marburgvirus").[\[33\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2012-33)
### Virology
Main articles: [*Ebolavirus* (taxonomic group)](https://en.wikipedia.org/wiki/Ebolavirus "Ebolavirus") and [Ebola virus (specific virus)](https://en.wikipedia.org/wiki/Ebola_virus "Ebola virus")
[](https://en.wikipedia.org/wiki/File:Ebola_virus_virion.jpg)
[Electron micrograph](https://en.wikipedia.org/wiki/Electron_micrograph "Electron micrograph") of an Ebola virus [virion](https://en.wikipedia.org/wiki/Virion "Virion")
Ebolaviruses contain single-stranded, non-infectious [RNA](https://en.wikipedia.org/wiki/RNA "RNA") [genomes](https://en.wikipedia.org/wiki/Genome "Genome").[\[38\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Fauquet2005-38) *Ebolavirus* genomes contain seven [genes](https://en.wikipedia.org/wiki/Gene "Gene") including [3'-UTR](https://en.wikipedia.org/wiki/Three_prime_untranslated_region "Three prime untranslated region")\-*NP*\-*VP35*\-*VP40*\-*GP*\-*VP30*\-*VP24*\-*L*\-[5'-UTR](https://en.wikipedia.org/wiki/Five_prime_untranslated_region "Five prime untranslated region").[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25)[\[39\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Stahelin2014-39) The genomes of the five different ebolaviruses (BDBV, EBOV, RESTV, SUDV and TAFV) differ in [sequence](https://en.wikipedia.org/wiki/Nucleic_acid_sequence "Nucleic acid sequence") and the number and location of gene overlaps. As with all [filoviruses](https://en.wikipedia.org/wiki/Filovirus "Filovirus"), ebolavirus virions are filamentous particles that may appear in the shape of a shepherd's crook, of a "U" or of a "6," and they may be coiled, toroid or branched.[\[39\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Stahelin2014-39)[\[40\]](https://en.wikipedia.org/wiki/Ebola#cite_note-40) In general, Ebola virions are 80 nanometers (nm) in width and may be as long as 14,000 nm.[\[41\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chippaux2014-41)
Their [life cycle](https://en.wikipedia.org/wiki/Biological_life_cycle "Biological life cycle") is thought to begin with a virion attaching to specific [cell-surface receptors](https://en.wikipedia.org/wiki/Cell_surface_receptor "Cell surface receptor") such as [C-type lectins](https://en.wikipedia.org/wiki/C-type_lectin "C-type lectin"), [DC-SIGN](https://en.wikipedia.org/wiki/DC-SIGN "DC-SIGN"), or [integrins](https://en.wikipedia.org/wiki/Integrin "Integrin"), which is followed by fusion of the [viral envelope with cellular membranes](https://en.wikipedia.org/wiki/Pinocytosis "Pinocytosis").[\[42\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Misasi2014-42) The virions taken up by the cell then travel to acidic [endosomes](https://en.wikipedia.org/wiki/Endosome "Endosome") and [lysosomes](https://en.wikipedia.org/wiki/Lysosome "Lysosome") where the viral envelope glycoprotein GP is cleaved.[\[42\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Misasi2014-42) This processing appears to allow the virus to bind to cellular proteins enabling it to fuse with internal cellular membranes and release the viral [nucleocapsid](https://en.wikipedia.org/wiki/Nucleocapsid "Nucleocapsid").[\[42\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Misasi2014-42) The *Ebolavirus* structural glycoprotein (known as GP1,2) is responsible for the virus' ability to bind to and infect targeted cells.[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) The viral [RNA polymerase](https://en.wikipedia.org/wiki/RNA-dependent_RNA_polymerase "RNA-dependent RNA polymerase"), encoded by the *L* gene, partially uncoats the nucleocapsid and [transcribes](https://en.wikipedia.org/wiki/Transcription_\(genetics\) "Transcription (genetics)") the genes into positive-strand [mRNAs](https://en.wikipedia.org/wiki/MRNA "MRNA"), which are then [translated](https://en.wikipedia.org/wiki/Translation_\(biology\) "Translation (biology)") into structural and nonstructural proteins. The most abundant protein produced is the nucleoprotein, whose concentration in the host cell determines when L switches from gene transcription to genome replication. Replication of the viral genome results in full-length, positive-strand antigenomes that are, in turn, transcribed into genome copies of negative-strand virus progeny.[\[44\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Olejnik2011-44) Newly synthesised structural proteins and genomes self-assemble and accumulate near the inside of the [cell membrane](https://en.wikipedia.org/wiki/Cell_membrane "Cell membrane"). Virions [bud](https://en.wikipedia.org/wiki/Budding "Budding") off from the cell, gaining their envelopes from the cellular membrane from which they bud. The mature progeny particles then infect other cells to repeat the cycle. The genetics of the Ebola virus are difficult to study because of EBOV's virulent characteristics.[\[45\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2005-45)
### Initial case
[](https://en.wikipedia.org/wiki/File:EbolaCycle.png)
Life cycles of the *[Ebolavirus](https://en.wikipedia.org/wiki/Ebolavirus "Ebolavirus")*
[](https://en.wikipedia.org/wiki/File:Bushmeat_-_Buschfleisch_Ghana.JPG)
Smoked [bushmeat](https://en.wikipedia.org/wiki/Bushmeat "Bushmeat") in [Ghana](https://en.wikipedia.org/wiki/Ghana "Ghana"). In Africa wild animals, including fruit bats, are hunted for food and are referred to as bushmeat.[\[46\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Bush-46)[\[47\]](https://en.wikipedia.org/wiki/Ebola#cite_note-47) In equatorial Africa human consumption of bushmeat has been linked to animal-to-human transmission of diseases, including Ebola.[\[48\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlAfrican_monkey_meat_that_could_be_behind_the_next_HIV_%E2%80%93_Health_News_%E2%80%93_Health_&_Families_%E2%80%93_The_Independent-48)
Although it is not entirely clear how Ebola initially spreads from animals to humans, the spread is believed to involve direct contact with an infected wild animal or fruit bat.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49) Besides bats, other wild animals that are sometimes infected with EBOV include several species of monkeys such as [baboons](https://en.wikipedia.org/wiki/Baboon "Baboon"), [great apes](https://en.wikipedia.org/wiki/Great_apes "Great apes") ([chimpanzees](https://en.wikipedia.org/wiki/Chimpanzee "Chimpanzee") and [gorillas](https://en.wikipedia.org/wiki/Gorilla "Gorilla")), and [duikers](https://en.wikipedia.org/wiki/Duikers "Duikers") (a species of [antelope](https://en.wikipedia.org/wiki/Antelope "Antelope")).[\[50\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlEbolavirus_%E2%80%93_Pathogen_Safety_Data_Sheets-50)
Animals may become infected when they eat fruit partially eaten by bats carrying the virus.[\[51\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gon2007-51) Fruit production, animal behavior and other factors may trigger outbreaks among animal populations.[\[51\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gon2007-51)
Evidence indicates that both domestic dogs and pigs can also be infected with EBOV.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52) Dogs do not appear to develop symptoms when they carry the virus, and pigs appear to be able to transmit the virus to at least some primates.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52) Although some dogs in an area in which a human outbreak occurred had antibodies to EBOV, it is unclear whether they played a role in spreading the disease to people.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52)
Areas undergoing [deforestation](https://en.wikipedia.org/wiki/Deforestation "Deforestation") are among the most likely places for outbreaks due to changes in the landscape bringing wildlife into closer contact with humans, including the [West African Ebola virus epidemic](https://en.wikipedia.org/wiki/West_African_Ebola_virus_epidemic "West African Ebola virus epidemic").[\[53\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Christensen_2019-53)[\[54\]](https://en.wikipedia.org/wiki/Ebola#cite_note-54) Index cases of EVD have often been close to recently deforested lands.[\[55\]](https://en.wikipedia.org/wiki/Ebola#cite_note-55)[\[56\]](https://en.wikipedia.org/wiki/Ebola#cite_note-56)
This section is an excerpt from [Climate change and infectious diseases § Ebola](https://en.wikipedia.org/wiki/Climate_change_and_infectious_diseases#Ebola "Climate change and infectious diseases").\[[edit](https://en.wikipedia.org/w/index.php?title=Climate_change_and_infectious_diseases&action=edit)\]
Climate change may indirectly contribute to the rise in Ebola cases. [Extreme weather](https://en.wikipedia.org/wiki/Extreme_weather "Extreme weather") events such as droughts, strong winds, thunderstorms, heat waves, floods, landslides, and shifting rainfall patterns can disrupt wildlife migration, pushing animals out of their natural habitats and nearer to human settlements.[\[57\]](https://en.wikipedia.org/wiki/Ebola#cite_note-57) For instance, a severe drought in Central Africa intensified [food insecurity](https://en.wikipedia.org/wiki/Food_security "Food security"), leading some West African communities to hunt and consume infected animals such as bats, which likely fueled an Ebola outbreak.[\[58\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Climate_change_and_infectious_diseases_Christensen_2019-58)
### Reservoir
The [natural reservoir](https://en.wikipedia.org/wiki/Natural_reservoir "Natural reservoir") for Ebola has yet to be confirmed; however, [bats](https://en.wikipedia.org/wiki/Bat "Bat") are considered to be the most likely candidate.[\[59\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chowell2014-59) Three types of fruit bats (*[Hypsignathus monstrosus](https://en.wikipedia.org/wiki/Hypsignathus_monstrosus "Hypsignathus monstrosus")*, *[Epomops franqueti](https://en.wikipedia.org/wiki/Epomops_franqueti "Epomops franqueti")* and *[Myonycteris torquata](https://en.wikipedia.org/wiki/Myonycteris_torquata "Myonycteris torquata")*) were found to possibly carry the virus without getting sick.[\[60\]](https://en.wikipedia.org/wiki/Ebola#cite_note-60) As of 2013[\[update\]](https://en.wikipedia.org/w/index.php?title=Ebola&action=edit), whether other animals are involved in its spread is not known.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52) Plants, [arthropods](https://en.wikipedia.org/wiki/Arthropod "Arthropod"), [rodents](https://en.wikipedia.org/wiki/Rodent "Rodent"), and birds have also been considered possible viral reservoirs.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[21\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Sharma2015-21)
Bats were known to roost in the cotton factory in which the [first cases](https://en.wikipedia.org/wiki/Index_case "Index case") of the 1976 and 1979 outbreaks were observed, and they have also been implicated in Marburg virus infections in 1975 and 1980.[\[61\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Pourrut2005-61) Of 24 plant and 19 vertebrate species experimentally inoculated with EBOV, only bats became infected.[\[62\]](https://en.wikipedia.org/wiki/Ebola#cite_note-62) The bats displayed no clinical signs of disease, which is considered evidence that these bats are a reservoir species of EBOV. In a 2002–2003 survey of 1,030 animals including 679 bats from [Gabon](https://en.wikipedia.org/wiki/Gabon "Gabon") and the [Republic of the Congo](https://en.wikipedia.org/wiki/Republic_of_the_Congo "Republic of the Congo"), immunoglobulin G (IgG) immune defense molecules indicative of Ebola infection were found in three bat species; at various periods of study, between 2.2 and 22.6% of bats were found to contain both RNA sequences and IgG molecules indicating Ebola infection.[\[63\]](https://en.wikipedia.org/wiki/Ebola#cite_note-63) Antibodies against Zaire and Reston viruses have been found in fruit bats in [Bangladesh](https://en.wikipedia.org/wiki/Bangladesh "Bangladesh"), suggesting that these bats are also potential hosts of the virus and that the filoviruses are present in Asia.[\[64\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Olival2013-64)
Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians and [arthropods](https://en.wikipedia.org/wiki/Arthropod "Arthropod") sampled from regions of EBOV outbreaks, no Ebola virus was detected apart from some genetic traces found in six rodents (belonging to the species *[Mus setulosus](https://en.wikipedia.org/wiki/Mus_setulosus "Mus setulosus")* and *[Praomys](https://en.wikipedia.org/wiki/Praomys "Praomys")*) and one [shrew](https://en.wikipedia.org/wiki/Shrew "Shrew") (*[Sylvisorex ollula](https://en.wikipedia.org/wiki/Sylvisorex_ollula "Sylvisorex ollula")*) collected from the [Central African Republic](https://en.wikipedia.org/wiki/Central_African_Republic "Central African Republic").[\[61\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Pourrut2005-61)[\[65\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Morvan1999-65) However, further research efforts have not confirmed rodents as a reservoir.[\[66\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Groseth2007-66) Traces of EBOV were detected in the carcasses of gorillas and chimpanzees during outbreaks in 2001 and 2003, which later became the source of human infections. However, the high rates of death in these species resulting from EBOV infection make it unlikely that these species represent a natural reservoir for the virus.[\[61\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Pourrut2005-61)
## Transmission
[](https://en.wikipedia.org/wiki/File:Ebola_illustration-_safe_burial_\(15573264517\).jpg)
An illustration of safe burial practices
It is believed that between people, Ebola disease spreads only by direct contact with the blood or other [body fluids](https://en.wikipedia.org/wiki/Body_fluid "Body fluid") of a person who has developed symptoms of the disease.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67)[\[68\]](https://en.wikipedia.org/wiki/Ebola#cite_note-68)[\[69\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Drazen2014-69) Body fluids that may contain Ebola viruses include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and [semen](https://en.wikipedia.org/wiki/Semen "Semen").[\[7\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cdc9months-7)[\[32\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014QAT-32) The WHO states that only people who are very sick are able to spread Ebola disease in [saliva](https://en.wikipedia.org/wiki/Saliva "Saliva"), and the virus has not been reported to be transmitted through sweat. Most people spread the virus through blood, [feces](https://en.wikipedia.org/wiki/Feces "Feces") and vomit.[\[70\]](https://en.wikipedia.org/wiki/Ebola#cite_note-70) Entry points for the virus include the nose, mouth, eyes, open wounds, cuts and abrasions.[\[32\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014QAT-32) Ebola may be spread through large [droplets](https://en.wikipedia.org/wiki/Transmission_\(medicine\)#Droplet "Transmission (medicine)"); however, this is believed to occur only when a person is very sick.[\[71\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCNOV2014-71) This contamination can happen if a person is splashed with droplets.[\[71\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCNOV2014-71) Contact with surfaces or objects contaminated by the virus, particularly needles and syringes, may also transmit the infection.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49)[\[59\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chowell2014-59) The virus is able to survive on objects for a few hours in a dried state, and can survive for a few days within body fluids outside of a person.[\[32\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014QAT-32)[\[72\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ost2015-72)
The Ebola virus may be able to persist for more than three months in the semen after recovery, which could lead to infections via [sexual intercourse](https://en.wikipedia.org/wiki/Sexual_intercourse "Sexual intercourse").[\[7\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cdc9months-7)[\[73\]](https://en.wikipedia.org/wiki/Ebola#cite_note-73) Virus persistence in semen for over a year has been recorded in a national screening programme.[\[74\]](https://en.wikipedia.org/wiki/Ebola#cite_note-74) Ebola may also occur in the breast milk of women after recovery, and it is not known when it is safe to breastfeed again.[\[8\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCBreast2014-8) The virus was also found in the eye of [one patient](https://en.wikipedia.org/wiki/Ian_Crozier "Ian Crozier"), in 2014, two months after it was cleared from his blood.[\[75\]](https://en.wikipedia.org/wiki/Ebola#cite_note-VarkeyShantha2015-75) Otherwise, people who have recovered are not infectious.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49)
The potential for [widespread infections](https://en.wikipedia.org/wiki/Pandemics "Pandemics") in countries with medical systems capable of observing correct medical isolation procedures is considered low.[\[76\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCPress2014-76) Usually when someone has symptoms of the disease, they are unable to travel without assistance.[\[77\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014T-77)
Dead bodies remain infectious; thus, people handling human remains in practices such as traditional burial rituals or more modern processes such as [embalming](https://en.wikipedia.org/wiki/Embalming "Embalming") are at risk.[\[76\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCPress2014-76) Of the cases of Ebola infections in Guinea during the 2014 outbreak, 69% are believed to have been contracted via unprotected (or unsuitably protected) contact with infected corpses during certain Guinean burial rituals.[\[78\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chan2014-78)[\[79\]](https://en.wikipedia.org/wiki/Ebola#cite_note-79)
Health-care workers treating people with Ebola are at greatest risk of infection.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49) The risk increases when they do not have appropriate protective clothing such as masks, gowns, gloves and eye protection; do not wear it properly; or handle contaminated clothing incorrectly.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49) This risk is particularly common in parts of Africa where the disease mostly occurs and health systems function poorly.[\[80\]](https://en.wikipedia.org/wiki/Ebola#cite_note-80) There has been transmission [in hospitals](https://en.wikipedia.org/wiki/Nosocomial "Nosocomial") in some African countries that reuse hypodermic needles.[\[81\]](https://en.wikipedia.org/wiki/Ebola#cite_note-81)[\[82\]](https://en.wikipedia.org/wiki/Ebola#cite_note-82) Some health-care centres caring for people with the disease do not have running water.[\[83\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCQA2014-83) In the United States the spread to two medical workers treating infected patients prompted criticism of inadequate training and procedures.[\[84\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NBC-ebolaTX-84)
Human-to-human transmission of EBOV through the air has not been reported to occur during EVD outbreaks,[\[6\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHOAir2014-6) and airborne transmission has only been demonstrated in very strict laboratory conditions, and then only from pigs to [primates](https://en.wikipedia.org/wiki/Primates "Primates"), but not from primates to primates.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67)[\[59\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chowell2014-59) Spread of EBOV by water, or food other than bushmeat, has not been observed.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49)[\[59\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chowell2014-59) No spread by mosquitos or other insects has been reported.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49) Other possible methods of transmission are being studied.[\[72\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ost2015-72)
Airborne transmission among humans is theoretically possible due to the presence of Ebola virus particles in saliva, which can be discharged into the air with a cough or sneeze, but observational data from previous epidemics suggests the actual risk of airborne transmission is low.[\[85\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Jones2015-85) A number of studies examining airborne transmission broadly concluded that transmission from pigs to primates could happen without direct contact because, unlike humans and primates, pigs with EVD get very high ebolavirus concentrations in their lungs, and not their bloodstream.[\[86\]](https://en.wikipedia.org/wiki/Ebola#cite_note-virology1-86) Therefore, pigs with EVD can spread the disease through droplets in the air or on the ground when they sneeze or cough.[\[87\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl2012-87) By contrast, humans and other primates accumulate the virus throughout their body and specifically in their blood, but not very much in their lungs.[\[87\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl2012-87) It is believed that this is the reason researchers have observed pig to primate transmission without physical contact, but no evidence has been found of primates being infected without actual contact, even in experiments where infected and uninfected primates shared the same air.[\[86\]](https://en.wikipedia.org/wiki/Ebola#cite_note-virology1-86)[\[87\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl2012-87)
## Pathophysiology
[](https://en.wikipedia.org/wiki/File:Ebola_Pathenogensis_path.svg)
[Pathogenesis](https://en.wikipedia.org/wiki/Pathogenesis "Pathogenesis") schematic
Like other [filoviruses](https://en.wikipedia.org/wiki/Filoviridae "Filoviridae"), EBOV replicates very efficiently in many [cells](https://en.wikipedia.org/wiki/List_of_distinct_cell_types_in_the_adult_human_body "List of distinct cell types in the adult human body"), producing large amounts of virus in [monocytes](https://en.wikipedia.org/wiki/Monocyte "Monocyte"), [macrophages](https://en.wikipedia.org/wiki/Macrophage "Macrophage"), [dendritic cells](https://en.wikipedia.org/wiki/Dendritic_cell "Dendritic cell") and other cells including [liver cells](https://en.wikipedia.org/wiki/Hepatocyte "Hepatocyte"), [fibroblasts](https://en.wikipedia.org/wiki/Fibroblast "Fibroblast"), and [adrenal gland cells](https://en.wikipedia.org/wiki/Adrenal_gland "Adrenal gland").[\[88\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ansari2014-88) Viral replication triggers [high levels of inflammatory chemical signals](https://en.wikipedia.org/wiki/Cytokine_storm "Cytokine storm") and leads to a [septic state](https://en.wikipedia.org/wiki/Sepsis "Sepsis").[\[29\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Tosh2014-29)
EBOV is thought to infect humans through contact with mucous membranes or skin breaks.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67) After infection, [endothelial cells](https://en.wikipedia.org/wiki/Endothelial_cells "Endothelial cells") (cells lining the inside of blood vessels), liver cells, and several types of immune cells such as [macrophages, monocytes](https://en.wikipedia.org/wiki/Mononuclear_phagocyte_system "Mononuclear phagocyte system"), and dendritic cells are the main targets of attack.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67) Following infection, immune cells carry the virus to nearby [lymph nodes](https://en.wikipedia.org/wiki/Lymph_node "Lymph node") where further reproduction of the virus takes place.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67) From there the virus can enter the bloodstream and [lymphatic system](https://en.wikipedia.org/wiki/Lymphatic_system "Lymphatic system") and spread throughout the body.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67) Macrophages are the first cells infected with the virus, and this infection results in [programmed cell death](https://en.wikipedia.org/wiki/Apoptosis "Apoptosis").[\[41\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chippaux2014-41) Other types of [white blood cells](https://en.wikipedia.org/wiki/White_blood_cell "White blood cell"), such as [lymphocytes](https://en.wikipedia.org/wiki/Lymphocyte "Lymphocyte"), also undergo programmed cell death leading to an abnormally [low concentration of lymphocytes](https://en.wikipedia.org/wiki/Lymphocytopenia "Lymphocytopenia") in the blood.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67) This contributes to the weakened immune response seen in those infected with EBOV.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67)
Endothelial cells may be infected within three days after exposure to the virus.[\[41\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chippaux2014-41) The breakdown of endothelial cells leading to [blood vessel](https://en.wikipedia.org/wiki/Blood_vessel "Blood vessel") injury can be attributed to EBOV [glycoproteins](https://en.wikipedia.org/wiki/Glycoprotein "Glycoprotein"). This damage occurs due to the synthesis of Ebola virus [glycoprotein](https://en.wikipedia.org/wiki/Glycoprotein "Glycoprotein") (GP), which reduces the availability of specific [integrins](https://en.wikipedia.org/wiki/Integrin "Integrin") responsible for cell adhesion to the intercellular structure and causes liver damage, leading to [improper clotting](https://en.wikipedia.org/wiki/Coagulopathy "Coagulopathy"). The widespread [bleeding](https://en.wikipedia.org/wiki/Bleeding "Bleeding") that occurs in affected people causes [swelling](https://en.wikipedia.org/wiki/Oedema "Oedema") and [shock due to loss of blood volume](https://en.wikipedia.org/wiki/Hypovolemic_shock "Hypovolemic shock").[\[89\]](https://en.wikipedia.org/wiki/Ebola#cite_note-isbn0-7910-8505-8-89) The [dysfunctional bleeding and clotting](https://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation "Disseminated intravascular coagulation") commonly seen in EVD has been attributed to increased activation of the [extrinsic pathway](https://en.wikipedia.org/wiki/Tissue_factor_pathway "Tissue factor pathway") of the [coagulation cascade](https://en.wikipedia.org/wiki/Coagulation_cascade "Coagulation cascade") due to excessive [tissue factor](https://en.wikipedia.org/wiki/Tissue_factor "Tissue factor") production by macrophages and monocytes.[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15)
After infection, a secreted [glycoprotein](https://en.wikipedia.org/wiki/Glycoprotein "Glycoprotein"), small soluble glycoprotein (sGP or GP) is synthesised. EBOV replication overwhelms protein synthesis of infected cells and the host immune defences. The GP forms a [trimeric complex](https://en.wikipedia.org/wiki/Trimer_\(biochemistry\) "Trimer (biochemistry)"), which tethers the virus to the endothelial cells. The sGP forms a [dimeric protein](https://en.wikipedia.org/wiki/Protein_dimer "Protein dimer") that interferes with the signalling of [neutrophils](https://en.wikipedia.org/wiki/Neutrophils "Neutrophils"), another type of white blood cell. This enables the virus to evade the immune system by inhibiting early steps of neutrophil activation.\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] Furthermore, the virus is capable of hijacking cellular metabolism. Studies have shown that Ebola virus-like particles can reprogram metabolism in both vascular and immune cells.[\[90\]](https://en.wikipedia.org/wiki/Ebola#cite_note-90)
### Immune system evasion
Filoviral infection also interferes with proper functioning of the [innate immune system](https://en.wikipedia.org/wiki/Innate_immune_system "Innate immune system").[\[42\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Misasi2014-42)[\[44\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Olejnik2011-44) EBOV proteins blunt the human immune system's response to viral infections by interfering with the cells' ability to produce and respond to interferon proteins such as [interferon-alpha](https://en.wikipedia.org/wiki/Interferon-alpha "Interferon-alpha"), [interferon-beta](https://en.wikipedia.org/wiki/Interferon-beta "Interferon-beta"), and [interferon gamma](https://en.wikipedia.org/wiki/Interferon_gamma "Interferon gamma").[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43)[\[91\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ramanan2011-91)
The VP24 and VP35 structural proteins of EBOV play a key role in this interference. When a cell is infected with EBOV, receptors located in the cell's [cytosol](https://en.wikipedia.org/wiki/Cytosol "Cytosol") (such as [RIG-I](https://en.wikipedia.org/wiki/RIG-I "RIG-I") and [MDA5](https://en.wikipedia.org/wiki/MDA5 "MDA5")) or outside of the cytosol (such as [Toll-like receptor 3 (TLR3)](https://en.wikipedia.org/wiki/Toll-like_receptor_3 "Toll-like receptor 3"), [TLR7](https://en.wikipedia.org/wiki/Toll-like_receptor_7 "Toll-like receptor 7"), [TLR8](https://en.wikipedia.org/wiki/Toll-like_receptor_8 "Toll-like receptor 8") and [TLR9](https://en.wikipedia.org/wiki/Toll-like_receptor_9 "Toll-like receptor 9")) recognise [infectious molecules](https://en.wikipedia.org/wiki/Pathogen-associated_molecular_pattern "Pathogen-associated molecular pattern") associated with the virus.[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) On TLR activation, proteins including [interferon regulatory factor 3](https://en.wikipedia.org/wiki/Interferon_Regulatory_Factor_3 "Interferon Regulatory Factor 3") and [interferon regulatory factor 7](https://en.wikipedia.org/wiki/Interferon_regulatory_factor-7 "Interferon regulatory factor-7") trigger a signalling cascade that leads to the expression of [type 1 interferons](https://en.wikipedia.org/wiki/Type_1_interferon "Type 1 interferon").[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) The type 1 interferons are then released and bind to the [IFNAR1](https://en.wikipedia.org/wiki/IFNAR1 "IFNAR1") and [IFNAR2](https://en.wikipedia.org/wiki/IFNAR2 "IFNAR2") receptors expressed on the surface of a neighbouring cell.[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) Once interferon has bound to its receptors on the neighbouring cell, the signalling proteins [STAT1](https://en.wikipedia.org/wiki/STAT1 "STAT1") and [STAT2](https://en.wikipedia.org/wiki/STAT2 "STAT2") are activated and move to the [cell's nucleus](https://en.wikipedia.org/wiki/Cell_nucleus "Cell nucleus").[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) This triggers the expression of [interferon-stimulated genes](https://en.wikipedia.org/wiki/Interferome "Interferome"), which code for proteins with antiviral properties.[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) EBOV's V24 protein blocks the production of these antiviral proteins by preventing the STAT1 signalling protein in the neighbouring cell from entering the nucleus.[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) The VP35 protein directly inhibits the production of interferon-beta.[\[91\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ramanan2011-91) By inhibiting these immune responses, EBOV may quickly spread throughout the body.[\[41\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chippaux2014-41)
## Diagnosis
When EVD is suspected, travel, work history, and exposure to wildlife are important factors with respect to further diagnostic efforts.[\[92\]](https://en.wikipedia.org/wiki/Ebola#cite_note-92)
### Laboratory testing
Possible non-specific laboratory indicators of EVD include a [low platelet count](https://en.wikipedia.org/wiki/Thrombocytopenia "Thrombocytopenia"); an initially [decreased white blood cell count](https://en.wikipedia.org/wiki/Leucopenia "Leucopenia") followed by an [increased white blood cell count](https://en.wikipedia.org/wiki/Leucocytosis "Leucocytosis"); elevated levels of the liver enzymes [alanine aminotransferase](https://en.wikipedia.org/wiki/Alanine_aminotransferase "Alanine aminotransferase") (ALT) and [aspartate aminotransferase](https://en.wikipedia.org/wiki/Aspartate_aminotransferase "Aspartate aminotransferase") (AST); and abnormalities in blood clotting often consistent with [disseminated intravascular coagulation](https://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation "Disseminated intravascular coagulation") (DIC) such as a prolonged [prothrombin time](https://en.wikipedia.org/wiki/Prothrombin_time "Prothrombin time"), [partial thromboplastin time](https://en.wikipedia.org/wiki/Partial_thromboplastin_time "Partial thromboplastin time"), and [bleeding time](https://en.wikipedia.org/wiki/Bleeding_time "Bleeding time").[\[93\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kortepeter2011-93) Filovirions such as EBOV may be identified by their unique filamentous shapes in cell cultures examined with [electron microscopy](https://en.wikipedia.org/wiki/Electron_microscopy "Electron microscopy").[\[94\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goldsmith2009-94)
The specific diagnosis of EVD is confirmed by isolating the virus, detecting its [RNA](https://en.wikipedia.org/wiki/RNA "RNA") or proteins, or detecting [antibodies](https://en.wikipedia.org/wiki/Antibodies "Antibodies") against the virus in a person's blood.[\[95\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Diag-95) Isolating the virus by [cell culture](https://en.wikipedia.org/wiki/Cell_culture "Cell culture"), detecting the viral RNA by [polymerase chain reaction](https://en.wikipedia.org/wiki/Polymerase_chain_reaction "Polymerase chain reaction") (PCR)[\[9\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Bro2016-9)[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15) and detecting proteins by [enzyme-linked immunosorbent assay](https://en.wikipedia.org/wiki/Enzyme-linked_immunosorbent_assay "Enzyme-linked immunosorbent assay") (ELISA) are methods best used in the early stages of the disease and also for detecting the virus in human remains.[\[9\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Bro2016-9)[\[95\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Diag-95) Detecting antibodies against the virus is most reliable in the later stages of the disease and in those who recover.[\[95\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Diag-95) [IgM antibodies](https://en.wikipedia.org/wiki/Immunoglobulin_M "Immunoglobulin M") are detectable two days after symptom onset and [IgG antibodies](https://en.wikipedia.org/wiki/Immunoglobulin_G "Immunoglobulin G") can be detected six to 18 days after symptom onset.[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15) During an outbreak, isolation of the virus with cell culture methods is often not feasible. In field or mobile hospitals, the most common and sensitive diagnostic methods are [real-time PCR](https://en.wikipedia.org/wiki/Real-time_PCR "Real-time PCR") and ELISA.[\[96\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Grolla2005-96) In 2014, with new mobile testing facilities deployed in parts of Liberia, test results were obtained 3–5 hours after sample submission.[\[97\]](https://en.wikipedia.org/wiki/Ebola#cite_note-97) In 2015, a rapid antigen test which gives results in 15 minutes was approved for use by WHO.[\[98\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2015Test-98) It is able to confirm Ebola in 92% of those affected and rule it out in 85% of those not affected.[\[98\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2015Test-98)
### Differential diagnosis
Early symptoms of EVD may be similar to those of other diseases common in Africa, including [malaria](https://en.wikipedia.org/wiki/Malaria "Malaria") and [dengue fever](https://en.wikipedia.org/wiki/Dengue_fever "Dengue fever").[\[17\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gatherer_2014-17) The symptoms are also similar to those of other viral haemorrhagic fevers such as [Marburg virus disease](https://en.wikipedia.org/wiki/Marburg_virus_disease "Marburg virus disease"), [Crimean–Congo haemorrhagic fever](https://en.wikipedia.org/wiki/Crimean%E2%80%93Congo_haemorrhagic_fever "Crimean–Congo haemorrhagic fever"), and [Lassa fever](https://en.wikipedia.org/wiki/Lassa_fever "Lassa fever").[\[99\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Harrison-99)[\[100\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Beeching2014-100)
The complete [differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") is extensive and requires consideration of many other infectious diseases such as [typhoid fever](https://en.wikipedia.org/wiki/Typhoid_fever "Typhoid fever"), [shigellosis](https://en.wikipedia.org/wiki/Shigellosis "Shigellosis"), [rickettsial diseases](https://en.wikipedia.org/wiki/Rickettsia "Rickettsia"), [cholera](https://en.wikipedia.org/wiki/Cholera "Cholera"), [sepsis](https://en.wikipedia.org/wiki/Sepsis "Sepsis"), [borreliosis](https://en.wikipedia.org/wiki/Borreliosis "Borreliosis"), [EHEC enteritis](https://en.wikipedia.org/wiki/Verotoxin-producing_Escherichia_coli "Verotoxin-producing Escherichia coli"), [leptospirosis](https://en.wikipedia.org/wiki/Leptospirosis "Leptospirosis"), [scrub typhus](https://en.wikipedia.org/wiki/Scrub_typhus "Scrub typhus"), [plague](https://en.wikipedia.org/wiki/Plague_\(disease\) "Plague (disease)"), [Q fever](https://en.wikipedia.org/wiki/Q_fever "Q fever"), [candidiasis](https://en.wikipedia.org/wiki/Candidiasis "Candidiasis"), [histoplasmosis](https://en.wikipedia.org/wiki/Histoplasmosis "Histoplasmosis"), [trypanosomiasis](https://en.wikipedia.org/wiki/Trypanosomiasis "Trypanosomiasis"), [visceral](https://en.wikipedia.org/wiki/Visceral "Visceral") [leishmaniasis](https://en.wikipedia.org/wiki/Leishmaniasis "Leishmaniasis"), [measles](https://en.wikipedia.org/wiki/Measles "Measles"), and [viral hepatitis](https://en.wikipedia.org/wiki/Viral_hepatitis "Viral hepatitis") among others.[\[101\]](https://en.wikipedia.org/wiki/Ebola#cite_note-101)
Non-infectious diseases that may result in symptoms similar to those of EVD include [acute promyelocytic leukaemia](https://en.wikipedia.org/wiki/Acute_promyelocytic_leukaemia "Acute promyelocytic leukaemia"), [haemolytic uraemic syndrome](https://en.wikipedia.org/wiki/Haemolytic_uraemic_syndrome "Haemolytic uraemic syndrome"), [snake envenomation](https://en.wikipedia.org/wiki/Snake_envenomation "Snake envenomation"), [clotting factor](https://en.wikipedia.org/wiki/Coagulation "Coagulation") deficiencies/platelet disorders, [thrombotic thrombocytopenic purpura](https://en.wikipedia.org/wiki/Thrombotic_thrombocytopenic_purpura "Thrombotic thrombocytopenic purpura"), [hereditary haemorrhagic telangiectasia](https://en.wikipedia.org/wiki/Hereditary_haemorrhagic_telangiectasia "Hereditary haemorrhagic telangiectasia"), [Kawasaki disease](https://en.wikipedia.org/wiki/Kawasaki_disease "Kawasaki disease"), and [warfarin](https://en.wikipedia.org/wiki/Warfarin "Warfarin") poisoning.[\[96\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Grolla2005-96)[\[102\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gear1989-102)[\[103\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gear1978-103)[\[104\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Bogomolov1998-104)
## Prevention
Main article: [Prevention of viral hemorrhagic fever](https://en.wikipedia.org/wiki/Prevention_of_viral_hemorrhagic_fever "Prevention of viral hemorrhagic fever")
### Vaccines
Main article: [Ebola vaccine](https://en.wikipedia.org/wiki/Ebola_vaccine "Ebola vaccine")
An [Ebola vaccine](https://en.wikipedia.org/wiki/Ebola_vaccine "Ebola vaccine"), [rVSV-ZEBOV](https://en.wikipedia.org/wiki/RVSV-ZEBOV "RVSV-ZEBOV"), was approved in the United States in December 2019.[\[105\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA2019Vac-105) It appears to be fully effective ten days after being given.[\[105\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA2019Vac-105) It was studied in Guinea between 2014 and 2016.[\[105\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA2019Vac-105) More than 100,000 people have been vaccinated against Ebola as of 2019[\[update\]](https://en.wikipedia.org/w/index.php?title=Ebola&action=edit).[\[106\]](https://en.wikipedia.org/wiki/Ebola#cite_note-106) The WHO reported that approximately 345,000 people were given the vaccine during the [Kivu Ebola epidemic](https://en.wikipedia.org/wiki/Kivu_Ebola_epidemic "Kivu Ebola epidemic") from 2018 to 2020.[\[107\]](https://en.wikipedia.org/wiki/Ebola#cite_note-107)
### Infection control
[](https://en.wikipedia.org/wiki/File:VHFisolation.png)
VHF isolation precautions poster
Community awareness of the benefits on survival chances of admitting cases early is important for the infected and infection control [\[12\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Guiliani_2022-12)
#### Caregivers
[](https://en.wikipedia.org/wiki/File:Donna_Wood,_Nurse_and_NHS_Ebola_volunteer_\(15652582937\).jpg)
British woman wearing protective gear
People who care for those infected with Ebola should wear protective clothing including masks, gloves, gowns and goggles.[\[108\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014P-108) The U.S. [Centers for Disease Control](https://en.wikipedia.org/wiki/Centers_for_Disease_Control "Centers for Disease Control") (CDC) recommend that the protective gear leaves no skin exposed.[\[109\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Oct2014CDC-109) These measures are also recommended for those who may handle objects contaminated by an infected person's body fluids.[\[110\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCBook1998-110) In 2014, the CDC began recommending that medical personnel receive training on the proper suit-up and removal of [personal protective equipment](https://en.wikipedia.org/wiki/Personal_protective_equipment "Personal protective equipment") (PPE); in addition, a designated person, appropriately trained in biosafety, should be watching each step of these procedures to ensure they are done correctly.[\[109\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Oct2014CDC-109) In Sierra Leone, the typical training period for the use of such safety equipment lasts approximately 12 days.[\[111\]](https://en.wikipedia.org/wiki/Ebola#cite_note-111) In 2022 in Uganda, lighter personal protection equipment has become available as well as possibilities to monitor and communicate with patients from windows in the treatment tents until it is necessary to enter if e.g. a patient's oxygen levels drop.[\[12\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Guiliani_2022-12)
#### Patients and household members
The infected person should be in [barrier-isolation](https://en.wikipedia.org/wiki/Isolation_\(health_care\) "Isolation (health care)") from other people.[\[108\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014P-108) All equipment, medical waste, patient waste and surfaces that may have come into contact with body fluids need to be [disinfected](https://en.wikipedia.org/wiki/Disinfection "Disinfection").[\[110\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCBook1998-110) During the 2014 outbreak, kits were put together to help families treat Ebola disease in their homes, which included protective clothing as well as [chlorine powder](https://en.wikipedia.org/wiki/Chlorine_powder "Chlorine powder") and other cleaning supplies.[\[112\]](https://en.wikipedia.org/wiki/Ebola#cite_note-112) Education of caregivers in these techniques, and providing such barrier-separation supplies has been a priority of [Doctors Without Borders](https://en.wikipedia.org/wiki/Doctors_Without_Borders "Doctors Without Borders").[\[113\]](https://en.wikipedia.org/wiki/Ebola#cite_note-113)
#### Disinfection
Ebolaviruses can be [eliminated](https://en.wikipedia.org/wiki/Sterilization_\(microbiology\) "Sterilization (microbiology)") with heat (heating for 30 to 60 minutes at 60 °C or boiling for five minutes). To [disinfect](https://en.wikipedia.org/wiki/Disinfectants "Disinfectants") surfaces, some lipid solvents such as some alcohol-based products, detergents, sodium hypochlorite (bleach) or [calcium hypochlorite](https://en.wikipedia.org/wiki/Calcium_hypochlorite "Calcium hypochlorite") (bleaching powder), and other suitable disinfectants may be used at appropriate concentrations.[\[50\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlEbolavirus_%E2%80%93_Pathogen_Safety_Data_Sheets-50)[\[114\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Infection_Guidance-114)
#### General population
Education of the general public about the risk factors for Ebola infection and of the protective measures individuals may take to prevent infection is recommended by the [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) These measures include avoiding direct contact with infected people and regular [hand washing](https://en.wikipedia.org/wiki/Hand_washing "Hand washing") using soap and water.[\[115\]](https://en.wikipedia.org/wiki/Ebola#cite_note-115)
#### Bushmeat
[Bushmeat](https://en.wikipedia.org/wiki/Bushmeat "Bushmeat"), an important source of protein in the diet of some Africans, should be handled and prepared with appropriate protective clothing and thoroughly cooked before consumption.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Some research suggests that an outbreak of Ebola disease in the wild animals used for consumption may result in a corresponding human outbreak. Since 2003, such animal outbreaks have been monitored to predict and prevent Ebola outbreaks in humans.[\[116\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Rouquet_2005-116)
#### Corpses, burial
If a person with Ebola disease dies, direct contact with the body should be avoided.[\[108\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014P-108) Certain [burial rituals](https://en.wikipedia.org/wiki/Burial_ritual "Burial ritual"), which may have included making various direct contacts with a dead body, require reformulation so that they consistently maintain a proper protective barrier between the dead body and the living.[\[110\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCBook1998-110)[\[117\]](https://en.wikipedia.org/wiki/Ebola#cite_note-url_www.who.int_burial-117)[\[118\]](https://en.wikipedia.org/wiki/Ebola#cite_note-118) Social anthropologists may help find alternatives to traditional rules for burials.[\[119\]](https://en.wikipedia.org/wiki/Ebola#cite_note-119)
#### Transport, travel, contact
Transportation crews are instructed to follow a certain isolation procedure, should anyone exhibit symptoms resembling EVD.[\[120\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlWHO_%E2%80%93_West_Africa_%E2%80%93_Ebola_virus_disease-120) As of August 2014[\[update\]](https://en.wikipedia.org/w/index.php?title=Ebola&action=edit), the WHO does not consider travel bans to be useful in decreasing spread of the disease.[\[77\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014T-77) In October 2014, the CDC defined four risk levels used to determine the level of 21-day monitoring for symptoms and restrictions on public activities.[\[121\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC_monitor_movement-121) In the United States, the CDC recommends that restrictions on public activity, including travel restrictions, are not required for the following defined risk levels:[\[121\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC_monitor_movement-121)
- having been in a country with widespread Ebola disease transmission and having no known exposure (low risk); or having been in that country more than 21 days ago (no risk)
- encounter with a person showing symptoms; but not within three feet of the person with Ebola without wearing PPE; and no direct contact with body fluids
- having had brief skin contact with a person showing symptoms of Ebola disease when the person was believed to be not very contagious (low risk)
- in countries without widespread Ebola disease transmission: direct contact with a person showing symptoms of the disease while wearing PPE (low risk)
- contact with a person with Ebola disease before the person was showing symptoms (no risk).
The CDC recommends monitoring for the symptoms of Ebola disease for those both at "low risk" and at higher risk.[\[121\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC_monitor_movement-121)
#### Laboratory
In laboratories where diagnostic testing is carried out, [biosafety level 4-equivalent containment](https://en.wikipedia.org/wiki/Biosafety_level "Biosafety level") is required.[\[122\]](https://en.wikipedia.org/wiki/Ebola#cite_note-OSHA-122) Laboratory researchers must be properly trained in BSL-4 practices and wear proper PPE.[\[122\]](https://en.wikipedia.org/wiki/Ebola#cite_note-OSHA-122)
### Isolation
Isolation refers to separating those who are sick from those who are not. [Quarantine](https://en.wikipedia.org/wiki/Quarantine "Quarantine") refers to separating those who may have been exposed to a disease until they either show signs of the disease or are no longer at risk.[\[123\]](https://en.wikipedia.org/wiki/Ebola#cite_note-123) Quarantine, also known as enforced isolation, is usually effective in decreasing spread.[\[124\]](https://en.wikipedia.org/wiki/Ebola#cite_note-124)[\[125\]](https://en.wikipedia.org/wiki/Ebola#cite_note-pmid16597410-125) Governments often quarantine areas where the disease is occurring or individuals who may transmit the disease outside of an initial area.[\[126\]](https://en.wikipedia.org/wiki/Ebola#cite_note-126) In the United States, the law allows quarantine of those infected with ebolaviruses.[\[127\]](https://en.wikipedia.org/wiki/Ebola#cite_note-127)[\[128\]](https://en.wikipedia.org/wiki/Ebola#cite_note-128)
### Contact tracing
[Contact tracing](https://en.wikipedia.org/wiki/Contact_tracing "Contact tracing") is considered important to contain an outbreak. It involves finding everyone who had close contact with infected individuals and monitoring them for signs of illness for 21 days. If any of these contacts comes down with the disease, they should be isolated, tested and treated. Then the process is repeated, tracing the contacts' contacts.[\[129\]](https://en.wikipedia.org/wiki/Ebola#cite_note-129)[\[130\]](https://en.wikipedia.org/wiki/Ebola#cite_note-130)
## Management
As of 2019[\[update\]](https://en.wikipedia.org/w/index.php?title=Ebola&action=edit) two treatments ([atoltivimab/maftivimab/odesivimab](https://en.wikipedia.org/wiki/Atoltivimab/maftivimab/odesivimab "Atoltivimab/maftivimab/odesivimab") and [ansuvimab](https://en.wikipedia.org/wiki/Ansuvimab "Ansuvimab")) are associated with improved outcomes.[\[131\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NIH2019-131)[\[11\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NIH2019Tx-11) The U.S. [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) advises people to be careful of advertisements making unverified or fraudulent claims of benefits supposedly gained from various anti-Ebola products.[\[132\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA2014R-132)[\[133\]](https://en.wikipedia.org/wiki/Ebola#cite_note-133)
In October 2020, the U.S. [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) approved atoltivimab/maftivimab/odesivimab with an [indication](https://en.wikipedia.org/wiki/Indication_\(medicine\) "Indication (medicine)") for the treatment of infection caused by *Zaire ebolavirus*.[\[13\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA_PR-13)
### Standard support
[](https://en.wikipedia.org/wiki/File:Ebola_outbreak_in_Gulu_Municipal_Hospital.jpg)
A hospital isolation ward in [Gulu, Uganda](https://en.wikipedia.org/wiki/Gulu "Gulu"), during the October 2000 outbreak
Treatment is primarily [supportive](https://en.wikipedia.org/wiki/Palliative_care "Palliative care") in nature.[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) Early supportive care with rehydration and symptomatic treatment improves survival.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Rehydration may be via the [oral](https://en.wikipedia.org/wiki/Oral_rehydration_therapy "Oral rehydration therapy") or [intravenous](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy") route.[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) These measures may include [pain management](https://en.wikipedia.org/wiki/Pain_management "Pain management"), and treatment for [nausea](https://en.wikipedia.org/wiki/Antiemetic "Antiemetic"), [fever](https://en.wikipedia.org/wiki/Antipyretic "Antipyretic"), and [anxiety](https://en.wikipedia.org/wiki/Anxiolytic "Anxiolytic").[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) The [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") (WHO) recommends avoiding [aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin") or [ibuprofen](https://en.wikipedia.org/wiki/Ibuprofen "Ibuprofen") for pain management, due to the risk of bleeding associated with these medications.[\[135\]](https://en.wikipedia.org/wiki/Ebola#cite_note-135)
Blood products such as [packed red blood cells](https://en.wikipedia.org/wiki/Packed_red_blood_cells "Packed red blood cells"), [platelets](https://en.wikipedia.org/wiki/Platelet "Platelet"), or [fresh frozen plasma](https://en.wikipedia.org/wiki/Fresh_frozen_plasma "Fresh frozen plasma") may also be used.[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) Other regulators of coagulation have also been tried including [heparin](https://en.wikipedia.org/wiki/Heparin "Heparin") in an effort to prevent [disseminated intravascular coagulation](https://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation "Disseminated intravascular coagulation") and [clotting factors](https://en.wikipedia.org/wiki/Coagulation_factors "Coagulation factors") to decrease bleeding.[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) [Antimalarial medications](https://en.wikipedia.org/wiki/Antimalarial_medication "Antimalarial medication") and [antibiotics](https://en.wikipedia.org/wiki/Antibiotics "Antibiotics") are often used before the diagnosis is confirmed,[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) though there is no evidence to suggest such treatment helps. Several [experimental treatments are being studied](https://en.wikipedia.org/wiki/Ebola_virus_disease_treatment_research "Ebola virus disease treatment research").[\[136\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:4-136)
Where hospital care is not possible, the WHO's guidelines for home care have been relatively successful. Recommendations include using towels soaked in a bleach solution when moving infected people or bodies and also applying bleach on stains. It is also recommended that the caregivers wash hands with bleach solutions and cover their mouth and nose with a cloth.[\[137\]](https://en.wikipedia.org/wiki/Ebola#cite_note-137)
### Intensive care
[Intensive care](https://en.wikipedia.org/wiki/Intensive_care "Intensive care") is often used in the developed world.[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25) This may include maintaining blood volume and electrolytes (salts) balance as well as treating any bacterial infections that may develop.[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25) [Dialysis](https://en.wikipedia.org/wiki/Haemodialysis "Haemodialysis") may be needed for [kidney failure](https://en.wikipedia.org/wiki/Kidney_failure "Kidney failure"), and [extracorporeal membrane oxygenation](https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation "Extracorporeal membrane oxygenation") may be used for lung dysfunction.[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25)
## Prognosis
EVD has a [risk of death in those infected](https://en.wikipedia.org/wiki/Case_fatality_rate "Case fatality rate") of between 25% and 90%.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[138\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Elsevier/Academic_Press-138) As of September 2014[\[update\]](https://en.wikipedia.org/w/index.php?title=Ebola&action=edit), the average risk of death among those infected is 50%.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) The highest risk of death was 90% in the 2002–2003 [Republic of the Congo](https://en.wikipedia.org/wiki/Republic_of_the_Congo "Republic of the Congo") outbreak.[\[139\]](https://en.wikipedia.org/wiki/Ebola#cite_note-139) Early admission significantly increases survival rates [\[12\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Guiliani_2022-12)
Death, if it occurs, follows typically six to sixteen days after symptoms appear and is often due to [low blood pressure from fluid loss](https://en.wikipedia.org/wiki/Hypovolemic_shock "Hypovolemic shock").[\[4\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ruz2014-4) Early supportive care to prevent dehydration may reduce the risk of death.[\[136\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:4-136)
### Post-Ebola virus syndrome
If an infected person survives, recovery may be quick and complete.[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15)[\[140\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Shantha2017-140) However, a large portion of survivors develop [post-Ebola virus syndrome](https://en.wikipedia.org/wiki/Post-Ebola_virus_syndrome "Post-Ebola virus syndrome") after the acute phase of the infection.[\[141\]](https://en.wikipedia.org/wiki/Ebola#cite_note-pmid31806422-141)
Prolonged cases are often complicated by the occurrence of long-term problems, such as [inflammation of the testicles](https://en.wikipedia.org/wiki/Orchitis "Orchitis"), [joint pains](https://en.wikipedia.org/wiki/Arthralgia "Arthralgia"), fatigue, hearing loss, mood and sleep disturbances, [muscular pain](https://en.wikipedia.org/wiki/Myalgia "Myalgia"), abdominal pain, [menstrual abnormalities](https://en.wikipedia.org/wiki/Menstrual_period "Menstrual period"), [miscarriages](https://en.wikipedia.org/wiki/Miscarriage "Miscarriage"), [skin peeling](https://en.wikipedia.org/wiki/Desquamation "Desquamation"), or [hair loss](https://en.wikipedia.org/wiki/Alopecia "Alopecia").[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15)[\[140\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Shantha2017-140) [Inflammation and swelling of the uveal layer of the eye](https://en.wikipedia.org/wiki/Uveitis "Uveitis") is the most common eye complication in survivors of Ebola virus disease.[\[140\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Shantha2017-140) Eye symptoms, such as [light sensitivity](https://en.wikipedia.org/wiki/Photophobia "Photophobia"), [excess tearing](https://en.wikipedia.org/wiki/Hyperlacrimation "Hyperlacrimation"), and [vision loss](https://en.wikipedia.org/wiki/Vision_loss "Vision loss") have been described.[\[142\]](https://en.wikipedia.org/wiki/Ebola#cite_note-142)
Ebola can stay in some body parts like the eyes,[\[75\]](https://en.wikipedia.org/wiki/Ebola#cite_note-VarkeyShantha2015-75) breasts, and testicles after infection.[\[7\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cdc9months-7)[\[143\]](https://en.wikipedia.org/wiki/Ebola#cite_note-MackayArden2015-143) Sexual transmission after recovery has been suspected.[\[144\]](https://en.wikipedia.org/wiki/Ebola#cite_note-144)[\[145\]](https://en.wikipedia.org/wiki/Ebola#cite_note-145) If sexual transmission occurs following recovery, it is believed to be a rare event.[\[146\]](https://en.wikipedia.org/wiki/Ebola#cite_note-146) One case of a condition similar to [meningitis](https://en.wikipedia.org/wiki/Meningitis "Meningitis") has been reported many months after recovery, as of October 2015[\[update\]](https://en.wikipedia.org/w/index.php?title=Ebola&action=edit).[\[147\]](https://en.wikipedia.org/wiki/Ebola#cite_note-147)
## Epidemiology
For more about specific outbreaks, see [List of Ebola outbreaks](https://en.wikipedia.org/wiki/List_of_Ebola_outbreaks "List of Ebola outbreaks").
The disease typically occurs in outbreaks in tropical regions of [Sub-Saharan Africa](https://en.wikipedia.org/wiki/Sub-Saharan_Africa "Sub-Saharan Africa").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) From 1976 (when it was first identified) through 2013, the WHO reported 2,387 confirmed cases with 1,590 overall fatalities.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[148\]](https://en.wikipedia.org/wiki/Ebola#cite_note-MMWRJune2014-148) The largest outbreak to date was the [Ebola virus epidemic in West Africa](https://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa "Ebola virus epidemic in West Africa"), which caused a large number of deaths in [Guinea](https://en.wikipedia.org/wiki/Guinea "Guinea"), [Sierra Leone](https://en.wikipedia.org/wiki/Sierra_Leone "Sierra Leone"), and [Liberia](https://en.wikipedia.org/wiki/Liberia "Liberia").[\[149\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014-149)[\[150\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCAug2014N-150)
### 1976
#### Sudan
[](https://en.wikipedia.org/wiki/File:Cotton_Factory_in_Nzara,_South_Sudan.jpg)
Cotton factory in Nzara, South Sudan, where the first outbreak occurred
The first known outbreak of EVD was identified only after the fact. It occurred between June and November 1976, in [Nzara, South Sudan](https://en.wikipedia.org/wiki/Nzara,_South_Sudan "Nzara, South Sudan")[\[33\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2012-33)[\[151\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Peterson_AT,_Bauer_JT,_Mills_JN_2004_40%E2%80%9347-151) (then part of [Sudan](https://en.wikipedia.org/wiki/Sudan "Sudan")), and was caused by [Sudan virus](https://en.wikipedia.org/wiki/Sudan_virus "Sudan virus") (SUDV). The Sudan outbreak infected 284 people and killed 151. The first identifiable case in Sudan occurred on 27 June in a storekeeper in a cotton factory in [Nzara](https://en.wikipedia.org/wiki/Nzara "Nzara"), who was hospitalised on 30 June and died on 6 July.[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25)[\[152\]](https://en.wikipedia.org/wiki/Ebola#cite_note-who's_first_encounter-152) Although the WHO medical staff involved in the Sudan outbreak knew that they were dealing with a heretofore unknown disease, the actual "positive identification" process and the naming of the virus did not occur until some months later in [Zaire](https://en.wikipedia.org/wiki/Zaire "Zaire").[\[152\]](https://en.wikipedia.org/wiki/Ebola#cite_note-who's_first_encounter-152)
#### Zaire
Main article: [1976 Zaire Ebola virus outbreak](https://en.wikipedia.org/wiki/1976_Zaire_Ebola_virus_outbreak "1976 Zaire Ebola virus outbreak")
[](https://en.wikipedia.org/wiki/File:CDC_worker_incinerates_med-waste_from_Ebola_patients_in_Zaire.jpg)
A CDC worker incinerates medical waste from Ebola patients in Zaire in 1976.
On 26 August 1976, the second outbreak of EVD began in [Yambuku](https://en.wikipedia.org/wiki/Yambuku "Yambuku"), a small rural village in [Mongala District](https://en.wikipedia.org/wiki/Mongala_District "Mongala District") in northern [Zaire](https://en.wikipedia.org/wiki/Zaire "Zaire") (now known as the [Democratic Republic of the Congo](https://en.wikipedia.org/wiki/Democratic_Republic_of_the_Congo "Democratic Republic of the Congo")).[\[153\]](https://en.wikipedia.org/wiki/Ebola#cite_note-153)[\[154\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2003-154) This outbreak was caused by EBOV, formerly designated *Zaire ebolavirus*, a different member of the [genus](https://en.wikipedia.org/wiki/Genus "Genus") *Ebolavirus* than in the first Sudan outbreak. The [first person infected with the disease](https://en.wikipedia.org/wiki/Index_case "Index case") was the village school's headmaster [Mabalo Lokela](https://en.wikipedia.org/wiki/Mabalo_Lokela "Mabalo Lokela"), who began displaying symptoms on 26 August 1976.[\[155\]](https://en.wikipedia.org/wiki/Ebola#cite_note-whqlibdoc.who.int-155) Lokela had returned from a trip to Northern Zaire near the border of the [Central African Republic](https://en.wikipedia.org/wiki/Central_African_Republic "Central African Republic"), after visiting the [Ebola River](https://en.wikipedia.org/wiki/Ebola_River "Ebola River") between 12 and 22 August. He was originally believed to have [malaria](https://en.wikipedia.org/wiki/Malaria "Malaria") and was given [quinine](https://en.wikipedia.org/wiki/Quinine "Quinine"). However, his symptoms continued to worsen, and he was admitted to Yambuku Mission Hospital on 5 September. Lokela died on 8 September 14 days after he began displaying symptoms.[\[156\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlOutbreak_of_Ebola_Viral_Hemorrhagic_Fever_%E2%80%93_Zaire,_1995-156)[\[157\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlMabalo_Lokela_Archives_%E2%80%93_Political_Moll-157)
Soon after Lokela's death, others who had been in contact with him also died, and people in Yambuku began to panic. The country's Minister of Health and Zaire President [Mobutu Sese Seko](https://en.wikipedia.org/wiki/Mobutu_Sese_Seko "Mobutu Sese Seko") declared the entire region, including Yambuku and the country's capital, [Kinshasa](https://en.wikipedia.org/wiki/Kinshasa "Kinshasa"), a quarantine zone. No-one was permitted to enter or leave the area, and roads, waterways, and airfields were placed under [martial law](https://en.wikipedia.org/wiki/Martial_law "Martial law"). Schools, businesses and social organisations were closed.[\[158\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Stimola-158) The initial response was led by Congolese doctors, including [Jean-Jacques Muyembe-Tamfum](https://en.wikipedia.org/wiki/Jean-Jacques_Muyembe-Tamfum "Jean-Jacques Muyembe-Tamfum"), one of the discoverers of Ebola. Muyembe took a blood sample from a Belgian nun; this sample would eventually be used by [Peter Piot](https://en.wikipedia.org/wiki/Peter_Piot "Peter Piot") to identify the previously unknown Ebola virus.[\[159\]](https://en.wikipedia.org/wiki/Ebola#cite_note-159) Muyembe was also the first scientist to come into direct contact with the disease and survive.[\[160\]](https://en.wikipedia.org/wiki/Ebola#cite_note-160) Researchers from the [Centers for Disease Control and Prevention](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention") (CDC), including Piot, co-discoverer of Ebola, later arrived to assess the effects of the outbreak, observing that "the whole region was in panic."[\[161\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Piot_2012-161)[\[162\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Piot-one-162)[\[163\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Piot-two-163)
Piot concluded that Belgian nuns had inadvertently started the epidemic by giving unnecessary vitamin injections to pregnant women without sterilizing the syringes and needles. The outbreak lasted 26 days and the quarantine lasted two weeks. Researchers speculated that the disease disappeared due to the precautions taken by locals, the quarantine of the area, and discontinuing of the injections.[\[158\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Stimola-158)
During this outbreak, Ngoy Mushola recorded the first clinical description of EVD in [Yambuku](https://en.wikipedia.org/wiki/Yambuku "Yambuku"), where he wrote the following in his daily log: "The illness is characterised with a high temperature of about 39 °C (102 °F), [haematemesis](https://en.wikipedia.org/wiki/Haematemesis "Haematemesis"), diarrhoea with blood, retrosternal abdominal pain, prostration with 'heavy' articulations, and rapid evolution death after a mean of three days."[\[164\]](https://en.wikipedia.org/wiki/Ebola#cite_note-164)
The virus responsible for the initial outbreak, first thought to be the [Marburg virus](https://en.wikipedia.org/wiki/Marburg_virus "Marburg virus"), was later identified as a new type of virus related to the genus *[Marburgvirus](https://en.wikipedia.org/wiki/Marburgvirus "Marburgvirus")*. Virus strain samples isolated from both outbreaks were named "Ebola virus" after the [Ebola River](https://en.wikipedia.org/wiki/Ebola_River "Ebola River"), near the first-identified viral outbreak site in Zaire.[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25) Reports conflict about who initially coined the name: either Karl Johnson of the American CDC team[\[165\]](https://en.wikipedia.org/wiki/Ebola#cite_note-hz-165) or Belgian researchers.[\[166\]](https://en.wikipedia.org/wiki/Ebola#cite_note-observer-166) Subsequently, a number of other cases were reported, almost all centred on the Yambuku mission hospital or close contacts of another case.[\[155\]](https://en.wikipedia.org/wiki/Ebola#cite_note-whqlibdoc.who.int-155) In all, 318 cases and 280 deaths (an 88% fatality rate) occurred in Zaire.[\[167\]](https://en.wikipedia.org/wiki/Ebola#cite_note-emedicine.com-167) Although the two outbreaks were at first believed connected, scientists later realised that they were caused by two distinct ebolaviruses, SUDV and EBOV.[\[154\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2003-154)
### 1995–2014
[](https://en.wikipedia.org/wiki/File:Ebolaf%C3%A4lle_bis_einschlie%C3%9Flich_2020_english.png)
Cases of Ebola fever in Africa since 1976
The second major outbreak occurred in Zaire (now the [Democratic Republic of the Congo](https://en.wikipedia.org/wiki/Democratic_Republic_of_the_Congo "Democratic Republic of the Congo"), DRC), in 1995, affecting 315 and killing 254.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)
In 2000, [Uganda](https://en.wikipedia.org/wiki/Uganda "Uganda") had an outbreak infecting 425 and killing 224; in this case, the Sudan virus was found to be the Ebola species responsible for the outbreak.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)
In 2003, an outbreak in the DRC infected 143 and killed 128, a 90% death rate, the highest of a [genus](https://en.wikipedia.org/wiki/Genus "Genus") *Ebolavirus* outbreak to date.[\[168\]](https://en.wikipedia.org/wiki/Ebola#cite_note-pmid14579469-168)
In 2004, a Russian scientist died from Ebola after [sticking](https://en.wikipedia.org/wiki/Needlestick_injury "Needlestick injury") herself with an infected needle.[\[169\]](https://en.wikipedia.org/wiki/Ebola#cite_note-169)
Between April and August 2007, a fever epidemic[\[170\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CBCRadioSept2007-170) in a four-village region[\[171\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Mystery_DR_Congo_fever_kills_100-171) of the DRC was confirmed in September to have been cases of Ebola.[\[172\]](https://en.wikipedia.org/wiki/Ebola#cite_note-172) Many people who attended the recent funeral of a local village chief died.[\[171\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Mystery_DR_Congo_fever_kills_100-171) The 2007 outbreak eventually infected 264 individuals and killed 187.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)
On 30 November 2007, the Uganda Ministry of Health confirmed an outbreak of Ebola in the [Bundibugyo District](https://en.wikipedia.org/wiki/Bundibugyo_District "Bundibugyo District") in Western Uganda. After confirming samples tested by the United States National Reference Laboratories and the Centers for Disease Control, the World Health Organization (WHO) confirmed the presence of a new species of [genus](https://en.wikipedia.org/wiki/Genus "Genus") *Ebolavirus*, which was tentatively named Bundibugyo.[\[173\]](https://en.wikipedia.org/wiki/Ebola#cite_note-173) The WHO reported 149 cases of this new strain and 37 of those led to deaths.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)
The WHO confirmed two small outbreaks in Uganda in 2012, both caused by the Sudan variant. The first outbreak affected seven people, killing four, and the second affected 24, killing 17.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)
On 17 August 2012, the Ministry of Health of the DRC reported an outbreak of the Ebola-Bundibugyo variant[\[174\]](https://en.wikipedia.org/wiki/Ebola#cite_note-174) in the eastern region.[\[175\]](https://en.wikipedia.org/wiki/Ebola#cite_note-175)[\[176\]](https://en.wikipedia.org/wiki/Ebola#cite_note-176) Other than its discovery in 2007, this was the only time that this variant has been identified as responsible for an outbreak. The WHO revealed that the virus had sickened 57 people and killed 29. The probable cause of the outbreak was tainted [bush meat](https://en.wikipedia.org/wiki/Bush_meat "Bush meat") hunted by local villagers around the towns of [Isiro](https://en.wikipedia.org/wiki/Isiro "Isiro") and Viadana.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[177\]](https://en.wikipedia.org/wiki/Ebola#cite_note-177)
In 2014, an outbreak occurred in the DRC. [Genome-sequencing](https://en.wikipedia.org/wiki/Whole_genome_sequencing "Whole genome sequencing") showed that this outbreak was not related to the [2014–15 West Africa Ebola virus outbreak](https://en.wikipedia.org/wiki/West_Africa_Ebola_virus_outbreak "West Africa Ebola virus outbreak"), but was the same [EBOV](https://en.wikipedia.org/wiki/EBOV "EBOV") species, the Zaire species.[\[178\]](https://en.wikipedia.org/wiki/Ebola#cite_note-2014_DRC_Who_Strain-178) It began in August 2014, and was declared over in November with 66 cases and 49 deaths.[\[179\]](https://en.wikipedia.org/wiki/Ebola#cite_note-reuters1511-179) This was the 7th outbreak in the DRC, three of which occurred during the period when the country was known as [Zaire](https://en.wikipedia.org/wiki/Zaire "Zaire").[\[180\]](https://en.wikipedia.org/wiki/Ebola#cite_note-180)
### 2013–2016 West Africa
Main article: [Western African Ebola epidemic](https://en.wikipedia.org/wiki/Western_African_Ebola_epidemic "Western African Ebola epidemic")
[](https://en.wikipedia.org/wiki/File:Diseased_Ebola_2014.png)
Cases and deaths from April 2014 to July 2015 during the [2013–2015 outbreak](https://en.wikipedia.org/wiki/Western_African_Ebola_epidemic "Western African Ebola epidemic")
In March 2014, the [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") (WHO) reported a major Ebola outbreak in [Guinea](https://en.wikipedia.org/wiki/Guinea "Guinea"), a West African nation.[\[181\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Out-181) Researchers traced the outbreak to a one-year-old child who died in December 2013.[\[182\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Baize2014-182)[\[183\]](https://en.wikipedia.org/wiki/Ebola#cite_note-1st_Chain-183) The disease rapidly spread to the neighbouring countries of [Liberia](https://en.wikipedia.org/wiki/Liberia "Liberia") and [Sierra Leone](https://en.wikipedia.org/wiki/Sierra_Leone "Sierra Leone"). It was the largest Ebola outbreak ever documented, and the first recorded in the region.[\[181\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Out-181) On 8 August 2014, the WHO declared the epidemic an international public health emergency. Urging the world to offer aid to the affected regions, its Director-General said, "Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible."[\[184\]](https://en.wikipedia.org/wiki/Ebola#cite_note-184) By mid-August 2014, [Doctors Without Borders](https://en.wikipedia.org/wiki/Doctors_Without_Borders "Doctors Without Borders") reported the situation in Liberia's capital, [Monrovia](https://en.wikipedia.org/wiki/Monrovia "Monrovia"), was "catastrophic" and "deteriorating daily". They reported that fears of Ebola among staff members and patients had shut down much of the city's health system, leaving many people without medical treatment for other conditions.[\[185\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Common_Dreams-185) In a 26 September statement, WHO said, "The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times. Never before in recorded history has a [biosafety level](https://en.wikipedia.org/wiki/Biosafety_level "Biosafety level") four pathogen infected so many people so quickly, over such a broad geographical area, for so long."[\[186\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ebola_situation_assessment-186)
Intense contact tracing and strict isolation largely prevented further spread of the disease in the countries that had imported cases.
It caused significant mortality, with a considerable [case fatality rate](https://en.wikipedia.org/wiki/Case_fatality_rate "Case fatality rate").[\[187\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:1-187)[\[188\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014_12_28-188)[\[189\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cfrebolavirus-189)[\[note 1\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cfr-190) By the end of the epidemic, 28,616 people had been infected; of these, 11,310 had died, for a case-fatality rate of 40%.[\[190\]](https://en.wikipedia.org/wiki/Ebola#cite_note-191) As of 8 May 2016[\[update\]](https://en.wikipedia.org/w/index.php?title=Ebola&action=edit), 28,646 suspected cases and 11,323 deaths were reported;[\[191\]](https://en.wikipedia.org/wiki/Ebola#cite_note-08who2016-192)[\[192\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:0-193) however, the WHO said that these numbers may be underestimated.[\[193\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ebola_Outbreak_total_WHO_28_Sept-194) Because they work closely with the body fluids of infected patients, healthcare workers were especially vulnerable to infection; in August 2014, the WHO reported that 10% of the dead were healthcare workers.[\[194\]](https://en.wikipedia.org/wiki/Ebola#cite_note-195)
[](https://en.wikipedia.org/wiki/File:2014_ebola_virus_epidemic_in_West_Africa.svg)
2014 Ebola virus epidemic in West Africa
In September 2014, it was estimated that the countries' capacity for treating Ebola patients was insufficient by the equivalent of 2,122 beds; by December there were a sufficient number of beds to treat and isolate all reported Ebola cases, although the uneven distribution of cases was causing serious shortfalls in some areas.[\[195\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014_12_10-196) On 28 January 2015, the WHO reported that for the first time since the week ending 29 June 2014, there had been fewer than 100 new confirmed cases reported in a week in the three most-affected countries. The response to the epidemic then moved to a second phase, as the focus shifted from slowing transmission to ending the epidemic.[\[196\]](https://en.wikipedia.org/wiki/Ebola#cite_note-World_Health_Organization-197) On 8 April 2015, the WHO reported only 30 confirmed cases, the lowest weekly total since the third week of May 2014.[\[197\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO-198)
On 29 December 2015, 42 days after the last person tested negative for a second time, Guinea was declared free of Ebola transmission.[\[198\]](https://en.wikipedia.org/wiki/Ebola#cite_note-199) At that time, a 90-day period of heightened surveillance was announced by that agency. "This is the first time that all three countries – Guinea, Liberia and Sierra Leone – have stopped the original chains of transmission ...", the organisation stated in a news release.[\[199\]](https://en.wikipedia.org/wiki/Ebola#cite_note-200) A new case was detected in Sierra Leone on 14 January 2016.[\[200\]](https://en.wikipedia.org/wiki/Ebola#cite_note-201) However, the outbreak was declared no longer an emergency on 29 March 2016.[\[201\]](https://en.wikipedia.org/wiki/Ebola#cite_note-who.int-202)
#### 2014 spread outside West Africa
Main articles: [Ebola virus cases in the United States](https://en.wikipedia.org/wiki/Ebola_virus_cases_in_the_United_States "Ebola virus cases in the United States"), [Ebola virus disease in Spain](https://en.wikipedia.org/wiki/Ebola_virus_disease_in_Spain "Ebola virus disease in Spain"), and [Ebola in the United Kingdom](https://en.wikipedia.org/wiki/Ebola_in_the_United_Kingdom "Ebola in the United Kingdom")
On 19 September, Eric Duncan flew from his native Liberia to Texas; five days later he began showing symptoms and visited a hospital but was sent home. His condition worsened and he returned to the hospital on 28 September, where he died on 8 October. Health officials confirmed a diagnosis of Ebola on 30 September – the first case in the United States.[\[202\]](https://en.wikipedia.org/wiki/Ebola#cite_note-203)
In early October, Teresa Romero, a 44-year-old Spanish nurse, contracted Ebola after caring for a priest who had been repatriated from West Africa. This was the first transmission of the virus to occur outside Africa.[\[203\]](https://en.wikipedia.org/wiki/Ebola#cite_note-204) Romero tested negative for the disease on 20 October, suggesting that she may have recovered from Ebola infection.[\[204\]](https://en.wikipedia.org/wiki/Ebola#cite_note-205)
On 12 October, the [Centers for Disease Control and Prevention](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention") (CDC) confirmed that a nurse in Texas, [Nina Pham](https://en.wikipedia.org/wiki/Nina_Pham "Nina Pham"), who had treated Duncan tested positive for the Ebola virus, the first known case of transmission in the United States.[\[205\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NYT-20141012-MF-206) On 15 October, a second Texas health-care worker who had treated Duncan was confirmed to have the virus.[\[84\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NBC-ebolaTX-84) Both of these people recovered.[\[206\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC-20142411-207) An unrelated case involved a doctor in New York City, who returned to the United States from Guinea after working with [Médecins Sans Frontières](https://en.wikipedia.org/wiki/M%C3%A9decins_Sans_Fronti%C3%A8res "Médecins Sans Frontières") and tested positive for Ebola on 23 October.[\[207\]](https://en.wikipedia.org/wiki/Ebola#cite_note-208) The person recovered and was discharged from [Bellevue Hospital](https://en.wikipedia.org/wiki/Bellevue_Hospital "Bellevue Hospital") on 11 November.[\[206\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC-20142411-207) On 24 December 2014, a laboratory in [Atlanta](https://en.wikipedia.org/wiki/Atlanta "Atlanta"), Georgia reported that a technician had been exposed to Ebola.[\[208\]](https://en.wikipedia.org/wiki/Ebola#cite_note-209)
On 29 December 2014, [Pauline Cafferkey](https://en.wikipedia.org/wiki/Pauline_Cafferkey "Pauline Cafferkey"), a British nurse who had just returned to [Glasgow](https://en.wikipedia.org/wiki/Glasgow "Glasgow") from Sierra Leone, was diagnosed with Ebola at Glasgow's [Gartnavel General Hospital](https://en.wikipedia.org/wiki/Gartnavel_General_Hospital "Gartnavel General Hospital").[\[209\]](https://en.wikipedia.org/wiki/Ebola#cite_note-BBC-30628349-210) After initial treatment in Glasgow, she was transferred by air to [RAF Northolt](https://en.wikipedia.org/wiki/RAF_Northolt "RAF Northolt"), then to the specialist [high-level isolation unit](https://en.wikipedia.org/wiki/High-level_isolation_unit "High-level isolation unit") at the [Royal Free Hospital](https://en.wikipedia.org/wiki/Royal_Free_Hospital "Royal Free Hospital") in [London](https://en.wikipedia.org/wiki/London "London") for longer-term treatment.[\[210\]](https://en.wikipedia.org/wiki/Ebola#cite_note-BBC-30629397-211)
### 2017 Democratic Republic of the Congo
Main article: [2017 Democratic Republic of the Congo Ebola virus outbreak](https://en.wikipedia.org/wiki/2017_Democratic_Republic_of_the_Congo_Ebola_virus_outbreak "2017 Democratic Republic of the Congo Ebola virus outbreak")
On 11 May 2017, the DRC Ministry of Public Health notified the WHO about an outbreak of Ebola. Four people died, and four people survived; five of these eight cases were laboratory-confirmed. A total of 583 contacts were monitored. On 2 July 2017, the WHO declared the end of the outbreak.[\[211\]](https://en.wikipedia.org/wiki/Ebola#cite_note-212)
### 2018 Équateur province
Main article: [2018 Équateur province Ebola outbreak](https://en.wikipedia.org/wiki/2018_%C3%89quateur_province_Ebola_outbreak "2018 Équateur province Ebola outbreak")
On 14 May 2018, the World Health Organization reported that "the Democratic Republic of Congo reported 39 suspected, probable or confirmed cases of Ebola between 4 April and 13 May, including 19 deaths."[\[212\]](https://en.wikipedia.org/wiki/Ebola#cite_note-first_2018_DRC_outbreak_report-213) Some 393 people identified as contacts of Ebola patients were being followed up. The outbreak centred on the [Bikoro](https://en.wikipedia.org/wiki/Bikoro "Bikoro"), Iboko, and [Wangata](https://en.wikipedia.org/wiki/Wangata "Wangata") areas in [Equateur](https://en.wikipedia.org/wiki/Equateur "Equateur") province,[\[212\]](https://en.wikipedia.org/wiki/Ebola#cite_note-first_2018_DRC_outbreak_report-213) including in the large city of [Mbandaka](https://en.wikipedia.org/wiki/Mbandaka "Mbandaka"). The DRC Ministry of Public Health approved the use of an experimental vaccine.[\[213\]](https://en.wikipedia.org/wiki/Ebola#cite_note-214)[\[214\]](https://en.wikipedia.org/wiki/Ebola#cite_note-215)[\[215\]](https://en.wikipedia.org/wiki/Ebola#cite_note-216) On 13 May 2018, WHO Director-General [Tedros Adhanom Ghebreyesus](https://en.wikipedia.org/wiki/Tedros_Adhanom_Ghebreyesus "Tedros Adhanom Ghebreyesus") visited Bikoro.[\[216\]](https://en.wikipedia.org/wiki/Ebola#cite_note-217) Reports emerged that maps of the area were inaccurate, not so much hampering medical providers as [epidemiologists](https://en.wikipedia.org/wiki/Epidemiologist "Epidemiologist") and officials trying to assess the outbreak and containment efforts.[\[217\]](https://en.wikipedia.org/wiki/Ebola#cite_note-218) The 2018 outbreak in the DRC was declared over on 24 July 2018.[\[218\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2018DRCOver-219)
### 2018–2020 Kivu
Main article: [Kivu Ebola epidemic](https://en.wikipedia.org/wiki/Kivu_Ebola_epidemic "Kivu Ebola epidemic")
On 1 August 2018, the world's 10th Ebola outbreak was declared in [North Kivu](https://en.wikipedia.org/wiki/North_Kivu "North Kivu") province of the Democratic Republic of the Congo. It was the first Ebola outbreak in a military conflict zone, with thousands of refugees in the area.[\[219\]](https://en.wikipedia.org/wiki/Ebola#cite_note-220)[\[220\]](https://en.wikipedia.org/wiki/Ebola#cite_note-221) By November 2018, nearly 200 Congolese had died of Ebola, about half of them from the city of [Beni](https://en.wikipedia.org/wiki/Beni,_Democratic_Republic_of_the_Congo "Beni, Democratic Republic of the Congo"), where armed groups are fighting over the region's mineral wealth, impeding medical relief efforts.[\[221\]](https://en.wikipedia.org/wiki/Ebola#cite_note-222)
By March 2019, this became the second largest Ebola outbreak ever recorded, with more than 1,000 cases and insecurity continuing to be the major resistance to providing an adequate response.[\[222\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC24March2019-223)[\[223\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHOMay2019-224) As of 4 June 2019[\[update\]](https://en.wikipedia.org/w/index.php?title=Ebola&action=edit), the WHO reported 2025 confirmed and probable cases with 1357 deaths.[\[224\]](https://en.wikipedia.org/wiki/Ebola#cite_note-225) In June 2019, two people died of Ebola in neighbouring [Uganda](https://en.wikipedia.org/wiki/Uganda "Uganda").[\[225\]](https://en.wikipedia.org/wiki/Ebola#cite_note-226)
In July 2019, an infected man travelled to [Goma](https://en.wikipedia.org/wiki/Goma "Goma"), home to more than two million people.[\[226\]](https://en.wikipedia.org/wiki/Ebola#cite_note-227) One week later, on 17 July 2019, the WHO declared the Ebola outbreak a [global health emergency](https://en.wikipedia.org/wiki/Public_Health_Emergency_of_International_Concern "Public Health Emergency of International Concern"), the fifth time such a declaration has been made by the organisation.[\[227\]](https://en.wikipedia.org/wiki/Ebola#cite_note-228) A government spokesman said that half of the Ebola cases are unidentified, and he added that the current outbreak could last up to three years.[\[228\]](https://en.wikipedia.org/wiki/Ebola#cite_note-229)
On 25 June 2020, the second biggest EVD outbreak ever was declared over.[\[229\]](https://en.wikipedia.org/wiki/Ebola#cite_note-finish-230)
### 2020 Équateur province
On 1 June 2020, the Congolese health ministry announced a new DRC outbreak of Ebola in [Mbandaka](https://en.wikipedia.org/wiki/Mbandaka "Mbandaka"), [Équateur Province](https://en.wikipedia.org/wiki/%C3%89quateur_Province "Équateur Province"), a region along the Congo River. Genome sequencing suggests that this outbreak, the 11th outbreak since the virus was first discovered in the country in 1976, is unrelated to the one in North Kivu Province or the previous outbreak in the same area in 2018. It was reported that six cases had been identified; four of the people had died. It is expected that more people will be identified as surveillance activities increase.[\[230\]](https://en.wikipedia.org/wiki/Ebola#cite_note-231) By 15 June the case count had increased to 17 with 11 deaths, with more than 2,500 people having been vaccinated.[\[231\]](https://en.wikipedia.org/wiki/Ebola#cite_note-232) The 11th EVD outbreak was officially declared over on 19 November 2020.[\[232\]](https://en.wikipedia.org/wiki/Ebola#cite_note-233) By the time the Équateur outbreak ended, it had 130 confirmed cases with 75 recoveries and 55 deaths.
### 2021
#### North Kivu
On 7 February 2021, the Congolese health ministry announced a new case of Ebola near Butembo, North Kivu detected a day before. The case was a 42-year-old woman who had symptoms of Ebola in Biena on 1 February 2021. A few days after, she died in a hospital in Butembo. The WHO said that more than 70 people with contact with the woman had been tracked.[\[233\]](https://en.wikipedia.org/wiki/Ebola#cite_note-234)[\[234\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:2-235)
On 11 February 2021, another woman who had contact with the previous woman died in the same town, and the number of traced contacts increased to 100.[\[235\]](https://en.wikipedia.org/wiki/Ebola#cite_note-236) A day after, a third case was detected in Butembo.[\[236\]](https://en.wikipedia.org/wiki/Ebola#cite_note-237)
On 3 May 2021, the 12th EVD outbreak was declared over, resulting in 12 cases and six deaths.[\[237\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:3-238)[\[238\]](https://en.wikipedia.org/wiki/Ebola#cite_note-239) Heightened surveillance will continue for 90 days after the declaration, in case of resurgence.[\[237\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:3-238)
#### Guinea
In February 2021, Sakoba Keita, head of Guinea's national health agency confirmed that three people had died of Ebola in the south-eastern region near the city of Nzérékoré. A further five people also tested positive. Keita also confirmed more testing was underway, and attempts to trace and isolate further cases had begun.[\[239\]](https://en.wikipedia.org/wiki/Ebola#cite_note-240) On 14 February, the Guinean government declared an Ebola epidemic.[\[240\]](https://en.wikipedia.org/wiki/Ebola#cite_note-241) The outbreak may have started following reactivation of a [latent case](https://en.wikipedia.org/wiki/Viral_latency "Viral latency") in a survivor of an earlier outbreak.[\[241\]](https://en.wikipedia.org/wiki/Ebola#cite_note-KuperschmidtReactivation-242)[\[242\]](https://en.wikipedia.org/wiki/Ebola#cite_note-VirologicalKeitaGuinea21-243) As of 4 May 2021, 23 cases were reported, with no new cases or deaths since 3 April 2021.[\[237\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:3-238) A 42-day countdown period was started on 8 May 2021, and on 19 June, the outbreak was declared over.[\[237\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:3-238)[\[243\]](https://en.wikipedia.org/wiki/Ebola#cite_note-244)
#### Ivory Coast
On 14 August 2021, The Ministry of Health of [Cote d’Ivoire](https://en.wikipedia.org/wiki/Cote_d%E2%80%99Ivoire "Cote d’Ivoire") confirmed the country's first case of Ebola since 1994. This came after the Institut Pasteur in Cote d'Ivoire confirmed the Ebola Virus Disease in samples collected from a patient, who was hospitalized in the commercial capital of [Abidjan](https://en.wikipedia.org/wiki/Abidjan "Abidjan"), after arriving from Guinea.[\[244\]](https://en.wikipedia.org/wiki/Ebola#cite_note-245)
However, on 31 August 2021, the WHO found that, after further tests in a laboratory in [Lyon](https://en.wikipedia.org/wiki/Lyon "Lyon"), the patient did not have Ebola. The cause of her disease is still being analyzed.[\[245\]](https://en.wikipedia.org/wiki/Ebola#cite_note-246)
### 2022
On 23 April 2022, a case of Ebola was confirmed in the DRC in the Equateur province. The case was a 31-year-old man whose symptoms began on 5 April, but did not seek treatment for over a week. On 21 April, he was admitted to an Ebola treatment centre and died later that day.[\[246\]](https://en.wikipedia.org/wiki/Ebola#cite_note-247) By 24 May 2022, there were 5 recorded deaths in the DRC.[\[247\]](https://en.wikipedia.org/wiki/Ebola#cite_note-248) On 15 August, the fifth case was buried, and the outbreak was declared over, 42 days after, on 4 July 2022.[\[248\]](https://en.wikipedia.org/wiki/Ebola#cite_note-249)
In September 2022, [Uganda reported 7 cases infected with the Ebola Sudan strain](https://en.wikipedia.org/wiki/2022_Uganda_Ebola_outbreak "2022 Uganda Ebola outbreak"),[\[249\]](https://en.wikipedia.org/wiki/Ebola#cite_note-250) but by mid-October the count had increased to 63.[\[250\]](https://en.wikipedia.org/wiki/Ebola#cite_note-251) In November 2022, the outbreak in Uganda continued — still without a vaccine.[\[12\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Guiliani_2022-12) On 10 January 2023, the outbreak was considered over after no new cases had been reported for 42 days; the outbreak killed nearly 80 people.[\[251\]](https://en.wikipedia.org/wiki/Ebola#cite_note-252)
## History
Ebola was first identified in 1976, in two simultaneous outbreaks, one in [Nzara](https://en.wikipedia.org/wiki/Nzara "Nzara") (a town in [South Sudan](https://en.wikipedia.org/wiki/South_Sudan "South Sudan")) and the other in [Yambuku](https://en.wikipedia.org/wiki/Yambuku "Yambuku") ([the Democratic Republic of the Congo](https://en.wikipedia.org/wiki/The_Democratic_Republic_of_the_Congo "The Democratic Republic of the Congo")), a village near the [Ebola River](https://en.wikipedia.org/wiki/Ebola_River "Ebola River"), for which the disease was named.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) [Ebola outbreaks](https://en.wikipedia.org/wiki/List_of_Ebola_outbreaks "List of Ebola outbreaks") occur intermittently in tropical regions of [sub-Saharan Africa](https://en.wikipedia.org/wiki/Sub-Saharan_Africa "Sub-Saharan Africa").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Between 1976 and 2012, according to the [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization"), there were 24 outbreaks of Ebola resulting in a total of [2,387 cases, and 1,590 deaths](https://en.wikipedia.org/wiki/List_of_Ebola_outbreaks "List of Ebola outbreaks").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[148\]](https://en.wikipedia.org/wiki/Ebola#cite_note-MMWRJune2014-148) The largest Ebola outbreak to date was an [epidemic in West Africa](https://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa "Ebola virus epidemic in West Africa") from December 2013 to January 2016, with 28,646 cases and 11,323 deaths.[\[191\]](https://en.wikipedia.org/wiki/Ebola#cite_note-08who2016-192)[\[149\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014-149)[\[150\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCAug2014N-150) On 29 March 2016, it was declared to no longer be an emergency.[\[201\]](https://en.wikipedia.org/wiki/Ebola#cite_note-who.int-202) Other outbreaks in Africa began in the Democratic Republic of the Congo in May 2017,[\[252\]](https://en.wikipedia.org/wiki/Ebola#cite_note-253)[\[253\]](https://en.wikipedia.org/wiki/Ebola#cite_note-254) and 2018.[\[254\]](https://en.wikipedia.org/wiki/Ebola#cite_note-255)[\[218\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2018DRCOver-219) In July 2019, the World Health Organization declared the Congo Ebola outbreak a [world health emergency](https://en.wikipedia.org/wiki/Public_health_emergency_of_international_concern "Public health emergency of international concern").[\[255\]](https://en.wikipedia.org/wiki/Ebola#cite_note-256)
## Society and culture
See also: [Cultural effects of the Ebola crisis](https://en.wikipedia.org/wiki/Cultural_effects_of_the_Ebola_crisis "Cultural effects of the Ebola crisis")
### Weaponisation
*Ebolavirus* is classified as a [biosafety level 4](https://en.wikipedia.org/wiki/Biosafety_level#Levels "Biosafety level") agent, as well as a [Category A bioterrorism](https://en.wikipedia.org/wiki/Bioterrorism#Category_A "Bioterrorism") agent by the Centers for Disease Control and Prevention.[\[88\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ansari2014-88)[\[256\]](https://en.wikipedia.org/wiki/Ebola#cite_note-MacNeil2012-257) It has the potential to be weaponised for use in [biological warfare](https://en.wikipedia.org/wiki/Biological_warfare "Biological warfare"),[\[257\]](https://en.wikipedia.org/wiki/Ebola#cite_note-pmid11988060-258)[\[258\]](https://en.wikipedia.org/wiki/Ebola#cite_note-259) and was investigated by [Biopreparat](https://en.wikipedia.org/wiki/Biopreparat "Biopreparat") for such use, but might be difficult to prepare as a [weapon of mass destruction](https://en.wikipedia.org/wiki/Weapon_of_mass_destruction "Weapon of mass destruction") because the virus becomes ineffective quickly in open air.[\[259\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Zubray-260) Fake emails pretending to be Ebola information from the WHO or the Mexican government have, in 2014, been misused to spread computer malware.[\[260\]](https://en.wikipedia.org/wiki/Ebola#cite_note-261) The BBC reported in 2015 that "North Korean state media has suggested the disease was created by the U.S. military as a biological weapon."[\[261\]](https://en.wikipedia.org/wiki/Ebola#cite_note-262)
### Displacement
Analysis of the 2014–2015 Ebola epidemic found that outbreaks can trigger displacement, as fear of infection, quarantine measures, lack of essential supplies, stigma, and violence around the response can lead people and even entire communities to flee their homes.[\[262\]](https://en.wikipedia.org/wiki/Ebola#cite_note-263)
### Literature
[Richard Preston](https://en.wikipedia.org/wiki/Richard_Preston "Richard Preston")'s 1995 [best-selling](https://en.wikipedia.org/wiki/Best-selling "Best-selling") book, *[The Hot Zone](https://en.wikipedia.org/wiki/The_Hot_Zone "The Hot Zone")*, dramatised the Ebola outbreak in Reston, Virginia.[\[263\]](https://en.wikipedia.org/wiki/Ebola#cite_note-264)[\[264\]](https://en.wikipedia.org/wiki/Ebola#cite_note-265)[\[265\]](https://en.wikipedia.org/wiki/Ebola#cite_note-266)
[William Close](https://en.wikipedia.org/wiki/William_Close "William Close")'s 1995 *Ebola: A Documentary Novel of Its First Explosion*[\[266\]](https://en.wikipedia.org/wiki/Ebola#cite_note-267)[\[267\]](https://en.wikipedia.org/wiki/Ebola#cite_note-268) and 2002 *Ebola: Through the Eyes of the People* focused on individuals' reactions to the 1976 Ebola outbreak in Zaire.[\[268\]](https://en.wikipedia.org/wiki/Ebola#cite_note-269)[\[269\]](https://en.wikipedia.org/wiki/Ebola#cite_note-270)
[Tom Clancy](https://en.wikipedia.org/wiki/Tom_Clancy "Tom Clancy")'s 1996 novel, *[Executive Orders](https://en.wikipedia.org/wiki/Executive_Orders "Executive Orders")*, involves a [Middle Eastern](https://en.wikipedia.org/wiki/Middle_East "Middle East") terrorist attack on the United States using an airborne form of a deadly Ebola virus strain named "Ebola Mayinga" (see [Mayinga N'Seka](https://en.wikipedia.org/wiki/Mayinga_N%27Seka "Mayinga N'Seka")).[\[270\]](https://en.wikipedia.org/wiki/Ebola#cite_note-271)[\[271\]](https://en.wikipedia.org/wiki/Ebola#cite_note-272)
As the Ebola virus epidemic in West Africa developed in 2014, a number of popular self-published and well-reviewed books containing sensational and misleading information about the disease appeared in electronic and printed formats. The authors of some such books admitted that they lacked medical credentials and were not technically qualified to give medical advice. The World Health Organization and the United Nations stated that such misinformation had contributed to the spread of the disease.[\[272\]](https://en.wikipedia.org/wiki/Ebola#cite_note-273)
## Other animals
### Wild animals
Ebola has a high mortality rate among primates.[\[273\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Choi2013-274) Frequent outbreaks of Ebola may have resulted in the deaths of 5,000 gorillas.[\[274\]](https://en.wikipedia.org/wiki/Ebola#cite_note-275) Outbreaks of Ebola may have been responsible for an 88% decline in tracking indices of observed chimpanzee populations in the 420 km2 Lossi Sanctuary between 2002 and 2003.[\[275\]](https://en.wikipedia.org/wiki/Ebola#cite_note-doi10.1126/science.1092528-276) Transmission among chimpanzees through meat consumption constitutes a significant risk factor, whereas contact between the animals, such as touching dead bodies and grooming, is not.[\[276\]](https://en.wikipedia.org/wiki/Ebola#cite_note-277)
Recovered gorilla carcasses have contained multiple Ebola virus strains, suggesting multiple introductions of the virus. Bodies decompose quickly and carcasses are not infectious after three to four days. Contact between gorilla groups is rare, suggesting that transmission among gorilla groups is unlikely, and that outbreaks result from transmission between viral reservoirs and animal populations.[\[275\]](https://en.wikipedia.org/wiki/Ebola#cite_note-doi10.1126/science.1092528-276)
### Domestic animals
In 2012, it was demonstrated that the virus can travel without contact from pigs to nonhuman primates, although the same study failed to achieve transmission in that manner between primates.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52)[\[87\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl2012-87)
Dogs may become infected with EBOV but not develop symptoms. Dogs in some parts of Africa [scavenge](https://en.wikipedia.org/wiki/Scavenge "Scavenge") for food, and they sometimes eat EBOV-infected animals and also the corpses of humans. A 2005 survey of dogs during an EBOV outbreak found that although they remain asymptomatic, about 32 percent of dogs closest to an outbreak showed a [seroprevalence](https://en.wikipedia.org/wiki/Seroprevalence "Seroprevalence") for EBOV versus nine percent of those farther away.[\[277\]](https://en.wikipedia.org/wiki/Ebola#cite_note-pmid15757552-278) The authors concluded that there were "potential implications for preventing and controlling human outbreaks."
### Reston virus
For more about the outbreak in Virginia, US, see [Reston virus](https://en.wikipedia.org/wiki/Reston_virus "Reston virus").
In late 1989, Hazelton Research Products' Reston Quarantine Unit in [Reston, Virginia](https://en.wikipedia.org/wiki/Reston,_Virginia "Reston, Virginia"), had an outbreak of fatal illness amongst certain lab monkeys. This lab outbreak was initially diagnosed as [simian haemorrhagic fever virus](https://en.wikipedia.org/wiki/Simian_haemorrhagic_fever_virus "Simian haemorrhagic fever virus") (SHFV) and occurred amongst a shipment of [crab-eating macaque](https://en.wikipedia.org/wiki/Crab-eating_macaque "Crab-eating macaque") monkeys imported from the Philippines. Hazelton's veterinary pathologist in Reston sent tissue samples from dead animals to the [United States Army Medical Research Institute of Infectious Diseases](https://en.wikipedia.org/wiki/United_States_Army_Medical_Research_Institute_of_Infectious_Diseases "United States Army Medical Research Institute of Infectious Diseases") (USAMRIID) at [Fort Detrick, Maryland](https://en.wikipedia.org/wiki/Fort_Detrick,_Maryland "Fort Detrick, Maryland"), where an [ELISA](https://en.wikipedia.org/wiki/ELISA "ELISA") test indicated the antibodies present in the tissue were a response to Ebola virus and not SHFV.[\[278\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Preston-279) An electron microscopist from USAMRIID discovered [filoviruses](https://en.wikipedia.org/wiki/Filoviruses "Filoviruses") similar in appearance, in crystalloid aggregates and as single filaments with a shepherd's hook, to Ebola in the tissue samples sent from Hazelton Research Products' Reston Quarantine Unit.[\[279\]](https://en.wikipedia.org/wiki/Ebola#cite_note-McCormick_1999_277%E2%80%93279-280)
A [US Army](https://en.wikipedia.org/wiki/US_Army "US Army") team headquartered at USAMRIID [euthanised](https://en.wikipedia.org/wiki/Euthanisia "Euthanisia") the surviving monkeys, and brought all the dead monkeys to Fort Detrick for study by the Army's veterinary pathologists and virologists, and eventual disposal under safe conditions.[\[278\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Preston-279) Blood samples were taken from 178 animal handlers during the incident.[\[280\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Waterman_1999-281) Of those, six animal handlers eventually [seroconverted](https://en.wikipedia.org/wiki/Seroconversion "Seroconversion"), including one who had cut himself with a bloody scalpel.[\[89\]](https://en.wikipedia.org/wiki/Ebola#cite_note-isbn0-7910-8505-8-89)[\[281\]](https://en.wikipedia.org/wiki/Ebola#cite_note-McCormick_1999_298%E2%80%93299-282) Despite its status as a [Level‑4](https://en.wikipedia.org/wiki/Biosafety_level_4 "Biosafety level 4") organism and its apparent [pathogenicity](https://en.wikipedia.org/wiki/Pathogen "Pathogen") in monkeys, when the handlers did not become ill, the CDC concluded that the virus had a very low pathogenicity to humans.[\[281\]](https://en.wikipedia.org/wiki/Ebola#cite_note-McCormick_1999_298%E2%80%93299-282)[\[282\]](https://en.wikipedia.org/wiki/Ebola#cite_note-283)
The Philippines and the United States had no previous cases of Ebola infection, and upon further isolation, researchers concluded it was another strain of Ebola, or a new filovirus of Asian origin, which they named *[Reston ebolavirus](https://en.wikipedia.org/wiki/Reston_ebolavirus "Reston ebolavirus")* (RESTV) after the location of the incident.[\[278\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Preston-279) Reston virus (RESTV) can be transmitted to pigs.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52) Since the initial outbreak it has since been found in nonhuman [primates](https://en.wikipedia.org/wiki/Primate "Primate") in Pennsylvania, Texas, and Italy,[\[283\]](https://en.wikipedia.org/wiki/Ebola#cite_note-KnownCasesCDC-284) where the virus had infected pigs.[\[284\]](https://en.wikipedia.org/wiki/Ebola#cite_note-285) According to the WHO, routine cleaning and disinfection of pig (or monkey) farms with [sodium hypochlorite](https://en.wikipedia.org/wiki/Sodium_hypochlorite "Sodium hypochlorite") or [detergents](https://en.wikipedia.org/wiki/Detergents "Detergents") should be effective in inactivating the *Reston ebolavirus*. Pigs that have been infected with RESTV tend to show [symptoms](https://en.wikipedia.org/wiki/Symptoms "Symptoms") of the disease.[\[285\]](https://en.wikipedia.org/wiki/Ebola#cite_note-286)
## Research
### Treatments
Main article: [Ebola virus disease treatment research](https://en.wikipedia.org/wiki/Ebola_virus_disease_treatment_research "Ebola virus disease treatment research")
[](https://en.wikipedia.org/wiki/File:Monoclonal_antibodies3.jpg)
Researchers looking at slides of cultures of cells that make [monoclonal antibodies](https://en.wikipedia.org/wiki/Monoclonal_antibodies "Monoclonal antibodies"). These are grown in a lab and the researchers are analyzing the products to select the most promising.
As of July 2015[\[update\]](https://en.wikipedia.org/w/index.php?title=Ebola&action=edit), no medication has been proven safe and effective for treating Ebola. By the time the [Ebola virus epidemic in West Africa](https://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa "Ebola virus epidemic in West Africa") began in 2013, there were at least nine different candidate treatments. Several trials were conducted in late 2014, and early 2015, but some were abandoned due to lack of efficacy or lack of people to study.[\[286\]](https://en.wikipedia.org/wiki/Ebola#cite_note-287)
As of August 2019[\[update\]](https://en.wikipedia.org/w/index.php?title=Ebola&action=edit), two experimental treatments known as [atoltivimab/maftivimab/odesivimab](https://en.wikipedia.org/wiki/Atoltivimab/maftivimab/odesivimab "Atoltivimab/maftivimab/odesivimab") and [ansuvimab](https://en.wikipedia.org/wiki/Ansuvimab "Ansuvimab") were found to be 90% effective.[\[287\]](https://en.wikipedia.org/wiki/Ebola#cite_note-288)[\[288\]](https://en.wikipedia.org/wiki/Ebola#cite_note-289)[\[289\]](https://en.wikipedia.org/wiki/Ebola#cite_note-290)
### Diagnostic tests
The diagnostic tests currently available require specialised equipment and highly trained personnel. Since there are few suitable testing centres in West Africa, this leads to delay in diagnosis.[\[290\]](https://en.wikipedia.org/wiki/Ebola#cite_note-291)
On 29 November 2014, a new 15-minute Ebola test was reported that if successful, "not only gives patients a better chance of survival, but it prevents transmission of the virus to other people." The new equipment, about the size of a laptop and solar-powered, allows testing to be done in remote areas.[\[291\]](https://en.wikipedia.org/wiki/Ebola#cite_note-292)
On 29 December 2014, the U.S. [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) approved the LightMix Ebola Zaire [rRT-PCR](https://en.wikipedia.org/wiki/Reverse_transcription_polymerase_chain_reaction "Reverse transcription polymerase chain reaction") test for patients with symptoms of Ebola.[\[292\]](https://en.wikipedia.org/wiki/Ebola#cite_note-293)
### Disease models
Animal models and in particular non-human primates are being used to study different aspects of Ebola virus disease. Developments in [organ-on-a-chip](https://en.wikipedia.org/wiki/Organ-on-a-chip "Organ-on-a-chip") technology have led to a chip-based model for Ebola haemorrhagic syndrome.[\[293\]](https://en.wikipedia.org/wiki/Ebola#cite_note-294)
## See also
- [Bibliography of Ebola](https://en.wikipedia.org/wiki/Bibliography_of_Ebola "Bibliography of Ebola")
## Notes
1. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-cfr_190-0)** The mortality (number of dead per number of healthy per time frame) recorded in Liberia up to 26 August 2014 was 70%.[\[189\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cfrebolavirus-189) However, due to the estimation method used, the estimated case fatality rate (70.8%) for this particular epidemic differs from the actual ratio between the number of deaths and the number of cases.
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Guiliani R. ["Our game-changing treatment centres will save more lives"](https://web.archive.org/web/20221115224626/https://msf.org.uk/article/ebola-uganda-our-game-changing-treatment-centres-will-save-more-lives). msf.org.urk. Archived from [the original](https://msf.org.uk/article/ebola-uganda-our-game-changing-treatment-centres-will-save-more-lives) on 15 November 2022. Retrieved 15 November 2022.
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275. ^ [***a***](https://en.wikipedia.org/wiki/Ebola#cite_ref-doi10.1126/science.1092528_276-0) [***b***](https://en.wikipedia.org/wiki/Ebola#cite_ref-doi10.1126/science.1092528_276-1)
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- *The article uses public domain text from the CDC as cited.*
### Bibliography
- McCormick J, Fisher-Hoch S, Horvitz LA (1999) \[1996\]. [*Level 4: Virus Hunters of the CDC*](https://books.google.com/books?id=QEvR3aJX2m0C) (Limited preview) (Updated \[3rd\] ed.). Barnes & Noble. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0760712085](https://en.wikipedia.org/wiki/Special:BookSources/978-0760712085 "Special:BookSources/978-0760712085")
. [Archived](https://web.archive.org/web/20240521143950/https://books.google.com/books?id=QEvR3aJX2m0C) from the original on 21 May 2024. Retrieved 3 September 2020.
## Further reading
- Wilson F (2014). [*CDC Guidance on Ebola Virus (EVD)*](https://books.google.com/books?id=yMQNBQAAQBAJ&pg=PP1). International Publications Media Group. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1632670113](https://en.wikipedia.org/wiki/Special:BookSources/978-1632670113 "Special:BookSources/978-1632670113")
.
- [*Ebola Virus: New Insights for the Healthcare Professional: 2011 Edition: ScholarlyPaper*](https://books.google.com/books?id=nLA4W5IjJpwC&pg=PP1). Scholarly Editions. 2012. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1464914935](https://en.wikipedia.org/wiki/Special:BookSources/978-1464914935 "Special:BookSources/978-1464914935")
.
- Klenk HD (January 1999). *Marburg and Ebola Viruses*. Current Topics in Microbiology and Immunology 235. Berlin: Springer-Verlag Telos. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-3540647294](https://en.wikipedia.org/wiki/Special:BookSources/978-3540647294 "Special:BookSources/978-3540647294")
.
- Klenk HD, Feldmann H (2004). [*Ebola and Marburg viruses: molecular and cellular biology*](https://books.google.com/books?id=EV_mFgnyPoMC) (Limited preview). Wymondham, Norfolk: Horizon Bioscience. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0954523237](https://en.wikipedia.org/wiki/Special:BookSources/978-0954523237 "Special:BookSources/978-0954523237")
. [Archived](https://web.archive.org/web/20240521143950/https://books.google.com/books?id=EV_mFgnyPoMC) from the original on 21 May 2024. Retrieved 3 September 2020.
- Kuhn JH (2008). [*Filoviruses: A Compendium of 40 Years of Epidemiological, Clinical, and Laboratory Studies. Archives of Virology Supplement*](https://books.google.com/books?id=LaOue0F9Ns4C) (Limited preview). Vol. 20. Vienna: SpringerWienNewYork. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-3211206706](https://en.wikipedia.org/wiki/Special:BookSources/978-3211206706 "Special:BookSources/978-3211206706")
. [Archived](https://web.archive.org/web/20240521144049/https://books.google.com/books?id=LaOue0F9Ns4C) from the original on 21 May 2024. Retrieved 3 September 2020.
- Pattyn SR (1978). [*Ebola Virus Haemorrhagic Fever*](https://web.archive.org/web/20101211083855/http://www.itg.be/ebola/) (1st ed.). Amsterdam: Elsevier/North-Holland Biomedical Press. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0444800602](https://en.wikipedia.org/wiki/Special:BookSources/978-0444800602 "Special:BookSources/978-0444800602")
. Archived from [the original](http://www.itg.be/ebola/) (Full free text) on 11 December 2010.
- Ryabchikova EI, Price BB (2004). *Ebola and Marburg Viruses: A View of Infection Using Electron Microscopy*. Columbus, Ohio: Battelle Press. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1574771312](https://en.wikipedia.org/wiki/Special:BookSources/978-1574771312 "Special:BookSources/978-1574771312")
.
## External links
[](https://en.wikipedia.org/wiki/File:Incubator-logo.svg)
***[Ebola test](https://incubator.wikimedia.org/wiki/Wp/vai/%EA%94%A4%EA%95%B7%EA%95%9E "incubator:Wp/vai/ꔤꕷꕞ")*** of [Wikipedia](https://en.wikipedia.org/wiki/Wikipedia "Wikipedia") at [Wikimedia Incubator](https://meta.wikimedia.org/wiki/Wikimedia_Incubator "meta:Wikimedia Incubator")
- [WHO fact sheet on Ebola](https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease)
- [Ebola (Ebola Virus Disease)](https://www.cdc.gov/vhf/ebola/) – Centers for Disease Control and Prevention, Viral Special Pathogens Branch.
- [Videos: Ebola outbreak response](https://web.archive.org/web/20140823072115/http://www.who.int/csr/disease/ebola/videos/en/) – World Health Organization.
- ["Ebola Preparedness and Response"](https://web.archive.org/web/20190708195151/https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/ebola-preparedness-and-response-updates-fda). *U.S. [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA)*. 13 January 2021. Archived from [the original](https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/ebola-preparedness-and-response-updates-fda) on 8 July 2019.
- [Ebola: What You Need to Know](https://www.scientificamerican.com/report/ebola-what-you-need-to-know1/) – *[Scientific American](https://en.wikipedia.org/wiki/Scientific_American "Scientific American")* articles related to Ebola; note these are general reading articles, they are not scientific peer-reviewed research articles.
| | |
|---|---|
| Classification | [D](https://www.wikidata.org/wiki/Q51993 "d:Q51993") **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[11](https://en.wikipedia.org/wiki/ICD-11 "ICD-11")**: [1D60.0](https://icd.who.int/browse10/2019/en#/1D60.0) **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[10](https://en.wikipedia.org/wiki/ICD-10 "ICD-10")**: [A98.4](https://icd.who.int/browse10/2019/en#/A98.4) **[ICD](https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems "International Statistical Classification of Diseases and Related Health Problems")\-[9-CM](https://en.wikipedia.org/wiki/List_of_ICD-9_codes "List of ICD-9 codes")**: [078\.89](http://www.icd9data.com/getICD9Code.ashx?icd9=078.89) **[MeSH](https://en.wikipedia.org/wiki/Medical_Subject_Headings "Medical Subject Headings")**: [D019142](https://meshb.nlm.nih.gov/record/ui?ui=D019142) **[DiseasesDB](https://en.wikipedia.org/wiki/Diseases_Database "Diseases Database")**: [18043](http://www.diseasesdatabase.com/ddb18043.htm) |
| External resources | **[MedlinePlus](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus")**: [001339](https://www.nlm.nih.gov/medlineplus/ency/article/001339.htm) **[eMedicine](https://en.wikipedia.org/wiki/EMedicine "EMedicine")**: [med/626](https://emedicine.medscape.com/med/626-overview) |
| [v](https://en.wikipedia.org/wiki/Template:Filoviridae "Template:Filoviridae") [t](https://en.wikipedia.org/wiki/Template_talk:Filoviridae "Template talk:Filoviridae") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Filoviridae "Special:EditPage/Template:Filoviridae")*[Filoviridae](https://en.wikipedia.org/wiki/Filoviridae "Filoviridae")* | |
|---|---|
| *[Ebolavirus](https://en.wikipedia.org/wiki/Ebolavirus "Ebolavirus")* | |
| | |
| [Outbreaks](https://en.wikipedia.org/wiki/List_of_Ebola_outbreaks "List of Ebola outbreaks") | [1976 Sudan outbreak](https://en.wikipedia.org/wiki/Ebola_virus_disease#Sudan_outbreak "Ebola virus disease") [1976 Zaire outbreak](https://en.wikipedia.org/wiki/1976_Zaire_Ebola_virus_outbreak "1976 Zaire Ebola virus outbreak") [2013−2016 West African Ebola virus epidemic](https://en.wikipedia.org/wiki/Western_African_Ebola_virus_epidemic "Western African Ebola virus epidemic") [Timeline](https://en.wikipedia.org/wiki/West_African_Ebola_virus_epidemic_timeline "West African Ebola virus epidemic timeline") [Reported cases and deaths](https://en.wikipedia.org/wiki/West_African_Ebola_virus_epidemic_timeline_of_reported_cases_and_deaths "West African Ebola virus epidemic timeline of reported cases and deaths") [Responses](https://en.wikipedia.org/wiki/Responses_to_the_West_African_Ebola_virus_epidemic "Responses to the West African Ebola virus epidemic") [United Nations Ebola Response Fund](https://en.wikipedia.org/wiki/United_Nations_Ebola_Response_Fund "United Nations Ebola Response Fund") [Operation United Assistance](https://en.wikipedia.org/wiki/Operation_United_Assistance "Operation United Assistance") [in Guinea](https://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_Guinea "Ebola virus epidemic in Guinea") [in Liberia](https://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_Liberia "Ebola virus epidemic in Liberia") [in Mali](https://en.wikipedia.org/wiki/Ebola_virus_disease_in_Mali "Ebola virus disease in Mali") [in Nigeria](https://en.wikipedia.org/wiki/Ebola_in_Nigeria "Ebola in Nigeria") [in Sierra Leone](https://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_Sierra_Leone "Ebola virus epidemic in Sierra Leone") [in Spain](https://en.wikipedia.org/wiki/Ebola_virus_disease_in_Spain "Ebola virus disease in Spain") [in the US](https://en.wikipedia.org/wiki/Ebola_virus_cases_in_the_United_States "Ebola virus cases in the United States") [in the UK](https://en.wikipedia.org/wiki/Ebola_virus_disease_in_the_United_Kingdom "Ebola virus disease in the United Kingdom") [Ouse to Ouse Tock](https://en.wikipedia.org/wiki/Ouse_to_Ouse_Tock "Ouse to Ouse Tock") [Womey massacre](https://en.wikipedia.org/wiki/Womey_massacre "Womey massacre") Recent DR Congo outbreaks and epidemics [2014](https://en.wikipedia.org/wiki/2014_Democratic_Republic_of_the_Congo_Ebola_virus_outbreak "2014 Democratic Republic of the Congo Ebola virus outbreak") [2017](https://en.wikipedia.org/wiki/2017_Democratic_Republic_of_the_Congo_Ebola_virus_outbreak "2017 Democratic Republic of the Congo Ebola virus outbreak") [2018 Équateur](https://en.wikipedia.org/wiki/2018_%C3%89quateur_province_Ebola_outbreak "2018 Équateur province Ebola outbreak") [Kivu epidemic](https://en.wikipedia.org/wiki/Kivu_Ebola_epidemic "Kivu Ebola epidemic") [2020 Équateur](https://en.wikipedia.org/wiki/Kivu_Ebola_epidemic#2020_%C3%89quateur_Province_outbreak_and_other_regional_health_issues "Kivu Ebola epidemic") [2021 North Kivu](https://en.wikipedia.org/wiki/2021_North_Kivu_Ebola "2021 North Kivu Ebola") |
| Species | *[Bundibugyo ebolavirus](https://en.wikipedia.org/wiki/Bundibugyo_ebolavirus "Bundibugyo ebolavirus")* [BDBV](https://en.wikipedia.org/wiki/Bundibugyo_virus "Bundibugyo virus") *[Reston ebolavirus](https://en.wikipedia.org/wiki/Reston_virus "Reston virus")* RESTV *[Sudan ebolavirus](https://en.wikipedia.org/wiki/Sudan_ebolavirus "Sudan ebolavirus")* [SUDV](https://en.wikipedia.org/wiki/Sudan_virus "Sudan virus") *[Taï Forest ebolavirus](https://en.wikipedia.org/wiki/Ta%C3%AF_Forest_ebolavirus "Taï Forest ebolavirus")* [TAFV](https://en.wikipedia.org/wiki/Ta%C3%AF_Forest_virus "Taï Forest virus") *[Zaire ebolavirus](https://en.wikipedia.org/wiki/Zaire_ebolavirus "Zaire ebolavirus")* EBOV |
| Drug candidates | [BCX4430](https://en.wikipedia.org/wiki/Galidesivir "Galidesivir") [Brincidofovir](https://en.wikipedia.org/wiki/Brincidofovir "Brincidofovir") [DZNep](https://en.wikipedia.org/wiki/3-Deazaneplanocin_A "3-Deazaneplanocin A") [Favipiravir](https://en.wikipedia.org/wiki/Favipiravir "Favipiravir") [FGI-103](https://en.wikipedia.org/wiki/FGI-103 "FGI-103") [FGI-104](https://en.wikipedia.org/wiki/FGI-104 "FGI-104") [FGI-106](https://en.wikipedia.org/wiki/FGI-106 "FGI-106") [JK-05](https://en.wikipedia.org/wiki/JK-05 "JK-05") [Lamivudine](https://en.wikipedia.org/wiki/Lamivudine "Lamivudine") [mAb114](https://en.wikipedia.org/wiki/MAb114 "MAb114") [TKM-Ebola](https://en.wikipedia.org/wiki/TKM-Ebola "TKM-Ebola") (failed) [Triazavirin](https://en.wikipedia.org/wiki/Triazavirin "Triazavirin") [ZMapp](https://en.wikipedia.org/wiki/ZMapp "ZMapp") [Vaccines](https://en.wikipedia.org/wiki/Ebola_vaccine "Ebola vaccine") [cAd3-ZEBOV](https://en.wikipedia.org/wiki/CAd3-ZEBOV "CAd3-ZEBOV") |
| Drugs | [Vaccines](https://en.wikipedia.org/wiki/Ebola_vaccine "Ebola vaccine") [rVSV-ZEBOV](https://en.wikipedia.org/wiki/RVSV-ZEBOV_vaccine "RVSV-ZEBOV vaccine") |
| Notable people | [Ebola researchers](https://en.wikipedia.org/wiki/Category:Ebola_researchers "Category:Ebola researchers") [William Close](https://en.wikipedia.org/wiki/William_Close "William Close") [Jean-Jacques Muyembe-Tamfum](https://en.wikipedia.org/wiki/Jean-Jacques_Muyembe-Tamfum "Jean-Jacques Muyembe-Tamfum") [Peter Piot](https://en.wikipedia.org/wiki/Peter_Piot "Peter Piot") [Ebola patients](https://en.wikipedia.org/wiki/List_of_Ebola_patients "List of Ebola patients") [Ameyo Adadevoh](https://en.wikipedia.org/wiki/Ameyo_Adadevoh "Ameyo Adadevoh") [Kent Brantly](https://en.wikipedia.org/wiki/Kent_Brantly "Kent Brantly") [Pauline Cafferkey](https://en.wikipedia.org/wiki/Pauline_Cafferkey "Pauline Cafferkey") [Thomas Eric Duncan](https://en.wikipedia.org/wiki/Thomas_Eric_Duncan "Thomas Eric Duncan") [Salome Karwah](https://en.wikipedia.org/wiki/Salome_Karwah "Salome Karwah") [Sheik Umar Khan](https://en.wikipedia.org/wiki/Sheik_Umar_Khan "Sheik Umar Khan") [Matthew Lukwiya](https://en.wikipedia.org/wiki/Matthew_Lukwiya "Matthew Lukwiya") [Mayinga N'Seka](https://en.wikipedia.org/wiki/Mayinga_N%27Seka "Mayinga N'Seka") [Patrick Sawyer](https://en.wikipedia.org/wiki/Patrick_Sawyer "Patrick Sawyer") |
| [Popular culture](https://en.wikipedia.org/wiki/Cultural_effects_of_the_Ebola_crisis "Cultural effects of the Ebola crisis") | *[The Hot Zone](https://en.wikipedia.org/wiki/The_Hot_Zone "The Hot Zone")* (1995 book by [Richard Preston](https://en.wikipedia.org/wiki/Richard_Preston "Richard Preston")) *[Outbreak](https://en.wikipedia.org/wiki/Outbreak_\(1995_film\) "Outbreak (1995 film)")* (1995 film) *[Ebola Syndrome](https://en.wikipedia.org/wiki/Ebola_Syndrome "Ebola Syndrome")* (1996 film) *[Executive Orders](https://en.wikipedia.org/wiki/Executive_Orders "Executive Orders")* (1996 novel) [Ebola-chan](https://en.wikipedia.org/wiki/Ebola-chan "Ebola-chan") (2014 meme) *[93 Days](https://en.wikipedia.org/wiki/93_Days "93 Days")* (2016 film) *[The Hot Zone](https://en.wikipedia.org/wiki/The_Hot_Zone_\(American_TV_series\) "The Hot Zone (American TV series)")* (2019 miniseries based on Preston book) |
| Miscellaneous | [Ebola virus disease](https://en.wikipedia.org/wiki/Ebola_virus_disease "Ebola virus disease") [Ebola virus disease treatment research](https://en.wikipedia.org/wiki/Ebola_virus_disease_treatment_research "Ebola virus disease treatment research") [Ebola River](https://en.wikipedia.org/wiki/Ebola_River "Ebola River") |
| *[Marburgvirus](https://en.wikipedia.org/wiki/Marburgvirus "Marburgvirus")* | |
| | |
| Outbreaks | [1967 Marburg virus outbreak in West Germany](https://en.wikipedia.org/wiki/1967_Marburg_virus_outbreak_in_West_Germany "1967 Marburg virus outbreak in West Germany") [2017 Uganda Marburg virus outbreak](https://en.wikipedia.org/wiki/2017_Uganda_Marburg_virus_outbreak "2017 Uganda Marburg virus outbreak") [2021 Marburg virus disease outbreak in Guinea](https://en.wikipedia.org/wiki/2021_Marburg_virus_disease_outbreak_in_Guinea "2021 Marburg virus disease outbreak in Guinea") [2022 Marburg virus disease outbreak in Ghana](https://en.wikipedia.org/wiki/2022_Marburg_virus_disease_outbreak_in_Ghana "2022 Marburg virus disease outbreak in Ghana") [2023 Marburg virus disease outbreak in Equatorial Guinea](https://en.wikipedia.org/wiki/2023_Marburg_virus_disease_outbreak_in_Equatorial_Guinea "2023 Marburg virus disease outbreak in Equatorial Guinea") [2023 Marburg virus disease outbreak in Tanzania](https://en.wikipedia.org/wiki/2023_Marburg_virus_disease_outbreak_in_Tanzania "2023 Marburg virus disease outbreak in Tanzania") [2024 Marburg virus disease outbreak in Rwanda](https://en.wikipedia.org/wiki/Rwanda_Marburg_virus_disease_outbreak "Rwanda Marburg virus disease outbreak") |
| Species | *[Marburg marburgvirus](https://en.wikipedia.org/wiki/Marburg_marburgvirus "Marburg marburgvirus")* [MARV](https://en.wikipedia.org/wiki/Marburg_virus "Marburg virus") [RAVV](https://en.wikipedia.org/wiki/Ravn_virus "Ravn virus") |
| Drug candidates | [BCX4430](https://en.wikipedia.org/wiki/Galidesivir "Galidesivir") [FGI-103](https://en.wikipedia.org/wiki/FGI-103 "FGI-103") [FGI-106](https://en.wikipedia.org/wiki/FGI-106 "FGI-106") |
| Popular culture | *[The Hot Zone](https://en.wikipedia.org/wiki/The_Hot_Zone "The Hot Zone")* (1995 book) |
| Miscellaneous | [Marburg virus disease](https://en.wikipedia.org/wiki/Marburg_virus_disease "Marburg virus disease") [Marburg](https://en.wikipedia.org/wiki/Marburg "Marburg") |
| *[Cuevavirus](https://en.wikipedia.org/wiki/Cuevavirus "Cuevavirus")* | |
| | |
| Species | *[Lloviu cuevavirus](https://en.wikipedia.org/wiki/Lloviu_cuevavirus "Lloviu cuevavirus")* ([LLOV](https://en.wikipedia.org/wiki/Lloviu_virus "Lloviu virus")) |
| *[Dianlovirus](https://en.wikipedia.org/wiki/Mengla_virus "Mengla virus")* | |
| | |
| Species | [Mengla virus](https://en.wikipedia.org/wiki/Mengla_virus "Mengla virus") (MLAV) |
| *[Striavirus](https://en.wikipedia.org/w/index.php?title=Striavirus&action=edit&redlink=1 "Striavirus (page does not exist)")* | |
| | |
| Species | *[Xilang striavirus](https://en.wikipedia.org/w/index.php?title=Striavirus&action=edit&redlink=1 "Striavirus (page does not exist)")* |
| *[Thamnovirus](https://en.wikipedia.org/w/index.php?title=Thamnovirus&action=edit&redlink=1 "Thamnovirus (page does not exist)")* | |
| | |
| Species | *[Huangjiao thamnovirus](https://en.wikipedia.org/w/index.php?title=Thamnovirus&action=edit&redlink=1 "Thamnovirus (page does not exist)")* |
| [](https://en.wikipedia.org/wiki/File:Commons-logo.svg "Commons page") [Commons](https://commons.wikimedia.org/wiki/Special:Search/Filoviridae "commons:Special:Search/Filoviridae") [](https://en.wikipedia.org/wiki/File:Wikispecies-logo.svg "Wikispecies page") [Wikispecies](https://species.wikimedia.org/wiki/Special:Search/Filoviridae "wikispecies:Special:Search/Filoviridae") | |
| [v](https://en.wikipedia.org/wiki/Template:Zoonotic_viral_diseases "Template:Zoonotic viral diseases") [t](https://en.wikipedia.org/wiki/Template_talk:Zoonotic_viral_diseases "Template talk:Zoonotic viral diseases") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:Zoonotic_viral_diseases "Special:EditPage/Template:Zoonotic viral diseases")[Zoonotic](https://en.wikipedia.org/wiki/Zoonosis "Zoonosis") [viral diseases](https://en.wikipedia.org/wiki/Viral_disease "Viral disease") (A80–B34, [042–079](https://en.wikipedia.org/wiki/042%E2%80%93079 "042–079")) | |
|---|---|
| [Arthropod \-borne](https://en.wikipedia.org/wiki/Arthropod "Arthropod") | |
| | |
| [Mosquito \-borne](https://en.wikipedia.org/wiki/Mosquito-borne_disease "Mosquito-borne disease") | |
| | |
| *[Bunyavirales](https://en.wikipedia.org/wiki/Bunyavirales "Bunyavirales")* | [Arbovirus encephalitides](https://en.wikipedia.org/wiki/Arbovirus_encephalitis "Arbovirus encephalitis"): [Batai virus](https://en.wikipedia.org/wiki/Batai_virus "Batai virus") BATV [Bwamba Fever](https://en.wikipedia.org/wiki/Bwamba_orthobunyavirus "Bwamba orthobunyavirus") BWAV [California encephalitis](https://en.wikipedia.org/wiki/California_encephalitis_orthobunyavirus "California encephalitis orthobunyavirus") CEV [Jamestown Canyon encephalitis](https://en.wikipedia.org/wiki/Jamestown_Canyon_encephalitis "Jamestown Canyon encephalitis") [La Crosse encephalitis](https://en.wikipedia.org/wiki/La_Crosse_encephalitis "La Crosse encephalitis") LACV [Tahyna virus](https://en.wikipedia.org/wiki/Tahyna_virus "Tahyna virus") TAHV [Tete virus](https://en.wikipedia.org/wiki/Tete_virus "Tete virus") [Viral hemorrhagic fevers](https://en.wikipedia.org/wiki/Viral_hemorrhagic_fever "Viral hemorrhagic fever"): [Bunyamwera fever](https://en.wikipedia.org/wiki/Bunyamwera_orthobunyavirus "Bunyamwera orthobunyavirus") BUNV [Ngari virus](https://en.wikipedia.org/wiki/Ngari_virus "Ngari virus") NRIV [Rift Valley fever](https://en.wikipedia.org/wiki/Rift_Valley_fever "Rift Valley fever") RVFV |
| *[Flaviviridae](https://en.wikipedia.org/wiki/Flaviviridae "Flaviviridae")* | [Arbovirus encephalitides](https://en.wikipedia.org/wiki/Arbovirus_encephalitis "Arbovirus encephalitis"): [Japanese encephalitis](https://en.wikipedia.org/wiki/Japanese_encephalitis "Japanese encephalitis") [JEV](https://en.wikipedia.org/wiki/Japanese_encephalitis_virus "Japanese encephalitis virus") [Australian encephalitis](https://en.wikipedia.org/wiki/Murray_Valley_encephalitis_virus "Murray Valley encephalitis virus") [MVEV](https://en.wikipedia.org/wiki/Murray_Valley_encephalitis_virus "Murray Valley encephalitis virus") [KUNV](https://en.wikipedia.org/wiki/Kunjin_virus "Kunjin virus") [Saint Louis encephalitis](https://en.wikipedia.org/wiki/Saint_Louis_encephalitis "Saint Louis encephalitis") SLEV [Usutu virus](https://en.wikipedia.org/wiki/Usutu_virus "Usutu virus") USUV [West Nile fever](https://en.wikipedia.org/wiki/West_Nile_fever "West Nile fever") [WNV](https://en.wikipedia.org/wiki/West_Nile_virus "West Nile virus") [Viral hemorrhagic fevers](https://en.wikipedia.org/wiki/Viral_hemorrhagic_fever "Viral hemorrhagic fever"): [Dengue fever](https://en.wikipedia.org/wiki/Dengue_fever "Dengue fever") [DENV-1-4](https://en.wikipedia.org/wiki/Dengue_virus "Dengue virus") [Yellow fever](https://en.wikipedia.org/wiki/Yellow_fever "Yellow fever") [YFV](https://en.wikipedia.org/wiki/Yellow_fever_virus "Yellow fever virus") [Zika fever](https://en.wikipedia.org/wiki/Zika_fever "Zika fever") [ZIKV](https://en.wikipedia.org/wiki/ZIKV "ZIKV") |
| *[Togaviridae](https://en.wikipedia.org/wiki/Togaviridae "Togaviridae")* | [Arbovirus encephalitides](https://en.wikipedia.org/wiki/Arbovirus_encephalitis "Arbovirus encephalitis"): [Eastern equine encephalomyelitis](https://en.wikipedia.org/wiki/Eastern_equine_encephalitis "Eastern equine encephalitis") EEEV [Western equine encephalomyelitis](https://en.wikipedia.org/wiki/Western_equine_encephalitis_virus "Western equine encephalitis virus") WEEV [Venezuelan equine encephalomyelitis](https://en.wikipedia.org/wiki/Venezuelan_equine_encephalitis_virus "Venezuelan equine encephalitis virus") VEEV [Chikungunya](https://en.wikipedia.org/wiki/Chikungunya "Chikungunya") [CHIKV](https://en.wikipedia.org/wiki/Chikungunya_virus "Chikungunya virus") [O'nyong'nyong fever](https://en.wikipedia.org/wiki/O%27nyong%27nyong_virus "O'nyong'nyong virus") ONNV [Pogosta disease](https://en.wikipedia.org/wiki/Pogosta_disease "Pogosta disease") [Sindbis virus](https://en.wikipedia.org/wiki/Sindbis_virus "Sindbis virus") [Ross River fever](https://en.wikipedia.org/wiki/Ross_River_fever "Ross River fever") [RRV](https://en.wikipedia.org/wiki/Ross_River_virus "Ross River virus") [Semliki Forest virus](https://en.wikipedia.org/wiki/Semliki_Forest_virus "Semliki Forest virus") |
| *[Reoviridae](https://en.wikipedia.org/wiki/Reoviridae "Reoviridae")* | [Banna virus encephalitis](https://en.wikipedia.org/wiki/Banna_virus "Banna virus") |
| [Tick \-borne](https://en.wikipedia.org/wiki/Tick-borne_disease#Viral "Tick-borne disease") | |
| | |
| *[Bunyavirales](https://en.wikipedia.org/wiki/Bunyavirales "Bunyavirales")* | [Viral hemorrhagic fevers](https://en.wikipedia.org/wiki/Viral_hemorrhagic_fever "Viral hemorrhagic fever"): [Crimean–Congo hemorrhagic fever](https://en.wikipedia.org/wiki/Crimean%E2%80%93Congo_hemorrhagic_fever "Crimean–Congo hemorrhagic fever") (CCHFV) [Heartland virus](https://en.wikipedia.org/wiki/Heartland_virus "Heartland virus") [Severe fever with thrombocytopenia syndrome](https://en.wikipedia.org/wiki/Severe_fever_with_thrombocytopenia_syndrome "Severe fever with thrombocytopenia syndrome") ([Huaiyangshan banyangvirus](https://en.wikipedia.org/wiki/Huaiyangshan_banyangvirus "Huaiyangshan banyangvirus")) [Tete virus](https://en.wikipedia.org/wiki/Tete_virus "Tete virus") [Arbovirus encephalitides](https://en.wikipedia.org/wiki/Arbovirus_encephalitis "Arbovirus encephalitis"): [Bhanja virus](https://en.wikipedia.org/wiki/Bhanja_virus "Bhanja virus") |
| *[Flaviviridae](https://en.wikipedia.org/wiki/Flaviviridae "Flaviviridae")* | [Arbovirus encephalitides](https://en.wikipedia.org/wiki/Arbovirus_encephalitis "Arbovirus encephalitis"): [Tick-borne encephalitis](https://en.wikipedia.org/wiki/Tick-borne_encephalitis "Tick-borne encephalitis") [TBEV](https://en.wikipedia.org/wiki/Tick-borne_encephalitis_virus "Tick-borne encephalitis virus") [Powassan encephalitis](https://en.wikipedia.org/wiki/Powassan_encephalitis "Powassan encephalitis") [POWV](https://en.wikipedia.org/wiki/Powassan_virus "Powassan virus") [Viral hemorrhagic fevers](https://en.wikipedia.org/wiki/Viral_hemorrhagic_fever "Viral hemorrhagic fever"): [Omsk hemorrhagic fever](https://en.wikipedia.org/wiki/Omsk_hemorrhagic_fever "Omsk hemorrhagic fever") OHFV [Kyasanur Forest disease](https://en.wikipedia.org/wiki/Kyasanur_Forest_disease "Kyasanur Forest disease") KFDV [AHFV](https://en.wikipedia.org/wiki/Alkhurma_virus "Alkhurma virus") [Langat virus](https://en.wikipedia.org/wiki/Langat_virus "Langat virus") LGTV |
| *[Orthomyxoviridae](https://en.wikipedia.org/wiki/Orthomyxoviridae "Orthomyxoviridae")* | [Bourbon virus](https://en.wikipedia.org/wiki/Bourbon_virus "Bourbon virus") |
| *[Reoviridae](https://en.wikipedia.org/wiki/Reoviridae "Reoviridae")* | [Colorado tick fever](https://en.wikipedia.org/wiki/Colorado_tick_fever "Colorado tick fever") CTFV [Kemerovo tickborne viral fever](https://en.wikipedia.org/wiki/Kemerovo_tickborne_viral_fever "Kemerovo tickborne viral fever") |
| [Sandfly \-borne](https://en.wikipedia.org/wiki/Sandfly#Viruses "Sandfly") | |
| | |
| *[Bunyavirales](https://en.wikipedia.org/wiki/Bunyavirales "Bunyavirales")* | [Adria virus](https://en.wikipedia.org/wiki/Adria_virus "Adria virus") (ADRV) [Oropouche fever](https://en.wikipedia.org/wiki/Oropouche_fever "Oropouche fever") [Oropouche virus](https://en.wikipedia.org/wiki/Oropouche_virus "Oropouche virus") [Pappataci fever](https://en.wikipedia.org/wiki/Pappataci_fever "Pappataci fever") [Toscana virus](https://en.wikipedia.org/wiki/Toscana_virus "Toscana virus") [Sandfly fever Naples virus](https://en.wikipedia.org/wiki/Sandfly_fever_Naples_phlebovirus "Sandfly fever Naples phlebovirus") |
| *[Rhabdoviridae](https://en.wikipedia.org/wiki/Rhabdoviridae "Rhabdoviridae")* | [Chandipura virus](https://en.wikipedia.org/wiki/Chandipura_vesiculovirus "Chandipura vesiculovirus") |
| [Mammal \-borne](https://en.wikipedia.org/wiki/Mammal "Mammal") | |
| | |
| [Rodent \-borne](https://en.wikipedia.org/wiki/Rodent "Rodent") | |
| | |
| *[Arenaviridae](https://en.wikipedia.org/wiki/Arenavirus "Arenavirus")* | [Viral hemorrhagic fevers](https://en.wikipedia.org/wiki/Viral_hemorrhagic_fever "Viral hemorrhagic fever"): [Lassa fever](https://en.wikipedia.org/wiki/Lassa_fever "Lassa fever") [LASV](https://en.wikipedia.org/wiki/Lassa_virus "Lassa virus") [Venezuelan hemorrhagic fever](https://en.wikipedia.org/wiki/Venezuelan_hemorrhagic_fever "Venezuelan hemorrhagic fever") GTOV [Argentine hemorrhagic fever](https://en.wikipedia.org/wiki/Argentine_hemorrhagic_fever "Argentine hemorrhagic fever") [JUNV](https://en.wikipedia.org/wiki/Argentinian_mammarenavirus "Argentinian mammarenavirus") [Brazilian hemorrhagic fever](https://en.wikipedia.org/wiki/Brazilian_hemorrhagic_fever "Brazilian hemorrhagic fever") [SABV](https://en.wikipedia.org/wiki/Brazilian_hemorrhagic_fever "Brazilian hemorrhagic fever") [Bolivian hemorrhagic fever](https://en.wikipedia.org/wiki/Bolivian_hemorrhagic_fever "Bolivian hemorrhagic fever") MACV [LUJV](https://en.wikipedia.org/wiki/Lujo_mammarenavirus "Lujo mammarenavirus") [CHPV](https://en.wikipedia.org/wiki/Chapare_virus "Chapare virus") |
| *[Bunyavirales](https://en.wikipedia.org/wiki/Bunyavirales "Bunyavirales")* | [Hemorrhagic fever with renal syndrome](https://en.wikipedia.org/wiki/Hantavirus_hemorrhagic_fever_with_renal_syndrome "Hantavirus hemorrhagic fever with renal syndrome") [DOBV](https://en.wikipedia.org/wiki/Dobrava-Belgrade_orthohantavirus "Dobrava-Belgrade orthohantavirus") [HTNV](https://en.wikipedia.org/wiki/Hantaan_orthohantavirus "Hantaan orthohantavirus") [PUUV](https://en.wikipedia.org/wiki/Puumala_orthohantavirus "Puumala orthohantavirus") [SEOV](https://en.wikipedia.org/wiki/Seoul_orthohantavirus "Seoul orthohantavirus") [AMRV](https://en.wikipedia.org/wiki/Amur_virus "Amur virus") [THAIV](https://en.wikipedia.org/wiki/Thailand_virus "Thailand virus") [Hantavirus pulmonary syndrome](https://en.wikipedia.org/wiki/Hantavirus_pulmonary_syndrome "Hantavirus pulmonary syndrome") [ANDV](https://en.wikipedia.org/wiki/Andes_orthohantavirus "Andes orthohantavirus") [SNV](https://en.wikipedia.org/wiki/Sin_Nombre_orthohantavirus "Sin Nombre orthohantavirus") |
| *[Herpesviridae](https://en.wikipedia.org/wiki/Herpesviridae "Herpesviridae")* | *[Murid gammaherpesvirus 4](https://en.wikipedia.org/wiki/Murid_gammaherpesvirus_4 "Murid gammaherpesvirus 4")* |
| [Bat \-borne](https://en.wikipedia.org/wiki/Bat#Disease_transmission "Bat") | |
| | |
| *[Filoviridae](https://en.wikipedia.org/wiki/Filoviridae "Filoviridae")* | [Ebola virus disease](https://en.wikipedia.org/wiki/Ebola_virus_disease "Ebola virus disease") [BDBV](https://en.wikipedia.org/wiki/Bundibugyo_virus "Bundibugyo virus") [SUDV](https://en.wikipedia.org/wiki/Sudan_virus "Sudan virus") [TAFV](https://en.wikipedia.org/wiki/Ta%C3%AF_Forest_virus "Taï Forest virus") [ZEBOV](https://en.wikipedia.org/wiki/Zaire_ebolavirus "Zaire ebolavirus") [Marburg virus disease](https://en.wikipedia.org/wiki/Marburg_virus_disease "Marburg virus disease") [MARV](https://en.wikipedia.org/wiki/Marburg_virus "Marburg virus") [RAVV](https://en.wikipedia.org/wiki/Ravn_virus "Ravn virus") |
| *[Rhabdoviridae](https://en.wikipedia.org/wiki/Rhabdoviridae "Rhabdoviridae")* | [Rabies](https://en.wikipedia.org/wiki/Rabies "Rabies") [ABLV](https://en.wikipedia.org/wiki/Australian_bat_lyssavirus "Australian bat lyssavirus") [MOKV](https://en.wikipedia.org/wiki/Mokola_lyssavirus "Mokola lyssavirus") [DUVV](https://en.wikipedia.org/wiki/Duvenhage_lyssavirus "Duvenhage lyssavirus") [LBV](https://en.wikipedia.org/wiki/Lagos_bat_lyssavirus "Lagos bat lyssavirus") [CHPV](https://en.wikipedia.org/wiki/Chandipura_vesiculovirus "Chandipura vesiculovirus") |
| *[Paramyxoviridae](https://en.wikipedia.org/wiki/Paramyxoviridae "Paramyxoviridae")* | [Henipavirus encephalitis](https://en.wikipedia.org/wiki/Henipavirus "Henipavirus") [HeV](https://en.wikipedia.org/wiki/Hendra_virus "Hendra virus") [NiV](https://en.wikipedia.org/wiki/Nipah_virus "Nipah virus") |
| *[Coronaviridae](https://en.wikipedia.org/wiki/Coronaviridae "Coronaviridae")* | [MERS-CoV](https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome%E2%80%93related_coronavirus "Middle East respiratory syndrome–related coronavirus") [SARS-related coronavirus](https://en.wikipedia.org/wiki/SARS-related_coronavirus "SARS-related coronavirus") [SARS-CoV](https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus "Severe acute respiratory syndrome coronavirus") [SARS-CoV-2](https://en.wikipedia.org/wiki/SARS-CoV-2 "SARS-CoV-2") |
| [Primate \-borne](https://en.wikipedia.org/wiki/Primate "Primate") | |
| | |
| *[Herpesviridae](https://en.wikipedia.org/wiki/Herpesviridae "Herpesviridae")* | *[B virus](https://en.wikipedia.org/wiki/B_virus "B virus")* |
| *[Retroviridae](https://en.wikipedia.org/wiki/Retrovirus "Retrovirus")* | [Simian foamy virus](https://en.wikipedia.org/wiki/Simian_foamy_virus "Simian foamy virus") [HTLV-1](https://en.wikipedia.org/wiki/Human_T-lymphotropic_virus_1 "Human T-lymphotropic virus 1") [HTLV-2](https://en.wikipedia.org/wiki/Human_T-lymphotropic_virus_2 "Human T-lymphotropic virus 2") |
| *[Poxviridae](https://en.wikipedia.org/wiki/Poxviridae "Poxviridae")* | [Tanapox](https://en.wikipedia.org/wiki/Tanapox "Tanapox") [Yaba monkey tumor virus](https://en.wikipedia.org/wiki/Yaba_monkey_tumor_virus "Yaba monkey tumor virus") |
| Multiple vectors | |
| | |
| *[Rhabdoviridae](https://en.wikipedia.org/wiki/Rhabdoviridae "Rhabdoviridae")* | [Rabies](https://en.wikipedia.org/wiki/Rabies "Rabies") [RABV](https://en.wikipedia.org/wiki/Rabies_virus "Rabies virus") [Mokola virus](https://en.wikipedia.org/wiki/Mokola_lyssavirus "Mokola lyssavirus") |
| *[Poxviridae](https://en.wikipedia.org/wiki/Poxviridae "Poxviridae")* | [Monkeypox](https://en.wikipedia.org/wiki/Monkeypox "Monkeypox") |
[Portals](https://en.wikipedia.org/wiki/Wikipedia:Contents/Portals "Wikipedia:Contents/Portals"):
-  [Medicine](https://en.wikipedia.org/wiki/Portal:Medicine "Portal:Medicine")
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**Ebola** at Wikipedia's [sister projects](https://en.wikipedia.org/wiki/Wikipedia:Wikimedia_sister_projects "Wikipedia:Wikimedia sister projects"):
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| [Authority control databases](https://en.wikipedia.org/wiki/Help:Authority_control "Help:Authority control") [](https://www.wikidata.org/wiki/Q51993#identifiers "Edit this at Wikidata") | |
|---|---|
| International | [GND](https://d-nb.info/gnd/4370218-1) |
| National | [United States](https://id.loc.gov/authorities/sh85040654) [France](https://catalogue.bnf.fr/ark:/12148/cb124633823) [BnF data](https://data.bnf.fr/ark:/12148/cb124633823) [Czech Republic](https://aleph.nkp.cz/F/?func=find-c&local_base=aut&ccl_term=ica=ph221309&CON_LNG=ENG) [Israel](https://www.nli.org.il/en/authorities/987007531373805171) |
| Other | [Yale LUX](https://lux.collections.yale.edu/view/concept/4d026f86-77ac-4ef9-ade3-e31d0d83ecfc) |
Retrieved from "<https://en.wikipedia.org/w/index.php?title=Ebola&oldid=1347760427>"
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Ebola
135 languages
[Add topic](https://en.wikipedia.org/wiki/Ebola) | ||||||||||||
| Readable Markdown | | Ebola | |
|---|---|
| Other names | Ebola haemorrhagic fever (EHF), Ebola virus disease (EBV) |
| [](https://en.wikipedia.org/wiki/File:7042_lores-Ebola-Zaire-CDC_Photo.jpg) | |
| Two nurses stand beside [Mayinga N'Seka](https://en.wikipedia.org/wiki/Mayinga_N%27Seka "Mayinga N'Seka"), a nurse with Ebola virus disease, during the [1976 outbreak in Zaire](https://en.wikipedia.org/wiki/1976_Zaire_Ebola_virus_outbreak "1976 Zaire Ebola virus outbreak") (now the [Democratic Republic of the Congo](https://en.wikipedia.org/wiki/Democratic_Republic_of_the_Congo "Democratic Republic of the Congo")). N'Seka was treated, but ultimately died a few days later. | |
| Pronunciation | [\[1\]](https://en.wikipedia.org/wiki/Ebola#cite_note-1) |
| [Specialty](https://en.wikipedia.org/wiki/Medical_specialty "Medical specialty") | [Infectious diseases](https://en.wikipedia.org/wiki/Infectious_diseases_\(medical_specialty\) "Infectious diseases (medical specialty)") [](https://www.wikidata.org/wiki/Q51993?uselang=en#P1995 "Edit this on Wikidata") |
| [Symptoms](https://en.wikipedia.org/wiki/Signs_and_symptoms "Signs and symptoms") | [Fever](https://en.wikipedia.org/wiki/Fever "Fever"), [sore throat](https://en.wikipedia.org/wiki/Sore_throat "Sore throat"), [muscle pain](https://en.wikipedia.org/wiki/Muscle_pain "Muscle pain"), [headaches](https://en.wikipedia.org/wiki/Headaches "Headaches"), [diarrhoea](https://en.wikipedia.org/wiki/Diarrhoea "Diarrhoea"), [bleeding](https://en.wikipedia.org/wiki/Bleeding "Bleeding")[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[3\]](https://en.wikipedia.org/wiki/Ebola#cite_note-3) |
| [Complications](https://en.wikipedia.org/wiki/Complication_\(medicine\) "Complication (medicine)") | [Shock](https://en.wikipedia.org/wiki/Hypovolemic_shock "Hypovolemic shock") from [fluid loss](https://en.wikipedia.org/wiki/Fluid_loss "Fluid loss")[\[4\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ruz2014-4) |
| Usual onset | 2 days to 3 weeks after exposure[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| [Causes](https://en.wikipedia.org/wiki/Cause_\(medicine\) "Cause (medicine)") | [Ebolaviruses](https://en.wikipedia.org/wiki/Ebolavirus "Ebolavirus") spread by direct contact with the [blood](https://en.wikipedia.org/wiki/Blood "Blood") or [body fluid](https://en.wikipedia.org/wiki/Body_fluid "Body fluid") of an [infected](https://en.wikipedia.org/wiki/Infection "Infection") person, or [contaminated](https://en.wikipedia.org/wiki/Contaminated "Contaminated") objects[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| [Diagnostic method](https://en.wikipedia.org/wiki/Medical_diagnosis "Medical diagnosis") | Finding [ebolaviruses](https://en.wikipedia.org/wiki/Ebolaviruses "Ebolaviruses"), viral [RNA](https://en.wikipedia.org/wiki/RNA "RNA"), or [antibodies](https://en.wikipedia.org/wiki/Antibodies "Antibodies") in blood[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| [Differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") | Other [viral haemorrhagic fevers](https://en.wikipedia.org/wiki/Viral_haemorrhagic_fevers "Viral haemorrhagic fevers"), such as [malaria](https://en.wikipedia.org/wiki/Malaria "Malaria"), [typhoid](https://en.wikipedia.org/wiki/Typhoid "Typhoid"), [cholera](https://en.wikipedia.org/wiki/Cholera "Cholera"), or [meningitis](https://en.wikipedia.org/wiki/Meningitis "Meningitis")[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| Prevention | Coordinated medical services, careful handling of [bushmeat](https://en.wikipedia.org/wiki/Bushmeat "Bushmeat")[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| Treatment | [Supportive care](https://en.wikipedia.org/wiki/Supportive_care "Supportive care")[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
| [Medication](https://en.wikipedia.org/wiki/Medication "Medication") | [Atoltivimab/maftivimab/odesivimab](https://en.wikipedia.org/wiki/Atoltivimab/maftivimab/odesivimab "Atoltivimab/maftivimab/odesivimab") (INMAZEB) |
| [Prognosis](https://en.wikipedia.org/wiki/Prognosis "Prognosis") | 25–90% mortality[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) |
**Ebola**, also known as **Ebola virus disease** (**EVD**) and **Ebola hemorrhagic fever** (**EHF**), is a [zoonotic](https://en.wikipedia.org/wiki/Zoonosis "Zoonosis") [viral hemorrhagic fever](https://en.wikipedia.org/wiki/Viral_hemorrhagic_fever "Viral hemorrhagic fever") in humans and other [primates](https://en.wikipedia.org/wiki/Primate "Primate"), caused by four of the six known [ebolaviruses](https://en.wikipedia.org/wiki/Ebolavirus "Ebolavirus").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Symptoms typically start anywhere between two days and three weeks after infection.[\[5\]](https://en.wikipedia.org/wiki/Ebola#cite_note-5) The first symptoms are usually [fever](https://en.wikipedia.org/wiki/Fever "Fever"), [sore throat](https://en.wikipedia.org/wiki/Sore_throat "Sore throat"), [muscle pain](https://en.wikipedia.org/wiki/Myalgia "Myalgia"), and [headaches](https://en.wikipedia.org/wiki/Headache "Headache").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) These are usually followed by [vomiting](https://en.wikipedia.org/wiki/Vomiting "Vomiting"), [diarrhoea](https://en.wikipedia.org/wiki/Diarrhoea "Diarrhoea"), [rash](https://en.wikipedia.org/wiki/Rash "Rash"), [hepatic](https://en.wikipedia.org/wiki/Liver "Liver") and [renal](https://en.wikipedia.org/wiki/Kidney "Kidney") dysfunction,[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) at which point some people begin to [bleed](https://en.wikipedia.org/wiki/Bleeding "Bleeding") both [internally](https://en.wikipedia.org/wiki/Internal_bleeding "Internal bleeding") and externally.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) The disease causes a mortality rate of anywhere between 25 and 90%, averaging out at approximately 50%.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) The viral species involved and timing of treatment play a critical role in its prognosis. Death is often due to [shock from fluid loss](https://en.wikipedia.org/wiki/Hypovolemic_shock "Hypovolemic shock"), and typically occurs between 6 and 16 days after the first symptoms appear.[\[4\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ruz2014-4)
The viruses have caused [intermittent outbreaks](https://en.wikipedia.org/wiki/List_of_Ebola_outbreaks "List of Ebola outbreaks") in [Sub-Sahara Africa](https://en.wikipedia.org/wiki/Sub-Sahara_Africa "Sub-Sahara Africa") since 1976 when the disease was first reported, with the largest one being the [2014 Western African epidemic](https://en.wikipedia.org/wiki/Western_African_Ebola_epidemic "Western African Ebola epidemic"). They spread through direct contact with [body fluids](https://en.wikipedia.org/wiki/Body_fluid "Body fluid"), such as [blood](https://en.wikipedia.org/wiki/Blood "Blood") from infected humans or other animals,[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) or from contact with items that have recently been contaminated with infected body fluids.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) There have been no documented cases, either in nature or under laboratory conditions, of spread through the air between humans or other [primates](https://en.wikipedia.org/wiki/Primate "Primate").[\[6\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHOAir2014-6) After recovering from Ebola, [semen](https://en.wikipedia.org/wiki/Semen "Semen") or [breast milk](https://en.wikipedia.org/wiki/Breast_milk "Breast milk") may continue to carry the virus for anywhere between several weeks to several months.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[7\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cdc9months-7)[\[8\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCBreast2014-8) [Fruit bats](https://en.wikipedia.org/wiki/Megabat "Megabat") are believed to be the [natural host](https://en.wikipedia.org/wiki/Natural_host "Natural host") of the viruses; they are able to spread the viruses without being affected by it.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) The symptoms of Ebola may resemble those of several other diseases, including [malaria](https://en.wikipedia.org/wiki/Malaria "Malaria"), [cholera](https://en.wikipedia.org/wiki/Cholera "Cholera"), [typhoid fever](https://en.wikipedia.org/wiki/Typhoid_fever "Typhoid fever"), [meningitis](https://en.wikipedia.org/wiki/Meningitis "Meningitis") and other viral hemorrhagic fevers.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Diagnosis is confirmed by testing blood samples for the presence of viral [RNA](https://en.wikipedia.org/wiki/RNA "RNA"), viral [antibodies](https://en.wikipedia.org/wiki/Antibodies "Antibodies") or the virus itself.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[9\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Bro2016-9)
Control of outbreaks requires coordinated medical services and community engagement,[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) including rapid detection, [contact tracing](https://en.wikipedia.org/wiki/Contact_tracing "Contact tracing") of those exposed, quick access to laboratory services, care for those infected, and proper disposal of the dead through [cremation](https://en.wikipedia.org/wiki/Cremation "Cremation") or burial.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[10\]](https://en.wikipedia.org/wiki/Ebola#cite_note-10) Prevention measures involve wearing proper protective clothing and [washing hands](https://en.wikipedia.org/wiki/Washing_hands "Washing hands") when in close proximity to patients and while handling potentially infected [bushmeat](https://en.wikipedia.org/wiki/Bushmeat "Bushmeat"), as well as thoroughly cooking bushmeat.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Two treatments ([atoltivimab/maftivimab/odesivimab](https://en.wikipedia.org/wiki/Atoltivimab/maftivimab/odesivimab "Atoltivimab/maftivimab/odesivimab") and [ansuvimab](https://en.wikipedia.org/wiki/Ansuvimab "Ansuvimab")) are associated with improved outcomes.[\[11\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NIH2019Tx-11) Early supportive care and treatment of symptoms increases the survival rate considerably compared to late start.[\[12\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Guiliani_2022-12)[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) These include [oral rehydration therapy](https://en.wikipedia.org/wiki/Oral_rehydration_therapy "Oral rehydration therapy") (drinking slightly sweetened and salty water) or giving [intravenous fluids](https://en.wikipedia.org/wiki/Intravenous_fluids "Intravenous fluids"), and treating symptoms.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) An [Ebola vaccine](https://en.wikipedia.org/wiki/Ebola_vaccine "Ebola vaccine") was approved by the US FDA in December 2019. In October 2020, atoltivimab/maftivimab/odesivimab (Inmazeb) was approved for medical use in the United States to treat the disease caused by *Zaire ebolavirus*.[\[13\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA_PR-13)
Signs and symptoms
[](https://en.wikipedia.org/wiki/File:Symptoms_of_ebola.png)
Signs and symptoms of Ebola[\[14\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014S-14)
Onset
The length of time between exposure to the virus and the development of symptoms ([incubation period](https://en.wikipedia.org/wiki/Incubation_period "Incubation period")) is between 2 and 21 days,[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[14\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014S-14) and usually between 4 and 10 days.[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15) However, recent estimates based on mathematical models predict that around 5% of cases may take longer than 21 days to develop.[\[16\]](https://en.wikipedia.org/wiki/Ebola#cite_note-16)
Symptoms usually begin with a sudden [influenza](https://en.wikipedia.org/wiki/Influenza "Influenza")\-like stage characterised by [fatigue](https://en.wikipedia.org/wiki/Fatigue_\(medical\) "Fatigue (medical)"), [fever](https://en.wikipedia.org/wiki/Fever "Fever"), [weakness](https://en.wikipedia.org/wiki/Asthenia "Asthenia"), [decreased appetite](https://en.wikipedia.org/wiki/Anorexia_\(symptom\) "Anorexia (symptom)"), [muscular pain](https://en.wikipedia.org/wiki/Myalgia "Myalgia"), [joint pain](https://en.wikipedia.org/wiki/Arthralgia "Arthralgia"), headache, and sore throat.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15)[\[17\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gatherer_2014-17)[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18) The fever is usually higher than 38.3 °C (101 °F).[\[19\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2006-19) This is often followed by nausea, vomiting, [diarrhoea](https://en.wikipedia.org/wiki/Diarrhoea "Diarrhoea"), abdominal pain, and sometimes [hiccups](https://en.wikipedia.org/wiki/Hiccups "Hiccups").[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18)[\[20\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Brown2017-20) The combination of severe vomiting and diarrhoea often leads to severe [dehydration](https://en.wikipedia.org/wiki/Dehydration "Dehydration").[\[21\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Sharma2015-21) Next, [shortness of breath](https://en.wikipedia.org/wiki/Shortness_of_breath "Shortness of breath") and [chest pain](https://en.wikipedia.org/wiki/Chest_pain "Chest pain") may occur, along with [swelling](https://en.wikipedia.org/wiki/Oedema "Oedema"), [headaches](https://en.wikipedia.org/wiki/Headaches "Headaches"), and [confusion](https://en.wikipedia.org/wiki/Decreased_level_of_consciousness "Decreased level of consciousness").[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18) In about half of the cases, the skin may develop a [maculopapular rash](https://en.wikipedia.org/wiki/Maculopapular_rash "Maculopapular rash"), a flat red area covered with small bumps, five to seven days after symptoms begin.[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15)[\[19\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2006-19)
Bleeding
In some cases, internal and external bleeding may occur.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) This typically begins five to seven days after the first symptoms.[\[22\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlwhqlibdoc.who.int-22) All infected people show some [decreased blood clotting](https://en.wikipedia.org/wiki/Bleeding_disorder "Bleeding disorder").[\[19\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2006-19) Bleeding from mucous membranes or from sites of needle punctures has been reported in 40–50% of cases.[\[23\]](https://en.wikipedia.org/wiki/Ebola#cite_note-23) This may cause [vomiting blood](https://en.wikipedia.org/wiki/Haematemesis "Haematemesis"), [coughing up of blood](https://en.wikipedia.org/wiki/Haemoptysis "Haemoptysis"), or [blood in stool](https://en.wikipedia.org/wiki/Blood_in_stool "Blood in stool").[\[24\]](https://en.wikipedia.org/wiki/Ebola#cite_note-24) Bleeding into the skin may create [petechiae](https://en.wikipedia.org/wiki/Petechia "Petechia"), [purpura](https://en.wikipedia.org/wiki/Purpura "Purpura"), [ecchymoses](https://en.wikipedia.org/wiki/Ecchymosis "Ecchymosis") or [haematomas](https://en.wikipedia.org/wiki/Haematoma "Haematoma") (especially around needle injection sites).[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25) [Bleeding into the whites of the eyes](https://en.wikipedia.org/wiki/Subconjunctival_haemorrhage "Subconjunctival haemorrhage") may also occur.[\[26\]](https://en.wikipedia.org/wiki/Ebola#cite_note-ShanthaEye2016-26) Heavy bleeding is uncommon; if it occurs, it is usually in the [gastrointestinal tract](https://en.wikipedia.org/wiki/Gastrointestinal_tract "Gastrointestinal tract").[\[27\]](https://en.wikipedia.org/wiki/Ebola#cite_note-West2014-27) The incidence of bleeding into the gastrointestinal tract was reported to be ~58% in the 2001 outbreak in Gabon,[\[21\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Sharma2015-21) but in the 2014–15 outbreak in the US it was ~18%,[\[28\]](https://en.wikipedia.org/wiki/Ebola#cite_note-28) possibly due to improved prevention of [disseminated intravascular coagulation](https://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation "Disseminated intravascular coagulation").[\[21\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Sharma2015-21)
Recovery or death
Recovery may begin between seven and 14 days after first symptoms.[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18) Death, if it occurs, follows typically six to sixteen days from first symptoms and is often due to [shock from fluid loss](https://en.wikipedia.org/wiki/Hypovolemic_shock "Hypovolemic shock").[\[4\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ruz2014-4) In general, bleeding often indicates a worse outcome, and blood loss may result in death.[\[17\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gatherer_2014-17) People are often in a [coma](https://en.wikipedia.org/wiki/Coma "Coma") near the end of life.[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18)
Those who survive often have ongoing muscular and joint pain, [liver inflammation](https://en.wikipedia.org/wiki/Hepatitis "Hepatitis"), and decreased hearing, and may have continued tiredness, continued weakness, decreased appetite, and difficulty returning to pre-illness weight.[\[18\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hun2012-18)[\[29\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Tosh2014-29) Problems with vision may develop.[\[30\]](https://en.wikipedia.org/wiki/Ebola#cite_note-30) It is recommended that survivors wear condoms for at least twelve months after initial infection or until the semen of a male survivor tests negative for Ebolavirus on two separate occasions.[\[31\]](https://en.wikipedia.org/wiki/Ebola#cite_note-31)
Survivors develop [antibodies](https://en.wikipedia.org/wiki/Antibodies "Antibodies") against Ebola that last at least 10 years, but it is unclear whether they are immune to additional infections.[\[32\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014QAT-32)
Cause
EVD in humans is caused by four of six viruses of the genus *[Ebolavirus](https://en.wikipedia.org/wiki/Ebolavirus "Ebolavirus")*. The four are [Bundibugyo virus](https://en.wikipedia.org/wiki/Bundibugyo_virus "Bundibugyo virus") (BDBV), [Sudan virus](https://en.wikipedia.org/wiki/Sudan_virus "Sudan virus") (SUDV), [Taï Forest virus](https://en.wikipedia.org/wiki/Ta%C3%AF_Forest_virus "Taï Forest virus") (TAFV) and one simply called [Ebola virus](https://en.wikipedia.org/wiki/Ebola_virus "Ebola virus") (EBOV, formerly Zaire Ebola virus).[\[33\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2012-33) EBOV, species *[Zaire ebolavirus](https://en.wikipedia.org/wiki/Zaire_ebolavirus "Zaire ebolavirus")*, is the most dangerous of the known EVD-causing viruses, and is responsible for the largest number of outbreaks.[\[34\]](https://en.wikipedia.org/wiki/Ebola#cite_note-KuhnArch-34) The fifth and sixth viruses, [Reston virus](https://en.wikipedia.org/wiki/Reston_virus "Reston virus") (RESTV) and [Bombali virus](https://en.wikipedia.org/wiki/Bombali_ebolavirus "Bombali ebolavirus") (BOMV),[\[35\]](https://en.wikipedia.org/wiki/Ebola#cite_note-35) are not thought to cause disease in humans, but have caused disease in other primates.[\[36\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Spickler-36)[\[37\]](https://en.wikipedia.org/wiki/Ebola#cite_note-37) All six viruses are closely related to [marburgviruses](https://en.wikipedia.org/wiki/Marburgvirus "Marburgvirus").[\[33\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2012-33)
Virology
[](https://en.wikipedia.org/wiki/File:Ebola_virus_virion.jpg)
[Electron micrograph](https://en.wikipedia.org/wiki/Electron_micrograph "Electron micrograph") of an Ebola virus [virion](https://en.wikipedia.org/wiki/Virion "Virion")
Ebolaviruses contain single-stranded, non-infectious [RNA](https://en.wikipedia.org/wiki/RNA "RNA") [genomes](https://en.wikipedia.org/wiki/Genome "Genome").[\[38\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Fauquet2005-38) *Ebolavirus* genomes contain seven [genes](https://en.wikipedia.org/wiki/Gene "Gene") including [3'-UTR](https://en.wikipedia.org/wiki/Three_prime_untranslated_region "Three prime untranslated region")\-*NP*\-*VP35*\-*VP40*\-*GP*\-*VP30*\-*VP24*\-*L*\-[5'-UTR](https://en.wikipedia.org/wiki/Five_prime_untranslated_region "Five prime untranslated region").[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25)[\[39\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Stahelin2014-39) The genomes of the five different ebolaviruses (BDBV, EBOV, RESTV, SUDV and TAFV) differ in [sequence](https://en.wikipedia.org/wiki/Nucleic_acid_sequence "Nucleic acid sequence") and the number and location of gene overlaps. As with all [filoviruses](https://en.wikipedia.org/wiki/Filovirus "Filovirus"), ebolavirus virions are filamentous particles that may appear in the shape of a shepherd's crook, of a "U" or of a "6," and they may be coiled, toroid or branched.[\[39\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Stahelin2014-39)[\[40\]](https://en.wikipedia.org/wiki/Ebola#cite_note-40) In general, Ebola virions are 80 nanometers (nm) in width and may be as long as 14,000 nm.[\[41\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chippaux2014-41)
Their [life cycle](https://en.wikipedia.org/wiki/Biological_life_cycle "Biological life cycle") is thought to begin with a virion attaching to specific [cell-surface receptors](https://en.wikipedia.org/wiki/Cell_surface_receptor "Cell surface receptor") such as [C-type lectins](https://en.wikipedia.org/wiki/C-type_lectin "C-type lectin"), [DC-SIGN](https://en.wikipedia.org/wiki/DC-SIGN "DC-SIGN"), or [integrins](https://en.wikipedia.org/wiki/Integrin "Integrin"), which is followed by fusion of the [viral envelope with cellular membranes](https://en.wikipedia.org/wiki/Pinocytosis "Pinocytosis").[\[42\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Misasi2014-42) The virions taken up by the cell then travel to acidic [endosomes](https://en.wikipedia.org/wiki/Endosome "Endosome") and [lysosomes](https://en.wikipedia.org/wiki/Lysosome "Lysosome") where the viral envelope glycoprotein GP is cleaved.[\[42\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Misasi2014-42) This processing appears to allow the virus to bind to cellular proteins enabling it to fuse with internal cellular membranes and release the viral [nucleocapsid](https://en.wikipedia.org/wiki/Nucleocapsid "Nucleocapsid").[\[42\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Misasi2014-42) The *Ebolavirus* structural glycoprotein (known as GP1,2) is responsible for the virus' ability to bind to and infect targeted cells.[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) The viral [RNA polymerase](https://en.wikipedia.org/wiki/RNA-dependent_RNA_polymerase "RNA-dependent RNA polymerase"), encoded by the *L* gene, partially uncoats the nucleocapsid and [transcribes](https://en.wikipedia.org/wiki/Transcription_\(genetics\) "Transcription (genetics)") the genes into positive-strand [mRNAs](https://en.wikipedia.org/wiki/MRNA "MRNA"), which are then [translated](https://en.wikipedia.org/wiki/Translation_\(biology\) "Translation (biology)") into structural and nonstructural proteins. The most abundant protein produced is the nucleoprotein, whose concentration in the host cell determines when L switches from gene transcription to genome replication. Replication of the viral genome results in full-length, positive-strand antigenomes that are, in turn, transcribed into genome copies of negative-strand virus progeny.[\[44\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Olejnik2011-44) Newly synthesised structural proteins and genomes self-assemble and accumulate near the inside of the [cell membrane](https://en.wikipedia.org/wiki/Cell_membrane "Cell membrane"). Virions [bud](https://en.wikipedia.org/wiki/Budding "Budding") off from the cell, gaining their envelopes from the cellular membrane from which they bud. The mature progeny particles then infect other cells to repeat the cycle. The genetics of the Ebola virus are difficult to study because of EBOV's virulent characteristics.[\[45\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2005-45)
Initial case
[](https://en.wikipedia.org/wiki/File:EbolaCycle.png)
Life cycles of the *[Ebolavirus](https://en.wikipedia.org/wiki/Ebolavirus "Ebolavirus")*
[](https://en.wikipedia.org/wiki/File:Bushmeat_-_Buschfleisch_Ghana.JPG)
Smoked [bushmeat](https://en.wikipedia.org/wiki/Bushmeat "Bushmeat") in [Ghana](https://en.wikipedia.org/wiki/Ghana "Ghana"). In Africa wild animals, including fruit bats, are hunted for food and are referred to as bushmeat.[\[46\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Bush-46)[\[47\]](https://en.wikipedia.org/wiki/Ebola#cite_note-47) In equatorial Africa human consumption of bushmeat has been linked to animal-to-human transmission of diseases, including Ebola.[\[48\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlAfrican_monkey_meat_that_could_be_behind_the_next_HIV_%E2%80%93_Health_News_%E2%80%93_Health_&_Families_%E2%80%93_The_Independent-48)
Although it is not entirely clear how Ebola initially spreads from animals to humans, the spread is believed to involve direct contact with an infected wild animal or fruit bat.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49) Besides bats, other wild animals that are sometimes infected with EBOV include several species of monkeys such as [baboons](https://en.wikipedia.org/wiki/Baboon "Baboon"), [great apes](https://en.wikipedia.org/wiki/Great_apes "Great apes") ([chimpanzees](https://en.wikipedia.org/wiki/Chimpanzee "Chimpanzee") and [gorillas](https://en.wikipedia.org/wiki/Gorilla "Gorilla")), and [duikers](https://en.wikipedia.org/wiki/Duikers "Duikers") (a species of [antelope](https://en.wikipedia.org/wiki/Antelope "Antelope")).[\[50\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlEbolavirus_%E2%80%93_Pathogen_Safety_Data_Sheets-50)
Animals may become infected when they eat fruit partially eaten by bats carrying the virus.[\[51\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gon2007-51) Fruit production, animal behavior and other factors may trigger outbreaks among animal populations.[\[51\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gon2007-51)
Evidence indicates that both domestic dogs and pigs can also be infected with EBOV.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52) Dogs do not appear to develop symptoms when they carry the virus, and pigs appear to be able to transmit the virus to at least some primates.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52) Although some dogs in an area in which a human outbreak occurred had antibodies to EBOV, it is unclear whether they played a role in spreading the disease to people.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52)
Areas undergoing [deforestation](https://en.wikipedia.org/wiki/Deforestation "Deforestation") are among the most likely places for outbreaks due to changes in the landscape bringing wildlife into closer contact with humans, including the [West African Ebola virus epidemic](https://en.wikipedia.org/wiki/West_African_Ebola_virus_epidemic "West African Ebola virus epidemic").[\[53\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Christensen_2019-53)[\[54\]](https://en.wikipedia.org/wiki/Ebola#cite_note-54) Index cases of EVD have often been close to recently deforested lands.[\[55\]](https://en.wikipedia.org/wiki/Ebola#cite_note-55)[\[56\]](https://en.wikipedia.org/wiki/Ebola#cite_note-56)
Climate change may indirectly contribute to the rise in Ebola cases. [Extreme weather](https://en.wikipedia.org/wiki/Extreme_weather "Extreme weather") events such as droughts, strong winds, thunderstorms, heat waves, floods, landslides, and shifting rainfall patterns can disrupt wildlife migration, pushing animals out of their natural habitats and nearer to human settlements.[\[57\]](https://en.wikipedia.org/wiki/Ebola#cite_note-57) For instance, a severe drought in Central Africa intensified [food insecurity](https://en.wikipedia.org/wiki/Food_security "Food security"), leading some West African communities to hunt and consume infected animals such as bats, which likely fueled an Ebola outbreak.[\[58\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Climate_change_and_infectious_diseases_Christensen_2019-58)
Reservoir
The [natural reservoir](https://en.wikipedia.org/wiki/Natural_reservoir "Natural reservoir") for Ebola has yet to be confirmed; however, [bats](https://en.wikipedia.org/wiki/Bat "Bat") are considered to be the most likely candidate.[\[59\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chowell2014-59) Three types of fruit bats (*[Hypsignathus monstrosus](https://en.wikipedia.org/wiki/Hypsignathus_monstrosus "Hypsignathus monstrosus")*, *[Epomops franqueti](https://en.wikipedia.org/wiki/Epomops_franqueti "Epomops franqueti")* and *[Myonycteris torquata](https://en.wikipedia.org/wiki/Myonycteris_torquata "Myonycteris torquata")*) were found to possibly carry the virus without getting sick.[\[60\]](https://en.wikipedia.org/wiki/Ebola#cite_note-60) As of 2013, whether other animals are involved in its spread is not known.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52) Plants, [arthropods](https://en.wikipedia.org/wiki/Arthropod "Arthropod"), [rodents](https://en.wikipedia.org/wiki/Rodent "Rodent"), and birds have also been considered possible viral reservoirs.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[21\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Sharma2015-21)
Bats were known to roost in the cotton factory in which the [first cases](https://en.wikipedia.org/wiki/Index_case "Index case") of the 1976 and 1979 outbreaks were observed, and they have also been implicated in Marburg virus infections in 1975 and 1980.[\[61\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Pourrut2005-61) Of 24 plant and 19 vertebrate species experimentally inoculated with EBOV, only bats became infected.[\[62\]](https://en.wikipedia.org/wiki/Ebola#cite_note-62) The bats displayed no clinical signs of disease, which is considered evidence that these bats are a reservoir species of EBOV. In a 2002–2003 survey of 1,030 animals including 679 bats from [Gabon](https://en.wikipedia.org/wiki/Gabon "Gabon") and the [Republic of the Congo](https://en.wikipedia.org/wiki/Republic_of_the_Congo "Republic of the Congo"), immunoglobulin G (IgG) immune defense molecules indicative of Ebola infection were found in three bat species; at various periods of study, between 2.2 and 22.6% of bats were found to contain both RNA sequences and IgG molecules indicating Ebola infection.[\[63\]](https://en.wikipedia.org/wiki/Ebola#cite_note-63) Antibodies against Zaire and Reston viruses have been found in fruit bats in [Bangladesh](https://en.wikipedia.org/wiki/Bangladesh "Bangladesh"), suggesting that these bats are also potential hosts of the virus and that the filoviruses are present in Asia.[\[64\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Olival2013-64)
Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians and [arthropods](https://en.wikipedia.org/wiki/Arthropod "Arthropod") sampled from regions of EBOV outbreaks, no Ebola virus was detected apart from some genetic traces found in six rodents (belonging to the species *[Mus setulosus](https://en.wikipedia.org/wiki/Mus_setulosus "Mus setulosus")* and *[Praomys](https://en.wikipedia.org/wiki/Praomys "Praomys")*) and one [shrew](https://en.wikipedia.org/wiki/Shrew "Shrew") (*[Sylvisorex ollula](https://en.wikipedia.org/wiki/Sylvisorex_ollula "Sylvisorex ollula")*) collected from the [Central African Republic](https://en.wikipedia.org/wiki/Central_African_Republic "Central African Republic").[\[61\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Pourrut2005-61)[\[65\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Morvan1999-65) However, further research efforts have not confirmed rodents as a reservoir.[\[66\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Groseth2007-66) Traces of EBOV were detected in the carcasses of gorillas and chimpanzees during outbreaks in 2001 and 2003, which later became the source of human infections. However, the high rates of death in these species resulting from EBOV infection make it unlikely that these species represent a natural reservoir for the virus.[\[61\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Pourrut2005-61)
Transmission
[](https://en.wikipedia.org/wiki/File:Ebola_illustration-_safe_burial_\(15573264517\).jpg)
An illustration of safe burial practices
It is believed that between people, Ebola disease spreads only by direct contact with the blood or other [body fluids](https://en.wikipedia.org/wiki/Body_fluid "Body fluid") of a person who has developed symptoms of the disease.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67)[\[68\]](https://en.wikipedia.org/wiki/Ebola#cite_note-68)[\[69\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Drazen2014-69) Body fluids that may contain Ebola viruses include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and [semen](https://en.wikipedia.org/wiki/Semen "Semen").[\[7\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cdc9months-7)[\[32\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014QAT-32) The WHO states that only people who are very sick are able to spread Ebola disease in [saliva](https://en.wikipedia.org/wiki/Saliva "Saliva"), and the virus has not been reported to be transmitted through sweat. Most people spread the virus through blood, [feces](https://en.wikipedia.org/wiki/Feces "Feces") and vomit.[\[70\]](https://en.wikipedia.org/wiki/Ebola#cite_note-70) Entry points for the virus include the nose, mouth, eyes, open wounds, cuts and abrasions.[\[32\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014QAT-32) Ebola may be spread through large [droplets](https://en.wikipedia.org/wiki/Transmission_\(medicine\)#Droplet "Transmission (medicine)"); however, this is believed to occur only when a person is very sick.[\[71\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCNOV2014-71) This contamination can happen if a person is splashed with droplets.[\[71\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCNOV2014-71) Contact with surfaces or objects contaminated by the virus, particularly needles and syringes, may also transmit the infection.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49)[\[59\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chowell2014-59) The virus is able to survive on objects for a few hours in a dried state, and can survive for a few days within body fluids outside of a person.[\[32\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014QAT-32)[\[72\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ost2015-72)
The Ebola virus may be able to persist for more than three months in the semen after recovery, which could lead to infections via [sexual intercourse](https://en.wikipedia.org/wiki/Sexual_intercourse "Sexual intercourse").[\[7\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cdc9months-7)[\[73\]](https://en.wikipedia.org/wiki/Ebola#cite_note-73) Virus persistence in semen for over a year has been recorded in a national screening programme.[\[74\]](https://en.wikipedia.org/wiki/Ebola#cite_note-74) Ebola may also occur in the breast milk of women after recovery, and it is not known when it is safe to breastfeed again.[\[8\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCBreast2014-8) The virus was also found in the eye of [one patient](https://en.wikipedia.org/wiki/Ian_Crozier "Ian Crozier"), in 2014, two months after it was cleared from his blood.[\[75\]](https://en.wikipedia.org/wiki/Ebola#cite_note-VarkeyShantha2015-75) Otherwise, people who have recovered are not infectious.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49)
The potential for [widespread infections](https://en.wikipedia.org/wiki/Pandemics "Pandemics") in countries with medical systems capable of observing correct medical isolation procedures is considered low.[\[76\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCPress2014-76) Usually when someone has symptoms of the disease, they are unable to travel without assistance.[\[77\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014T-77)
Dead bodies remain infectious; thus, people handling human remains in practices such as traditional burial rituals or more modern processes such as [embalming](https://en.wikipedia.org/wiki/Embalming "Embalming") are at risk.[\[76\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCPress2014-76) Of the cases of Ebola infections in Guinea during the 2014 outbreak, 69% are believed to have been contracted via unprotected (or unsuitably protected) contact with infected corpses during certain Guinean burial rituals.[\[78\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chan2014-78)[\[79\]](https://en.wikipedia.org/wiki/Ebola#cite_note-79)
Health-care workers treating people with Ebola are at greatest risk of infection.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49) The risk increases when they do not have appropriate protective clothing such as masks, gowns, gloves and eye protection; do not wear it properly; or handle contaminated clothing incorrectly.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49) This risk is particularly common in parts of Africa where the disease mostly occurs and health systems function poorly.[\[80\]](https://en.wikipedia.org/wiki/Ebola#cite_note-80) There has been transmission [in hospitals](https://en.wikipedia.org/wiki/Nosocomial "Nosocomial") in some African countries that reuse hypodermic needles.[\[81\]](https://en.wikipedia.org/wiki/Ebola#cite_note-81)[\[82\]](https://en.wikipedia.org/wiki/Ebola#cite_note-82) Some health-care centres caring for people with the disease do not have running water.[\[83\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCQA2014-83) In the United States the spread to two medical workers treating infected patients prompted criticism of inadequate training and procedures.[\[84\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NBC-ebolaTX-84)
Human-to-human transmission of EBOV through the air has not been reported to occur during EVD outbreaks,[\[6\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHOAir2014-6) and airborne transmission has only been demonstrated in very strict laboratory conditions, and then only from pigs to [primates](https://en.wikipedia.org/wiki/Primates "Primates"), but not from primates to primates.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67)[\[59\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chowell2014-59) Spread of EBOV by water, or food other than bushmeat, has not been observed.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49)[\[59\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chowell2014-59) No spread by mosquitos or other insects has been reported.[\[49\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014T-49) Other possible methods of transmission are being studied.[\[72\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ost2015-72)
Airborne transmission among humans is theoretically possible due to the presence of Ebola virus particles in saliva, which can be discharged into the air with a cough or sneeze, but observational data from previous epidemics suggests the actual risk of airborne transmission is low.[\[85\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Jones2015-85) A number of studies examining airborne transmission broadly concluded that transmission from pigs to primates could happen without direct contact because, unlike humans and primates, pigs with EVD get very high ebolavirus concentrations in their lungs, and not their bloodstream.[\[86\]](https://en.wikipedia.org/wiki/Ebola#cite_note-virology1-86) Therefore, pigs with EVD can spread the disease through droplets in the air or on the ground when they sneeze or cough.[\[87\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl2012-87) By contrast, humans and other primates accumulate the virus throughout their body and specifically in their blood, but not very much in their lungs.[\[87\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl2012-87) It is believed that this is the reason researchers have observed pig to primate transmission without physical contact, but no evidence has been found of primates being infected without actual contact, even in experiments where infected and uninfected primates shared the same air.[\[86\]](https://en.wikipedia.org/wiki/Ebola#cite_note-virology1-86)[\[87\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl2012-87)
Pathophysiology
[](https://en.wikipedia.org/wiki/File:Ebola_Pathenogensis_path.svg)
[Pathogenesis](https://en.wikipedia.org/wiki/Pathogenesis "Pathogenesis") schematic
Like other [filoviruses](https://en.wikipedia.org/wiki/Filoviridae "Filoviridae"), EBOV replicates very efficiently in many [cells](https://en.wikipedia.org/wiki/List_of_distinct_cell_types_in_the_adult_human_body "List of distinct cell types in the adult human body"), producing large amounts of virus in [monocytes](https://en.wikipedia.org/wiki/Monocyte "Monocyte"), [macrophages](https://en.wikipedia.org/wiki/Macrophage "Macrophage"), [dendritic cells](https://en.wikipedia.org/wiki/Dendritic_cell "Dendritic cell") and other cells including [liver cells](https://en.wikipedia.org/wiki/Hepatocyte "Hepatocyte"), [fibroblasts](https://en.wikipedia.org/wiki/Fibroblast "Fibroblast"), and [adrenal gland cells](https://en.wikipedia.org/wiki/Adrenal_gland "Adrenal gland").[\[88\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ansari2014-88) Viral replication triggers [high levels of inflammatory chemical signals](https://en.wikipedia.org/wiki/Cytokine_storm "Cytokine storm") and leads to a [septic state](https://en.wikipedia.org/wiki/Sepsis "Sepsis").[\[29\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Tosh2014-29)
EBOV is thought to infect humans through contact with mucous membranes or skin breaks.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67) After infection, [endothelial cells](https://en.wikipedia.org/wiki/Endothelial_cells "Endothelial cells") (cells lining the inside of blood vessels), liver cells, and several types of immune cells such as [macrophages, monocytes](https://en.wikipedia.org/wiki/Mononuclear_phagocyte_system "Mononuclear phagocyte system"), and dendritic cells are the main targets of attack.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67) Following infection, immune cells carry the virus to nearby [lymph nodes](https://en.wikipedia.org/wiki/Lymph_node "Lymph node") where further reproduction of the virus takes place.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67) From there the virus can enter the bloodstream and [lymphatic system](https://en.wikipedia.org/wiki/Lymphatic_system "Lymphatic system") and spread throughout the body.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67) Macrophages are the first cells infected with the virus, and this infection results in [programmed cell death](https://en.wikipedia.org/wiki/Apoptosis "Apoptosis").[\[41\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chippaux2014-41) Other types of [white blood cells](https://en.wikipedia.org/wiki/White_blood_cell "White blood cell"), such as [lymphocytes](https://en.wikipedia.org/wiki/Lymphocyte "Lymphocyte"), also undergo programmed cell death leading to an abnormally [low concentration of lymphocytes](https://en.wikipedia.org/wiki/Lymphocytopenia "Lymphocytopenia") in the blood.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67) This contributes to the weakened immune response seen in those infected with EBOV.[\[67\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Funk2014-67)
Endothelial cells may be infected within three days after exposure to the virus.[\[41\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chippaux2014-41) The breakdown of endothelial cells leading to [blood vessel](https://en.wikipedia.org/wiki/Blood_vessel "Blood vessel") injury can be attributed to EBOV [glycoproteins](https://en.wikipedia.org/wiki/Glycoprotein "Glycoprotein"). This damage occurs due to the synthesis of Ebola virus [glycoprotein](https://en.wikipedia.org/wiki/Glycoprotein "Glycoprotein") (GP), which reduces the availability of specific [integrins](https://en.wikipedia.org/wiki/Integrin "Integrin") responsible for cell adhesion to the intercellular structure and causes liver damage, leading to [improper clotting](https://en.wikipedia.org/wiki/Coagulopathy "Coagulopathy"). The widespread [bleeding](https://en.wikipedia.org/wiki/Bleeding "Bleeding") that occurs in affected people causes [swelling](https://en.wikipedia.org/wiki/Oedema "Oedema") and [shock due to loss of blood volume](https://en.wikipedia.org/wiki/Hypovolemic_shock "Hypovolemic shock").[\[89\]](https://en.wikipedia.org/wiki/Ebola#cite_note-isbn0-7910-8505-8-89) The [dysfunctional bleeding and clotting](https://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation "Disseminated intravascular coagulation") commonly seen in EVD has been attributed to increased activation of the [extrinsic pathway](https://en.wikipedia.org/wiki/Tissue_factor_pathway "Tissue factor pathway") of the [coagulation cascade](https://en.wikipedia.org/wiki/Coagulation_cascade "Coagulation cascade") due to excessive [tissue factor](https://en.wikipedia.org/wiki/Tissue_factor "Tissue factor") production by macrophages and monocytes.[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15)
After infection, a secreted [glycoprotein](https://en.wikipedia.org/wiki/Glycoprotein "Glycoprotein"), small soluble glycoprotein (sGP or GP) is synthesised. EBOV replication overwhelms protein synthesis of infected cells and the host immune defences. The GP forms a [trimeric complex](https://en.wikipedia.org/wiki/Trimer_\(biochemistry\) "Trimer (biochemistry)"), which tethers the virus to the endothelial cells. The sGP forms a [dimeric protein](https://en.wikipedia.org/wiki/Protein_dimer "Protein dimer") that interferes with the signalling of [neutrophils](https://en.wikipedia.org/wiki/Neutrophils "Neutrophils"), another type of white blood cell. This enables the virus to evade the immune system by inhibiting early steps of neutrophil activation.\[*[medical citation needed](https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_\(medicine\) "Wikipedia:Identifying reliable sources (medicine)")*\] Furthermore, the virus is capable of hijacking cellular metabolism. Studies have shown that Ebola virus-like particles can reprogram metabolism in both vascular and immune cells.[\[90\]](https://en.wikipedia.org/wiki/Ebola#cite_note-90)
Immune system evasion
Filoviral infection also interferes with proper functioning of the [innate immune system](https://en.wikipedia.org/wiki/Innate_immune_system "Innate immune system").[\[42\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Misasi2014-42)[\[44\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Olejnik2011-44) EBOV proteins blunt the human immune system's response to viral infections by interfering with the cells' ability to produce and respond to interferon proteins such as [interferon-alpha](https://en.wikipedia.org/wiki/Interferon-alpha "Interferon-alpha"), [interferon-beta](https://en.wikipedia.org/wiki/Interferon-beta "Interferon-beta"), and [interferon gamma](https://en.wikipedia.org/wiki/Interferon_gamma "Interferon gamma").[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43)[\[91\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ramanan2011-91)
The VP24 and VP35 structural proteins of EBOV play a key role in this interference. When a cell is infected with EBOV, receptors located in the cell's [cytosol](https://en.wikipedia.org/wiki/Cytosol "Cytosol") (such as [RIG-I](https://en.wikipedia.org/wiki/RIG-I "RIG-I") and [MDA5](https://en.wikipedia.org/wiki/MDA5 "MDA5")) or outside of the cytosol (such as [Toll-like receptor 3 (TLR3)](https://en.wikipedia.org/wiki/Toll-like_receptor_3 "Toll-like receptor 3"), [TLR7](https://en.wikipedia.org/wiki/Toll-like_receptor_7 "Toll-like receptor 7"), [TLR8](https://en.wikipedia.org/wiki/Toll-like_receptor_8 "Toll-like receptor 8") and [TLR9](https://en.wikipedia.org/wiki/Toll-like_receptor_9 "Toll-like receptor 9")) recognise [infectious molecules](https://en.wikipedia.org/wiki/Pathogen-associated_molecular_pattern "Pathogen-associated molecular pattern") associated with the virus.[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) On TLR activation, proteins including [interferon regulatory factor 3](https://en.wikipedia.org/wiki/Interferon_Regulatory_Factor_3 "Interferon Regulatory Factor 3") and [interferon regulatory factor 7](https://en.wikipedia.org/wiki/Interferon_regulatory_factor-7 "Interferon regulatory factor-7") trigger a signalling cascade that leads to the expression of [type 1 interferons](https://en.wikipedia.org/wiki/Type_1_interferon "Type 1 interferon").[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) The type 1 interferons are then released and bind to the [IFNAR1](https://en.wikipedia.org/wiki/IFNAR1 "IFNAR1") and [IFNAR2](https://en.wikipedia.org/wiki/IFNAR2 "IFNAR2") receptors expressed on the surface of a neighbouring cell.[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) Once interferon has bound to its receptors on the neighbouring cell, the signalling proteins [STAT1](https://en.wikipedia.org/wiki/STAT1 "STAT1") and [STAT2](https://en.wikipedia.org/wiki/STAT2 "STAT2") are activated and move to the [cell's nucleus](https://en.wikipedia.org/wiki/Cell_nucleus "Cell nucleus").[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) This triggers the expression of [interferon-stimulated genes](https://en.wikipedia.org/wiki/Interferome "Interferome"), which code for proteins with antiviral properties.[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) EBOV's V24 protein blocks the production of these antiviral proteins by preventing the STAT1 signalling protein in the neighbouring cell from entering the nucleus.[\[43\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kuhl2012-43) The VP35 protein directly inhibits the production of interferon-beta.[\[91\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ramanan2011-91) By inhibiting these immune responses, EBOV may quickly spread throughout the body.[\[41\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Chippaux2014-41)
Diagnosis
When EVD is suspected, travel, work history, and exposure to wildlife are important factors with respect to further diagnostic efforts.[\[92\]](https://en.wikipedia.org/wiki/Ebola#cite_note-92)
Laboratory testing
Possible non-specific laboratory indicators of EVD include a [low platelet count](https://en.wikipedia.org/wiki/Thrombocytopenia "Thrombocytopenia"); an initially [decreased white blood cell count](https://en.wikipedia.org/wiki/Leucopenia "Leucopenia") followed by an [increased white blood cell count](https://en.wikipedia.org/wiki/Leucocytosis "Leucocytosis"); elevated levels of the liver enzymes [alanine aminotransferase](https://en.wikipedia.org/wiki/Alanine_aminotransferase "Alanine aminotransferase") (ALT) and [aspartate aminotransferase](https://en.wikipedia.org/wiki/Aspartate_aminotransferase "Aspartate aminotransferase") (AST); and abnormalities in blood clotting often consistent with [disseminated intravascular coagulation](https://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation "Disseminated intravascular coagulation") (DIC) such as a prolonged [prothrombin time](https://en.wikipedia.org/wiki/Prothrombin_time "Prothrombin time"), [partial thromboplastin time](https://en.wikipedia.org/wiki/Partial_thromboplastin_time "Partial thromboplastin time"), and [bleeding time](https://en.wikipedia.org/wiki/Bleeding_time "Bleeding time").[\[93\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Kortepeter2011-93) Filovirions such as EBOV may be identified by their unique filamentous shapes in cell cultures examined with [electron microscopy](https://en.wikipedia.org/wiki/Electron_microscopy "Electron microscopy").[\[94\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goldsmith2009-94)
The specific diagnosis of EVD is confirmed by isolating the virus, detecting its [RNA](https://en.wikipedia.org/wiki/RNA "RNA") or proteins, or detecting [antibodies](https://en.wikipedia.org/wiki/Antibodies "Antibodies") against the virus in a person's blood.[\[95\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Diag-95) Isolating the virus by [cell culture](https://en.wikipedia.org/wiki/Cell_culture "Cell culture"), detecting the viral RNA by [polymerase chain reaction](https://en.wikipedia.org/wiki/Polymerase_chain_reaction "Polymerase chain reaction") (PCR)[\[9\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Bro2016-9)[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15) and detecting proteins by [enzyme-linked immunosorbent assay](https://en.wikipedia.org/wiki/Enzyme-linked_immunosorbent_assay "Enzyme-linked immunosorbent assay") (ELISA) are methods best used in the early stages of the disease and also for detecting the virus in human remains.[\[9\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Bro2016-9)[\[95\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Diag-95) Detecting antibodies against the virus is most reliable in the later stages of the disease and in those who recover.[\[95\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Diag-95) [IgM antibodies](https://en.wikipedia.org/wiki/Immunoglobulin_M "Immunoglobulin M") are detectable two days after symptom onset and [IgG antibodies](https://en.wikipedia.org/wiki/Immunoglobulin_G "Immunoglobulin G") can be detected six to 18 days after symptom onset.[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15) During an outbreak, isolation of the virus with cell culture methods is often not feasible. In field or mobile hospitals, the most common and sensitive diagnostic methods are [real-time PCR](https://en.wikipedia.org/wiki/Real-time_PCR "Real-time PCR") and ELISA.[\[96\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Grolla2005-96) In 2014, with new mobile testing facilities deployed in parts of Liberia, test results were obtained 3–5 hours after sample submission.[\[97\]](https://en.wikipedia.org/wiki/Ebola#cite_note-97) In 2015, a rapid antigen test which gives results in 15 minutes was approved for use by WHO.[\[98\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2015Test-98) It is able to confirm Ebola in 92% of those affected and rule it out in 85% of those not affected.[\[98\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2015Test-98)
Differential diagnosis
Early symptoms of EVD may be similar to those of other diseases common in Africa, including [malaria](https://en.wikipedia.org/wiki/Malaria "Malaria") and [dengue fever](https://en.wikipedia.org/wiki/Dengue_fever "Dengue fever").[\[17\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gatherer_2014-17) The symptoms are also similar to those of other viral haemorrhagic fevers such as [Marburg virus disease](https://en.wikipedia.org/wiki/Marburg_virus_disease "Marburg virus disease"), [Crimean–Congo haemorrhagic fever](https://en.wikipedia.org/wiki/Crimean%E2%80%93Congo_haemorrhagic_fever "Crimean–Congo haemorrhagic fever"), and [Lassa fever](https://en.wikipedia.org/wiki/Lassa_fever "Lassa fever").[\[99\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Harrison-99)[\[100\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Beeching2014-100)
The complete [differential diagnosis](https://en.wikipedia.org/wiki/Differential_diagnosis "Differential diagnosis") is extensive and requires consideration of many other infectious diseases such as [typhoid fever](https://en.wikipedia.org/wiki/Typhoid_fever "Typhoid fever"), [shigellosis](https://en.wikipedia.org/wiki/Shigellosis "Shigellosis"), [rickettsial diseases](https://en.wikipedia.org/wiki/Rickettsia "Rickettsia"), [cholera](https://en.wikipedia.org/wiki/Cholera "Cholera"), [sepsis](https://en.wikipedia.org/wiki/Sepsis "Sepsis"), [borreliosis](https://en.wikipedia.org/wiki/Borreliosis "Borreliosis"), [EHEC enteritis](https://en.wikipedia.org/wiki/Verotoxin-producing_Escherichia_coli "Verotoxin-producing Escherichia coli"), [leptospirosis](https://en.wikipedia.org/wiki/Leptospirosis "Leptospirosis"), [scrub typhus](https://en.wikipedia.org/wiki/Scrub_typhus "Scrub typhus"), [plague](https://en.wikipedia.org/wiki/Plague_\(disease\) "Plague (disease)"), [Q fever](https://en.wikipedia.org/wiki/Q_fever "Q fever"), [candidiasis](https://en.wikipedia.org/wiki/Candidiasis "Candidiasis"), [histoplasmosis](https://en.wikipedia.org/wiki/Histoplasmosis "Histoplasmosis"), [trypanosomiasis](https://en.wikipedia.org/wiki/Trypanosomiasis "Trypanosomiasis"), [visceral](https://en.wikipedia.org/wiki/Visceral "Visceral") [leishmaniasis](https://en.wikipedia.org/wiki/Leishmaniasis "Leishmaniasis"), [measles](https://en.wikipedia.org/wiki/Measles "Measles"), and [viral hepatitis](https://en.wikipedia.org/wiki/Viral_hepatitis "Viral hepatitis") among others.[\[101\]](https://en.wikipedia.org/wiki/Ebola#cite_note-101)
Non-infectious diseases that may result in symptoms similar to those of EVD include [acute promyelocytic leukaemia](https://en.wikipedia.org/wiki/Acute_promyelocytic_leukaemia "Acute promyelocytic leukaemia"), [haemolytic uraemic syndrome](https://en.wikipedia.org/wiki/Haemolytic_uraemic_syndrome "Haemolytic uraemic syndrome"), [snake envenomation](https://en.wikipedia.org/wiki/Snake_envenomation "Snake envenomation"), [clotting factor](https://en.wikipedia.org/wiki/Coagulation "Coagulation") deficiencies/platelet disorders, [thrombotic thrombocytopenic purpura](https://en.wikipedia.org/wiki/Thrombotic_thrombocytopenic_purpura "Thrombotic thrombocytopenic purpura"), [hereditary haemorrhagic telangiectasia](https://en.wikipedia.org/wiki/Hereditary_haemorrhagic_telangiectasia "Hereditary haemorrhagic telangiectasia"), [Kawasaki disease](https://en.wikipedia.org/wiki/Kawasaki_disease "Kawasaki disease"), and [warfarin](https://en.wikipedia.org/wiki/Warfarin "Warfarin") poisoning.[\[96\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Grolla2005-96)[\[102\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gear1989-102)[\[103\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Gear1978-103)[\[104\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Bogomolov1998-104)
Prevention
Vaccines
An [Ebola vaccine](https://en.wikipedia.org/wiki/Ebola_vaccine "Ebola vaccine"), [rVSV-ZEBOV](https://en.wikipedia.org/wiki/RVSV-ZEBOV "RVSV-ZEBOV"), was approved in the United States in December 2019.[\[105\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA2019Vac-105) It appears to be fully effective ten days after being given.[\[105\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA2019Vac-105) It was studied in Guinea between 2014 and 2016.[\[105\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA2019Vac-105) More than 100,000 people have been vaccinated against Ebola as of 2019.[\[106\]](https://en.wikipedia.org/wiki/Ebola#cite_note-106) The WHO reported that approximately 345,000 people were given the vaccine during the [Kivu Ebola epidemic](https://en.wikipedia.org/wiki/Kivu_Ebola_epidemic "Kivu Ebola epidemic") from 2018 to 2020.[\[107\]](https://en.wikipedia.org/wiki/Ebola#cite_note-107)
Infection control
[](https://en.wikipedia.org/wiki/File:VHFisolation.png)
VHF isolation precautions poster
Community awareness of the benefits on survival chances of admitting cases early is important for the infected and infection control [\[12\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Guiliani_2022-12)
Caregivers
[](https://en.wikipedia.org/wiki/File:Donna_Wood,_Nurse_and_NHS_Ebola_volunteer_\(15652582937\).jpg)
British woman wearing protective gear
People who care for those infected with Ebola should wear protective clothing including masks, gloves, gowns and goggles.[\[108\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014P-108) The U.S. [Centers for Disease Control](https://en.wikipedia.org/wiki/Centers_for_Disease_Control "Centers for Disease Control") (CDC) recommend that the protective gear leaves no skin exposed.[\[109\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Oct2014CDC-109) These measures are also recommended for those who may handle objects contaminated by an infected person's body fluids.[\[110\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCBook1998-110) In 2014, the CDC began recommending that medical personnel receive training on the proper suit-up and removal of [personal protective equipment](https://en.wikipedia.org/wiki/Personal_protective_equipment "Personal protective equipment") (PPE); in addition, a designated person, appropriately trained in biosafety, should be watching each step of these procedures to ensure they are done correctly.[\[109\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Oct2014CDC-109) In Sierra Leone, the typical training period for the use of such safety equipment lasts approximately 12 days.[\[111\]](https://en.wikipedia.org/wiki/Ebola#cite_note-111) In 2022 in Uganda, lighter personal protection equipment has become available as well as possibilities to monitor and communicate with patients from windows in the treatment tents until it is necessary to enter if e.g. a patient's oxygen levels drop.[\[12\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Guiliani_2022-12)
Patients and household members
The infected person should be in [barrier-isolation](https://en.wikipedia.org/wiki/Isolation_\(health_care\) "Isolation (health care)") from other people.[\[108\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014P-108) All equipment, medical waste, patient waste and surfaces that may have come into contact with body fluids need to be [disinfected](https://en.wikipedia.org/wiki/Disinfection "Disinfection").[\[110\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCBook1998-110) During the 2014 outbreak, kits were put together to help families treat Ebola disease in their homes, which included protective clothing as well as [chlorine powder](https://en.wikipedia.org/wiki/Chlorine_powder "Chlorine powder") and other cleaning supplies.[\[112\]](https://en.wikipedia.org/wiki/Ebola#cite_note-112) Education of caregivers in these techniques, and providing such barrier-separation supplies has been a priority of [Doctors Without Borders](https://en.wikipedia.org/wiki/Doctors_Without_Borders "Doctors Without Borders").[\[113\]](https://en.wikipedia.org/wiki/Ebola#cite_note-113)
Disinfection
Ebolaviruses can be [eliminated](https://en.wikipedia.org/wiki/Sterilization_\(microbiology\) "Sterilization (microbiology)") with heat (heating for 30 to 60 minutes at 60 °C or boiling for five minutes). To [disinfect](https://en.wikipedia.org/wiki/Disinfectants "Disinfectants") surfaces, some lipid solvents such as some alcohol-based products, detergents, sodium hypochlorite (bleach) or [calcium hypochlorite](https://en.wikipedia.org/wiki/Calcium_hypochlorite "Calcium hypochlorite") (bleaching powder), and other suitable disinfectants may be used at appropriate concentrations.[\[50\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlEbolavirus_%E2%80%93_Pathogen_Safety_Data_Sheets-50)[\[114\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Infection_Guidance-114)
General population
Education of the general public about the risk factors for Ebola infection and of the protective measures individuals may take to prevent infection is recommended by the [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) These measures include avoiding direct contact with infected people and regular [hand washing](https://en.wikipedia.org/wiki/Hand_washing "Hand washing") using soap and water.[\[115\]](https://en.wikipedia.org/wiki/Ebola#cite_note-115)
Bushmeat
[Bushmeat](https://en.wikipedia.org/wiki/Bushmeat "Bushmeat"), an important source of protein in the diet of some Africans, should be handled and prepared with appropriate protective clothing and thoroughly cooked before consumption.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Some research suggests that an outbreak of Ebola disease in the wild animals used for consumption may result in a corresponding human outbreak. Since 2003, such animal outbreaks have been monitored to predict and prevent Ebola outbreaks in humans.[\[116\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Rouquet_2005-116)
Corpses, burial
If a person with Ebola disease dies, direct contact with the body should be avoided.[\[108\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014P-108) Certain [burial rituals](https://en.wikipedia.org/wiki/Burial_ritual "Burial ritual"), which may have included making various direct contacts with a dead body, require reformulation so that they consistently maintain a proper protective barrier between the dead body and the living.[\[110\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCBook1998-110)[\[117\]](https://en.wikipedia.org/wiki/Ebola#cite_note-url_www.who.int_burial-117)[\[118\]](https://en.wikipedia.org/wiki/Ebola#cite_note-118) Social anthropologists may help find alternatives to traditional rules for burials.[\[119\]](https://en.wikipedia.org/wiki/Ebola#cite_note-119)
Transport, travel, contact
Transportation crews are instructed to follow a certain isolation procedure, should anyone exhibit symptoms resembling EVD.[\[120\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlWHO_%E2%80%93_West_Africa_%E2%80%93_Ebola_virus_disease-120) As of August 2014, the WHO does not consider travel bans to be useful in decreasing spread of the disease.[\[77\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014T-77) In October 2014, the CDC defined four risk levels used to determine the level of 21-day monitoring for symptoms and restrictions on public activities.[\[121\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC_monitor_movement-121) In the United States, the CDC recommends that restrictions on public activity, including travel restrictions, are not required for the following defined risk levels:[\[121\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC_monitor_movement-121)
- having been in a country with widespread Ebola disease transmission and having no known exposure (low risk); or having been in that country more than 21 days ago (no risk)
- encounter with a person showing symptoms; but not within three feet of the person with Ebola without wearing PPE; and no direct contact with body fluids
- having had brief skin contact with a person showing symptoms of Ebola disease when the person was believed to be not very contagious (low risk)
- in countries without widespread Ebola disease transmission: direct contact with a person showing symptoms of the disease while wearing PPE (low risk)
- contact with a person with Ebola disease before the person was showing symptoms (no risk).
The CDC recommends monitoring for the symptoms of Ebola disease for those both at "low risk" and at higher risk.[\[121\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC_monitor_movement-121)
Laboratory
In laboratories where diagnostic testing is carried out, [biosafety level 4-equivalent containment](https://en.wikipedia.org/wiki/Biosafety_level "Biosafety level") is required.[\[122\]](https://en.wikipedia.org/wiki/Ebola#cite_note-OSHA-122) Laboratory researchers must be properly trained in BSL-4 practices and wear proper PPE.[\[122\]](https://en.wikipedia.org/wiki/Ebola#cite_note-OSHA-122)
Isolation
Isolation refers to separating those who are sick from those who are not. [Quarantine](https://en.wikipedia.org/wiki/Quarantine "Quarantine") refers to separating those who may have been exposed to a disease until they either show signs of the disease or are no longer at risk.[\[123\]](https://en.wikipedia.org/wiki/Ebola#cite_note-123) Quarantine, also known as enforced isolation, is usually effective in decreasing spread.[\[124\]](https://en.wikipedia.org/wiki/Ebola#cite_note-124)[\[125\]](https://en.wikipedia.org/wiki/Ebola#cite_note-pmid16597410-125) Governments often quarantine areas where the disease is occurring or individuals who may transmit the disease outside of an initial area.[\[126\]](https://en.wikipedia.org/wiki/Ebola#cite_note-126) In the United States, the law allows quarantine of those infected with ebolaviruses.[\[127\]](https://en.wikipedia.org/wiki/Ebola#cite_note-127)[\[128\]](https://en.wikipedia.org/wiki/Ebola#cite_note-128)
Contact tracing
[Contact tracing](https://en.wikipedia.org/wiki/Contact_tracing "Contact tracing") is considered important to contain an outbreak. It involves finding everyone who had close contact with infected individuals and monitoring them for signs of illness for 21 days. If any of these contacts comes down with the disease, they should be isolated, tested and treated. Then the process is repeated, tracing the contacts' contacts.[\[129\]](https://en.wikipedia.org/wiki/Ebola#cite_note-129)[\[130\]](https://en.wikipedia.org/wiki/Ebola#cite_note-130)
Management
As of 2019 two treatments ([atoltivimab/maftivimab/odesivimab](https://en.wikipedia.org/wiki/Atoltivimab/maftivimab/odesivimab "Atoltivimab/maftivimab/odesivimab") and [ansuvimab](https://en.wikipedia.org/wiki/Ansuvimab "Ansuvimab")) are associated with improved outcomes.[\[131\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NIH2019-131)[\[11\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NIH2019Tx-11) The U.S. [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) advises people to be careful of advertisements making unverified or fraudulent claims of benefits supposedly gained from various anti-Ebola products.[\[132\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA2014R-132)[\[133\]](https://en.wikipedia.org/wiki/Ebola#cite_note-133)
In October 2020, the U.S. [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) approved atoltivimab/maftivimab/odesivimab with an [indication](https://en.wikipedia.org/wiki/Indication_\(medicine\) "Indication (medicine)") for the treatment of infection caused by *Zaire ebolavirus*.[\[13\]](https://en.wikipedia.org/wiki/Ebola#cite_note-FDA_PR-13)
Standard support
[](https://en.wikipedia.org/wiki/File:Ebola_outbreak_in_Gulu_Municipal_Hospital.jpg)
A hospital isolation ward in [Gulu, Uganda](https://en.wikipedia.org/wiki/Gulu "Gulu"), during the October 2000 outbreak
Treatment is primarily [supportive](https://en.wikipedia.org/wiki/Palliative_care "Palliative care") in nature.[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) Early supportive care with rehydration and symptomatic treatment improves survival.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Rehydration may be via the [oral](https://en.wikipedia.org/wiki/Oral_rehydration_therapy "Oral rehydration therapy") or [intravenous](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy") route.[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) These measures may include [pain management](https://en.wikipedia.org/wiki/Pain_management "Pain management"), and treatment for [nausea](https://en.wikipedia.org/wiki/Antiemetic "Antiemetic"), [fever](https://en.wikipedia.org/wiki/Antipyretic "Antipyretic"), and [anxiety](https://en.wikipedia.org/wiki/Anxiolytic "Anxiolytic").[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) The [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") (WHO) recommends avoiding [aspirin](https://en.wikipedia.org/wiki/Aspirin "Aspirin") or [ibuprofen](https://en.wikipedia.org/wiki/Ibuprofen "Ibuprofen") for pain management, due to the risk of bleeding associated with these medications.[\[135\]](https://en.wikipedia.org/wiki/Ebola#cite_note-135)
Blood products such as [packed red blood cells](https://en.wikipedia.org/wiki/Packed_red_blood_cells "Packed red blood cells"), [platelets](https://en.wikipedia.org/wiki/Platelet "Platelet"), or [fresh frozen plasma](https://en.wikipedia.org/wiki/Fresh_frozen_plasma "Fresh frozen plasma") may also be used.[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) Other regulators of coagulation have also been tried including [heparin](https://en.wikipedia.org/wiki/Heparin "Heparin") in an effort to prevent [disseminated intravascular coagulation](https://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation "Disseminated intravascular coagulation") and [clotting factors](https://en.wikipedia.org/wiki/Coagulation_factors "Coagulation factors") to decrease bleeding.[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) [Antimalarial medications](https://en.wikipedia.org/wiki/Antimalarial_medication "Antimalarial medication") and [antibiotics](https://en.wikipedia.org/wiki/Antibiotics "Antibiotics") are often used before the diagnosis is confirmed,[\[134\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Clark_2012-134) though there is no evidence to suggest such treatment helps. Several [experimental treatments are being studied](https://en.wikipedia.org/wiki/Ebola_virus_disease_treatment_research "Ebola virus disease treatment research").[\[136\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:4-136)
Where hospital care is not possible, the WHO's guidelines for home care have been relatively successful. Recommendations include using towels soaked in a bleach solution when moving infected people or bodies and also applying bleach on stains. It is also recommended that the caregivers wash hands with bleach solutions and cover their mouth and nose with a cloth.[\[137\]](https://en.wikipedia.org/wiki/Ebola#cite_note-137)
Intensive care
[Intensive care](https://en.wikipedia.org/wiki/Intensive_care "Intensive care") is often used in the developed world.[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25) This may include maintaining blood volume and electrolytes (salts) balance as well as treating any bacterial infections that may develop.[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25) [Dialysis](https://en.wikipedia.org/wiki/Haemodialysis "Haemodialysis") may be needed for [kidney failure](https://en.wikipedia.org/wiki/Kidney_failure "Kidney failure"), and [extracorporeal membrane oxygenation](https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation "Extracorporeal membrane oxygenation") may be used for lung dysfunction.[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25)
Prognosis
EVD has a [risk of death in those infected](https://en.wikipedia.org/wiki/Case_fatality_rate "Case fatality rate") of between 25% and 90%.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[138\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Elsevier/Academic_Press-138) As of September 2014, the average risk of death among those infected is 50%.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) The highest risk of death was 90% in the 2002–2003 [Republic of the Congo](https://en.wikipedia.org/wiki/Republic_of_the_Congo "Republic of the Congo") outbreak.[\[139\]](https://en.wikipedia.org/wiki/Ebola#cite_note-139) Early admission significantly increases survival rates [\[12\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Guiliani_2022-12)
Death, if it occurs, follows typically six to sixteen days after symptoms appear and is often due to [low blood pressure from fluid loss](https://en.wikipedia.org/wiki/Hypovolemic_shock "Hypovolemic shock").[\[4\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ruz2014-4) Early supportive care to prevent dehydration may reduce the risk of death.[\[136\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:4-136)
Post-Ebola virus syndrome
If an infected person survives, recovery may be quick and complete.[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15)[\[140\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Shantha2017-140) However, a large portion of survivors develop [post-Ebola virus syndrome](https://en.wikipedia.org/wiki/Post-Ebola_virus_syndrome "Post-Ebola virus syndrome") after the acute phase of the infection.[\[141\]](https://en.wikipedia.org/wiki/Ebola#cite_note-pmid31806422-141)
Prolonged cases are often complicated by the occurrence of long-term problems, such as [inflammation of the testicles](https://en.wikipedia.org/wiki/Orchitis "Orchitis"), [joint pains](https://en.wikipedia.org/wiki/Arthralgia "Arthralgia"), fatigue, hearing loss, mood and sleep disturbances, [muscular pain](https://en.wikipedia.org/wiki/Myalgia "Myalgia"), abdominal pain, [menstrual abnormalities](https://en.wikipedia.org/wiki/Menstrual_period "Menstrual period"), [miscarriages](https://en.wikipedia.org/wiki/Miscarriage "Miscarriage"), [skin peeling](https://en.wikipedia.org/wiki/Desquamation "Desquamation"), or [hair loss](https://en.wikipedia.org/wiki/Alopecia "Alopecia").[\[15\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Goeijenbier2014-15)[\[140\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Shantha2017-140) [Inflammation and swelling of the uveal layer of the eye](https://en.wikipedia.org/wiki/Uveitis "Uveitis") is the most common eye complication in survivors of Ebola virus disease.[\[140\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Shantha2017-140) Eye symptoms, such as [light sensitivity](https://en.wikipedia.org/wiki/Photophobia "Photophobia"), [excess tearing](https://en.wikipedia.org/wiki/Hyperlacrimation "Hyperlacrimation"), and [vision loss](https://en.wikipedia.org/wiki/Vision_loss "Vision loss") have been described.[\[142\]](https://en.wikipedia.org/wiki/Ebola#cite_note-142)
Ebola can stay in some body parts like the eyes,[\[75\]](https://en.wikipedia.org/wiki/Ebola#cite_note-VarkeyShantha2015-75) breasts, and testicles after infection.[\[7\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cdc9months-7)[\[143\]](https://en.wikipedia.org/wiki/Ebola#cite_note-MackayArden2015-143) Sexual transmission after recovery has been suspected.[\[144\]](https://en.wikipedia.org/wiki/Ebola#cite_note-144)[\[145\]](https://en.wikipedia.org/wiki/Ebola#cite_note-145) If sexual transmission occurs following recovery, it is believed to be a rare event.[\[146\]](https://en.wikipedia.org/wiki/Ebola#cite_note-146) One case of a condition similar to [meningitis](https://en.wikipedia.org/wiki/Meningitis "Meningitis") has been reported many months after recovery, as of October 2015.[\[147\]](https://en.wikipedia.org/wiki/Ebola#cite_note-147)
Epidemiology
The disease typically occurs in outbreaks in tropical regions of [Sub-Saharan Africa](https://en.wikipedia.org/wiki/Sub-Saharan_Africa "Sub-Saharan Africa").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) From 1976 (when it was first identified) through 2013, the WHO reported 2,387 confirmed cases with 1,590 overall fatalities.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[148\]](https://en.wikipedia.org/wiki/Ebola#cite_note-MMWRJune2014-148) The largest outbreak to date was the [Ebola virus epidemic in West Africa](https://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa "Ebola virus epidemic in West Africa"), which caused a large number of deaths in [Guinea](https://en.wikipedia.org/wiki/Guinea "Guinea"), [Sierra Leone](https://en.wikipedia.org/wiki/Sierra_Leone "Sierra Leone"), and [Liberia](https://en.wikipedia.org/wiki/Liberia "Liberia").[\[149\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014-149)[\[150\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCAug2014N-150)
1976
Sudan
[](https://en.wikipedia.org/wiki/File:Cotton_Factory_in_Nzara,_South_Sudan.jpg)
Cotton factory in Nzara, South Sudan, where the first outbreak occurred
The first known outbreak of EVD was identified only after the fact. It occurred between June and November 1976, in [Nzara, South Sudan](https://en.wikipedia.org/wiki/Nzara,_South_Sudan "Nzara, South Sudan")[\[33\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Hoenen2012-33)[\[151\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Peterson_AT,_Bauer_JT,_Mills_JN_2004_40%E2%80%9347-151) (then part of [Sudan](https://en.wikipedia.org/wiki/Sudan "Sudan")), and was caused by [Sudan virus](https://en.wikipedia.org/wiki/Sudan_virus "Sudan virus") (SUDV). The Sudan outbreak infected 284 people and killed 151. The first identifiable case in Sudan occurred on 27 June in a storekeeper in a cotton factory in [Nzara](https://en.wikipedia.org/wiki/Nzara "Nzara"), who was hospitalised on 30 June and died on 6 July.[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25)[\[152\]](https://en.wikipedia.org/wiki/Ebola#cite_note-who's_first_encounter-152) Although the WHO medical staff involved in the Sudan outbreak knew that they were dealing with a heretofore unknown disease, the actual "positive identification" process and the naming of the virus did not occur until some months later in [Zaire](https://en.wikipedia.org/wiki/Zaire "Zaire").[\[152\]](https://en.wikipedia.org/wiki/Ebola#cite_note-who's_first_encounter-152)
Zaire
[](https://en.wikipedia.org/wiki/File:CDC_worker_incinerates_med-waste_from_Ebola_patients_in_Zaire.jpg)
A CDC worker incinerates medical waste from Ebola patients in Zaire in 1976.
On 26 August 1976, the second outbreak of EVD began in [Yambuku](https://en.wikipedia.org/wiki/Yambuku "Yambuku"), a small rural village in [Mongala District](https://en.wikipedia.org/wiki/Mongala_District "Mongala District") in northern [Zaire](https://en.wikipedia.org/wiki/Zaire "Zaire") (now known as the [Democratic Republic of the Congo](https://en.wikipedia.org/wiki/Democratic_Republic_of_the_Congo "Democratic Republic of the Congo")).[\[153\]](https://en.wikipedia.org/wiki/Ebola#cite_note-153)[\[154\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2003-154) This outbreak was caused by EBOV, formerly designated *Zaire ebolavirus*, a different member of the [genus](https://en.wikipedia.org/wiki/Genus "Genus") *Ebolavirus* than in the first Sudan outbreak. The [first person infected with the disease](https://en.wikipedia.org/wiki/Index_case "Index case") was the village school's headmaster [Mabalo Lokela](https://en.wikipedia.org/wiki/Mabalo_Lokela "Mabalo Lokela"), who began displaying symptoms on 26 August 1976.[\[155\]](https://en.wikipedia.org/wiki/Ebola#cite_note-whqlibdoc.who.int-155) Lokela had returned from a trip to Northern Zaire near the border of the [Central African Republic](https://en.wikipedia.org/wiki/Central_African_Republic "Central African Republic"), after visiting the [Ebola River](https://en.wikipedia.org/wiki/Ebola_River "Ebola River") between 12 and 22 August. He was originally believed to have [malaria](https://en.wikipedia.org/wiki/Malaria "Malaria") and was given [quinine](https://en.wikipedia.org/wiki/Quinine "Quinine"). However, his symptoms continued to worsen, and he was admitted to Yambuku Mission Hospital on 5 September. Lokela died on 8 September 14 days after he began displaying symptoms.[\[156\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlOutbreak_of_Ebola_Viral_Hemorrhagic_Fever_%E2%80%93_Zaire,_1995-156)[\[157\]](https://en.wikipedia.org/wiki/Ebola#cite_note-urlMabalo_Lokela_Archives_%E2%80%93_Political_Moll-157)
Soon after Lokela's death, others who had been in contact with him also died, and people in Yambuku began to panic. The country's Minister of Health and Zaire President [Mobutu Sese Seko](https://en.wikipedia.org/wiki/Mobutu_Sese_Seko "Mobutu Sese Seko") declared the entire region, including Yambuku and the country's capital, [Kinshasa](https://en.wikipedia.org/wiki/Kinshasa "Kinshasa"), a quarantine zone. No-one was permitted to enter or leave the area, and roads, waterways, and airfields were placed under [martial law](https://en.wikipedia.org/wiki/Martial_law "Martial law"). Schools, businesses and social organisations were closed.[\[158\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Stimola-158) The initial response was led by Congolese doctors, including [Jean-Jacques Muyembe-Tamfum](https://en.wikipedia.org/wiki/Jean-Jacques_Muyembe-Tamfum "Jean-Jacques Muyembe-Tamfum"), one of the discoverers of Ebola. Muyembe took a blood sample from a Belgian nun; this sample would eventually be used by [Peter Piot](https://en.wikipedia.org/wiki/Peter_Piot "Peter Piot") to identify the previously unknown Ebola virus.[\[159\]](https://en.wikipedia.org/wiki/Ebola#cite_note-159) Muyembe was also the first scientist to come into direct contact with the disease and survive.[\[160\]](https://en.wikipedia.org/wiki/Ebola#cite_note-160) Researchers from the [Centers for Disease Control and Prevention](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention") (CDC), including Piot, co-discoverer of Ebola, later arrived to assess the effects of the outbreak, observing that "the whole region was in panic."[\[161\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Piot_2012-161)[\[162\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Piot-one-162)[\[163\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Piot-two-163)
Piot concluded that Belgian nuns had inadvertently started the epidemic by giving unnecessary vitamin injections to pregnant women without sterilizing the syringes and needles. The outbreak lasted 26 days and the quarantine lasted two weeks. Researchers speculated that the disease disappeared due to the precautions taken by locals, the quarantine of the area, and discontinuing of the injections.[\[158\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Stimola-158)
During this outbreak, Ngoy Mushola recorded the first clinical description of EVD in [Yambuku](https://en.wikipedia.org/wiki/Yambuku "Yambuku"), where he wrote the following in his daily log: "The illness is characterised with a high temperature of about 39 °C (102 °F), [haematemesis](https://en.wikipedia.org/wiki/Haematemesis "Haematemesis"), diarrhoea with blood, retrosternal abdominal pain, prostration with 'heavy' articulations, and rapid evolution death after a mean of three days."[\[164\]](https://en.wikipedia.org/wiki/Ebola#cite_note-164)
The virus responsible for the initial outbreak, first thought to be the [Marburg virus](https://en.wikipedia.org/wiki/Marburg_virus "Marburg virus"), was later identified as a new type of virus related to the genus *[Marburgvirus](https://en.wikipedia.org/wiki/Marburgvirus "Marburgvirus")*. Virus strain samples isolated from both outbreaks were named "Ebola virus" after the [Ebola River](https://en.wikipedia.org/wiki/Ebola_River "Ebola River"), near the first-identified viral outbreak site in Zaire.[\[25\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2011-25) Reports conflict about who initially coined the name: either Karl Johnson of the American CDC team[\[165\]](https://en.wikipedia.org/wiki/Ebola#cite_note-hz-165) or Belgian researchers.[\[166\]](https://en.wikipedia.org/wiki/Ebola#cite_note-observer-166) Subsequently, a number of other cases were reported, almost all centred on the Yambuku mission hospital or close contacts of another case.[\[155\]](https://en.wikipedia.org/wiki/Ebola#cite_note-whqlibdoc.who.int-155) In all, 318 cases and 280 deaths (an 88% fatality rate) occurred in Zaire.[\[167\]](https://en.wikipedia.org/wiki/Ebola#cite_note-emedicine.com-167) Although the two outbreaks were at first believed connected, scientists later realised that they were caused by two distinct ebolaviruses, SUDV and EBOV.[\[154\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Feldmann2003-154)
1995–2014
[](https://en.wikipedia.org/wiki/File:Ebolaf%C3%A4lle_bis_einschlie%C3%9Flich_2020_english.png)
Cases of Ebola fever in Africa since 1976
The second major outbreak occurred in Zaire (now the [Democratic Republic of the Congo](https://en.wikipedia.org/wiki/Democratic_Republic_of_the_Congo "Democratic Republic of the Congo"), DRC), in 1995, affecting 315 and killing 254.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)
In 2000, [Uganda](https://en.wikipedia.org/wiki/Uganda "Uganda") had an outbreak infecting 425 and killing 224; in this case, the Sudan virus was found to be the Ebola species responsible for the outbreak.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)
In 2003, an outbreak in the DRC infected 143 and killed 128, a 90% death rate, the highest of a [genus](https://en.wikipedia.org/wiki/Genus "Genus") *Ebolavirus* outbreak to date.[\[168\]](https://en.wikipedia.org/wiki/Ebola#cite_note-pmid14579469-168)
In 2004, a Russian scientist died from Ebola after [sticking](https://en.wikipedia.org/wiki/Needlestick_injury "Needlestick injury") herself with an infected needle.[\[169\]](https://en.wikipedia.org/wiki/Ebola#cite_note-169)
Between April and August 2007, a fever epidemic[\[170\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CBCRadioSept2007-170) in a four-village region[\[171\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Mystery_DR_Congo_fever_kills_100-171) of the DRC was confirmed in September to have been cases of Ebola.[\[172\]](https://en.wikipedia.org/wiki/Ebola#cite_note-172) Many people who attended the recent funeral of a local village chief died.[\[171\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Mystery_DR_Congo_fever_kills_100-171) The 2007 outbreak eventually infected 264 individuals and killed 187.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)
On 30 November 2007, the Uganda Ministry of Health confirmed an outbreak of Ebola in the [Bundibugyo District](https://en.wikipedia.org/wiki/Bundibugyo_District "Bundibugyo District") in Western Uganda. After confirming samples tested by the United States National Reference Laboratories and the Centers for Disease Control, the World Health Organization (WHO) confirmed the presence of a new species of [genus](https://en.wikipedia.org/wiki/Genus "Genus") *Ebolavirus*, which was tentatively named Bundibugyo.[\[173\]](https://en.wikipedia.org/wiki/Ebola#cite_note-173) The WHO reported 149 cases of this new strain and 37 of those led to deaths.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)
The WHO confirmed two small outbreaks in Uganda in 2012, both caused by the Sudan variant. The first outbreak affected seven people, killing four, and the second affected 24, killing 17.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)
On 17 August 2012, the Ministry of Health of the DRC reported an outbreak of the Ebola-Bundibugyo variant[\[174\]](https://en.wikipedia.org/wiki/Ebola#cite_note-174) in the eastern region.[\[175\]](https://en.wikipedia.org/wiki/Ebola#cite_note-175)[\[176\]](https://en.wikipedia.org/wiki/Ebola#cite_note-176) Other than its discovery in 2007, this was the only time that this variant has been identified as responsible for an outbreak. The WHO revealed that the virus had sickened 57 people and killed 29. The probable cause of the outbreak was tainted [bush meat](https://en.wikipedia.org/wiki/Bush_meat "Bush meat") hunted by local villagers around the towns of [Isiro](https://en.wikipedia.org/wiki/Isiro "Isiro") and Viadana.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[177\]](https://en.wikipedia.org/wiki/Ebola#cite_note-177)
In 2014, an outbreak occurred in the DRC. [Genome-sequencing](https://en.wikipedia.org/wiki/Whole_genome_sequencing "Whole genome sequencing") showed that this outbreak was not related to the [2014–15 West Africa Ebola virus outbreak](https://en.wikipedia.org/wiki/West_Africa_Ebola_virus_outbreak "West Africa Ebola virus outbreak"), but was the same [EBOV](https://en.wikipedia.org/wiki/EBOV "EBOV") species, the Zaire species.[\[178\]](https://en.wikipedia.org/wiki/Ebola#cite_note-2014_DRC_Who_Strain-178) It began in August 2014, and was declared over in November with 66 cases and 49 deaths.[\[179\]](https://en.wikipedia.org/wiki/Ebola#cite_note-reuters1511-179) This was the 7th outbreak in the DRC, three of which occurred during the period when the country was known as [Zaire](https://en.wikipedia.org/wiki/Zaire "Zaire").[\[180\]](https://en.wikipedia.org/wiki/Ebola#cite_note-180)
2013–2016 West Africa
[](https://en.wikipedia.org/wiki/File:Diseased_Ebola_2014.png)
Cases and deaths from April 2014 to July 2015 during the [2013–2015 outbreak](https://en.wikipedia.org/wiki/Western_African_Ebola_epidemic "Western African Ebola epidemic")
In March 2014, the [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") (WHO) reported a major Ebola outbreak in [Guinea](https://en.wikipedia.org/wiki/Guinea "Guinea"), a West African nation.[\[181\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Out-181) Researchers traced the outbreak to a one-year-old child who died in December 2013.[\[182\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Baize2014-182)[\[183\]](https://en.wikipedia.org/wiki/Ebola#cite_note-1st_Chain-183) The disease rapidly spread to the neighbouring countries of [Liberia](https://en.wikipedia.org/wiki/Liberia "Liberia") and [Sierra Leone](https://en.wikipedia.org/wiki/Sierra_Leone "Sierra Leone"). It was the largest Ebola outbreak ever documented, and the first recorded in the region.[\[181\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014Out-181) On 8 August 2014, the WHO declared the epidemic an international public health emergency. Urging the world to offer aid to the affected regions, its Director-General said, "Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible."[\[184\]](https://en.wikipedia.org/wiki/Ebola#cite_note-184) By mid-August 2014, [Doctors Without Borders](https://en.wikipedia.org/wiki/Doctors_Without_Borders "Doctors Without Borders") reported the situation in Liberia's capital, [Monrovia](https://en.wikipedia.org/wiki/Monrovia "Monrovia"), was "catastrophic" and "deteriorating daily". They reported that fears of Ebola among staff members and patients had shut down much of the city's health system, leaving many people without medical treatment for other conditions.[\[185\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Common_Dreams-185) In a 26 September statement, WHO said, "The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times. Never before in recorded history has a [biosafety level](https://en.wikipedia.org/wiki/Biosafety_level "Biosafety level") four pathogen infected so many people so quickly, over such a broad geographical area, for so long."[\[186\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ebola_situation_assessment-186)
Intense contact tracing and strict isolation largely prevented further spread of the disease in the countries that had imported cases.
It caused significant mortality, with a considerable [case fatality rate](https://en.wikipedia.org/wiki/Case_fatality_rate "Case fatality rate").[\[187\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:1-187)[\[188\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014_12_28-188)[\[189\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cfrebolavirus-189)[\[note 1\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cfr-190) By the end of the epidemic, 28,616 people had been infected; of these, 11,310 had died, for a case-fatality rate of 40%.[\[190\]](https://en.wikipedia.org/wiki/Ebola#cite_note-191) As of 8 May 2016, 28,646 suspected cases and 11,323 deaths were reported;[\[191\]](https://en.wikipedia.org/wiki/Ebola#cite_note-08who2016-192)[\[192\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:0-193) however, the WHO said that these numbers may be underestimated.[\[193\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ebola_Outbreak_total_WHO_28_Sept-194) Because they work closely with the body fluids of infected patients, healthcare workers were especially vulnerable to infection; in August 2014, the WHO reported that 10% of the dead were healthcare workers.[\[194\]](https://en.wikipedia.org/wiki/Ebola#cite_note-195)
[](https://en.wikipedia.org/wiki/File:2014_ebola_virus_epidemic_in_West_Africa.svg)
2014 Ebola virus epidemic in West Africa
In September 2014, it was estimated that the countries' capacity for treating Ebola patients was insufficient by the equivalent of 2,122 beds; by December there were a sufficient number of beds to treat and isolate all reported Ebola cases, although the uneven distribution of cases was causing serious shortfalls in some areas.[\[195\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014_12_10-196) On 28 January 2015, the WHO reported that for the first time since the week ending 29 June 2014, there had been fewer than 100 new confirmed cases reported in a week in the three most-affected countries. The response to the epidemic then moved to a second phase, as the focus shifted from slowing transmission to ending the epidemic.[\[196\]](https://en.wikipedia.org/wiki/Ebola#cite_note-World_Health_Organization-197) On 8 April 2015, the WHO reported only 30 confirmed cases, the lowest weekly total since the third week of May 2014.[\[197\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO-198)
On 29 December 2015, 42 days after the last person tested negative for a second time, Guinea was declared free of Ebola transmission.[\[198\]](https://en.wikipedia.org/wiki/Ebola#cite_note-199) At that time, a 90-day period of heightened surveillance was announced by that agency. "This is the first time that all three countries – Guinea, Liberia and Sierra Leone – have stopped the original chains of transmission ...", the organisation stated in a news release.[\[199\]](https://en.wikipedia.org/wiki/Ebola#cite_note-200) A new case was detected in Sierra Leone on 14 January 2016.[\[200\]](https://en.wikipedia.org/wiki/Ebola#cite_note-201) However, the outbreak was declared no longer an emergency on 29 March 2016.[\[201\]](https://en.wikipedia.org/wiki/Ebola#cite_note-who.int-202)
2014 spread outside West Africa
On 19 September, Eric Duncan flew from his native Liberia to Texas; five days later he began showing symptoms and visited a hospital but was sent home. His condition worsened and he returned to the hospital on 28 September, where he died on 8 October. Health officials confirmed a diagnosis of Ebola on 30 September – the first case in the United States.[\[202\]](https://en.wikipedia.org/wiki/Ebola#cite_note-203)
In early October, Teresa Romero, a 44-year-old Spanish nurse, contracted Ebola after caring for a priest who had been repatriated from West Africa. This was the first transmission of the virus to occur outside Africa.[\[203\]](https://en.wikipedia.org/wiki/Ebola#cite_note-204) Romero tested negative for the disease on 20 October, suggesting that she may have recovered from Ebola infection.[\[204\]](https://en.wikipedia.org/wiki/Ebola#cite_note-205)
On 12 October, the [Centers for Disease Control and Prevention](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention") (CDC) confirmed that a nurse in Texas, [Nina Pham](https://en.wikipedia.org/wiki/Nina_Pham "Nina Pham"), who had treated Duncan tested positive for the Ebola virus, the first known case of transmission in the United States.[\[205\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NYT-20141012-MF-206) On 15 October, a second Texas health-care worker who had treated Duncan was confirmed to have the virus.[\[84\]](https://en.wikipedia.org/wiki/Ebola#cite_note-NBC-ebolaTX-84) Both of these people recovered.[\[206\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC-20142411-207) An unrelated case involved a doctor in New York City, who returned to the United States from Guinea after working with [Médecins Sans Frontières](https://en.wikipedia.org/wiki/M%C3%A9decins_Sans_Fronti%C3%A8res "Médecins Sans Frontières") and tested positive for Ebola on 23 October.[\[207\]](https://en.wikipedia.org/wiki/Ebola#cite_note-208) The person recovered and was discharged from [Bellevue Hospital](https://en.wikipedia.org/wiki/Bellevue_Hospital "Bellevue Hospital") on 11 November.[\[206\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC-20142411-207) On 24 December 2014, a laboratory in [Atlanta](https://en.wikipedia.org/wiki/Atlanta "Atlanta"), Georgia reported that a technician had been exposed to Ebola.[\[208\]](https://en.wikipedia.org/wiki/Ebola#cite_note-209)
On 29 December 2014, [Pauline Cafferkey](https://en.wikipedia.org/wiki/Pauline_Cafferkey "Pauline Cafferkey"), a British nurse who had just returned to [Glasgow](https://en.wikipedia.org/wiki/Glasgow "Glasgow") from Sierra Leone, was diagnosed with Ebola at Glasgow's [Gartnavel General Hospital](https://en.wikipedia.org/wiki/Gartnavel_General_Hospital "Gartnavel General Hospital").[\[209\]](https://en.wikipedia.org/wiki/Ebola#cite_note-BBC-30628349-210) After initial treatment in Glasgow, she was transferred by air to [RAF Northolt](https://en.wikipedia.org/wiki/RAF_Northolt "RAF Northolt"), then to the specialist [high-level isolation unit](https://en.wikipedia.org/wiki/High-level_isolation_unit "High-level isolation unit") at the [Royal Free Hospital](https://en.wikipedia.org/wiki/Royal_Free_Hospital "Royal Free Hospital") in [London](https://en.wikipedia.org/wiki/London "London") for longer-term treatment.[\[210\]](https://en.wikipedia.org/wiki/Ebola#cite_note-BBC-30629397-211)
2017 Democratic Republic of the Congo
On 11 May 2017, the DRC Ministry of Public Health notified the WHO about an outbreak of Ebola. Four people died, and four people survived; five of these eight cases were laboratory-confirmed. A total of 583 contacts were monitored. On 2 July 2017, the WHO declared the end of the outbreak.[\[211\]](https://en.wikipedia.org/wiki/Ebola#cite_note-212)
2018 Équateur province
On 14 May 2018, the World Health Organization reported that "the Democratic Republic of Congo reported 39 suspected, probable or confirmed cases of Ebola between 4 April and 13 May, including 19 deaths."[\[212\]](https://en.wikipedia.org/wiki/Ebola#cite_note-first_2018_DRC_outbreak_report-213) Some 393 people identified as contacts of Ebola patients were being followed up. The outbreak centred on the [Bikoro](https://en.wikipedia.org/wiki/Bikoro "Bikoro"), Iboko, and [Wangata](https://en.wikipedia.org/wiki/Wangata "Wangata") areas in [Equateur](https://en.wikipedia.org/wiki/Equateur "Equateur") province,[\[212\]](https://en.wikipedia.org/wiki/Ebola#cite_note-first_2018_DRC_outbreak_report-213) including in the large city of [Mbandaka](https://en.wikipedia.org/wiki/Mbandaka "Mbandaka"). The DRC Ministry of Public Health approved the use of an experimental vaccine.[\[213\]](https://en.wikipedia.org/wiki/Ebola#cite_note-214)[\[214\]](https://en.wikipedia.org/wiki/Ebola#cite_note-215)[\[215\]](https://en.wikipedia.org/wiki/Ebola#cite_note-216) On 13 May 2018, WHO Director-General [Tedros Adhanom Ghebreyesus](https://en.wikipedia.org/wiki/Tedros_Adhanom_Ghebreyesus "Tedros Adhanom Ghebreyesus") visited Bikoro.[\[216\]](https://en.wikipedia.org/wiki/Ebola#cite_note-217) Reports emerged that maps of the area were inaccurate, not so much hampering medical providers as [epidemiologists](https://en.wikipedia.org/wiki/Epidemiologist "Epidemiologist") and officials trying to assess the outbreak and containment efforts.[\[217\]](https://en.wikipedia.org/wiki/Ebola#cite_note-218) The 2018 outbreak in the DRC was declared over on 24 July 2018.[\[218\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2018DRCOver-219)
2018–2020 Kivu
On 1 August 2018, the world's 10th Ebola outbreak was declared in [North Kivu](https://en.wikipedia.org/wiki/North_Kivu "North Kivu") province of the Democratic Republic of the Congo. It was the first Ebola outbreak in a military conflict zone, with thousands of refugees in the area.[\[219\]](https://en.wikipedia.org/wiki/Ebola#cite_note-220)[\[220\]](https://en.wikipedia.org/wiki/Ebola#cite_note-221) By November 2018, nearly 200 Congolese had died of Ebola, about half of them from the city of [Beni](https://en.wikipedia.org/wiki/Beni,_Democratic_Republic_of_the_Congo "Beni, Democratic Republic of the Congo"), where armed groups are fighting over the region's mineral wealth, impeding medical relief efforts.[\[221\]](https://en.wikipedia.org/wiki/Ebola#cite_note-222)
By March 2019, this became the second largest Ebola outbreak ever recorded, with more than 1,000 cases and insecurity continuing to be the major resistance to providing an adequate response.[\[222\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC24March2019-223)[\[223\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHOMay2019-224) As of 4 June 2019, the WHO reported 2025 confirmed and probable cases with 1357 deaths.[\[224\]](https://en.wikipedia.org/wiki/Ebola#cite_note-225) In June 2019, two people died of Ebola in neighbouring [Uganda](https://en.wikipedia.org/wiki/Uganda "Uganda").[\[225\]](https://en.wikipedia.org/wiki/Ebola#cite_note-226)
In July 2019, an infected man travelled to [Goma](https://en.wikipedia.org/wiki/Goma "Goma"), home to more than two million people.[\[226\]](https://en.wikipedia.org/wiki/Ebola#cite_note-227) One week later, on 17 July 2019, the WHO declared the Ebola outbreak a [global health emergency](https://en.wikipedia.org/wiki/Public_Health_Emergency_of_International_Concern "Public Health Emergency of International Concern"), the fifth time such a declaration has been made by the organisation.[\[227\]](https://en.wikipedia.org/wiki/Ebola#cite_note-228) A government spokesman said that half of the Ebola cases are unidentified, and he added that the current outbreak could last up to three years.[\[228\]](https://en.wikipedia.org/wiki/Ebola#cite_note-229)
On 25 June 2020, the second biggest EVD outbreak ever was declared over.[\[229\]](https://en.wikipedia.org/wiki/Ebola#cite_note-finish-230)
2020 Équateur province
On 1 June 2020, the Congolese health ministry announced a new DRC outbreak of Ebola in [Mbandaka](https://en.wikipedia.org/wiki/Mbandaka "Mbandaka"), [Équateur Province](https://en.wikipedia.org/wiki/%C3%89quateur_Province "Équateur Province"), a region along the Congo River. Genome sequencing suggests that this outbreak, the 11th outbreak since the virus was first discovered in the country in 1976, is unrelated to the one in North Kivu Province or the previous outbreak in the same area in 2018. It was reported that six cases had been identified; four of the people had died. It is expected that more people will be identified as surveillance activities increase.[\[230\]](https://en.wikipedia.org/wiki/Ebola#cite_note-231) By 15 June the case count had increased to 17 with 11 deaths, with more than 2,500 people having been vaccinated.[\[231\]](https://en.wikipedia.org/wiki/Ebola#cite_note-232) The 11th EVD outbreak was officially declared over on 19 November 2020.[\[232\]](https://en.wikipedia.org/wiki/Ebola#cite_note-233) By the time the Équateur outbreak ended, it had 130 confirmed cases with 75 recoveries and 55 deaths.
2021
North Kivu
On 7 February 2021, the Congolese health ministry announced a new case of Ebola near Butembo, North Kivu detected a day before. The case was a 42-year-old woman who had symptoms of Ebola in Biena on 1 February 2021. A few days after, she died in a hospital in Butembo. The WHO said that more than 70 people with contact with the woman had been tracked.[\[233\]](https://en.wikipedia.org/wiki/Ebola#cite_note-234)[\[234\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:2-235)
On 11 February 2021, another woman who had contact with the previous woman died in the same town, and the number of traced contacts increased to 100.[\[235\]](https://en.wikipedia.org/wiki/Ebola#cite_note-236) A day after, a third case was detected in Butembo.[\[236\]](https://en.wikipedia.org/wiki/Ebola#cite_note-237)
On 3 May 2021, the 12th EVD outbreak was declared over, resulting in 12 cases and six deaths.[\[237\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:3-238)[\[238\]](https://en.wikipedia.org/wiki/Ebola#cite_note-239) Heightened surveillance will continue for 90 days after the declaration, in case of resurgence.[\[237\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:3-238)
Guinea
In February 2021, Sakoba Keita, head of Guinea's national health agency confirmed that three people had died of Ebola in the south-eastern region near the city of Nzérékoré. A further five people also tested positive. Keita also confirmed more testing was underway, and attempts to trace and isolate further cases had begun.[\[239\]](https://en.wikipedia.org/wiki/Ebola#cite_note-240) On 14 February, the Guinean government declared an Ebola epidemic.[\[240\]](https://en.wikipedia.org/wiki/Ebola#cite_note-241) The outbreak may have started following reactivation of a [latent case](https://en.wikipedia.org/wiki/Viral_latency "Viral latency") in a survivor of an earlier outbreak.[\[241\]](https://en.wikipedia.org/wiki/Ebola#cite_note-KuperschmidtReactivation-242)[\[242\]](https://en.wikipedia.org/wiki/Ebola#cite_note-VirologicalKeitaGuinea21-243) As of 4 May 2021, 23 cases were reported, with no new cases or deaths since 3 April 2021.[\[237\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:3-238) A 42-day countdown period was started on 8 May 2021, and on 19 June, the outbreak was declared over.[\[237\]](https://en.wikipedia.org/wiki/Ebola#cite_note-:3-238)[\[243\]](https://en.wikipedia.org/wiki/Ebola#cite_note-244)
Ivory Coast
On 14 August 2021, The Ministry of Health of [Cote d’Ivoire](https://en.wikipedia.org/wiki/Cote_d%E2%80%99Ivoire "Cote d’Ivoire") confirmed the country's first case of Ebola since 1994. This came after the Institut Pasteur in Cote d'Ivoire confirmed the Ebola Virus Disease in samples collected from a patient, who was hospitalized in the commercial capital of [Abidjan](https://en.wikipedia.org/wiki/Abidjan "Abidjan"), after arriving from Guinea.[\[244\]](https://en.wikipedia.org/wiki/Ebola#cite_note-245)
However, on 31 August 2021, the WHO found that, after further tests in a laboratory in [Lyon](https://en.wikipedia.org/wiki/Lyon "Lyon"), the patient did not have Ebola. The cause of her disease is still being analyzed.[\[245\]](https://en.wikipedia.org/wiki/Ebola#cite_note-246)
2022
On 23 April 2022, a case of Ebola was confirmed in the DRC in the Equateur province. The case was a 31-year-old man whose symptoms began on 5 April, but did not seek treatment for over a week. On 21 April, he was admitted to an Ebola treatment centre and died later that day.[\[246\]](https://en.wikipedia.org/wiki/Ebola#cite_note-247) By 24 May 2022, there were 5 recorded deaths in the DRC.[\[247\]](https://en.wikipedia.org/wiki/Ebola#cite_note-248) On 15 August, the fifth case was buried, and the outbreak was declared over, 42 days after, on 4 July 2022.[\[248\]](https://en.wikipedia.org/wiki/Ebola#cite_note-249)
In September 2022, [Uganda reported 7 cases infected with the Ebola Sudan strain](https://en.wikipedia.org/wiki/2022_Uganda_Ebola_outbreak "2022 Uganda Ebola outbreak"),[\[249\]](https://en.wikipedia.org/wiki/Ebola#cite_note-250) but by mid-October the count had increased to 63.[\[250\]](https://en.wikipedia.org/wiki/Ebola#cite_note-251) In November 2022, the outbreak in Uganda continued — still without a vaccine.[\[12\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Guiliani_2022-12) On 10 January 2023, the outbreak was considered over after no new cases had been reported for 42 days; the outbreak killed nearly 80 people.[\[251\]](https://en.wikipedia.org/wiki/Ebola#cite_note-252)
History
Ebola was first identified in 1976, in two simultaneous outbreaks, one in [Nzara](https://en.wikipedia.org/wiki/Nzara "Nzara") (a town in [South Sudan](https://en.wikipedia.org/wiki/South_Sudan "South Sudan")) and the other in [Yambuku](https://en.wikipedia.org/wiki/Yambuku "Yambuku") ([the Democratic Republic of the Congo](https://en.wikipedia.org/wiki/The_Democratic_Republic_of_the_Congo "The Democratic Republic of the Congo")), a village near the [Ebola River](https://en.wikipedia.org/wiki/Ebola_River "Ebola River"), for which the disease was named.[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) [Ebola outbreaks](https://en.wikipedia.org/wiki/List_of_Ebola_outbreaks "List of Ebola outbreaks") occur intermittently in tropical regions of [sub-Saharan Africa](https://en.wikipedia.org/wiki/Sub-Saharan_Africa "Sub-Saharan Africa").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2) Between 1976 and 2012, according to the [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization"), there were 24 outbreaks of Ebola resulting in a total of [2,387 cases, and 1,590 deaths](https://en.wikipedia.org/wiki/List_of_Ebola_outbreaks "List of Ebola outbreaks").[\[2\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2014-2)[\[148\]](https://en.wikipedia.org/wiki/Ebola#cite_note-MMWRJune2014-148) The largest Ebola outbreak to date was an [epidemic in West Africa](https://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa "Ebola virus epidemic in West Africa") from December 2013 to January 2016, with 28,646 cases and 11,323 deaths.[\[191\]](https://en.wikipedia.org/wiki/Ebola#cite_note-08who2016-192)[\[149\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDC2014-149)[\[150\]](https://en.wikipedia.org/wiki/Ebola#cite_note-CDCAug2014N-150) On 29 March 2016, it was declared to no longer be an emergency.[\[201\]](https://en.wikipedia.org/wiki/Ebola#cite_note-who.int-202) Other outbreaks in Africa began in the Democratic Republic of the Congo in May 2017,[\[252\]](https://en.wikipedia.org/wiki/Ebola#cite_note-253)[\[253\]](https://en.wikipedia.org/wiki/Ebola#cite_note-254) and 2018.[\[254\]](https://en.wikipedia.org/wiki/Ebola#cite_note-255)[\[218\]](https://en.wikipedia.org/wiki/Ebola#cite_note-WHO2018DRCOver-219) In July 2019, the World Health Organization declared the Congo Ebola outbreak a [world health emergency](https://en.wikipedia.org/wiki/Public_health_emergency_of_international_concern "Public health emergency of international concern").[\[255\]](https://en.wikipedia.org/wiki/Ebola#cite_note-256)
Society and culture
Weaponisation
*Ebolavirus* is classified as a [biosafety level 4](https://en.wikipedia.org/wiki/Biosafety_level#Levels "Biosafety level") agent, as well as a [Category A bioterrorism](https://en.wikipedia.org/wiki/Bioterrorism#Category_A "Bioterrorism") agent by the Centers for Disease Control and Prevention.[\[88\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Ansari2014-88)[\[256\]](https://en.wikipedia.org/wiki/Ebola#cite_note-MacNeil2012-257) It has the potential to be weaponised for use in [biological warfare](https://en.wikipedia.org/wiki/Biological_warfare "Biological warfare"),[\[257\]](https://en.wikipedia.org/wiki/Ebola#cite_note-pmid11988060-258)[\[258\]](https://en.wikipedia.org/wiki/Ebola#cite_note-259) and was investigated by [Biopreparat](https://en.wikipedia.org/wiki/Biopreparat "Biopreparat") for such use, but might be difficult to prepare as a [weapon of mass destruction](https://en.wikipedia.org/wiki/Weapon_of_mass_destruction "Weapon of mass destruction") because the virus becomes ineffective quickly in open air.[\[259\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Zubray-260) Fake emails pretending to be Ebola information from the WHO or the Mexican government have, in 2014, been misused to spread computer malware.[\[260\]](https://en.wikipedia.org/wiki/Ebola#cite_note-261) The BBC reported in 2015 that "North Korean state media has suggested the disease was created by the U.S. military as a biological weapon."[\[261\]](https://en.wikipedia.org/wiki/Ebola#cite_note-262)
Displacement
Analysis of the 2014–2015 Ebola epidemic found that outbreaks can trigger displacement, as fear of infection, quarantine measures, lack of essential supplies, stigma, and violence around the response can lead people and even entire communities to flee their homes.[\[262\]](https://en.wikipedia.org/wiki/Ebola#cite_note-263)
Literature
[Richard Preston](https://en.wikipedia.org/wiki/Richard_Preston "Richard Preston")'s 1995 [best-selling](https://en.wikipedia.org/wiki/Best-selling "Best-selling") book, *[The Hot Zone](https://en.wikipedia.org/wiki/The_Hot_Zone "The Hot Zone")*, dramatised the Ebola outbreak in Reston, Virginia.[\[263\]](https://en.wikipedia.org/wiki/Ebola#cite_note-264)[\[264\]](https://en.wikipedia.org/wiki/Ebola#cite_note-265)[\[265\]](https://en.wikipedia.org/wiki/Ebola#cite_note-266)
[William Close](https://en.wikipedia.org/wiki/William_Close "William Close")'s 1995 *Ebola: A Documentary Novel of Its First Explosion*[\[266\]](https://en.wikipedia.org/wiki/Ebola#cite_note-267)[\[267\]](https://en.wikipedia.org/wiki/Ebola#cite_note-268) and 2002 *Ebola: Through the Eyes of the People* focused on individuals' reactions to the 1976 Ebola outbreak in Zaire.[\[268\]](https://en.wikipedia.org/wiki/Ebola#cite_note-269)[\[269\]](https://en.wikipedia.org/wiki/Ebola#cite_note-270)
[Tom Clancy](https://en.wikipedia.org/wiki/Tom_Clancy "Tom Clancy")'s 1996 novel, *[Executive Orders](https://en.wikipedia.org/wiki/Executive_Orders "Executive Orders")*, involves a [Middle Eastern](https://en.wikipedia.org/wiki/Middle_East "Middle East") terrorist attack on the United States using an airborne form of a deadly Ebola virus strain named "Ebola Mayinga" (see [Mayinga N'Seka](https://en.wikipedia.org/wiki/Mayinga_N%27Seka "Mayinga N'Seka")).[\[270\]](https://en.wikipedia.org/wiki/Ebola#cite_note-271)[\[271\]](https://en.wikipedia.org/wiki/Ebola#cite_note-272)
As the Ebola virus epidemic in West Africa developed in 2014, a number of popular self-published and well-reviewed books containing sensational and misleading information about the disease appeared in electronic and printed formats. The authors of some such books admitted that they lacked medical credentials and were not technically qualified to give medical advice. The World Health Organization and the United Nations stated that such misinformation had contributed to the spread of the disease.[\[272\]](https://en.wikipedia.org/wiki/Ebola#cite_note-273)
Other animals
Wild animals
Ebola has a high mortality rate among primates.[\[273\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Choi2013-274) Frequent outbreaks of Ebola may have resulted in the deaths of 5,000 gorillas.[\[274\]](https://en.wikipedia.org/wiki/Ebola#cite_note-275) Outbreaks of Ebola may have been responsible for an 88% decline in tracking indices of observed chimpanzee populations in the 420 km2 Lossi Sanctuary between 2002 and 2003.[\[275\]](https://en.wikipedia.org/wiki/Ebola#cite_note-doi10.1126/science.1092528-276) Transmission among chimpanzees through meat consumption constitutes a significant risk factor, whereas contact between the animals, such as touching dead bodies and grooming, is not.[\[276\]](https://en.wikipedia.org/wiki/Ebola#cite_note-277)
Recovered gorilla carcasses have contained multiple Ebola virus strains, suggesting multiple introductions of the virus. Bodies decompose quickly and carcasses are not infectious after three to four days. Contact between gorilla groups is rare, suggesting that transmission among gorilla groups is unlikely, and that outbreaks result from transmission between viral reservoirs and animal populations.[\[275\]](https://en.wikipedia.org/wiki/Ebola#cite_note-doi10.1126/science.1092528-276)
Domestic animals
In 2012, it was demonstrated that the virus can travel without contact from pigs to nonhuman primates, although the same study failed to achieve transmission in that manner between primates.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52)[\[87\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl2012-87)
Dogs may become infected with EBOV but not develop symptoms. Dogs in some parts of Africa [scavenge](https://en.wikipedia.org/wiki/Scavenge "Scavenge") for food, and they sometimes eat EBOV-infected animals and also the corpses of humans. A 2005 survey of dogs during an EBOV outbreak found that although they remain asymptomatic, about 32 percent of dogs closest to an outbreak showed a [seroprevalence](https://en.wikipedia.org/wiki/Seroprevalence "Seroprevalence") for EBOV versus nine percent of those farther away.[\[277\]](https://en.wikipedia.org/wiki/Ebola#cite_note-pmid15757552-278) The authors concluded that there were "potential implications for preventing and controlling human outbreaks."
Reston virus
For more about the outbreak in Virginia, US, see [Reston virus](https://en.wikipedia.org/wiki/Reston_virus "Reston virus").
In late 1989, Hazelton Research Products' Reston Quarantine Unit in [Reston, Virginia](https://en.wikipedia.org/wiki/Reston,_Virginia "Reston, Virginia"), had an outbreak of fatal illness amongst certain lab monkeys. This lab outbreak was initially diagnosed as [simian haemorrhagic fever virus](https://en.wikipedia.org/wiki/Simian_haemorrhagic_fever_virus "Simian haemorrhagic fever virus") (SHFV) and occurred amongst a shipment of [crab-eating macaque](https://en.wikipedia.org/wiki/Crab-eating_macaque "Crab-eating macaque") monkeys imported from the Philippines. Hazelton's veterinary pathologist in Reston sent tissue samples from dead animals to the [United States Army Medical Research Institute of Infectious Diseases](https://en.wikipedia.org/wiki/United_States_Army_Medical_Research_Institute_of_Infectious_Diseases "United States Army Medical Research Institute of Infectious Diseases") (USAMRIID) at [Fort Detrick, Maryland](https://en.wikipedia.org/wiki/Fort_Detrick,_Maryland "Fort Detrick, Maryland"), where an [ELISA](https://en.wikipedia.org/wiki/ELISA "ELISA") test indicated the antibodies present in the tissue were a response to Ebola virus and not SHFV.[\[278\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Preston-279) An electron microscopist from USAMRIID discovered [filoviruses](https://en.wikipedia.org/wiki/Filoviruses "Filoviruses") similar in appearance, in crystalloid aggregates and as single filaments with a shepherd's hook, to Ebola in the tissue samples sent from Hazelton Research Products' Reston Quarantine Unit.[\[279\]](https://en.wikipedia.org/wiki/Ebola#cite_note-McCormick_1999_277%E2%80%93279-280)
A [US Army](https://en.wikipedia.org/wiki/US_Army "US Army") team headquartered at USAMRIID [euthanised](https://en.wikipedia.org/wiki/Euthanisia "Euthanisia") the surviving monkeys, and brought all the dead monkeys to Fort Detrick for study by the Army's veterinary pathologists and virologists, and eventual disposal under safe conditions.[\[278\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Preston-279) Blood samples were taken from 178 animal handlers during the incident.[\[280\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Waterman_1999-281) Of those, six animal handlers eventually [seroconverted](https://en.wikipedia.org/wiki/Seroconversion "Seroconversion"), including one who had cut himself with a bloody scalpel.[\[89\]](https://en.wikipedia.org/wiki/Ebola#cite_note-isbn0-7910-8505-8-89)[\[281\]](https://en.wikipedia.org/wiki/Ebola#cite_note-McCormick_1999_298%E2%80%93299-282) Despite its status as a [Level‑4](https://en.wikipedia.org/wiki/Biosafety_level_4 "Biosafety level 4") organism and its apparent [pathogenicity](https://en.wikipedia.org/wiki/Pathogen "Pathogen") in monkeys, when the handlers did not become ill, the CDC concluded that the virus had a very low pathogenicity to humans.[\[281\]](https://en.wikipedia.org/wiki/Ebola#cite_note-McCormick_1999_298%E2%80%93299-282)[\[282\]](https://en.wikipedia.org/wiki/Ebola#cite_note-283)
The Philippines and the United States had no previous cases of Ebola infection, and upon further isolation, researchers concluded it was another strain of Ebola, or a new filovirus of Asian origin, which they named *[Reston ebolavirus](https://en.wikipedia.org/wiki/Reston_ebolavirus "Reston ebolavirus")* (RESTV) after the location of the incident.[\[278\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Preston-279) Reston virus (RESTV) can be transmitted to pigs.[\[52\]](https://en.wikipedia.org/wiki/Ebola#cite_note-Weingartl_2013-52) Since the initial outbreak it has since been found in nonhuman [primates](https://en.wikipedia.org/wiki/Primate "Primate") in Pennsylvania, Texas, and Italy,[\[283\]](https://en.wikipedia.org/wiki/Ebola#cite_note-KnownCasesCDC-284) where the virus had infected pigs.[\[284\]](https://en.wikipedia.org/wiki/Ebola#cite_note-285) According to the WHO, routine cleaning and disinfection of pig (or monkey) farms with [sodium hypochlorite](https://en.wikipedia.org/wiki/Sodium_hypochlorite "Sodium hypochlorite") or [detergents](https://en.wikipedia.org/wiki/Detergents "Detergents") should be effective in inactivating the *Reston ebolavirus*. Pigs that have been infected with RESTV tend to show [symptoms](https://en.wikipedia.org/wiki/Symptoms "Symptoms") of the disease.[\[285\]](https://en.wikipedia.org/wiki/Ebola#cite_note-286)
Research
Treatments
[](https://en.wikipedia.org/wiki/File:Monoclonal_antibodies3.jpg)
Researchers looking at slides of cultures of cells that make [monoclonal antibodies](https://en.wikipedia.org/wiki/Monoclonal_antibodies "Monoclonal antibodies"). These are grown in a lab and the researchers are analyzing the products to select the most promising.
As of July 2015, no medication has been proven safe and effective for treating Ebola. By the time the [Ebola virus epidemic in West Africa](https://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa "Ebola virus epidemic in West Africa") began in 2013, there were at least nine different candidate treatments. Several trials were conducted in late 2014, and early 2015, but some were abandoned due to lack of efficacy or lack of people to study.[\[286\]](https://en.wikipedia.org/wiki/Ebola#cite_note-287)
As of August 2019, two experimental treatments known as [atoltivimab/maftivimab/odesivimab](https://en.wikipedia.org/wiki/Atoltivimab/maftivimab/odesivimab "Atoltivimab/maftivimab/odesivimab") and [ansuvimab](https://en.wikipedia.org/wiki/Ansuvimab "Ansuvimab") were found to be 90% effective.[\[287\]](https://en.wikipedia.org/wiki/Ebola#cite_note-288)[\[288\]](https://en.wikipedia.org/wiki/Ebola#cite_note-289)[\[289\]](https://en.wikipedia.org/wiki/Ebola#cite_note-290)
Diagnostic tests
The diagnostic tests currently available require specialised equipment and highly trained personnel. Since there are few suitable testing centres in West Africa, this leads to delay in diagnosis.[\[290\]](https://en.wikipedia.org/wiki/Ebola#cite_note-291)
On 29 November 2014, a new 15-minute Ebola test was reported that if successful, "not only gives patients a better chance of survival, but it prevents transmission of the virus to other people." The new equipment, about the size of a laptop and solar-powered, allows testing to be done in remote areas.[\[291\]](https://en.wikipedia.org/wiki/Ebola#cite_note-292)
On 29 December 2014, the U.S. [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) approved the LightMix Ebola Zaire [rRT-PCR](https://en.wikipedia.org/wiki/Reverse_transcription_polymerase_chain_reaction "Reverse transcription polymerase chain reaction") test for patients with symptoms of Ebola.[\[292\]](https://en.wikipedia.org/wiki/Ebola#cite_note-293)
Disease models
Animal models and in particular non-human primates are being used to study different aspects of Ebola virus disease. Developments in [organ-on-a-chip](https://en.wikipedia.org/wiki/Organ-on-a-chip "Organ-on-a-chip") technology have led to a chip-based model for Ebola haemorrhagic syndrome.[\[293\]](https://en.wikipedia.org/wiki/Ebola#cite_note-294)
See also
- [Bibliography of Ebola](https://en.wikipedia.org/wiki/Bibliography_of_Ebola "Bibliography of Ebola")
Notes
1. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-cfr_190-0)** The mortality (number of dead per number of healthy per time frame) recorded in Liberia up to 26 August 2014 was 70%.[\[189\]](https://en.wikipedia.org/wiki/Ebola#cite_note-cfrebolavirus-189) However, due to the estimation method used, the estimated case fatality rate (70.8%) for this particular epidemic differs from the actual ratio between the number of deaths and the number of cases.
References
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Ebola in Uganda:
Guiliani R. ["Our game-changing treatment centres will save more lives"](https://web.archive.org/web/20221115224626/https://msf.org.uk/article/ebola-uganda-our-game-changing-treatment-centres-will-save-more-lives). msf.org.urk. Archived from [the original](https://msf.org.uk/article/ebola-uganda-our-game-changing-treatment-centres-will-save-more-lives) on 15 November 2022. Retrieved 15 November 2022.
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Preston R (1994). [*The Hot Zone*](https://archive.org/details/hotzone00pres). New York: Random House. p. [300](https://archive.org/details/hotzone00pres/page/300). [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
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279. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-McCormick_1999_277%E2%80%93279_280-0)** [McCormick, Fisher-Hoch & Horvitz 1999](https://en.wikipedia.org/wiki/Ebola#CITEREFMcCormickFisher-HochHorvitz1999), pp. 277–279
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Waterman T (1999). [*Ebola Reston Outbreaks*](http://www.stanford.edu/group/virus/filo/ebor.html). Stanford University. [Archived](https://web.archive.org/web/20080616192533/http://www.stanford.edu/group/virus/filo/ebor.html) from the original on 16 June 2008. Retrieved 2 August 2008.
281. ^ [***a***](https://en.wikipedia.org/wiki/Ebola#cite_ref-McCormick_1999_298%E2%80%93299_282-0) [***b***](https://en.wikipedia.org/wiki/Ebola#cite_ref-McCormick_1999_298%E2%80%93299_282-1) [McCormick, Fisher-Hoch & Horvitz 1999](https://en.wikipedia.org/wiki/Ebola#CITEREFMcCormickFisher-HochHorvitz1999), pp. 298–299
282. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-283)** [McCormick, Fisher-Hoch & Horvitz 1999](https://en.wikipedia.org/wiki/Ebola#CITEREFMcCormickFisher-HochHorvitz1999), p. 300
283. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-KnownCasesCDC_284-0)**
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McNeil Jr DG (24 January 2009). ["Pig-to-Human Ebola Case Suspected in Philippines"](https://www.nytimes.com/2009/01/24/health/24ebola.html). *The New York Times*. [Archived](https://web.archive.org/web/20090310113731/http://www.nytimes.com/2009/01/24/health/24ebola.html) from the original on 10 March 2009. Retrieved 26 January 2009.
285. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-286)**
Lee J (2009). ["Ebola-Reston virus in pigs"](https://doi.org/10.1071%2Fma09140). *Microbiology Australia*. **30** (4): 140. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1071/ma09140](https://doi.org/10.1071%2Fma09140). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1324-4272](https://search.worldcat.org/issn/1324-4272).
286. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-287)**
["Final trial results confirm Ebola vaccine provides high protection against disease"](https://www.who.int/mediacentre/news/releases/2016/ebola-vaccine-results/en/). [World Health Organization](https://en.wikipedia.org/wiki/World_Health_Organization "World Health Organization") (WHO). [Archived](https://web.archive.org/web/20170401042946/http://who.int/mediacentre/news/releases/2016/ebola-vaccine-results/en/) from the original on 1 April 2017. Retrieved 29 March 2017.
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Maxmen A (12 August 2019). "Two Ebola drugs show promise amid ongoing outbreak". *Nature*. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/d41586-019-02442-6](https://doi.org/10.1038%2Fd41586-019-02442-6). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [0028-0836](https://search.worldcat.org/issn/0028-0836). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [32778704](https://pubmed.ncbi.nlm.nih.gov/32778704). [S2CID](https://en.wikipedia.org/wiki/S2CID_\(identifier\) "S2CID (identifier)") [201975390](https://api.semanticscholar.org/CorpusID:201975390).
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Hoenen T, Groseth A, Feldmann H (24 July 2019). ["Therapeutic strategies to target the Ebola virus life cycle"](https://doi.org/10.1038%2Fs41579-019-0233-2). *Nature Reviews. Microbiology*. **17** (10): 593–606\. [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1038/s41579-019-0233-2](https://doi.org/10.1038%2Fs41579-019-0233-2). [ISSN](https://en.wikipedia.org/wiki/ISSN_\(identifier\) "ISSN (identifier)") [1740-1526](https://search.worldcat.org/issn/1740-1526). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31341272](https://pubmed.ncbi.nlm.nih.gov/31341272).
289. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-290)**
["Investigational Monoclonal Antibody to Treat Ebola Is Safe in Adults"](https://web.archive.org/web/20190813064914/https://www.niaid.nih.gov/news-events/investigational-monoclonal-antibody-treat-ebola-safe-adults) (Press release). [National Institute of Allergy and Infectious Diseases](https://en.wikipedia.org/wiki/National_Institute_of_Allergy_and_Infectious_Diseases "National Institute of Allergy and Infectious Diseases") (NIAID). 24 January 2019. Archived from [the original](https://www.niaid.nih.gov/news-events/investigational-monoclonal-antibody-treat-ebola-safe-adults) on 13 August 2019. Retrieved 12 August 2019.
290. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-291)**
Butler D. ["Ebola Experts Seek to Expand Testing"](http://www.scientificamerican.com/article/ebola-experts-seek-to-expand-testing/). *[Scientific American](https://en.wikipedia.org/wiki/Scientific_American "Scientific American")*. [Archived](https://web.archive.org/web/20141213012943/http://www.scientificamerican.com/article/ebola-experts-seek-to-expand-testing/) from the original on 13 December 2014. Retrieved 11 December 2014.
291. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-292)**
Buchanan RT (29 November 2014). ["Ebola outbreak: New 15-minute test offers hope for thousands"](https://www.independent.co.uk/news/world/africa/ebola-outbreak-new-15minute-test-trialled-in-guinea-offers-hope-for-thousands-9892543.html). *The Independent*. [Archived](https://web.archive.org/web/20141201003020/http://www.independent.co.uk/news/world/africa/ebola-outbreak-new-15minute-test-trialled-in-guinea-offers-hope-for-thousands-9892543.html) from the original on 1 December 2014. Retrieved 1 December 2014.
292. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-293)**
Falconi M (29 December 2014). ["Roche Secures Emergency Approval by U.S. Regulators for Ebola Test"](https://www.wsj.com/articles/roche-secures-emergency-approval-by-u-s-regulators-for-ebola-test-1419840858). *[The Wall Street Journal](https://en.wikipedia.org/wiki/The_Wall_Street_Journal "The Wall Street Journal")*. [Archived](https://web.archive.org/web/20141229163045/http://www.wsj.com/articles/roche-secures-emergency-approval-by-u-s-regulators-for-ebola-test-1419840858) from the original on 29 December 2014. Retrieved 29 December 2014.
293. **[^](https://en.wikipedia.org/wiki/Ebola#cite_ref-294)**
Junaid A, Tang H, van Reeuwijk A, Abouleila Y, Wuelfroth P, van Duinen V, et al. (January 2020). ["Ebola Hemorrhagic Shock Syndrome-on-a-Chip"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941864). *iScience*. **23** (1) 100765. [Bibcode](https://en.wikipedia.org/wiki/Bibcode_\(identifier\) "Bibcode (identifier)"):[2020iSci...23j0765J](https://ui.adsabs.harvard.edu/abs/2020iSci...23j0765J). [doi](https://en.wikipedia.org/wiki/Doi_\(identifier\) "Doi (identifier)"):[10\.1016/j.isci.2019.100765](https://doi.org/10.1016%2Fj.isci.2019.100765). [PMC](https://en.wikipedia.org/wiki/PMC_\(identifier\) "PMC (identifier)") [6941864](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941864). [PMID](https://en.wikipedia.org/wiki/PMID_\(identifier\) "PMID (identifier)") [31887664](https://pubmed.ncbi.nlm.nih.gov/31887664).
- *The article uses public domain text from the CDC as cited.*
Bibliography
- McCormick J, Fisher-Hoch S, Horvitz LA (1999) \[1996\]. [*Level 4: Virus Hunters of the CDC*](https://books.google.com/books?id=QEvR3aJX2m0C) (Limited preview) (Updated \[3rd\] ed.). Barnes & Noble. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0760712085](https://en.wikipedia.org/wiki/Special:BookSources/978-0760712085 "Special:BookSources/978-0760712085")
. [Archived](https://web.archive.org/web/20240521143950/https://books.google.com/books?id=QEvR3aJX2m0C) from the original on 21 May 2024. Retrieved 3 September 2020.
Further reading
- Wilson F (2014). [*CDC Guidance on Ebola Virus (EVD)*](https://books.google.com/books?id=yMQNBQAAQBAJ&pg=PP1). International Publications Media Group. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1632670113](https://en.wikipedia.org/wiki/Special:BookSources/978-1632670113 "Special:BookSources/978-1632670113")
.
- [*Ebola Virus: New Insights for the Healthcare Professional: 2011 Edition: ScholarlyPaper*](https://books.google.com/books?id=nLA4W5IjJpwC&pg=PP1). Scholarly Editions. 2012. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1464914935](https://en.wikipedia.org/wiki/Special:BookSources/978-1464914935 "Special:BookSources/978-1464914935")
.
- Klenk HD (January 1999). *Marburg and Ebola Viruses*. Current Topics in Microbiology and Immunology 235. Berlin: Springer-Verlag Telos. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-3540647294](https://en.wikipedia.org/wiki/Special:BookSources/978-3540647294 "Special:BookSources/978-3540647294")
.
- Klenk HD, Feldmann H (2004). [*Ebola and Marburg viruses: molecular and cellular biology*](https://books.google.com/books?id=EV_mFgnyPoMC) (Limited preview). Wymondham, Norfolk: Horizon Bioscience. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0954523237](https://en.wikipedia.org/wiki/Special:BookSources/978-0954523237 "Special:BookSources/978-0954523237")
. [Archived](https://web.archive.org/web/20240521143950/https://books.google.com/books?id=EV_mFgnyPoMC) from the original on 21 May 2024. Retrieved 3 September 2020.
- Kuhn JH (2008). [*Filoviruses: A Compendium of 40 Years of Epidemiological, Clinical, and Laboratory Studies. Archives of Virology Supplement*](https://books.google.com/books?id=LaOue0F9Ns4C) (Limited preview). Vol. 20. Vienna: SpringerWienNewYork. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-3211206706](https://en.wikipedia.org/wiki/Special:BookSources/978-3211206706 "Special:BookSources/978-3211206706")
. [Archived](https://web.archive.org/web/20240521144049/https://books.google.com/books?id=LaOue0F9Ns4C) from the original on 21 May 2024. Retrieved 3 September 2020.
- Pattyn SR (1978). [*Ebola Virus Haemorrhagic Fever*](https://web.archive.org/web/20101211083855/http://www.itg.be/ebola/) (1st ed.). Amsterdam: Elsevier/North-Holland Biomedical Press. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-0444800602](https://en.wikipedia.org/wiki/Special:BookSources/978-0444800602 "Special:BookSources/978-0444800602")
. Archived from [the original](http://www.itg.be/ebola/) (Full free text) on 11 December 2010.
- Ryabchikova EI, Price BB (2004). *Ebola and Marburg Viruses: A View of Infection Using Electron Microscopy*. Columbus, Ohio: Battelle Press. [ISBN](https://en.wikipedia.org/wiki/ISBN_\(identifier\) "ISBN (identifier)")
[978-1574771312](https://en.wikipedia.org/wiki/Special:BookSources/978-1574771312 "Special:BookSources/978-1574771312")
.
External links
[](https://en.wikipedia.org/wiki/File:Incubator-logo.svg)
- [WHO fact sheet on Ebola](https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease)
- [Ebola (Ebola Virus Disease)](https://www.cdc.gov/vhf/ebola/) – Centers for Disease Control and Prevention, Viral Special Pathogens Branch.
- [Videos: Ebola outbreak response](https://web.archive.org/web/20140823072115/http://www.who.int/csr/disease/ebola/videos/en/) – World Health Organization.
- ["Ebola Preparedness and Response"](https://web.archive.org/web/20190708195151/https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/ebola-preparedness-and-response-updates-fda). *U.S. [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA)*. 13 January 2021. Archived from [the original](https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/ebola-preparedness-and-response-updates-fda) on 8 July 2019.
- [Ebola: What You Need to Know](https://www.scientificamerican.com/report/ebola-what-you-need-to-know1/) – *[Scientific American](https://en.wikipedia.org/wiki/Scientific_American "Scientific American")* articles related to Ebola; note these are general reading articles, they are not scientific peer-reviewed research articles. | ||||||||||||
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