Ebola Warning: You are not logged in. Your IP address will be publicly visible if you make any edits. If you log in or create an account, your edits will be attributed to your username, along with other benefits.Anti-spam check. Do not fill this in! {{Short description|Viral hemorrhagic fever of humans and other primates caused by ebolaviruses}} {{about|the disease}} {{pp-vandalism|small=yes}} {{Use British English|date=February 2020}} {{Use dmy dates|date=July 2023}} {{Infobox medical condition | name = Ebola | synonyms = Ebola haemorrhagic fever (EHF), Ebola virus disease | image = 7042 lores-Ebola-Zaire-CDC Photo.jpg | caption = Two nurses standing near [[Mayinga N'Seka]], a nurse with Ebola virus disease in the [[1976 Zaire Ebola virus outbreak|1976 outbreak in Zaire]]. N'Seka died a few days later. | field = [[Infectious disease (medical specialty)|Infectious disease]] | symptoms = [[Fever]], [[sore throat]], [[Myalgia|muscular pain]], [[headaches]], [[diarrhoea]], bleeding<ref name=WHO2014/> | complications = [[hypovolemic shock|shock from fluid loss]]<ref name=Ruz2014/> | onset = Two days to three weeks post exposure<ref name=WHO2014/> | duration = | causes = [[Ebolavirus]]es spread by direct contact<ref name=WHO2014/> | risks = | diagnosis = Finding the virus, viral [[RNA]], or [[antibodies]] in blood<ref name=WHO2014/> | differential = [[Malaria]], [[cholera]], [[typhoid fever]], [[meningitis]], other [[viral haemorrhagic fevers]]<ref name=WHO2014/> | prevention = Coordinated medical services, careful handling of [[bushmeat]]<ref name=WHO2014/> | treatment = [[Supportive care]]<ref name=WHO2014/> | medication = [[Atoltivimab/maftivimab/odesivimab]] (Inmazeb) | prognosis = 25–90% mortality<ref name=WHO2014/> | frequency = | deaths = | alt = | image_size = 200 }} '''Ebola''', also known as '''Ebola virus disease''' ('''EVD''') and '''Ebola hemorrhagic fever''' ('''EHF'''), is a [[viral hemorrhagic fever]] in humans and other [[primate]]s, caused by [[ebolavirus]]es.<ref name=WHO2014/> Symptoms typically start anywhere between two days and three weeks after infection.<ref>{{Cite book | vauthors = Modrow S, Falke D, Truyen U, Schätzl H |title=Molecular Virology |chapter=Viruses: Definition, Structure, Classification |date=2013 |pages=17–30 | veditors = Modrow S, Falke D, Truyen U, Schätzl H |place=Berlin, Heidelberg |publisher=Springer |language=en |doi=10.1007/978-3-642-20718-1_2 |isbn=978-3-642-20718-1 |s2cid=83235976|doi-access=free }}</ref> The first symptoms are usually [[fever]], [[sore throat]], [[Myalgia|muscle pain]], and [[headache]]s.<ref name=WHO2014/> These are usually followed by [[vomiting]], [[diarrhoea]], [[rash]] and decreased [[liver]] and [[kidney]] function,<ref name=WHO2014/> at which point some people begin to [[bleeding|bleed]] both [[internal bleeding|internally]] and externally.<ref name="WHO2014">{{Cite web |date=September 2014 |title=Ebola virus disease, Fact sheet N°103, Updated September 2014 |url=https://www.who.int/mediacentre/factsheets/fs103/en/ |url-status=deviated |archive-url=https://web.archive.org/web/20141214011751/https://www.who.int/mediacentre/factsheets/fs103/en/ |archive-date=14 December 2014 |access-date=15 December 2014 |publisher=[[World Health Organization]] (WHO)}}</ref> It kills between 25% and 90% of those infected – about 50% on average.<ref name=WHO2014/> Death is often due to [[hypovolemic shock|shock from fluid loss]], and typically occurs between six and 16 days after the first symptoms appear.<ref name="Ruz2014">{{Cite book |url=https://books.google.com/books?id=l5MtJdDhie0C&pg=PA444 |title=Viral hemorrhagic fevers |date=2014 |publisher=CRC Press, Taylor & Francis Group |isbn=978-1439884294 | veditors = Singh SK, Ruzek D |location=Boca Raton |page=444 |archive-url=https://web.archive.org/web/20160429192429/https://books.google.com/books?id=l5MtJdDhie0C&pg=PA444 |archive-date=29 April 2016 }}</ref> Early treatment of symptoms increases the survival rate considerably compared to late start.<ref name="Guiliani 2022">Ebola in Uganda: {{Cite web | vauthors = Guiliani R |title=Our game-changing treatment centres will save more lives |url=https://msf.org.uk/article/ebola-uganda-our-game-changing-treatment-centres-will-save-more-lives |archive-url=https://web.archive.org/web/20221115224626/https://msf.org.uk/article/ebola-uganda-our-game-changing-treatment-centres-will-save-more-lives |archive-date=15 November 2022 |access-date=15 November 2022 |publisher=msf.org.urk}}</ref> An [[Ebola vaccine]] was approved by the US FDA in December 2019. The virus spreads through direct contact with [[body fluid]]s, such as [[blood]] from infected humans or other animals,<ref name=WHO2014/> or from contact with items that have recently been contaminated with infected body fluids.<ref name=WHO2014/> There have been no documented cases, either in nature or under laboratory conditions, of spread through the air between humans or other [[primate]]s.<ref name="WHOAir2014">{{Cite web |date=21 April 2014 |title=2014 Ebola Virus Disease (EVD) outbreak in West Africa |url=https://www.who.int/ith/updates/20140421/en/ |url-status=dead |archive-url=https://web.archive.org/web/20140729034008/https://www.who.int/ith/updates/20140421/en/ |archive-date=29 July 2014 |access-date=3 August 2014 |publisher=World Health Organization (WHO) }}</ref> After recovering from Ebola, [[semen]] or [[breast milk]] may continue to carry the virus for anywhere between several weeks to several months.<ref name=WHO2014/><ref name="cdc9months">{{Cite web |date=14 October 2015 |title=Preliminary study finds that Ebola virus fragments can persist in the semen of some survivors for at least nine months |url=https://www.cdc.gov/media/releases/2015/p1014-ebola-virus.html |url-status=live |archive-url=https://web.archive.org/web/20170824104650/https://www.cdc.gov/media/releases/2015/p1014-ebola-virus.html |archive-date=24 August 2017 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref><ref name="CDCBreast2014">{{Cite web |date=19 September 2014 |title=Recommendations for Breastfeeding/Infant Feeding in the Context of Ebola |url=https://www.cdc.gov/vhf/ebola/hcp/recommendations-breastfeeding-infant-feeding-ebola.html |url-status=live |archive-url=https://web.archive.org/web/20141024235607/https://www.cdc.gov/vhf/ebola/hcp/recommendations-breastfeeding-infant-feeding-ebola.html |archive-date=24 October 2014 |access-date=26 October 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> [[Megabat|Fruit bat]]s are believed to be the normal [[natural host|carrier in nature]]; they are able to spread the virus without being affected by it.<ref name=WHO2014/> The symptoms of Ebola may resemble those of several other diseases, including [[malaria]], [[cholera]], [[typhoid fever]], [[meningitis]] and other viral hemorrhagic fevers.<ref name=WHO2014/> Diagnosis is confirmed by testing blood samples for the presence of viral [[RNA]], viral [[antibodies]] or the virus itself.<ref name=WHO2014/><ref name="Bro2016">{{Cite journal |vauthors=Broadhurst MJ, Brooks TJ, Pollock NR |date=13 July 2016 |title=Diagnosis of Ebola Virus Disease: Past, Present, and Future |journal=Clinical Microbiology Reviews |publisher=American Society for Microbiology |volume=29 |issue=4 |pages=773–793 |doi=10.1128/cmr.00003-16 |issn=0893-8512 |lccn=88647279 |oclc=38839512 |pmc=5010747 |pmid=27413095}}</ref> Control of outbreaks requires coordinated medical services and community engagement,<ref name=WHO2014/> 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.<ref name=WHO2014/><ref>{{Cite web |title=Guidance for Safe Handling of Human Remains of Ebola Patients in U.S. Hospitals and Mortuaries |url=https://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html |url-status=live |archive-url=https://web.archive.org/web/20141009172209/https://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html |archive-date=9 October 2014 |access-date=10 October 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> 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.<ref name=WHO2014/> An [[Ebola vaccine]] was approved by the US FDA in December 2019.<ref name="FDA2019Vac">{{Cite press release |title=First FDA-approved vaccine for the prevention of Ebola virus disease, marking a critical milestone in public health preparedness and response |date=20 December 2019 |url=https://www.fda.gov/news-events/press-announcements/first-fda-approved-vaccine-prevention-ebola-virus-disease-marking-critical-milestone-public-health |access-date=22 December 2019 |publisher=U.S. [[Food and Drug Administration]] (FDA)}}</ref> While there is no approved treatment for Ebola {{as of |2019|lc=yes}},<ref name="NIH2019">{{Cite web |title=Ebola Treatment Research |url=https://www.niaid.nih.gov/diseases-conditions/ebola-treatment |access-date=20 August 2019 |publisher=NIH: National Institute of Allergy and Infectious Diseases}}</ref> two treatments ([[atoltivimab/maftivimab/odesivimab]] and [[ansuvimab]]) are associated with improved outcomes.<ref name="NIH2019Tx">{{Cite web |title=Independent Monitoring Board Recommends Early Termination of Ebola Therapeutics Trial in DRC Because of Favorable Results with Two of Four Candidates |date=12 August 2019 |url=https://www.niaid.nih.gov/news-events/independent-monitoring-board-recommends-early-termination-ebola-therapeutics-trial-drc |access-date=20 August 2019 |publisher=NIH: National Institute of Allergy and Infectious Diseases}}</ref> Supportive efforts also improve outcomes.<ref name=WHO2014/> These include [[oral rehydration therapy]] (drinking slightly sweetened and salty water) or giving [[intravenous fluids]], and treating symptoms.<ref name=WHO2014/> In October 2020, atoltivimab/maftivimab/odesivimab (Inmazeb) was approved for medical use in the United States to treat the disease caused by ''Zaire ebolavirus''.<ref name="FDA PR" /> {{TOC limit}} ==History and name== 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.<ref name="WHO2014" /> [[List of Ebola outbreaks|Ebola outbreaks]] occur intermittently in tropical regions of [[sub-Saharan Africa]].<ref name=WHO2014/> Between 1976 and 2012, according to the [[World Health Organization]], there were 24 outbreaks of Ebola resulting in a total of [[List of Ebola outbreaks|2,387 cases, and 1,590 deaths]].<ref name=WHO2014/><ref name="MMWRJune2014">{{Cite journal |vauthors=Dixon MG, Schafer IJ |date=June 2014 |title=Ebola viral disease outbreak – West Africa, 2014 |url=https://www.cdc.gov/mmwr/pdf/wk/mm6325.pdf |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=63 |issue=25 |pages=548–551 |pmc=5779383 |pmid=24964881}}</ref> The largest Ebola outbreak to date was an [[Ebola virus epidemic in West Africa|epidemic in West Africa]] from December 2013 to January 2016, with {{#section:Ebola virus epidemic in West Africa|cases}} cases and {{#section:Ebola virus epidemic in West Africa|deaths}} deaths.{{#section:Ebola virus epidemic in West Africa|caserefs}}<ref name="CDC2014">{{Cite web |date=31 July 2014 |title=CDC urges all US residents to avoid nonessential travel to Liberia, Guinea and Sierra Leone because of an unprecedented outbreak of Ebola |url=https://wwwnc.cdc.gov/travel/notices/warning/ebola-liberia |archive-url=https://web.archive.org/web/20140809181737/https://wwwnc.cdc.gov/travel/notices/warning/ebola-liberia |archive-date=9 August 2014 |access-date=2 August 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC) }}</ref><ref name="CDCAug2014N">{{Cite web |date=4 August 2014 |title=2014 Ebola Outbreak in West Africa |url=https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/ |url-status=live |archive-url=https://web.archive.org/web/20141002134254/https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/ |archive-date=2 October 2014 |access-date=5 August 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> On 29 March 2016, it was declared to no longer be an emergency.<ref name="who.int">{{Cite web |date=29 March 2016 |title=Statement on the 9th meeting of the IHR Emergency Committee regarding the Ebola outbreak in West Africa |url=https://www.who.int/mediacentre/news/statements/2016/end-of-ebola-pheic/en/ |url-status=live |archive-url=https://web.archive.org/web/20160331231040/https://www.who.int/mediacentre/news/statements/2016/end-of-ebola-pheic/en/ |archive-date=31 March 2016 |access-date=30 March 2016 |publisher=[[World Health Organization]] (WHO)}}</ref> Other outbreaks in Africa began in the Democratic Republic of the Congo in May 2017,<ref>{{Cite web |title=Statement on Ebola in the Democratic Republic of the Congo |url=https://www.who.int/mediacentre/news/statements/2017/ebola-drc/en/ |url-status=live |archive-url=https://web.archive.org/web/20170512203522/https://www.who.int/mediacentre/news/statements/2017/ebola-drc/en/ |archive-date=12 May 2017 |access-date=12 May 2017 |publisher=[[World Health Organization]] (WHO)}}</ref><ref>{{Cite news | vauthors = Hodal K |date=12 May 2017 |title=Ebola outbreak declared in Democratic Republic of the Congo after three die |work=[[The Guardian]] |location=United Kingdom |url=https://www.theguardian.com/world/2017/may/12/ebola-outbreak-declared-democratic-republic-of-congo-after-three-die |url-status=live |access-date=12 May 2017 |archive-url=https://web.archive.org/web/20170512161809/https://www.theguardian.com/world/2017/may/12/ebola-outbreak-declared-democratic-republic-of-congo-after-three-die |archive-date=12 May 2017 |issn=1756-3224 |oclc=60623878}}</ref> and 2018.<ref>{{Cite news | vauthors = Scutti S, Goldschmidt D |title=Ebola outbreak declared in Democratic Republic of Congo |publisher=CNN |url=https://www.cnn.com/2018/05/08/health/ebola-outbreak-who-bn/index.html |access-date=9 May 2018}}</ref><ref name="WHO2018DRCOver">{{Cite web |title=Ebola outbreak in DRC ends: WHO calls for international efforts to stop other deadly outbreaks in the country |url=https://www.who.int/news-room/detail/24-07-2018-ebola-outbreak-in-drc-ends-who-calls-for-international-efforts-to-stop-other-deadly-outbreaks-in-the-country |access-date=26 July 2018 |publisher=[[World Health Organization]] (WHO)}}</ref> In July 2019, the World Health Organization declared the Congo Ebola outbreak a [[Public health emergency of international concern|world health emergency]].<ref>{{Cite news | vauthors = Grady D |date=17 July 2019 |title=Congo's Ebola Outbreak Is Declared a Global Health Emergency |work=[[The New York Times]] |url=https://www.nytimes.com/2019/07/17/health/ebola-congo-who-emergency.html |access-date=17 July 2019 |archive-url=https://web.archive.org/web/20190717180831/https://www.nytimes.com/2019/07/17/health/ebola-congo-who-emergency.html |archive-date=17 July 2019 |issn=1553-8095 |oclc=1645522}}</ref> ==Signs and symptoms== [[File:Symptoms of ebola.png|thumb|upright=1.3|Signs and symptoms of Ebola<ref name="CDC2014S" />]] ===Onset=== <!-- Incubation --> The length of time between exposure to the virus and the development of symptoms ([[incubation period]]) is between 2 and 21 days,<ref name=WHO2014/><ref name="CDC2014S">{{Cite web |date=28 January 2014 |title=Ebola Hemorrhagic Fever Signs and Symptoms |url=https://www.cdc.gov/vhf/ebola/symptoms/index.html |url-status=live |archive-url=https://web.archive.org/web/20140801015854/https://www.cdc.gov/vhf/ebola/symptoms/index.html |archive-date=1 August 2014 |access-date=2 August 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC) }}</ref> and usually between 4 and 10 days.<ref name="Goeijenbier2014">{{Cite journal |vauthors=Goeijenbier M, van Kampen JJ, Reusken CB, Koopmans MP, van Gorp EC |date=November 2014 |title=Ebola virus disease: a review on epidemiology, symptoms, treatment and pathogenesis |url=http://www.njmonline.nl/getpdf.php?t=a&id=10001148 |url-status=live |journal=Neth J Med |volume=72 |issue=9 |pages=442–448 |pmid=25387613 |archive-url=https://web.archive.org/web/20141129144852/http://www.njmonline.nl/getpdf.php?t=a&id=10001148 |archive-date=29 November 2014}}</ref> However, recent estimates based on mathematical models predict that around 5% of cases may take longer than 21 days to develop.<ref>{{Cite journal |vauthors=Haas CN |date=14 October 2014 |title=On the Quarantine Period for Ebola Virus |journal=PLOS Currents Outbreaks |volume=6 |doi=10.1371/currents.outbreaks.2ab4b76ba7263ff0f084766e43abbd89 |pmc=4205154 |pmid=25642371 |doi-access=free }}</ref> <!-- Early --> Symptoms usually begin with a sudden [[influenza]]-like stage characterised by [[fatigue (medical)|fatigue]], [[fever]], [[asthenia|weakness]], [[anorexia (symptom)|decreased appetite]], [[myalgia|muscular pain]], [[arthralgia|joint pain]], headache, and sore throat.<ref name=WHO2014/><ref name="Goeijenbier2014" /><ref name="Gatherer 2014">{{Cite journal |vauthors=Gatherer D |date=August 2014 |title=The 2014 Ebola virus disease outbreak in West Africa |journal=J Gen Virol |volume=95 |issue=Pt 8 |pages=1619–1624 |doi=10.1099/vir.0.067199-0 |pmid=24795448 |doi-access=free}}</ref><ref name="Hun2012">{{Cite book | vauthors = Magill A |url= https://books.google.com/books?id=UgvdM8WRld4C&pg=PA332 |title=Hunter's tropical medicine and emerging infectious diseases |date=2013 |publisher=Saunders |isbn=978-1416043904 |edition=9th |location=New York |page=332 |author-link=Alan Magill |archive-url=https://web.archive.org/web/20160320072816/https://books.google.com/books?id=UgvdM8WRld4C&pg=PA332 |archive-date=20 March 2016 |url-status=live |name-list-style=vanc}}</ref> The fever is usually higher than {{convert|38.3|°C|°F|0}}.<ref name="Hoenen2006">{{Cite journal |vauthors=Hoenen T, Groseth A, Falzarano D, Feldmann H |date=May 2006 |title=Ebola virus: unravelling pathogenesis to combat a deadly disease |journal=Trends in Molecular Medicine |volume=12 |issue=5 |pages=206–215 |doi=10.1016/j.molmed.2006.03.006 |pmid=16616875}}</ref> This is often followed by nausea, vomiting, [[diarrhoea]], abdominal pain, and sometimes [[hiccups]].<ref name=Hun2012/><ref name="Brown2017">{{Cite journal |vauthors=Brown CS, Mepham S, Shorten RJ |date=June 2017 |title=Ebola Virus Disease: An Update on Epidemiology, Symptoms, Laboratory Findings, Diagnostic Issues, and Infection Prevention and Control Issues for Laboratory Professionals |journal=Clinical Laboratory Medicine |type=Review |volume=37 |issue=2 |pages=269–284 |doi=10.1016/j.cll.2017.01.003 |pmid=28457350}}</ref> The combination of severe vomiting and diarrhoea often leads to severe [[dehydration]].<ref name="Sharma2015">{{Cite journal |vauthors=Sharma N, Cappell MS |date=September 2015 |title=Gastrointestinal and Hepatic Manifestations of Ebola Virus Infection |journal=Digestive Diseases and Sciences |type=Review |volume=60 |issue=9 |pages=2590–2603 |doi=10.1007/s10620-015-3691-z |pmid=25972150 |s2cid=5674317|doi-access=free }}</ref> Next, [[shortness of breath]] and [[chest pain]] may occur, along with [[oedema|swelling]], [[headaches]], and [[decreased level of consciousness|confusion]].<ref name=Hun2012/> 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.<ref name="Goeijenbier2014" /><ref name="Hoenen2006" /> ===Bleeding=== In some cases, internal and external bleeding may occur.<ref name="WHO2014" /> This typically begins five to seven days after the first symptoms.<ref name="urlwhqlibdoc.who.int">{{Cite book |title=Marburg and Ebola virus infections: a guide for their diagnosis, management, and control |vauthors=Simpson DI |publisher=World Health Organization |year=1977 |isbn=924170036X |page=10f |hdl=10665/37138 |id=WHO offset publication; no. 36 |hdl-access=free}}</ref> All infected people show some [[bleeding disorder|decreased blood clotting]].<ref name="Hoenen2006" /> Bleeding from mucous membranes or from sites of needle punctures has been reported in 40–50% of cases.<ref>{{Cite web | vauthors = King JW, Rafeek H | date = 14 January 2021 | veditors = Chandrasekar PH |title=Ebola Virus, Clinical Presentation |url=http://emedicine.medscape.com/article/216288-clinical#showall |url-status=live |archive-url=https://web.archive.org/web/20120101205843/http://emedicine.medscape.com/article/216288-clinical#showall |archive-date=1 January 2012 |access-date=30 July 2012 |publisher=Medscape }}</ref> This may cause [[haematemesis|vomiting blood]], [[haemoptysis|coughing up of blood]], or [[blood in stool]].<ref>{{Cite web |title=Appendix A: Disease-Specific Chapters – Chapter: Hemorrhagic fevers caused by: i) Ebola virus and ii) Marburg virus and iii) Other viral causes including bunyaviruses, arenaviruses, and flaviviruses |url=http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/hemorrhagic_fevers_chapter.pdf |url-status=live |archive-url=https://web.archive.org/web/20141015081924/http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/hemorrhagic_fevers_chapter.pdf |archive-date=15 October 2014 |access-date=9 October 2014 |publisher=[[Ministry of Health and Long-Term Care]]}}</ref> Bleeding into the skin may create [[petechia]]e, [[purpura]], [[Ecchymosis|ecchymoses]] or [[haematoma]]s (especially around needle injection sites).<ref name="Feldmann2011" /> [[Subconjunctival haemorrhage|Bleeding into the whites of the eyes]] may also occur.<ref name="ShanthaEye2016">{{cite journal | vauthors = Shantha JG, Yeh S, Nguyen QD | title = Ebola virus disease and the eye | journal = Current Opinion in Ophthalmology | volume = 27 | issue = 6 | pages = 538–544 | date = November 2016 | pmid = 27585217 | doi = 10.1097/ICU.0000000000000313 | type = Review | s2cid = 34367099 }}</ref> Heavy bleeding is uncommon; if it occurs, it is usually in the [[gastrointestinal tract]].<ref name="West2014">{{cite journal | vauthors = West TE, von Saint André-von Arnim A | title = Clinical presentation and management of severe Ebola virus disease | journal = Annals of the American Thoracic Society | volume = 11 | issue = 9 | pages = 1341–1350 | date = November 2014 | pmid = 25369317 | doi = 10.1513/AnnalsATS.201410-481PS | type = Review }}</ref> The incidence of bleeding into the gastrointestinal tract was reported to be ~58% in the 2001 outbreak in Gabon,<ref>{{cite journal | vauthors = Sharma N, Cappell MS | title = Gastrointestinal and Hepatic Manifestations of Ebola Virus Infection | journal = Digestive Diseases and Sciences | volume = 60 | issue = 9 | pages = 2590–2603 | date = September 2015 | pmid = 25972150 | doi = 10.1007/s10620-015-3691-z | s2cid = 5674317 | doi-access = free }}</ref> but in the 2014–15 outbreak in the US it was ~18%,<ref>{{Cite web |date=6 January 2020 |title=Ebola virus disease Information for Clinicians in U.S. Healthcare Settings {{!}} For Clinicians {{!}} Ebola (Ebola Virus Disease) {{!}} Ebola Hemorrhagic Fever {{!}} CDC |url=https://www.cdc.gov/vhf/ebola/clinicians/evd/clinicians.html |access-date=22 March 2020 |website=www.cdc.gov |language=en-us}}</ref> possibly due to improved prevention of [[disseminated intravascular coagulation]].<ref name="Sharma2015" /> ===Recovery or death=== Recovery may begin between seven and 14 days after first symptoms.<ref name=Hun2012/> Death, if it occurs, follows typically six to sixteen days from first symptoms and is often due to [[hypovolemic shock|shock from fluid loss]].<ref name=Ruz2014/> In general, bleeding often indicates a worse outcome, and blood loss may result in death.<ref name="Gatherer 2014" /> People are often in a [[coma]] near the end of life.<ref name=Hun2012/> Those who survive often have ongoing muscular and joint pain, [[hepatitis|liver inflammation]], and decreased hearing, and may have continued tiredness, continued weakness, decreased appetite, and difficulty returning to pre-illness weight.<ref name="Hun2012" /><ref name="Tosh2014" /> Problems with vision may develop.<ref>{{Cite web |date=7 August 2015 |title=An emergency within an emergency: caring for Ebola survivors |url=https://www.afro.who.int/news/emergency-within-emergency-caring-ebola-survivors |url-status=live |archive-url=https://web.archive.org/web/20150813163313/https://www.afro.who.int/en/sierra-leone/press-materials/item/7908-an-emergency-within-an-emergency-caring-for-ebola-survivors.html |archive-date=13 August 2015 |access-date=12 August 2015 |publisher=[[World Health Organization]] (WHO)}}</ref> It is recommended that survivors of EVD wear condoms for at least twelve months after initial infection or until the semen of a male survivor tests negative for Ebola virus on two separate occasions.<ref>{{Cite web |title=Ebola Virus Disease |url=https://srhd.org/health-topics/diseases-conditions/ebola |access-date=15 September 2020 |website=SRHD |language=en-US}}</ref> Survivors develop [[antibodies]] against Ebola that last at least 10 years, but it is unclear whether they are immune to additional infections.<ref name="CDC2014QAT" /> ==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).<ref name="Hoenen2012" /> EBOV, species ''[[Zaire ebolavirus]]'', is the most dangerous of the known EVD-causing viruses, and is responsible for the largest number of outbreaks.<ref name="KuhnArch">{{Cite journal |display-authors=6 |vauthors=Kuhn JH, Becker S, Ebihara H, Geisbert TW, Johnson KM, Kawaoka Y, Lipkin WI, Negredo AI, Netesov SV, Nichol ST, Palacios G, Peters CJ, Tenorio A, Volchkov VE, Jahrling PB |date=December 2010 |title=Proposal for a revised taxonomy of the family Filoviridae: Classification, names of taxa and viruses, and virus abbreviations |journal=Archives of Virology |volume=155 |issue=12 |pages=2083–2103 |doi=10.1007/s00705-010-0814-x |pmc=3074192 |pmid=21046175}}</ref> The fifth and sixth viruses, [[Reston virus]] (RESTV) and [[Bombali ebolavirus|Bombali virus]] (BOMV),<ref>{{Cite web | vauthors = Branswell H |date=27 July 2018 |title=New Ebola species is reported for first time in a decade |url=https://www.statnews.com/2018/07/27/ebola-virus-discovery/ |access-date=8 July 2022 |website=[[Stat (website)|Stat]] |language=en-US}}</ref> are not thought to cause disease in humans, but have caused disease in other primates.<ref name="Spickler">{{Cite web | vauthors = Spickler A |title=Ebolavirus and Marburgvirus Infections |url=http://www.cfsph.iastate.edu/Factsheets/pdfs/viral_hemorrhagic_fever_filovirus.pdf |url-status=live |archive-url=https://web.archive.org/web/20150430165458/http://www.cfsph.iastate.edu/Factsheets/pdfs/viral_hemorrhagic_fever_filovirus.pdf |archive-date=30 April 2015}}</ref><ref>{{Cite web |title=About Ebola Virus Disease |url=https://www.cdc.gov/vhf/ebola/about.html |url-status=live |archive-url=https://web.archive.org/web/20141016080233/https://www.cdc.gov/vhf/ebola/about.html |archive-date=16 October 2014 |access-date=18 October 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> All five viruses are closely related to [[marburgvirus]]es.<ref name="Hoenen2012" /> ===Virology=== {{Main|Ebolavirus|l1=''Ebolavirus'' (taxonomic group)|Ebola virus|l2=Ebola virus (specific virus)}} [[File:Ebola virus virion.jpg|thumb|[[Electron micrograph]] of an Ebola virus [[virion]]]] Ebolaviruses contain single-stranded, non-infectious [[RNA]] [[genome]]s.<ref name="Fauquet2005">{{Cite book | vauthors = Pringle CR |title=Virus Taxonomy – Eighth Report of the International Committee on Taxonomy of Viruses |publisher=Elsevier/Academic Press |year=2005 |isbn=978-0-12-370200-5 | veditors = Fauquet CM, Mayo MA, Maniloff J, Desselberger U, Ball LA |location=San Diego |pages=609–614 |chapter=Order Mononegavirales }}</ref> ''Ebolavirus'' genomes contain seven [[gene]]s including [[Three prime untranslated region|3'-UTR]]-''NP''-''VP35''-''VP40''-''GP''-''VP30''-''VP24''-''L''-[[Five prime untranslated region|5'-UTR]].<ref name="Feldmann2011" /><ref name="Stahelin2014">{{Cite journal |vauthors=Stahelin RV |date=June 2014 |title=Membrane binding and bending in Ebola VP40 assembly and egress |journal=Front Microbiol |volume=5 |page=300 |doi=10.3389/fmicb.2014.00300 |pmc=4061899 |pmid=24995005 |doi-access=free}}</ref> The genomes of the five different ebolaviruses (BDBV, EBOV, RESTV, SUDV and TAFV) differ in [[nucleic acid sequence|sequence]] and the number and location of gene overlaps. As with all [[filovirus]]es, 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.<ref name="Stahelin2014" /><ref>{{Cite journal |display-authors=6 |vauthors=Ascenzi P, Bocedi A, Heptonstall J, Capobianchi MR, Di Caro A, Mastrangelo E, Bolognesi M, Ippolito G |date=June 2008 |title=Ebolavirus and Marburgvirus: insight the Filoviridae family |url=https://air.unimi.it/retrieve/handle/2434/53604/1077822/Ebola_2008%29_Proofs.pdf |journal=Mol Aspects Med |volume=29 |issue=3 |pages=151–185 |doi=10.1016/j.mam.2007.09.005 |pmid=18063023 |hdl-access=free |hdl=2434/53604}}</ref> In general, ebolavirions are 80 nanometers (nm) in width and may be as long as 14,000 nm.<ref name="Chippaux2014">{{Cite journal |vauthors=Chippaux JP |date=October 2014 |title=Outbreaks of Ebola virus disease in Africa: the beginnings of a tragic saga |journal=J Venom Anim Toxins Incl Trop Dis |volume=20 |issue=1 |page=44 |doi=10.1186/1678-9199-20-44 |pmc=4197285 |pmid=25320574 |doi-access=free }}</ref> Their [[Biological life cycle|life cycle]] is thought to begin with a virion attaching to specific [[Cell surface receptor|cell-surface receptors]] such as [[C-type lectin]]s, [[DC-SIGN]], or [[integrin]]s, which is followed by fusion of the [[Pinocytosis|viral envelope with cellular membranes]].<ref name="Misasi2014">{{Cite journal |vauthors=Misasi J, Sullivan NJ |date=October 2014 |title=Camouflage and Misdirection: The Full-On Assault of Ebola Virus Disease |journal=Cell |volume=159 |issue=3 |pages=477–486 |doi=10.1016/j.cell.2014.10.006 |pmc=4243531 |pmid=25417101}}</ref> The virions taken up by the cell then travel to acidic [[endosome]]s and [[lysosome]]s where the viral envelope glycoprotein GP is cleaved.<ref name="Misasi2014" /> 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]].<ref name="Misasi2014" /> The ''Ebolavirus'' structural glycoprotein (known as GP1,2) is responsible for the virus' ability to bind to and infect targeted cells.<ref name="Kuhl2012">{{Cite journal |vauthors=Kühl A, Pöhlmann S |date=September 2012 |title=How Ebola virus counters the interferon system |journal=Zoonoses Public Health |volume=59 |issue=Supplement 2 |pages=116–131 |doi=10.1111/j.1863-2378.2012.01454.x |pmc=7165950 |pmid=22958256}}</ref> The viral [[RNA-dependent RNA polymerase|RNA polymerase]], encoded by the ''L'' gene, partially uncoats the nucleocapsid and [[Transcription (genetics)|transcribes]] the genes into positive-strand [[mRNA]]s, which are then [[translation (biology)|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.<ref name="Olejnik2011" /> Newly synthesised structural proteins and genomes self-assemble and accumulate near the inside of the [[cell membrane]]. Virions [[Budding|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.<ref name="Feldmann2005">{{Cite book | vauthors = Feldmann H, Geisbert TW, Jahrling PB, Klenk H, Netesov SV, Peters CJ, Sanchez A, Swanepoel R, Volchkov VE |title=Virus Taxonomy – Eighth Report of the International Committee on Taxonomy of Viruses | publisher=Elsevier/Academic Press |year=2005 |isbn=978-0123702005 | veditors = Fauquet CM, Mayo MA, Maniloff J, Desselberger U, Ball LA }}</ref> ===Transmission=== [[File:EbolaCycle.png|thumb|upright=1.8|Life cycles of the ''[[Ebolavirus]]'']] [[File:Ebola illustration- safe burial (15573264517).jpg|thumb|An illustration of safe burial practices]] <!-- Between people --> It is believed that between people, Ebola disease spreads only by direct contact with the blood or other [[body fluid]]s of a person who has developed symptoms of the disease.<ref name="Funk2014" /><ref>{{Cite web |date=5 November 2014 |title=Ebola (Ebola Virus Disease) Transmission |url=https://www.cdc.gov/vhf/ebola/transmission/index.html |url-status=live |archive-url=https://web.archive.org/web/20141106022141/https://www.cdc.gov/vhf/ebola/transmission/index.html |archive-date=6 November 2014 |access-date=7 November 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref><ref name="Drazen2014">{{Cite journal |vauthors=Drazen JM, Kanapathipillai R, Campion EW, Rubin EJ, Hammer SM, Morrissey S, Baden LR |date=November 2014 |title=Ebola and quarantine |journal=N Engl J Med |volume=371 |issue=21 |pages=2029–2030 |doi=10.1056/NEJMe1413139 |pmid=25347231|doi-access=free }}</ref> Body fluids that may contain Ebola viruses include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and [[semen]].<ref name=cdc9months/><ref name=CDC2014QAT/> 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.<ref>{{Cite news | vauthors = McNeil Jr DG |author-link=Donald McNeil Jr. |name-list-style=vanc |date=3 October 2014 |title=Ask Well: How Does Ebola Spread? How Long Can the Virus Survive? |work=[[The New York Times]] |url=http://well.blogs.nytimes.com/2014/10/03/ebola-ask-well-spread-public-transit/ |url-status=live |access-date=24 October 2014 |archive-url=https://web.archive.org/web/20141024061521/http://well.blogs.nytimes.com/2014/10/03/ebola-ask-well-spread-public-transit/ |archive-date=24 October 2014 }}</ref> Entry points for the virus include the nose, mouth, eyes, open wounds, cuts and abrasions.<ref name="CDC2014QAT">{{Cite web |date=September 2014 |title=Q&A on Transmission, Ebola |url=https://www.cdc.gov/vhf/ebola/transmission/qas.html |url-status=live |archive-url=https://web.archive.org/web/20141002210702/https://www.cdc.gov/vhf/ebola/transmission/qas.html |archive-date=2 October 2014 |access-date=3 October 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> Ebola may be spread through large [[Transmission (medicine)#Droplet|droplets]]; however, this is believed to occur only when a person is very sick.<ref name="CDCNOV2014">{{Cite web |date=1 November 2014 |title=How Ebola Is Spread |url=https://www.cdc.gov/vhf/ebola/pdf/infections-spread-by-air-or-droplets.pdf |url-status=live |archive-url=https://web.archive.org/web/20170708092027/https://www.cdc.gov/vhf/ebola/pdf/infections-spread-by-air-or-droplets.pdf |archive-date=8 July 2017 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> This contamination can happen if a person is splashed with droplets.<ref name=CDCNOV2014/> Contact with surfaces or objects contaminated by the virus, particularly needles and syringes, may also transmit the infection.<ref name=CDC2014T/><ref name="Chowell2014" /> 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.<ref name=CDC2014QAT/><ref name=Ost2015/> 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]].<ref name=cdc9months/><ref>{{Cite web |date=4 April 2015 |title=Sexual transmission of the Ebola Virus : evidence and knowledge gaps |url=https://www.who.int/reproductivehealth/topics/rtis/ebola-virus-semen/en/ |url-status=live |archive-url=https://web.archive.org/web/20150414084657/https://www.who.int/reproductivehealth/topics/rtis/ebola-virus-semen/en/ |archive-date=14 April 2015 |access-date=16 April 2015 |publisher=[[World Health Organization]] (WHO)}}</ref><ref>{{Cite news | vauthors = Wu B |date=2 May 2015 |title=Ebola Can Be Transmitted Through Sex |work=Science Times |url=http://www.sciencetimes.com/articles/6000/20150502/ebola-transmitted-through-sex.htm |url-status=live |access-date=3 May 2015 |archive-url=https://web.archive.org/web/20150502222419/http://www.sciencetimes.com/articles/6000/20150502/ebola-transmitted-through-sex.htm |archive-date=2 May 2015}}</ref> Virus persistence in semen for over a year has been recorded in a national screening programme.<ref>{{Cite journal |display-authors=6 |vauthors=Soka MJ, Choi MJ, Baller A, White S, Rogers E, Purpura LJ, Mahmoud N, Wasunna C, Massaquoi M, Abad N, Kollie J, Dweh S, Bemah PK, Christie A, Ladele V, Subah OC, Pillai S, Mugisha M, Kpaka J, Kowalewski S, German E, Stenger M, Nichol S, Ströher U, Vanderende KE, Zarecki SM, Green HH, Bailey JA, Rollin P, Marston B, Nyenswah TG, Gasasira A, Knust B, Williams D |year=2016 |title=Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors: an analysis of Ebola virus RNA results and behavioural data |journal=Lancet Global Health |volume=4 |issue=10 |pages=e736–e743 |doi=10.1016/S2214-109X(16)30175-9 |pmid=27596037 |doi-access=free}}</ref> Ebola may also occur in the breast milk of women after recovery, and it is not known when it is safe to breastfeed again.<ref name=CDCBreast2014/> The virus was also found in the eye of one patient in 2014, two months after it was cleared from his blood.<ref>{{Cite journal |display-authors=6 |vauthors=Varkey JB, Shantha JG, Crozier I, Kraft CS, Lyon GM, Mehta AK, Kumar G, Smith JR, Kainulainen MH, Whitmer S, Ströher U, Uyeki TM, Ribner BS, Yeh S |date=7 May 2015 |title=Persistence of Ebola Virus in Ocular Fluid during Convalescence |journal=The New England Journal of Medicine |volume=372 |issue=25 |pages=2423–227 |doi=10.1056/NEJMoa1500306 |pmc=4547451 |pmid=25950269 |hdl=2328/35704}}</ref> Otherwise, people who have recovered are not infectious.<ref name=CDC2014T/> The potential for [[pandemics|widespread infections]] in countries with medical systems capable of observing correct medical isolation procedures is considered low.<ref name="CDCPress2014">{{Cite web |date=28 July 2014 |title=CDC Telebriefing on Ebola outbreak in West Africa |url=https://www.cdc.gov/media/releases/2014/t0728-ebola.html |url-status=live |archive-url=https://web.archive.org/web/20140802025607/https://www.cdc.gov/media/releases/2014/t0728-ebola.html |archive-date=2 August 2014 |access-date=3 August 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> Usually when someone has symptoms of the disease, they are unable to travel without assistance.<ref name="WHO2014T">{{Cite web |date=14 August 2014 |title=Air travel is low-risk for Ebola transmission |url=https://www.who.int/mediacentre/news/notes/2014/ebola-travel/en/ |url-status=dead |archive-url=https://web.archive.org/web/20150119231747/https://www.who.int/mediacentre/news/notes/2014/ebola-travel/en/ |archive-date=19 January 2015 |publisher=[[World Health Organization]] (WHO)}}</ref> <!-- Dead bodies --> 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.<ref name=CDCPress2014/> 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.<ref name="Chan2014">{{Cite journal |vauthors=Chan M |date=September 2014 |title=Ebola virus disease in West Africa – no early end to the outbreak |journal=N Engl J Med |volume=371 |issue=13 |pages=1183–1185 |doi=10.1056/NEJMp1409859 |pmid=25140856|doi-access=free }}</ref><ref>{{Cite web |title=Sierra Leone: a traditional healer and a funeral |url=https://www.who.int/csr/disease/ebola/ebola-6-months/sierra-leone/en/ |url-status=dead |archive-url=https://web.archive.org/web/20141006082559/https://www.who.int/csr/disease/ebola/ebola-6-months/sierra-leone/en/ |archive-date=6 October 2014 |access-date=6 October 2014 |publisher=[[World Health Organization]] (WHO) }}</ref> <!-- Hospitals --> Health-care workers treating people with Ebola are at greatest risk of infection.<ref name="CDC2014T">{{Cite web |date=17 October 2014 |title=Transmission |url=https://www.cdc.gov/vhf/ebola/transmission/ |url-status=live |archive-url=https://web.archive.org/web/20141019024316/https://www.cdc.gov/vhf/ebola/transmission/ |archive-date=19 October 2014 |access-date=18 October 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> 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.<ref name=CDC2014T/> This risk is particularly common in parts of Africa where the disease mostly occurs and health systems function poorly.<ref>{{Cite web | vauthors = Salaam-Blyther T |date=26 August 2014 |title=The 2014 Ebola Outbreak: International and U.S. Responses |url=https://fas.org/sgp/crs/row/R43697.pdf |url-status=live |archive-url=https://web.archive.org/web/20140903122230/http://fas.org/sgp/crs/row/R43697.pdf |archive-date=3 September 2014 |access-date=9 September 2014}}</ref> There has been transmission [[nosocomial|in hospitals]] in some African countries that reuse hypodermic needles.<ref>{{Cite book |url=https://books.google.com/books?id=fsaWlKQ4OjcC&pg=PA141 |title=Emerging infectious diseases trends and issues |date=2007 |publisher=Springer |isbn=978-0826103505 | veditors = Lashley FR, Durham JD |edition=2nd |location=New York |page=141 |archive-url=https://web.archive.org/web/20160509224252/https://books.google.com/books?id=fsaWlKQ4OjcC&pg=PA141 |archive-date=9 May 2016 |url-status=live}}</ref><ref>{{Cite book |url=https://books.google.com/books?id=x15umovaD08C&pg=PA170 |title=Hunter's tropical medicine and emerging infectious disease |publisher=Elsevier |year=2013 |isbn=978-1455740437 | veditors = Magill AJ, Strickland GT, Maguire JH, Ryan ET, Solomon T |edition=9th |location=London; New York |pages=170–172 |oclc=822525408 |archive-url=https://web.archive.org/web/20160520120141/https://books.google.com/books?id=x15umovaD08C&pg=PA170 |archive-date=20 May 2016 |url-status=live}}</ref> Some health-care centres caring for people with the disease do not have running water.<ref name="CDCQA2014">{{Cite web |date=22 May 2018 |title=Questions and Answers on Ebola Hemorrhagic Fever |url=https://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa.html |url-status=live |archive-url=https://web.archive.org/web/20170728032458/https://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa.html |archive-date=28 July 2017 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> In the United States the spread to two medical workers treating infected patients prompted criticism of inadequate training and procedures.<ref name="NBC-ebolaTX">{{Cite web |date=15 October 2014 |title=Ebola in Texas: Second Health Care Worker Tests Positive |url=https://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-texas-second-health-care-worker-tests-positive-n226161 |url-status=live |archive-url=https://web.archive.org/web/20141015211852/http://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-texas-second-health-care-worker-tests-positive-n226161 |archive-date=15 October 2014 |website=NBC News}}</ref> <!-- Air, water, insects --> Human-to-human transmission of EBOV through the air has not been reported to occur during EVD outbreaks,<ref name=WHOAir2014/> 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.<ref name="Funk2014" /><ref name="Chowell2014" /> Spread of EBOV by water, or food other than bushmeat, has not been observed.<ref name=CDC2014T/><ref name="Chowell2014" /> No spread by mosquitos or other insects has been reported.<ref name=CDC2014T/> Other possible methods of transmission are being studied.<ref name="Ost2015">{{Cite journal |display-authors=6 |vauthors=Osterholm MT, Moore KA, Kelley NS, Brosseau LM, Wong G, Murphy FA, Peters CJ, LeDuc JW, Russell PK, Van Herp M, Kapetshi J, Muyembe JJ, Ilunga BK, Strong JE, Grolla A, Wolz A, Kargbo B, Kargbo DK, Sanders DA, Kobinger GP |date=19 February 2015 |title=Transmission of Ebola viruses: what we know and what we do not know |journal=mBio |volume=6 |issue=2 |pages=e00137 |doi=10.1128/mBio.00137-15 |pmc=4358015 |pmid=25698835}}</ref> 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.<ref name="Jones2015">{{Cite journal |vauthors=Jones RM, Brosseau LM |date=May 2015 |title=Aerosol transmission of infectious disease |journal=Journal of Occupational and Environmental Medicine |type=Review |volume=57 |issue=5 |pages=501–508 |doi=10.1097/JOM.0000000000000448 |pmid=25816216 |s2cid=11166016}}</ref> 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.<ref name="virology1">{{Cite web |date=27 September 2014 |title=Transmission of Ebola virus |url=http://www.virology.ws/2014/09/27/transmission-of-ebola-virus/ |url-status=live |archive-url=https://web.archive.org/web/20160129111738/http://www.virology.ws/2014/09/27/transmission-of-ebola-virus/ |archive-date=29 January 2016 |access-date=22 January 2016 |website=virology.ws}}</ref> Therefore, pigs with EVD can spread the disease through droplets in the air or on the ground when they sneeze or cough.<ref name="sb1">{{Cite journal |vauthors=Weingartl HM, Embury-Hyatt C, Nfon C, Leung A, Smith G, Kobinger G |date=2012 |title=Transmission of Ebola virus from pigs to non-human primates |journal=Scientific Reports |volume=2 |page=811 |bibcode=2012NatSR...2E.811W |doi=10.1038/srep00811 |pmc=3498927 |pmid=23155478}}</ref> By contrast, humans and other primates accumulate the virus throughout their body and specifically in their blood, but not very much in their lungs.<ref name="sb1" /> 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.<ref name="virology1" /><ref name="sb1" /> ===Initial case=== <!-- Animals to humans --> [[File:Bushmeat - Buschfleisch Ghana.JPG|thumb|[[Bushmeat]] having been smoked in [[Ghana]]. In Africa, wild animals including fruit bats are hunted for food and are referred to as bushmeat.<ref name="CDC2014Bush">{{Cite web |date=12 October 2014 |title=Risk of Exposure |url=https://www.cdc.gov/vhf/ebola/exposure/index.html |url-status=live |archive-url=https://web.archive.org/web/20141016205158/https://www.cdc.gov/vhf/ebola/exposure/index.html |archive-date=16 October 2014 |access-date=18 October 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref><ref>{{Cite web |date=21 July 2014 |title=FAO warns of fruit bat risk in West African Ebola epidemic |url=http://www.fao.org/news/story/en/item/239123/icode/ |url-status=live |archive-url=https://web.archive.org/web/20141013151812/http://www.fao.org/news/story/en/item/239123/icode/ |archive-date=13 October 2014 |access-date=22 October 2014 |website=fao.org}}</ref> In equatorial Africa, human consumption of bushmeat has been linked to animal-to-human transmission of diseases, including Ebola.<ref name="urlAfrican monkey meat that could be behind the next HIV – Health News – Health & Families – The Independent">{{Cite news | vauthors = Williams E |title=African monkey meat that could be behind the next HIV |work=[[The Independent]] |url=https://www.independent.co.uk/life-style/health-and-families/health-news/african-monkey-meat-that-could-be-behind-the-next-hiv-7786152.html |url-status=live |archive-url=https://web.archive.org/web/20170622133307/http://www.independent.co.uk/life-style/health-and-families/health-news/african-monkey-meat-that-could-be-behind-the-next-hiv-7786152.html |archive-date=22 June 2017 |quote=25 people in Bakaklion, Cameroon killed due to eating of ape }}</ref>]] 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.<ref name=CDC2014T/> Besides bats, other wild animals that are sometimes infected with EBOV include several species of monkeys such as [[baboon]]s, [[great apes]] ([[chimpanzee]]s and [[gorilla]]s), and [[duikers]] (a species of [[antelope]]).<ref name="urlEbolavirus – Pathogen Safety Data Sheets">{{Cite web |date=17 September 2001 |title=Ebolavirus – Pathogen Safety Data Sheets |url=http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php |url-status=live |archive-url=https://web.archive.org/web/20140820211755/http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php |archive-date=20 August 2014 |access-date=22 August 2014 |publisher=Public Health Agency of Canada }}</ref> Animals may become infected when they eat fruit partially eaten by bats carrying the virus.<ref name=Gon2007/> Fruit production, animal behavior and other factors may trigger outbreaks among animal populations.<ref name="Gon2007">{{Cite book |title=Wildlife and Emerging Zoonotic Diseases: The Biology, Circumstances and Consequences of Cross-Species Transmission |vauthors=Gonzalez JP, Pourrut X, Leroy E |work=Current Topics in Microbiology and Immunology |year=2007 |isbn=978-3540709619 |series=Ebolavirus and other filoviruses |volume=315 |pages=363–387 |chapter=Ebolavirus and Other Filoviruses |doi=10.1007/978-3-540-70962-6_15 |pmc=7121322 |pmid=17848072}}</ref> Evidence indicates that both domestic dogs and pigs can also be infected with EBOV.<ref name="Weingartl_2013">{{Cite book |title=Vaccines and Diagnostics for Transboundary Animal Diseases |vauthors=Weingartl HM, Nfon C, Kobinger G |chapter=Review of Ebola Virus Infections in Domestic Animals |date=May 2013 |work=Dev Biol |isbn=978-3318023657 |series=Developments in Biologicals |volume=135 |pages=211–218 |doi=10.1159/000178495 |pmid=23689899 |author-link3=Gary Kobinger}}</ref> 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.<ref name="Weingartl_2013" /> 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.<ref name="Weingartl_2013" /> ===Reservoir=== The [[natural reservoir]] for Ebola has yet to be confirmed; however, [[bat]]s are considered to be the most likely candidate.<ref name="Chowell2014">{{Cite journal |vauthors=Chowell G, Nishiura H |date=October 2014 |title=Transmission dynamics and control of Ebola virus disease (EVD): a review |journal=BMC Med |volume=12 |issue=1 |page=196 |doi=10.1186/s12916-014-0196-0 |pmc=4207625 |pmid=25300956 |doi-access=free }}</ref> Three types of fruit bats (''[[Hypsignathus monstrosus]]'', ''[[Epomops franqueti]]'' and ''[[Myonycteris torquata]]'') were found to possibly carry the virus without getting sick.<ref>{{Cite journal |vauthors=Laupland KB, Valiquette L |date=May 2014 |title=Ebola virus disease |journal=Can J Infect Dis Med Microbiol |volume=25 |issue=3 |pages=128–129 |doi=10.1155/2014/527378 |pmc=4173971 |pmid=25285105 |doi-access=free}}</ref> {{As of|2013}}, whether other animals are involved in its spread is not known.<ref name="Weingartl_2013" /> Plants, [[arthropod]]s, [[rodent]]s, and birds have also been considered possible viral reservoirs.<ref name=WHO2014/><ref name="Sharma2015" /> Bats were known to roost in the cotton factory in which the [[index case|first case]]s of the 1976 and 1979 outbreaks were observed, and they have also been implicated in Marburg virus infections in 1975 and 1980.<ref name="Pourrut2005" /> Of 24 plant and 19 vertebrate species experimentally inoculated with EBOV, only bats became infected.<ref>{{Cite journal |display-authors=6 |vauthors=Swanepoel R, Leman PA, Burt FJ, Zachariades NA, Braack LE, Ksiazek TG, Rollin PE, Zaki SR, Peters CJ |date=October 1996 |title=Experimental inoculation of plants and animals with Ebola virus |journal=Emerg. Infect. Dis. |volume=2 |issue=4 |pages=321–325 |doi=10.3201/eid0204.960407 |issn=1080-6040 |pmc=2639914 |pmid=8969248}}</ref> 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.<ref>{{Cite journal |display-authors=6 |vauthors=Leroy EM, Kumulungui B, Pourrut X, Rouquet P, Hassanin A, Yaba P, Délicat A, Paweska JT, Gonzalez JP, Swanepoel R |date=December 2005 |title=Fruit bats as reservoirs of Ebola virus |journal=Nature |volume=438 |issue=7068 |pages=575–576 |bibcode=2005Natur.438..575L |doi=10.1038/438575a |pmid=16319873 |s2cid=4403209}}</ref> 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.<ref name="Olival2013">{{Cite journal |display-authors=6 |vauthors=Olival KJ, Islam A, Yu M, Anthony SJ, Epstein JH, Khan SA, Khan SU, Crameri G, Wang LF, Lipkin WI, Luby SP, Daszak P |date=February 2013 |title=Ebola virus antibodies in fruit bats, Bangladesh |journal=Emerg. Infect. Dis. |volume=19 |issue=2 |pages=270–273 |doi=10.3201/eid1902.120524 |pmc=3559038 |pmid=23343532}}</ref> Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians and [[arthropod]]s 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]].<ref name="Pourrut2005">{{Cite journal |display-authors=6 |vauthors=Pourrut X, Kumulungui B, Wittmann T, Moussavou G, Délicat A, Yaba P, Nkoghe D, Gonzalez JP, Leroy EM |date=June 2005 |title=The natural history of Ebola virus in Africa |journal=Microbes Infect |volume=7 |issue=7–8 |pages=1005–1014 |doi=10.1016/j.micinf.2005.04.006 |pmid=16002313|doi-access=free }}</ref><ref name="Morvan1999">{{Cite journal |display-authors=6 |vauthors=Morvan JM, Deubel V, Gounon P, Nakouné E, Barrière P, Murri S, Perpète O, Selekon B, Coudrier D, Gautier-Hion A, Colyn M, Volehkov V |date=December 1999 |title=Identification of Ebola virus sequences present as RNA or DNA in organs of terrestrial small mammals of the Central African Republic |journal=Microbes and Infection |volume=1 |issue=14 |pages=1193–1201 |doi=10.1016/S1286-4579(99)00242-7 |pmid=10580275}}</ref> However, further research efforts have not confirmed rodents as a reservoir.<ref name="Groseth2007">{{Cite journal |vauthors=Groseth A, Feldmann H, Strong JE |date=September 2007 |title=The ecology of Ebola virus |journal=Trends Microbiol |volume=15 |issue=9 |pages=408–416 |doi=10.1016/j.tim.2007.08.001 |pmid=17698361}}</ref> 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.<ref name="Pourrut2005" /> [[Deforestation in the Democratic Republic of the Congo|Deforestation]] has been mentioned as a possible contributor to recent outbreaks, including the [[West African Ebola virus epidemic]]. Index cases of EVD have often been close to recently deforested lands.<ref>{{Cite web |date=10 April 2018 |title=Did deforestation cause the Ebola outbreak? |url=https://newint.org/features/web-exclusive/2018/04/10/deforestation-ebola-outbreak |access-date=10 July 2018 |website=New Internationalist}}</ref><ref>{{Cite journal |display-authors=6 |vauthors=Olivero J, Fa JE, Real R, Márquez AL, Farfán MA, Vargas JM, Gaveau D, Salim MA, Park D, Suter J, King S, Leendertz SA, Sheil D, Nasi R |date=30 October 2017 |title=Recent loss of closed forests is associated with Ebola virus disease outbreaks |journal=Scientific Reports |volume=7 |issue=1 |pages=14291 |bibcode=2017NatSR...714291O |doi=10.1038/s41598-017-14727-9 |issn=2045-2322 |pmc=5662765 |pmid=29085050}}</ref> ==Pathophysiology== [[File:Ebola Pathenogensis path.svg|thumb|[[Pathogenesis]] schematic]] Like other [[Filoviridae|filoviruses]], EBOV replicates very efficiently in many [[List of distinct cell types in the adult human body|cells]], producing large amounts of virus in [[monocyte]]s, [[macrophage]]s, [[dendritic cell]]s and other cells including [[hepatocyte|liver cells]], [[fibroblast]]s, and [[adrenal gland|adrenal gland cells]].<ref name="Ansari2014">{{Cite journal |vauthors=Ansari AA |date=September 2014 |title=Clinical features and pathobiology of Ebolavirus infection |journal=J Autoimmun |volume=55 |pages=1–9 |doi=10.1016/j.jaut.2014.09.001 |pmid=25260583}}</ref> Viral replication triggers [[cytokine storm|high levels of inflammatory chemical signals]] and leads to a [[Sepsis|septic state]].<ref name="Tosh2014">{{Cite journal |vauthors=Tosh PK, Sampathkumar P |date=December 2014 |title=What Clinicians Should Know About the 2014 Ebola Outbreak |journal=Mayo Clin Proc |volume=89 |issue=12 |pages=1710–17 |doi=10.1016/j.mayocp.2014.10.010 |pmid=25467644 |doi-access=free}}</ref> EBOV is thought to infect humans through contact with mucous membranes or skin breaks.<ref name="Funk2014">{{Cite journal |vauthors=Funk DJ, Kumar A |date=November 2014 |title=Ebola virus disease: an update for anesthesiologists and intensivists |journal=Can J Anaesth |volume=62 |issue=1 |pages=80–91 |doi=10.1007/s12630-014-0257-z |pmc=4286619 |pmid=25373801}}</ref> After infection, [[endothelial cells]] (cells lining the inside of blood vessels), liver cells, and several types of immune cells such as [[Mononuclear phagocyte system|macrophages, monocytes]], and dendritic cells are the main targets of attack.<ref name="Funk2014" /> Following infection, immune cells carry the virus to nearby [[lymph node]]s where further reproduction of the virus takes place.<ref name="Funk2014" /> From there the virus can enter the bloodstream and [[lymphatic system]] and spread throughout the body.<ref name="Funk2014" /> Macrophages are the first cells infected with the virus, and this infection results in [[Apoptosis|programmed cell death]].<ref name="Chippaux2014" /> Other types of [[white blood cell]]s, such as [[lymphocyte]]s, also undergo programmed cell death leading to an abnormally [[lymphocytopenia|low concentration of lymphocytes]] in the blood.<ref name="Funk2014" /> This contributes to the weakened immune response seen in those infected with EBOV.<ref name="Funk2014" /> Endothelial cells may be infected within three days after exposure to the virus.<ref name="Chippaux2014" /> The breakdown of endothelial cells leading to [[blood vessel]] injury can be attributed to EBOV [[glycoprotein]]s. This damage occurs due to the synthesis of Ebola virus [[glycoprotein]] (GP), which reduces the availability of specific [[integrin]]s responsible for cell adhesion to the intercellular structure and causes liver damage, leading to [[coagulopathy|improper clotting]]. The widespread [[bleeding]] that occurs in affected people causes [[oedema|swelling]] and [[Hypovolemic shock|shock due to loss of blood volume]].<ref name="isbn0-7910-8505-8" /> The [[Disseminated intravascular coagulation|dysfunctional bleeding and clotting]] commonly seen in EVD has been attributed to increased activation of the [[Tissue factor pathway|extrinsic pathway]] of the [[coagulation cascade]] due to excessive [[tissue factor]] production by macrophages and monocytes.<ref name="Goeijenbier2014" /> 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 [[Trimer (biochemistry)|trimeric complex]], which tethers the virus to the endothelial cells. The sGP forms a [[protein dimer|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.{{medcn|date=August 2019}} 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.<ref>{{cite journal | vauthors = Tang H, Abouleila Y, Saris A, Shimizu Y, Ottenhoff TH, Mashaghi A | title = Ebola virus-like particles reprogram cellular metabolism | journal = Journal of Molecular Medicine | volume = 101 | issue = 5 | pages = 557–568 | date = May 2023 | pmid = 36959259 | pmc = 10036248 | doi = 10.1007/s00109-023-02309-4 }}</ref> ===Immune system evasion=== Filoviral infection also interferes with proper functioning of the [[innate immune system]].<ref name="Misasi2014" /><ref name="Olejnik2011">{{Cite journal |vauthors=Olejnik J, Ryabchikova E, Corley RB, Mühlberger E |date=August 2011 |title=Intracellular events and cell fate in filovirus infection |journal=Viruses |volume=3 |issue=8 |pages=1501–31 |doi=10.3390/v3081501 |pmc=3172725 |pmid=21927676 |doi-access=free}}</ref> 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]].<ref name="Kuhl2012" /><ref name="Ramanan2011">{{Cite journal |vauthors=Ramanan P, Shabman RS, Brown CS, Amarasinghe GK, Basler CF, Leung DW |date=September 2011 |title=Filoviral immune evasion mechanisms |journal=Viruses |volume=3 |issue=9 |pages=1634–49 |doi=10.3390/v3091634 |pmc=3187693 |pmid=21994800 |doi-access=free}}</ref> 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|Toll-like receptor 3 (TLR3)]], [[Toll-like receptor 7|TLR7]], [[Toll-like receptor 8|TLR8]] and [[Toll-like receptor 9|TLR9]]) recognise [[pathogen-associated molecular pattern|infectious molecules]] associated with the virus.<ref name="Kuhl2012" /> On TLR activation, proteins including [[Interferon Regulatory Factor 3|interferon regulatory factor 3]] and [[Interferon regulatory factor-7|interferon regulatory factor 7]] trigger a signalling cascade that leads to the expression of [[type 1 interferon]]s.<ref name="Kuhl2012" /> The type 1 interferons are then released and bind to the [[IFNAR1]] and [[IFNAR2]] receptors expressed on the surface of a neighbouring cell.<ref name="Kuhl2012" /> Once interferon has bound to its receptors on the neighbouring cell, the signalling proteins [[STAT1]] and [[STAT2]] are activated and move to the [[Cell nucleus|cell's nucleus]].<ref name="Kuhl2012" /> This triggers the expression of [[Interferome|interferon-stimulated genes]], which code for proteins with antiviral properties.<ref name="Kuhl2012" /> 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.<ref name="Kuhl2012" /> The VP35 protein directly inhibits the production of interferon-beta.<ref name="Ramanan2011" /> By inhibiting these immune responses, EBOV may quickly spread throughout the body.<ref name="Chippaux2014" /> ==Diagnosis== When EVD is suspected, travel, work history, and exposure to wildlife are important factors with respect to further diagnostic efforts.<ref>{{Cite web |date=5 May 2021 |title=Screening Patients {{!}} For Clinicians {{!}} Ebola Virus Disease {{!}} CDC |url=https://www.cdc.gov/vhf/ebola/clinicians/evaluating-patients/index.html |access-date=20 September 2022 |website=www.cdc.gov |language=en-us}}</ref> ===Laboratory testing=== Possible non-specific laboratory indicators of EVD include a [[thrombocytopenia|low platelet count]]; an initially [[leucopenia|decreased white blood cell count]] followed by an [[leucocytosis|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]].<ref name="Kortepeter2011">{{Cite journal |vauthors=Kortepeter MG, Bausch DG, Bray M |date=November 2011 |title=Basic clinical and laboratory features of filoviral hemorrhagic fever |journal=J Infect Dis |volume=204 |issue=Supplement 3 |pages=S810–16 |doi=10.1093/infdis/jir299 |pmid=21987756 |doi-access=free }}</ref> Filovirions such as EBOV may be identified by their unique filamentous shapes in cell cultures examined with [[electron microscopy]].<ref name="Goldsmith2009">{{Cite journal |vauthors=Goldsmith CS, Miller SE |date=October 2009 |title=Modern uses of electron microscopy for detection of viruses |journal=Clinical Microbiology Reviews |type=Review |volume=22 |issue=4 |pages=552–63 |doi=10.1128/CMR.00027-09 |pmc=2772359 |pmid=19822888}}</ref> 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.<ref name=CDC2014Diag/> Isolating the virus by [[cell culture]], detecting the viral RNA by [[polymerase chain reaction]] (PCR)<ref name="Bro2016" /><ref name="Goeijenbier2014" /> 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.<ref name="Bro2016" /><ref name=CDC2014Diag/> Detecting antibodies against the virus is most reliable in the later stages of the disease and in those who recover.<ref name="CDC2014Diag">{{Cite web |date=28 January 2014 |title=Ebola Hemorrhagic Fever Diagnosis |url=https://www.cdc.gov/vhf/ebola/diagnosis/index.html |url-status=live |archive-url=https://web.archive.org/web/20140924150049/https://www.cdc.gov/vhf/ebola/diagnosis/index.html |archive-date=24 September 2014 |access-date=3 August 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> [[Immunoglobulin M|IgM antibodies]] are detectable two days after symptom onset and [[Immunoglobulin G|IgG antibodies]] can be detected six to 18 days after symptom onset.<ref name="Goeijenbier2014" /> 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.<ref name="Grolla2005">{{Cite journal |vauthors=Grolla A, Lucht A, Dick D, Strong JE, Feldmann H |date=September 2005 |title=Laboratory diagnosis of Ebola and Marburg hemorrhagic fever |journal=Bull Soc Pathol Exot |volume=98 |issue=3 |pages=205–09 |pmid=16267962}}</ref> In 2014, with new mobile testing facilities deployed in parts of Liberia, test results were obtained 3–5 hours after sample submission.<ref>{{Cite web |date=October 2014 |title=Liberia: New Ebola mobile lab speeds up diagnosis and improves care |url=https://www.who.int/features/2014/liberia-mobile-ebola-lab/en/ |url-status=dead |archive-url=https://web.archive.org/web/20141024235048/http://who.int/features/2014/liberia-mobile-ebola-lab/en/ |archive-date=24 October 2014 |access-date=26 October 2014 |publisher=[[World Health Organization]] (WHO)}}</ref> In 2015, a rapid antigen test which gives results in 15 minutes was approved for use by WHO.<ref name=WHO2015Test/> It is able to confirm Ebola in 92% of those affected and rule it out in 85% of those not affected.<ref name="WHO2015Test">{{Cite web |title=First Antigen Rapid Test for Ebola through Emergency Assessment and Eligible for Procurement |url=https://www.who.int/medicines/ebola-treatment/1st_antigen_RT_Ebola/en/ |url-status=dead |archive-url=https://web.archive.org/web/20150220203131/https://www.who.int/medicines/ebola-treatment/1st_antigen_RT_Ebola/en/ |archive-date=20 February 2015 |access-date=20 February 2015 |publisher=[[World Health Organization]] (WHO)}}</ref> ===Differential diagnosis=== Early symptoms of EVD may be similar to those of other diseases common in Africa, including [[malaria]] and [[dengue fever]].<ref name="Gatherer 2014" /> The symptoms are also similar to those of other viral haemorrhagic fevers such as [[Marburg virus disease]], [[Crimean–Congo haemorrhagic fever]], and [[Lassa fever]].<ref name="Harrison">{{Cite book | veditors = Longo DL, Kasper DL, Jameson JL, Fauci AS, Hauser SL, Loscalzo J |title=Harrison's Principles of Internal Medicine |publisher=McGraw-Hill |year=2011 |isbn=978-0071748896 |edition=18th |chapter=Chapter 197 }}</ref><ref name="Beeching2014">{{Cite journal |vauthors=Beeching NJ, Fenech M, Houlihan CF |date=December 2014 |title=Ebola Virus Disease |journal=BMJ |type=Review |volume=10 |issue=349 |page=g7438 |doi=10.1136/bmj.g7348 |pmc=4707720 |pmid=25497512}}</ref> The complete [[differential diagnosis]] is extensive and requires consideration of many other infectious diseases such as [[typhoid fever]], [[shigellosis]], [[rickettsia|rickettsial diseases]], [[cholera]], [[sepsis]], [[borreliosis]], [[Verotoxin-producing Escherichia coli|EHEC enteritis]], [[leptospirosis]], [[scrub typhus]], [[plague (disease)|plague]], [[Q fever]], [[candidiasis]], [[histoplasmosis]], [[trypanosomiasis]], [[visceral]] [[leishmaniasis]], [[measles]], and [[viral hepatitis]] among others.<ref>{{Cite web |date=July 2008 |title=Viral Hemorrhagic Fever |url=https://www.sfcdcp.org/document.html?id=316 |url-status=dead |archive-url=https://web.archive.org/web/20130420174306/http://www.sfcdcp.org/document.html?id=316 |archive-date=20 April 2013 |access-date=17 August 2014 |publisher=S.F. Dept Public Health – Infectious Disease Emergencies |format=PDF}}</ref> Non-infectious diseases that may result in symptoms similar to those of EVD include [[acute promyelocytic leukaemia]], [[haemolytic uraemic syndrome]], [[snake envenomation]], [[coagulation|clotting factor]] deficiencies/platelet disorders, [[thrombotic thrombocytopenic purpura]], [[hereditary haemorrhagic telangiectasia]], [[Kawasaki disease]], and [[warfarin]] poisoning.<ref name="Grolla2005" /><ref name="Gear1989">{{Cite journal |vauthors=Gear JH |date=May–June 1989 |title=Clinical aspects of African viral hemorrhagic fevers |journal=Rev Infect Dis |volume=11 |issue=Supplement 4 |pages=S777–82 |doi=10.1093/clinids/11.supplement_4.s777 |pmid=2665013}}</ref><ref name="Gear1978">{{Cite journal |vauthors=Gear JH, Ryan J, Rossouw E |date=February 1978 |title=A consideration of the diagnosis of dangerous infectious fevers in South Africa |journal=South African Medical Journal |volume=53 |issue=7 |pages=235–37 |pmid=565951}}</ref><ref name="Bogomolov1998">{{Cite journal |vauthors=Bogomolov BP |year=1998 |title=Differential diagnosis of infectious diseases with hemorrhagic syndrome |journal=Terapevticheskii Arkhiv |volume=70 |issue=4 |pages=63–68 |pmid=9612907}}</ref> ==Prevention== {{Main|Prevention of viral hemorrhagic fever}} ===Vaccines=== {{Main|Ebola vaccine}} An [[Ebola vaccine]], [[rVSV-ZEBOV]], was approved in the United States in December 2019.<ref name="FDA2019Vac" /> It appears to be fully effective ten days after being given.<ref name=FDA2019Vac/> It was studied in Guinea between 2014 and 2016.<ref name=FDA2019Vac/> More than 100,000 people have been vaccinated against Ebola {{as of |2019|lc=yes}}.<ref>{{Cite news |date=3 May 2019 |title=Congo Ebola deaths surpass 1,000 as attacks on treatment centers go on |work=Reuters |url=https://www.reuters.com/article/us-health-ebola-who/congo-ebola-death-toll-to-hit-1000-new-vaccine-planned-who-idUSKCN1S9161 |access-date=8 May 2019}}</ref> The WHO reported that approximately 345,000 people were given the vaccine during the [[Kivu Ebola epidemic]] from 2018 to 2020.<ref>{{Cite web |title=Ebola virus disease: Vaccines |url=https://www.who.int/news-room/questions-and-answers/item/ebola-vaccines |access-date=29 March 2023 |website=www.who.int |language=en}}</ref> ===Infection control=== <!-- Caring for the infected --> [[File:VHFisolation.png|thumb|upright=1.5|VHF isolation precautions poster]] Community awareness of the benefits on survival chances of admitting cases early is important for the infected and infection control <ref name="Guiliani 2022" /> ====Caregivers==== [[File:Donna Wood, Nurse and NHS Ebola volunteer (15652582937).jpg|thumb|right|British woman wearing protective gear]] People who care for those infected with Ebola should wear protective clothing including masks, gloves, gowns and goggles.<ref name=CDC2014P/> The U.S. [[Centers for Disease Control]] (CDC) recommend that the protective gear leaves no skin exposed.<ref name=Oct2014CDC/> These measures are also recommended for those who may handle objects contaminated by an infected person's body fluids.<ref name=CDCBook1998/> 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.<ref name="Oct2014CDC">{{Cite web |date=20 October 2014 |title=Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) |url=https://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html |url-status=live |archive-url=https://web.archive.org/web/20141022024557/https://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html |archive-date=22 October 2014 |access-date=22 October 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> In Sierra Leone, the typical training period for the use of such safety equipment lasts approximately 12 days.<ref>{{cite web | url = https://www.telegraph.co.uk/news/worldnews/ebola/11155840/Ebola-medics-better-trained-in-Sierra-Leone-than-Spain.html | title = Ebola medics 'better trained in Sierra Leone than Spain' | archive-url = https://web.archive.org/web/20200628201158/https://www.telegraph.co.uk/news/worldnews/ebola/11155840/Ebola-medics-better-trained-in-Sierra-Leone-than-Spain.html | archive-date=28 June 2020 | work = The Telegraph | vauthors = Govan F | date = 11 October 2014 }}</ref> 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. <ref name="Guiliani 2022" /> ====Patients and household members==== The infected person should be in [[Isolation (health care)|barrier-isolation]] from other people.<ref name=CDC2014P/> All equipment, medical waste, patient waste and surfaces that may have come into contact with body fluids need to be [[disinfection|disinfected]].<ref name="CDCBook1998">{{Cite book | vauthors = Peters CJ |url= https://www.cdc.gov/vhf/abroad/pdf/african-healthcare-setting-vhf.pdf |title=Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting |date=December 1998 |publisher=[[Centers for Disease Control and Prevention]] (CDC) |archive-url=https://web.archive.org/web/20170708093022/https://www.cdc.gov/vhf/abroad/pdf/african-healthcare-setting-vhf.pdf |archive-date=8 July 2017 |url-status=live}}</ref> 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.<ref>{{cite web | url = http://time.com/3481394/equipping-homes-to-treat-ebola-patients/ | title = This Is How Ebola Patients Are Equipping Their Homes | archive-url = https://web.archive.org/web/20150305172616/http://time.com/3481394/equipping-homes-to-treat-ebola-patients/ | archive-date=5 March 2015 | work = Time Magazine | vauthors = Sifferlin A | date = 9 October 2014 }}</ref> Education of caregivers in these techniques, and providing such barrier-separation supplies has been a priority of [[Doctors Without Borders]].<ref>{{Cite news | vauthors = Sheri F, Nossiter A, Kanter J |date=10 October 2014 |title=Doctors Without Borders Evolves as It Forms the Vanguard in Ebola Fight |work=[[The New York Times]] |url=https://www.nytimes.com/2014/10/11/world/africa/doctors-without-borders-evolves-as-it-forms-the-vanguard-in-ebola-fight-.html |url-status=live |access-date=12 October 2014 |archive-url=https://web.archive.org/web/20141014172320/http://www.nytimes.com/2014/10/11/world/africa/doctors-without-borders-evolves-as-it-forms-the-vanguard-in-ebola-fight-.html |archive-date=14 October 2014}}</ref> ====Disinfection==== <!-- Disinfecting surfaces --> Ebolaviruses can be [[Sterilization (microbiology)|eliminated]] with heat (heating for 30 to 60 minutes at 60 °C or boiling for five minutes). To [[disinfectants|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.<ref name="urlEbolavirus – Pathogen Safety Data Sheets" /><ref name="Infection Guidance">{{Cite journal |date=August 2014 |title=Interim infection prevention and control guidance for care of patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola |publisher=[[World Health Organization]] (WHO) |id=WHO/HIS/SDS/2014.4 Rev. 1 |hdl-access=free |hdl=10665/130596 |periodical=WHO Technical Documents |last1=Organization |first1=World Health }}</ref> ====General population==== <!-- 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]].<ref name=WHO2014/> These measures include avoiding direct contact with infected people and regular [[hand washing]] using soap and water.<ref>{{Cite web |date=6 September 2014 |title=Ebola – 5 tips to avoid the deadly disease |url=https://plan-international.org/about-plan/resources/news/ebola-outbreak-5-tips-to-avoid-the-deadly-disease/ |url-status=live |archive-url=https://web.archive.org/web/20150324061050/http://plan-international.org/about-plan/resources/news/ebola-outbreak-5-tips-to-avoid-the-deadly-disease/ |archive-date=24 March 2015 |publisher=Plan International }}</ref> ====Bushmeat==== <!-- Bush meat --> [[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.<ref name=WHO2014/> 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.<ref name="Rouquet_2005">{{Cite journal |display-authors=6 |vauthors=Rouquet P, Froment JM, Bermejo M, Kilbourn A, Karesh W, Reed P, Kumulungui B, Yaba P, Délicat A, Rollin PE, Leroy EM |date=February 2005 |title=Wild animal mortality monitoring and human Ebola outbreaks, Gabon and Republic of Congo, 2001–2003 |journal=Emerg. Infect. Dis. |volume=11 |issue=2 |pages=283–90 |doi=10.3201/eid1102.040533 |issn=1080-6040 |pmc=3320460 |pmid=15752448 }}</ref> ====Corpses, burial==== <!-- Dead bodies --> If a person with Ebola disease dies, direct contact with the body should be avoided.<ref name="CDC2014P">{{Cite web |date=31 July 2014 |title=Ebola Hemorrhagic Fever Prevention |url=https://www.cdc.gov/vhf/ebola/prevention/index.html |url-status=live |archive-url=https://web.archive.org/web/20140904125431/https://www.cdc.gov/vhf/ebola/prevention/index.html |archive-date=4 September 2014 |access-date=2 August 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> Certain [[burial ritual]]s, 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.<ref name="CDC1998">{{Cite book |last=Centers for Disease Control and Prevention and World Health Organization |url=https://www.cdc.gov/vhf/abroad/pdf/african-healthcare-setting-vhf.pdf |title=Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting |publisher=[[Centers for Disease Control and Prevention]] (CDC) |year=1998 |access-date=8 February 2013 |archive-url=https://web.archive.org/web/20140411222536/https://www.cdc.gov/vhf/abroad/pdf/african-healthcare-setting-vhf.pdf |archive-date=11 April 2014 |url-status=live }}</ref><ref name="url_www.who.int_ burial">{{Cite web |date=1 June 2014 |title=Section 7: Use Safe Burial Practices |url=https://www.who.int/csr/resources/publications/ebola/whoemcesr982sec7-9.pdf |url-status=live |archive-url=https://web.archive.org/web/20150226091100/https://www.who.int/csr/resources/publications/ebola/whoemcesr982sec7-9.pdf |archive-date=26 February 2015 |website=Information resources on Ebola virus disease |publisher=[[World Health Organization]] (WHO) }}</ref><ref>{{Cite news | vauthors = Harden B |date=24 December 2000 |title=Ebola's Shadow |work=[[The New York Times]] |url=https://archive.nytimes.com/www.nytimes.com/library/magazine/home/20001224mag-ebola.html |url-status=live |access-date=12 October 2014 |archive-url=https://web.archive.org/web/20141020200433/http://partners.nytimes.com/library/magazine/home/20001224mag-ebola.html |archive-date=20 October 2014}}</ref> Social anthropologists may help find alternatives to traditional rules for burials.<ref>{{Cite web | vauthors = Fassassi A |date=September 2014 |title=How anthropologists help medics fight Ebola in Guinea |url=http://www.scidev.net/global/cooperation/feature/anthropologists-medics-ebola-guinea.html |url-status=live |archive-url=https://web.archive.org/web/20141006112752/http://www.scidev.net/global/cooperation/feature/anthropologists-medics-ebola-guinea.html |archive-date=6 October 2014 |access-date=3 October 2014 |publisher=SciDev.Net }}</ref> ====Transport, travel, contact==== <!-- Transportation --> Transportation crews are instructed to follow a certain isolation procedure, should anyone exhibit symptoms resembling EVD.<ref name="urlWHO – West Africa – Ebola virus disease">{{Cite web |title=West Africa – Ebola virus disease Update: Travel and transport |url=https://www.who.int/ith/updates/20140421/en/ |url-status=dead |archive-url=https://web.archive.org/web/20140729034008/https://www.who.int/ith/updates/20140421/en/ |archive-date=29 July 2014 |website=International travel and health |publisher=[[World Health Organization]] (WHO) }}</ref> {{As of|August 2014}}, the WHO does not consider travel bans to be useful in decreasing spread of the disease.<ref name=WHO2014T/> 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.<ref name="CDC_monitor_movement">{{Cite web |date=27 October 2014 |title=Monitoring Symptoms and Controlling Movement to Stop Spread of Ebola |url=https://www.cdc.gov/media/releases/2014/fs1027-monitoring-symptoms-controlling-movement.html |url-status=live |archive-url=https://web.archive.org/web/20170708091445/https://www.cdc.gov/media/releases/2014/fs1027-monitoring-symptoms-controlling-movement.html |archive-date=8 July 2017 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> In the United States, the CDC recommends that restrictions on public activity, including travel restrictions, are not required for the following defined risk levels:<ref name=CDC_monitor_movement/> * 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.<ref name=CDC_monitor_movement/> ====Laboratory==== <!-- Laboratory --> In laboratories where diagnostic testing is carried out, [[Biosafety level|biosafety level 4-equivalent containment]] is required.<ref name="OSHA">{{Cite web |title=Ebola: Control and Prevention |url=https://www.osha.gov/SLTC/ebola/control_prevention.html |url-status=live |archive-url=https://web.archive.org/web/20141109145135/https://www.osha.gov/SLTC/ebola/control_prevention.html |archive-date=9 November 2014 |access-date=9 November 2014 |publisher=[[Occupational Safety and Health Administration]] (OSHA) }}</ref> Laboratory researchers must be properly trained in BSL-4 practices and wear proper PPE.<ref name=OSHA/> ===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.<ref>{{Cite web |date=28 August 2014 |title=About Quarantine and Isolation |url=https://www.cdc.gov/quarantine/quarantineisolation.html |url-status=live |archive-url=https://web.archive.org/web/20141020041517/https://www.cdc.gov/quarantine/quarantineisolation.html |archive-date=20 October 2014 |access-date=26 October 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> Quarantine, also known as enforced isolation, is usually effective in decreasing spread.<ref>{{Cite book | vauthors = Sompayrac L |url=https://archive.org/details/howpathogenicvir0000somp |title=How pathogenic viruses work |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0763720827 |edition=3rd |location=Boston |page=[https://archive.org/details/howpathogenicvir0000somp/page/87 87] |url-access=registration}}</ref><ref name="pmid16597410">{{Cite journal |vauthors = Alazard-Dany N, Ottmann Terrangle M, Volchkov V |date=April 2006 |title=[Ebola and Marburg viruses: the humans strike back] |url=https://www.medecinesciences.org/articles/medsci/pdf/2006/05/medsci2006224p405.pdf |journal=Med Sci (Paris) |language=fr |volume=22 |issue=4 |pages=405–10 |doi=10.1051/medsci/2006224405 |pmid=16597410 |doi-access=free}}</ref> Governments often quarantine areas where the disease is occurring or individuals who may transmit the disease outside of an initial area.<ref>{{Cite web |date=19 August 2014 |title=Ebola virus disease update – west Africa |url=https://www.who.int/csr/don/2014_08_19_ebola/en/ |url-status=dead |archive-url=https://web.archive.org/web/20141022110953/https://www.who.int/csr/don/2014_08_19_ebola/en/ |archive-date=22 October 2014 |access-date=26 October 2014 |publisher=[[World Health Organization]] (WHO)}}</ref> In the United States, the law allows quarantine of those infected with ebolaviruses.<ref>{{Cite book |url=https://books.google.com/books?id=IfpOtV-FAl4C&pg=PA209 |title=Koenig and Schultz's disaster medicine : comprehensive principles and practices |date=2009 |publisher=Cambridge University Press |isbn=978-0521873673 | veditors = Koenig K, Schultz C |location=Cambridge |page=209 |archive-url=https://web.archive.org/web/20160515175653/https://books.google.com/books?id=IfpOtV-FAl4C&pg=PA209 |archive-date=15 May 2016 |url-status=live}}</ref><ref>{{Cite web |date=19 January 2017 |title=Control of Communicable Diseases |url=https://www.federalregister.gov/documents/2017/01/19/2017-00615/control-of-communicable-diseases |access-date=13 August 2019 |website=[[Federal Register]]}}</ref> ===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.<ref>{{Cite journal |vauthors=Frieden TR, Damon I, Bell BP, Kenyon T, Nichol S |date=25 September 2014 |title=Ebola 2014 – New Challenges, New Global Response and Responsibility |journal=New England Journal of Medicine |volume=371 |issue=13 |pages=1177–1180 |doi=10.1056/NEJMp1409903 |pmid=25140858|doi-access=free }}</ref><ref>{{Cite web |title=What is Contact Tracing? |url=https://www.cdc.gov/vhf/ebola/pdf/contact-tracing.pdf |url-status=live |archive-url=https://web.archive.org/web/20140912114723/https://www.cdc.gov/vhf/ebola/pdf/contact-tracing.pdf |archive-date=12 September 2014 |access-date=15 September 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> {{anchor|Treatment}} ==Management== {{as of |2019}} two treatments ([[atoltivimab/maftivimab/odesivimab]] and [[ansuvimab]]) are associated with improved outcomes.<ref name="NIH2019" /><ref name=NIH2019Tx/> 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.<ref name="FDA2014R">{{Cite press release |title=FDA warns consumers about fraudulent Ebola treatment products |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm410086.htm |access-date=20 August 2014 |url-status=dead |archive-url=https://wayback.archive-it.org/7993/20170111194035/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm410086.htm |archive-date=11 January 2017}}</ref><ref>{{Cite web |date=22 September 2014 |title=Natural Solutions Foundation Warning Letter |url=https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/natural-solutions-foundation-09222014 |url-status=live |archive-url=https://web.archive.org/web/20141008213137/https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2014/ucm416051.htm |archive-date=8 October 2014 |access-date=9 October 2014 |publisher=U.S. [[Food and Drug Administration]] (FDA)}}</ref> In October 2020, the U.S. [[Food and Drug Administration]] (FDA) approved atoltivimab/maftivimab/odesivimab with an [[Indication (medicine)|indication]] for the treatment of infection caused by ''Zaire ebolavirus''.<ref name="FDA PR">{{Cite press release |title=FDA Approves First Treatment for Ebola Virus |date=14 October 2020 |url=https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-ebola-virus |access-date=14 October 2020 |website=U.S. [[Food and Drug Administration]] (FDA)}} {{PD-notice}}</ref> ===Standard support=== [[File:Ebola outbreak in Gulu Municipal Hospital.jpg|thumb|A hospital isolation ward in [[Gulu|Gulu, Uganda]], during the October 2000 outbreak]] Treatment is primarily [[Palliative care|supportive]] in nature.<ref name="Clark_2012">{{Cite journal |vauthors=Clark DV, Jahrling PB, Lawler JV |date=September 2012 |title=Clinical management of filovirus-infected patients |journal=Viruses |volume=4 |issue=9 |pages=1668–86 |doi=10.3390/v4091668 |pmc=3499825 |pmid=23170178 |doi-access=free}}</ref> Early supportive care with rehydration and symptomatic treatment improves survival.<ref name=WHO2014/> Rehydration may be via the [[Oral rehydration therapy|oral]] or [[Intravenous therapy|intravenous]] route.<ref name=Clark_2012/> These measures may include [[pain management]], and treatment for [[antiemetic|nausea]], [[antipyretic|fever]], and [[anxiolytic|anxiety]].<ref name=Clark_2012/> The [[World Health Organization]] (WHO) recommends avoiding [[aspirin]] or [[ibuprofen]] for pain management, due to the risk of bleeding associated with these medications.<ref>{{Cite web |title=Ebola messages for the general public |url=https://www.who.int/csr/disease/ebola/messages/en/ |url-status=dead |archive-url=https://web.archive.org/web/20141025120028/https://www.who.int/csr/disease/ebola/messages/en/ |archive-date=25 October 2014 |access-date=26 October 2014 |publisher=[[World Health Organization]] (WHO)}}</ref> Blood products such as [[packed red blood cells]], [[platelet]]s, or [[fresh frozen plasma]] may also be used.<ref name=Clark_2012/> Other regulators of coagulation have also been tried including [[heparin]] in an effort to prevent [[disseminated intravascular coagulation]] and [[Coagulation factors|clotting factors]] to decrease bleeding.<ref name=Clark_2012/> [[Antimalarial medication]]s and [[antibiotics]] are often used before the diagnosis is confirmed,<ref name=Clark_2012/> though there is no evidence to suggest such treatment helps. Several [[Ebola virus disease treatment research|experimental treatments are being studied]].<ref name=":4">{{Cite web |title=Ebola virus disease |url=https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease |access-date=28 May 2020 |website=www.who.int |language=en}}</ref> 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.<ref>{{Cite web |title=Annex 18. Transmission risk reduction of filoviruses in home-care settings |url=https://www.who.int/csr/disease/ebola/Annex_18_risk_reduction_home_care.pdf?ua=1 |url-status=live |archive-url=https://web.archive.org/web/20141026092619/https://www.who.int/csr/disease/ebola/Annex_18_risk_reduction_home_care.pdf?ua=1 |archive-date=26 October 2014 |access-date=26 October 2014 |publisher=[[World Health Organization]] (WHO)}}</ref> ===Intensive care=== [[Intensive care]] is often used in the developed world.<ref name="Feldmann2011" /> This may include maintaining blood volume and electrolytes (salts) balance as well as treating any bacterial infections that may develop.<ref name="Feldmann2011">{{Cite journal |vauthors=Feldmann H, Geisbert TW |date=March 2011 |title=Ebola haemorrhagic fever |journal=Lancet |volume=377 |issue=9768 |pages=849–62 |doi=10.1016/S0140-6736(10)60667-8 |pmc=3406178 |pmid=21084112}}</ref> [[Haemodialysis|Dialysis]] may be needed for [[kidney failure]], and [[extracorporeal membrane oxygenation]] may be used for lung dysfunction.<ref name="Feldmann2011" /> ==Prognosis== EVD has a [[case fatality rate|risk of death in those infected]] of between 25% and 90%.<ref name=WHO2014/><ref name="Elsevier/Academic Press">{{Cite book | vauthors = Fauquet CM |url=https://books.google.com/books?id=9Wy7Jgy5RWYC&pg=PA648 |title=Virus taxonomy classification and nomenclature of viruses; 8th report of the International Committee on Taxonomy of Viruses |date=2005 |publisher=Elsevier/Academic Press |isbn=978-0080575483 |location=Oxford |page=648 |archive-url=https://web.archive.org/web/20160604013646/https://books.google.com/books?id=9Wy7Jgy5RWYC&pg=PA648 |archive-date=4 June 2016 |url-status=live}}</ref> {{As of|September 2014}}, the average risk of death among those infected is 50%.<ref name="WHO2014" /> The highest risk of death was 90% in the 2002–2003 [[Republic of the Congo]] outbreak.<ref>{{Cite web |title=More or Less behind the stats Ebola |url=http://www.bbc.co.uk/programmes/p0244jdt |url-status=live |archive-url=https://web.archive.org/web/20140903044359/http://www.bbc.co.uk/programmes/p0244jdt |archive-date=3 September 2014 |access-date=8 October 2014 |publisher=BBC World Service}}</ref> Early admission significantly increases survival rates <ref name="Guiliani 2022" /> Death, if it occurs, follows typically six to sixteen days after symptoms appear and is often due to [[hypovolemic shock|low blood pressure from fluid loss]].<ref name=Ruz2014/> Early supportive care to prevent dehydration may reduce the risk of death.<ref name=":4" /> === Post-Ebola virus syndrome === If an infected person survives, recovery may be quick and complete.<ref name="Goeijenbier2014" /><ref name="Shantha2017" /> However, a large portion of survivors develop [[post-Ebola virus syndrome]] after the acute phase of the infection.<ref name="pmid31806422">{{cite journal |vauthors=Rojas M, Monsalve DM, Pacheco Y, Acosta-Ampudia Y, Ramírez-Santana C, Ansari AA, Gershwin ME, Anaya JM |date=January 2020 |title=Ebola virus disease: An emerging and re-emerging viral threat |url= |journal=Journal of Autoimmunity |volume=106 |issue= |pages=102375 |doi=10.1016/j.jaut.2019.102375 |pmid=31806422|doi-access=free }}</ref> Prolonged cases are often complicated by the occurrence of long-term problems, such as [[orchitis|inflammation of the testicles]], [[arthralgia|joint pains]], fatigue, hearing loss, mood and sleep disturbances, [[myalgia|muscular pain]], abdominal pain, [[menstrual period|menstrual abnormalities]], [[miscarriage]]s, [[desquamation|skin peeling]], or [[alopecia|hair loss]].<ref name="Goeijenbier2014" /><ref name="Shantha2017">{{Cite journal |vauthors=Shantha JG, Crozier I, Yeh S |date=November 2017 |title=An update on ocular complications of Ebola virus disease |journal=Current Opinion in Ophthalmology |volume=28 |issue=6 |pages=600–606 |doi=10.1097/ICU.0000000000000426 |pmc=5988239 |pmid=28872492}}</ref> [[Uveitis|Inflammation and swelling of the uveal layer of the eye]] is the most common eye complication in survivors of Ebola virus disease.<ref name="Shantha2017" /> Eye symptoms, such as [[photophobia|light sensitivity]], [[hyperlacrimation|excess tearing]], and [[vision loss]] have been described.<ref>{{Cite journal |vauthors=Wiwanitkit S, Wiwanitkit V |date=2015 |title=Ocular problem in Ebola virus infection: A short review |journal=Saudi Journal of Ophthalmology |volume=29 |issue=3 |pages=225–226 |doi=10.1016/j.sjopt.2015.02.006 |pmc=4487942 |pmid=26155084}}</ref> Ebola can stay in some body parts like the eyes,<ref name="VarkeyShantha2015">{{Cite journal |display-authors=6 |vauthors=Varkey JB, Shantha JG, Crozier I, Kraft CS, Lyon GM, Mehta AK, Kumar G, Smith JR, Kainulainen MH, Whitmer S, Ströher U, Uyeki TM, Ribner BS, Yeh S |year=2015 |title=Persistence of Ebola Virus in Ocular Fluid during Convalescence |journal=New England Journal of Medicine |volume=372 |issue=25 |pages=2423–2427 |doi=10.1056/NEJMoa1500306 |issn=0028-4793 |pmc=4547451 |pmid=25950269 |hdl=2328/35704}}</ref> breasts, and testicles after infection.<ref name=cdc9months/><ref name="MackayArden2015">{{Cite journal |vauthors=Mackay IM, Arden KE |year=2015 |title=Ebola virus in the semen of convalescent men |journal=The Lancet Infectious Diseases |volume=15 |issue=2 |pages=149–150 |doi=10.1016/S1473-3099(14)71033-3 |issn=1473-3099 |pmid=25467652}}</ref> Sexual transmission after recovery has been suspected.<ref>{{Cite journal |vauthors=Rogstad KE, Tunbridge A |date=February 2015 |title=Ebola virus as a sexually transmitted infection |journal=Current Opinion in Infectious Diseases |volume=28 |issue=1 |pages=83–85 |doi=10.1097/qco.0000000000000135 |pmid=25501666 |s2cid=7538665}}</ref><ref>{{Cite journal |display-authors=6 |vauthors=Christie A, Davies-Wayne GJ, Cordier-Lassalle T, Blackley DJ, Laney AS, Williams DE, Shinde SA, Badio M, Lo T, Mate SE, Ladner JT, Wiley MR, Kugelman JR, Palacios G, Holbrook MR, Janosko KB, de Wit E, van Doremalen N, Munster VJ, Pettitt J, Schoepp RJ, Verhenne L, Evlampidou I, Kollie KK, Sieh SB, Gasasira A, Bolay F, Kateh FN, Nyenswah TG, De Cock KM, ((Centers for Disease Control and Prevention (CDC))) |date=8 May 2015 |title=Possible sexual transmission of Ebola virus – Liberia, 2015 |journal=MMWR. Morbidity and Mortality Weekly Report |volume=64 |issue=17 |pages=479–481 |pmc=4584553 |pmid=25950255}}</ref> If sexual transmission occurs following recovery it is believed to be a rare event.<ref>{{Cite journal |vauthors=Sprecher, A |date=14 October 2015 |title=Handle Survivors with Care |journal=The New England Journal of Medicine |volume=377 |issue=15 |pages=1480–1482 |doi=10.1056/NEJMe1512928 |pmid=26465064 |doi-access=free}}</ref> One case of a condition similar to [[meningitis]] has been reported many months after recovery, {{as of|October 2015|lc=yes}}.<ref>{{Cite web |title=Neuro complications cited in UK nurse's Ebola case |date=15 October 2015 |url=http://www.cidrap.umn.edu/news-perspective/2015/10/neuro-complications-cited-uk-nurses-ebola-case |url-status=live |archive-url=https://web.archive.org/web/20151017211314/http://www.cidrap.umn.edu/news-perspective/2015/10/neuro-complications-cited-uk-nurses-ebola-case |archive-date=17 October 2015 |access-date=19 October 2015}}</ref> ==Epidemiology== {{For|more about specific outbreaks|List of Ebola outbreaks}} The disease typically occurs in outbreaks in tropical regions of [[Sub-Saharan Africa]].<ref name="WHO2014" /> From 1976 (when it was first identified) through 2013, the WHO reported 2,387 confirmed cases with 1,590 overall fatalities.<ref name="WHO2014" /><ref name="MMWRJune2014" /> 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]].<ref name="CDC2014" /><ref name="CDCAug2014N" /> ===1976=== ====Sudan==== [[File:Cotton Factory in Nzara, South Sudan.jpg|thumb|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]]<ref name="Hoenen2012">{{Cite journal |vauthors=Hoenen T, Groseth A, Feldmann H |date=July 2012 |title=Current Ebola vaccines |journal=Expert Opin Biol Ther |volume=12 |issue=7 |pages=859–872 |doi=10.1517/14712598.2012.685152 |pmc=3422127 |pmid=22559078}}</ref><ref name="Peterson AT, Bauer JT, Mills JN 2004 40–47">{{Cite journal |vauthors=Peterson AT, Bauer JT, Mills JN |year=2004 |title=Ecologic and Geographic Distribution of Filovirus Disease |journal=Emerg. Infect. Dis. |volume=10 |issue=1 |pages=40–47 |doi=10.3201/eid1001.030125 |pmc=3322747 |pmid=15078595}}</ref> (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.<ref name="Feldmann2011" /><ref name="who's first encounter">{{Cite web |title=Ebola haemorrhagic fever in Sudan, 1976 |url=http://whqlibdoc.who.int/bulletin/1978/Vol56-No2/bulletin_1978_56(2)_247-270.pdf |url-status=dead |archive-url=https://web.archive.org/web/20141013194802/http://whqlibdoc.who.int/bulletin/1978/Vol56-No2/bulletin_1978_56(2)_247-270.pdf |archive-date=13 October 2014 |access-date=8 October 2014}}</ref> 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]].<ref name="who's first encounter" /> ====Zaire==== {{main|1976 Zaire Ebola virus outbreak}} [[File:CDC worker incinerates med-waste from Ebola patients in Zaire.jpg|thumb|upright|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]]).<ref>{{Cite book | vauthors = Hewlett B, Hewlett B |url=https://books.google.com/books?id=aboFAAAAQBAJ&pg=PA103 |title=Ebola, Culture and Politics: The Anthropology of an Emerging Disease |date=2007 |publisher=Cengage Learning |isbn=978-1111797317 |page=103 |access-date=31 July 2014}}</ref><ref name="Feldmann2003">{{Cite journal |vauthors=Feldmann H, Jones S, Klenk HD, Schnittler HJ |date=August 2003 |title=Ebola virus: from discovery to vaccine |journal=Nature Reviews Immunology |volume=3 |issue=8 |pages=677–685 |doi=10.1038/nri1154 |pmid=12974482 |s2cid=27486878|doi-access=free }}</ref> This outbreak was caused by EBOV, formerly designated ''Zaire ebolavirus'', a different member of the [[genus]] ''Ebolavirus'' than in the first Sudan outbreak. The [[index case|first person infected with the disease]] was the village school's headmaster [[Mabalo Lokela]], who began displaying symptoms on 26 August 1976.<ref name="whqlibdoc.who.int">{{Cite journal |last=Report of an International Commission |year=1978 |title=Ebola haemorrhagic fever in Zaire, 1976 |url=http://whqlibdoc.who.int/bulletin/1978/Vol56-No2/bulletin_1978_56(2)_271-293.pdf |url-status=dead |journal=Bull. World Health Organ. |volume=56 |issue=2 |pages=271–293 |pmc=2395567 |pmid=307456 |archive-url=https://web.archive.org/web/20140808213715/http://whqlibdoc.who.int/bulletin/1978/Vol56-No2/bulletin_1978_56%282%29_271-293.pdf |archive-date=8 August 2014 |access-date=14 August 2014 }}</ref> 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.<ref name="urlOutbreak of Ebola Viral Hemorrhagic Fever – Zaire, 1995">{{Cite journal |last=Centers for Disease Control Prevention (CDC) |year=1995 |title=Outbreak of Ebola Viral Hemorrhagic Fever – Zaire, 1995 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00037078.htm |url-status=live |journal=Morbidity and Mortality Weekly Report |volume=44 |issue=19 |pages=381–382 |pmid=7739512 |archive-url=https://web.archive.org/web/20170625191457/https://www.cdc.gov/mmwr/preview/mmwrhtml/00037078.htm |archive-date=25 June 2017 }}</ref><ref name="urlMabalo Lokela Archives – Political Moll">{{Cite web | vauthors = Elezra M |title=Ebola: The Truth Behind The Outbreak (Video) l |url=http://politicalmoll.com/tag/mabalo-lokela/ |url-status=dead |archive-url=https://web.archive.org/web/20150712140500/http://politicalmoll.com/tag/mabalo-lokela/ |archive-date=12 July 2015 |access-date=18 October 2014 |website=Mabalo Lokela Archives – Political Mol}}</ref> 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.<ref name="Stimola">{{Cite book | vauthors = Stimola A |url=https://archive.org/details/ebola0000stim/page/31 |title=Ebola |publisher=Rosen Pub. |year=2011 |isbn=978-1435894334 |edition=1st |location=New York |pages=[https://archive.org/details/ebola0000stim/page/31 31, 52] |url-access=registration}}</ref> 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.<ref>{{Cite news |title=This Congolese Doctor Discovered Ebola But Never Got Credit For It – Until Now |work=NPR.org |url=https://www.npr.org/sections/goatsandsoda/2019/11/04/774863495/this-congolese-doctor-discovered-ebola-but-never-got-credit-for-it-until-now |access-date=5 November 2019}}</ref> Muyembe was also the first scientist to come into direct contact with the disease and survive.<ref>{{Cite web | vauthors = McNeish H |date=24 March 2017 |title=He Treated The Very First Ebola Cases 40 Years Ago. Then He Watched The World Forget. |url=https://www.huffpost.com/entry/ebola-neglected-tropical-diseases_n_58d2ac02e4b0f838c62e9e0d |access-date=5 November 2019 |website=HuffPost}}</ref> 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."<ref name="Piot_2012">{{Cite book |title=No time to lose: a life in pursuit of deadly viruses |vauthors=Piot P, Marshall R |publisher=W.W. Norton & Co. |year=2012 |isbn=978-0393063165 |edition=1st |location=New York |pages=30, 90}}</ref><ref name="Piot-one">{{Cite news | vauthors = Piot P |date=11 August 2014 |title=Part one: A virologist's tale of Africa's first encounter with Ebola |work=ScienceInsider |url=https://www.science.org/content/article/part-one-virologists-tale-africas-first-encounter-ebola |url-status=live |archive-url=https://web.archive.org/web/20141009050901/http://news.sciencemag.org/africa/2014/08/part-one-virologists-tale-africas-first-encounter-ebola |archive-date=9 October 2014 }}</ref><ref name="Piot-two">{{Cite news | vauthors = Piot P |date=13 August 2014 |title=Part two: A virologist's tale of Africa's first encounter with Ebola |work=ScienceInsider |url=https://www.science.org/content/article/part-two-virologists-tale-africas-first-encounter-ebola |url-status=live |archive-url=https://web.archive.org/web/20141116233325/http://news.sciencemag.org/africa/2014/08/part-two-virologists-tale-africas-first-encounter-ebola |archive-date=16 November 2014 }}</ref> 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.<ref name=Stimola/> 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 {{convert|39|°C|0}}, [[haematemesis]], diarrhoea with blood, retrosternal abdominal pain, prostration with 'heavy' articulations, and rapid evolution death after a mean of three days."<ref>{{Cite web | vauthors = Bardi JS |title=Death Called a River |url=http://www.scripps.edu/newsandviews/e_20020114/ebola1.html |url-status=live |archive-url=https://web.archive.org/web/20140802170848/http://www.scripps.edu/newsandviews/e_20020114/ebola1.html |archive-date=2 August 2014 |access-date=9 October 2014 |website=The Scripps Research Institute}}</ref> 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.<ref name=Feldmann2011/> Reports conflict about who initially coined the name: either Karl Johnson of the American CDC team<ref name="hz">{{Cite book | vauthors = Preston R |title=The Hot Zone |title-link=The Hot Zone |date=20 July 1995 |publisher=Anchor Books ([[Random House]]) |page=[https://archive.org/details/hotzone1995pres/page/n144 117] |quote=Karl Johnson named it Ebola |author-link=Richard Preston}}</ref> or Belgian researchers.<ref name="observer">{{Cite web | vauthors = von Bredow R, Hackenbroch V |date=4 October 2014 |title=In 1976 I Discovered Ebola – Now I Fear an Unimaginable Tragedy |url=https://www.theguardian.com/world/2014/oct/04/ebola-zaire-peter-piot-outbreak |url-status=live |archive-url=https://web.archive.org/web/20170103105318/https://www.theguardian.com/world/2014/oct/04/ebola-zaire-peter-piot-outbreak |archive-date=3 January 2017 |website=[[The Guardian]]}}</ref> Subsequently, a number of other cases were reported, almost all centred on the Yambuku mission hospital or close contacts of another case.<ref name="whqlibdoc.who.int" /> In all, 318 cases and 280 deaths (an 88% fatality rate) occurred in Zaire.<ref name="emedicine.com">{{Cite web | vauthors = King JW |date=2 April 2008 |title=Ebola Virus |url=http://www.emedicine.com/MED/topic626.htm |url-status=live |archive-url=https://web.archive.org/web/20080928063653/http://www.emedicine.com/med/TOPIC626.HTM |archive-date=28 September 2008 |access-date=6 October 2008 |website=eMedicine |publisher=WebMD }}</ref> Although the two outbreaks were at first believed connected, scientists later realised that they were caused by two distinct ebolaviruses, SUDV and EBOV.<ref name=Feldmann2003/> ===1995–2014=== [[File:Ebolafälle bis einschließlich 2020 english.png|thumb|upright=1.3|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.<ref name="WHO2014" /> 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.<ref name="WHO2014" /> 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.<ref name="pmid14579469">{{Cite journal |display-authors=6 |vauthors=Formenty P, Libama F, Epelboin A, Allarangar Y, Leroy E, Moudzeo H, Tarangonia P, Molamou A, Lenzi M, Ait-Ikhlef K, Hewlett B, Roth C, Grein T |year=2003 |title=[Outbreak of Ebola hemorrhagic fever in the Republic of the Congo, 2003: a new strategy?] |journal=Med Trop (Mars) |language=fr |volume=63 |issue=3 |pages=291–295 |pmid=14579469}}</ref> In 2004, a Russian scientist died from Ebola after [[Needlestick injury|sticking]] herself with an infected needle.<ref>{{Cite news | vauthors = Miller J |date=25 May 2004 |title=Russian Scientist Dies in Ebola Accident at Former Weapons Lab |work=[[The New York Times]] |url=https://www.nytimes.com/2004/05/25/world/russian-scientist-dies-in-ebola-accident-at-former-weapons-lab.html |url-status=live |access-date=12 October 2014 |archive-url=https://web.archive.org/web/20141017035417/http://www.nytimes.com/2004/05/25/world/russian-scientist-dies-in-ebola-accident-at-former-weapons-lab.html |archive-date=17 October 2014}}</ref> Between April and August 2007, a fever epidemic<ref name="CBCRadioSept2007">{{Cite news |date=12 September 2007 |title=Ebola outbreak in Congo |publisher=[[CBC News]] |url=http://www.cbc.ca/news/world/ebola-outbreak-in-congo-1.648593 |url-status=live |archive-url=https://web.archive.org/web/20141119105248/http://www.cbc.ca/news/world/ebola-outbreak-in-congo-1.648593 |archive-date=19 November 2014}}</ref> in a four-village region<ref name="Mystery DR Congo fever kills 100">{{Cite news |date=31 August 2007 |title=Mystery DR Congo fever kills 100 |work=BBC News Online |url=http://news.bbc.co.uk/2/hi/africa/6973013.stm |url-status=live |archive-url=https://web.archive.org/web/20071111024636/http://news.bbc.co.uk/2/hi/africa/6973013.stm |archive-date=11 November 2007}}</ref> of the DRC was confirmed in September to have been cases of Ebola.<ref>{{Cite news |date=11 September 2007 |title=Ebola Outbreak Confirmed in Congo |work=NewScientist.com |url=https://www.newscientist.com/article/dn12624-ebola-outbreak-confirmed-in-congo.html |url-status=live |archive-url=https://web.archive.org/web/20150618230241/http://www.newscientist.com/article/dn12624-ebola-outbreak-confirmed-in-congo.html |archive-date=18 June 2015}}</ref> Many people who attended the recent funeral of a local village chief died.<ref name="Mystery DR Congo fever kills 100" /> The 2007 outbreak eventually infected 264 individuals and killed 187.<ref name="WHO2014" /> 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.<ref>{{Cite news |date=30 November 2007 |title=Uganda: Deadly Ebola Outbreak Confirmed – UN |publisher=UN News Service |url=http://allafrica.com/stories/200711301070.html |url-status=live |access-date=25 February 2008 |archive-url=https://web.archive.org/web/20080303200540/http://allafrica.com/stories/200711301070.html |archive-date=3 March 2008}}</ref> The WHO reported 149 cases of this new strain and 37 of those led to deaths.<ref name="WHO2014" /> 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.<ref name="WHO2014" /> On 17 August 2012, the Ministry of Health of the DRC reported an outbreak of the Ebola-Bundibugyo variant<ref>{{Cite web |title=DRC Confirms Ebola Outbreak |date=21 August 2012 |url=http://www.voanews.com/content/Ebola-drc-outbreak/1492233.html |url-status=live |archive-url=https://web.archive.org/web/20120915235056/http://www.voanews.com/content/Ebola-drc-outbreak/1492233.html |archive-date=15 September 2012 |access-date=15 April 2013 |publisher=Voanews.com}}</ref> in the eastern region.<ref>{{Cite web |date=17 August 2012 |title=WHO – Ebola outbreak in Democratic Republic of Congo |url=https://www.who.int/csr/don/2012_08_18/en/index.html |url-status=dead |archive-url=https://web.archive.org/web/20131027035536/https://www.who.int/csr/don/2012_08_18/en/index.html |archive-date=27 October 2013 |access-date=15 April 2013 |publisher=[[World Health Organization]] (WHO)}}</ref><ref>{{Cite web |date=21 August 2012 |title=WHO – Ebola outbreak in Democratic Republic of Congo – update |url=https://www.who.int/csr/don/2012_08_21/en/index.html |url-status=dead |archive-url=https://web.archive.org/web/20121216144914/https://www.who.int/csr/don/2012_08_21/en/index.html |archive-date=16 December 2012 |access-date=15 April 2013 |publisher=[[World Health Organization]] (WHO)}}</ref> 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.<ref name="WHO2014" /><ref>{{Cite news | vauthors = Castillo M |year=2012 |title=Ebola virus claims 31 lives in Democratic Republic of the Congo |work=[[CBS News]] |location=United States |url=https://www.cbsnews.com/8301-504763_162-57512216-10391704/ebola-virus-claims-31-lives-in-democratic-republic-of-the-congo/ |url-status=live |access-date=14 September 2012 |archive-url=https://web.archive.org/web/20120914015301/http://www.cbsnews.com/8301-504763_162-57512216-10391704/ebola-virus-claims-31-lives-in-democratic-republic-of-the-congo/ |archive-date=14 September 2012 }}</ref> In 2014, an outbreak occurred in the DRC. [[Whole genome sequencing|Genome-sequencing]] showed that this outbreak was not related to the [[West Africa Ebola virus outbreak|2014–15 West Africa Ebola virus outbreak]], but was the same [[EBOV]] species, the Zaire species.<ref name="2014 DRC Who Strain">{{Cite web |date=2 September 2014 |title=Virological Analysis: no link between Ebola outbreaks in west Africa and Democratic Republic of Congo |url=https://www.who.int/mediacentre/news/ebola/2-september-2014/en/ |url-status=dead |archive-url=https://web.archive.org/web/20141121121328/https://www.who.int/mediacentre/news/ebola/2-september-2014/en/ |archive-date=21 November 2014 |publisher=[[World Health Organization]] (WHO) }}</ref> It began in August 2014, and was declared over in November with 66 cases and 49 deaths.<ref name="reuters1511">{{Cite news |date=15 November 2014 |title=Congo declares its Ebola outbreak over |work=Reuters |url=http://uk.reuters.com/article/health-ebola-congodemocratic-idUKL6N0T50F720141115 |url-status=live |access-date=15 November 2014 |archive-url=https://web.archive.org/web/20141129065140/http://uk.reuters.com/article/2014/11/15/health-ebola-congodemocratic-idUKL6N0T50F720141115 |archive-date=29 November 2014}}</ref> This was the 7th outbreak in the DRC, three of which occurred during the period when the country was known as [[Zaire]].<ref>{{Cite web |date=December 2014 |title=Democratic Republic of the Congo: The country that knows how to beat Ebola |url=https://www.who.int/features/2014/drc-beats-ebola/en/ |url-status=dead |archive-url=https://web.archive.org/web/20150226005300/https://www.who.int/features/2014/drc-beats-ebola/en/ |archive-date=26 February 2015 |access-date=26 February 2015 |publisher=[[World Health Organization]] (WHO)}}</ref> ===2013–2016 West Africa=== {{main|West African Ebola virus epidemic}} [[File:Diseased Ebola 2014.png|thumb|upright=1.3|Cases and deaths from April 2014 to July 2015 during the [[Ebola virus epidemic in West Africa|2013–2015 outbreak]]]] In March 2014, the [[World Health Organization]] (WHO) reported a major Ebola outbreak in [[Guinea]], a West African nation.<ref name="CDC2014Out">{{Cite web |date=1 August 2014 |title=Guidelines for Evaluation of US Patients Suspected of Having Ebola Virus Disease |url=https://stacks.cdc.gov/view/cdc/24830 |url-status=live |archive-url=https://web.archive.org/web/20140808075214/http://emergency.cdc.gov/han/han00364.asp |archive-date=8 August 2014 |access-date=5 August 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC)}}</ref> Researchers traced the outbreak to a one-year-old child who died in December 2013.<ref name="Baize2014">{{Cite journal |display-authors=6 |vauthors=Baize S, Pannetier D, Oestereich L, Rieger T, Koivogui L, Magassouba N, Soropogui B, Sow MS, Keïta S, De Clerck H, Tiffany A, Dominguez G, Loua M, Traoré A, Kolié M, Malano ER, Heleze E, Bocquin A, Mély S, Raoul H, Caro V, Cadar D, Gabriel M, Pahlmann M, Tappe D, Schmidt-Chanasit J, Impouma B, Diallo AK, Formenty P, Van Herp M, Günther S |date=October 2014 |title=Emergence of Zaire Ebola Virus Disease in Guinea |url=http://pdfs.semanticscholar.org/2fac/85d09a91e4b0f670afda192af30d9620498b.pdf |url-status=dead |journal=New England Journal of Medicine |volume=371 |issue=15 |pages=1418–1425 |doi=10.1056/NEJMoa1404505 |pmid=24738640 |archive-url=https://web.archive.org/web/20190221224737/http://pdfs.semanticscholar.org/2fac/85d09a91e4b0f670afda192af30d9620498b.pdf |archive-date=21 February 2019 |s2cid=34198809}}</ref><ref name="1st Chain">{{Cite web |name-list-style=vanc |year=2014 |title=The first cases of this Ebola outbreak traced by WHO |url=http://who.int/csr/disease/ebola/ebola-6-months/guinea-chart-big.png?ua=1 |url-status=live |archive-url=https://web.archive.org/web/20141006092047/http://who.int/csr/disease/ebola/ebola-6-months/guinea-chart-big.png?ua=1 |archive-date=6 October 2014 |publisher=[[World Health Organization]] (WHO) |format=png |ref=1st-chain}}</ref> 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.<ref name="CDC2014Out" /> 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."<ref>{{Cite news |title=WHO raises global alarm over Ebola outbreak |work=CBS News |url=https://www.cbsnews.com/news/ebola-outbreak-international-public-health-emergency-who/ |url-status=live |access-date=2 August 2014 |archive-url=https://web.archive.org/web/20140808095616/http://www.cbsnews.com/news/ebola-outbreak-international-public-health-emergency-who/ |archive-date=8 August 2014 }}</ref> 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.<ref name="Common Dreams">{{Cite web | vauthors = Fulton D |date=18 August 2014 |title=In Liberia's Ebola-Stricken Villages, Residents Face 'Stark' Choices |url=http://www.commondreams.org/news/2014/08/18/liberias-ebola-stricken-villages-residents-face-stark-choices |url-status=live |archive-url=https://web.archive.org/web/20140820041111/http://www.commondreams.org/news/2014/08/18/liberias-ebola-stricken-villages-residents-face-stark-choices |archive-date=20 August 2014 |access-date=20 August 2014 |publisher=Common Dreams }}</ref> 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."<ref name="Ebola situation assessment ">{{Cite press release |title=Experimental therapies: growing interest in the use of whole blood or plasma from recovered Ebola patients (convalescent therapies) |date=26 September 2014 |publisher=World Health Organization (WHO) |url=https://www.who.int/mediacentre/news/ebola/26-september-2014/en/ |access-date=28 September 2014 |url-status=dead |archive-url=https://web.archive.org/web/20140928143036/https://www.who.int/mediacentre/news/ebola/26-september-2014/en/ |archive-date=28 September 2014 }}</ref> Intense contact tracing and strict isolation largely prevented further spread of the disease in the countries that had imported cases. {{#section:Ebola virus epidemic in West Africa|casesasof}}, {{#section:Ebola virus epidemic in West Africa|cases}} suspected cases and {{#section:Ebola virus epidemic in West Africa|deaths}} deaths were reported;{{#section:Ebola virus epidemic in West Africa|caserefs}}<ref name=":0">{{Cite web |date=2014 |title=2014 Ebola Outbreak in West Africa – Case Counts |url=https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.html |url-status=live |archive-url=https://web.archive.org/web/20170806135144/https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/index.html |archive-date=6 August 2017 |publisher=[[Centers for Disease Control and Prevention]] (CDC) }}</ref> however, the WHO said that these numbers may be underestimated.<ref name="Ebola_Outbreak_total_WHO_28_Sept">{{Cite web |date=1 October 2014 |title=Ebola Response Roadmap Situation Report |url=http://apps.who.int/iris/bitstream/10665/135600/1/roadmapsitrep_1Oct2014_eng.pdf?ua=1 |url-status=live |archive-url=https://web.archive.org/web/20141002142707/http://apps.who.int/iris/bitstream/10665/135600/1/roadmapsitrep_1Oct2014_eng.pdf?ua=1 |archive-date=2 October 2014 |publisher=[[World Health Organization]] (WHO) }}</ref> 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.<ref>{{Cite web |date=25 August 2014 |title=Unprecedented number of medical staff infected with Ebola |url=https://www.who.int/mediacentre/news/ebola/25-august-2014/en/ |url-status=dead |archive-url=https://web.archive.org/web/20140828123825/https://www.who.int/mediacentre/news/ebola/25-august-2014/en/ |archive-date=28 August 2014 |access-date=29 August 2014 |publisher=[[World Health Organization]] (WHO)}}</ref> [[File:2014 ebola virus epidemic in West Africa.svg|thumb|upright=1.3|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.<ref name="WHO2014_12_10">{{Cite web |date=10 December 2014 |title=Ebola response roadmap – Situation report |url=http://apps.who.int/iris/bitstream/10665/145198/1/roadmapsitrep_10Dec2014_eng.pdf?ua=1 |url-status=live |archive-url=https://web.archive.org/web/20141210214551/http://apps.who.int/iris/bitstream/10665/145198/1/roadmapsitrep_10Dec2014_eng.pdf?ua=1 |archive-date=10 December 2014 |access-date=11 December 2014 |publisher=[[World Health Organization]] (WHO) |format=PDF}}</ref> 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.<ref name="World Health Organization">{{Cite web |date=28 January 2015 |title=Ebola Situation Report |url=http://apps.who.int/ebola/en/ebola-situation-report/situation-reports/ebola-situation-report-28-january-2015 |url-status=dead |archive-url=https://web.archive.org/web/20150203214717/http://apps.who.int/ebola/en/ebola-situation-report/situation-reports/ebola-situation-report-28-january-2015 |archive-date=3 February 2015 |access-date=5 February 2015 |publisher=[[World Health Organization]] (WHO) }}</ref> On 8 April 2015, the WHO reported only 30 confirmed cases, the lowest weekly total since the third week of May 2014.<ref name="WHO">{{Cite web |date=8 April 2015 |title=Ebola Situation Report |url=http://apps.who.int/iris/bitstream/10665/161244/1/roadmapsitrep_8Apr2015_eng.pdf?ua=1&ua=1 |url-status=live |archive-url=https://web.archive.org/web/20150414170339/http://apps.who.int/iris/bitstream/10665/161244/1/roadmapsitrep_8Apr2015_eng.pdf?ua=1&ua=1 |archive-date=14 April 2015 |access-date=14 April 2015 |publisher=[[World Health Organization]] (WHO) }}</ref> On 29 December 2015, 42 days after the last person tested negative for a second time, Guinea was declared free of Ebola transmission.<ref>{{Cite news |date=29 December 2015 |title=Ebola gone from Guinea |publisher=[[CBC News]] |agency=Thomson Reuters |url=http://www.cbc.ca/news/health/ebola-guinea-1.3382945 |url-status=live |access-date=30 December 2015 |archive-url=https://web.archive.org/web/20151230001240/http://www.cbc.ca/news/health/ebola-guinea-1.3382945 |archive-date=30 December 2015}}</ref> 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.<ref>{{Cite press release |title=UN declares end to Ebola virus transmission in Guinea; first time all three host countries free |publisher=United Nations |url=https://www.un.org/apps/news/story.asp?NewsID=52913 |access-date=30 December 2015 |url-status=live |archive-url=https://web.archive.org/web/20160101115517/http://www.un.org/apps/news/story.asp?NewsID=52913 |archive-date=1 January 2016 |author=<!-- no by-line. --> |name-list-style=vanc}}</ref> A new case was detected in Sierra Leone on 14 January 2016.<ref>{{Cite web |date=15 January 2016 |title=New Ebola case in Sierra Leone. WHO continues to stress risk of more flare-ups |url=https://www.who.int/mediacentre/news/statements/2016/new-ebola-case/en/ |url-status=live |archive-url=https://web.archive.org/web/20160127143222/https://www.who.int/mediacentre/news/statements/2016/new-ebola-case/en/ |archive-date=27 January 2016 |access-date=25 January 2016 |publisher=[[World Health Organization]] (WHO)}}</ref> However, the outbreak was declared no longer an emergency on 29 March 2016.<ref name="who.int" /> ====2014 spread outside West Africa==== {{main|Ebola virus cases in the United States|Ebola virus disease in Spain|Ebola virus disease 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.<ref>{{Cite news | vauthors = Botelho G, Wilson J |date=8 October 2014 |title=Thomas Eric Duncan: First Ebola death in U.S. |publisher=CNN |url=http://edition.cnn.com/2014/10/08/health/thomas-eric-duncan-ebola/index.html |url-status=live |access-date=8 August 2017 |archive-url=https://web.archive.org/web/20160529040652/http://edition.cnn.com/2014/10/08/health/thomas-eric-duncan-ebola/index.html |archive-date=29 May 2016}}</ref> 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.<ref>{{Cite web |title=Second US Ebola diagnosis 'deeply concerning', admits CDC chief |url=https://www.msn.com/en-us/news/us/second-us-ebola-diagnosis-deeply-concerning-admits-cdc-chief/ar-BB8UFz0 |url-status=dead |archive-url=https://web.archive.org/web/20141014175544/http://www.msn.com/en-us/news/us/second-us-ebola-diagnosis-deeply-concerning-admits-cdc-chief/ar-BB8UFz0 |archive-date=14 October 2014 |access-date=20 February 2020 |website=[[MSN]]}}archive-url= October 2013</ref> Romero tested negative for the disease on 20 October, suggesting that she may have recovered from Ebola infection.<ref>{{Cite news |date=20 October 2014 |title=Ebola crisis: Tests show Spanish nurse Teresa Romero no longer has the virus |work=ABC News |url=http://www.abc.net.au/news/2014-10-20/spanish-nurse-infected-with-ebola-no-longer-has-virus/5825720 |url-status=live |archive-url=https://web.archive.org/web/20141029201132/http://www.abc.net.au/news/2014-10-20/spanish-nurse-infected-with-ebola-no-longer-has-virus/5825720 |archive-date=29 October 2014 }}</ref> 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.<ref name="NYT-20141012-MF">{{Cite news | vauthors = Fernandez M |date=12 October 2014 |title=Texas Health Worker Tests Positive for Ebola |work=[[The New York Times]] |url=https://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html |url-status=live |access-date=12 October 2014 |archive-url=https://web.archive.org/web/20141012162113/http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html |archive-date=12 October 2014}}</ref> On 15 October, a second Texas health-care worker who had treated Duncan was confirmed to have the virus.<ref name="NBC-ebolaTX" /><ref>{{Cite news |title=Ebola in Texas: Second Health Care Worker Tests Positive |url=https://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-texas-second-health-care-worker-tests-positive-n226161 |url-status=live |archive-url=https://web.archive.org/web/20141015211852/http://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-texas-second-health-care-worker-tests-positive-n226161 |archive-date=15 October 2014}}</ref> Both of these people recovered.<ref name="CDC-20142411">{{Cite web |date=22 May 2018 |title=Cases of Ebola Diagnosed in the United States |url=https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html |url-status=live |archive-url=https://web.archive.org/web/20170226055827/https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html |archive-date=26 February 2017 }}</ref> 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.<ref>{{Cite news | vauthors = Sanchez R, Prokupecz S |date=23 October 2014 |title=N.Y. doctor positive for Ebola had no symptoms until Thursday, officials say |publisher=CNN |url=http://www.cnn.com/2014/10/23/health/new-york-possible-ebola-case/index.html |url-status=live |access-date=23 October 2014 |archive-url=https://web.archive.org/web/20141024022702/http://www.cnn.com/2014/10/23/health/new-york-possible-ebola-case/index.html?hpt=hp_t1 |archive-date=24 October 2014 }}</ref> The person recovered and was discharged from [[Bellevue Hospital]] on 11 November.<ref name="CDC-20142411" /> On 24 December 2014, a laboratory in [[Atlanta]], Georgia reported that a technician had been exposed to Ebola.<ref>{{Cite news | vauthors = Sun LH, Achenbach J |date=24 December 2014 |title=CDC reports potential Ebola exposure in Atlanta lab |newspaper=[[The Washington Post]] |url=https://www.washingtonpost.com/national/health-science/cdc-reports-potential-ebola-exposure-in-atlanta-lab/2014/12/24/f1a9f26c-8b8e-11e4-8ff4-fb93129c9c8b_story.html |url-status=live |access-date=25 December 2014 |archive-url=https://web.archive.org/web/20141225002131/http://www.washingtonpost.com/national/health-science/cdc-reports-potential-ebola-exposure-in-atlanta-lab/2014/12/24/f1a9f26c-8b8e-11e4-8ff4-fb93129c9c8b_story.html |archive-date=25 December 2014}}</ref> 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]].<ref name="BBC-30628349">{{Cite news |date=29 December 2014 |title=Ebola case confirmed in Glasgow hospital |work=BBC News Online |url=https://www.bbc.co.uk/news/uk-scotland-30628349 |url-status=live |archive-url=https://web.archive.org/web/20141229191607/http://www.bbc.co.uk/news/uk-scotland-30628349 |archive-date=29 December 2014}}</ref> 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.<ref name="BBC-30629397">{{Cite news |date=30 December 2014 |title=Ebola nurse Pauline Cafferkey transferred to London unit |work=BBC News Online |url=https://www.bbc.com/news/uk-scotland-30629397 |url-status=live |archive-url=https://web.archive.org/web/20141230120858/http://www.bbc.com/news/uk-scotland-30629397 |archive-date=30 December 2014}}</ref> === 2017 Democratic Republic of the Congo === {{Main|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.<ref>{{Cite web |title=Ebola Epidemiology |url=http://www.ebolavirusnet.com/epidemiology.html |access-date=26 May 2020 |website=www.ebolavirusnet.com |language=en-gb |archive-date=31 May 2020 |archive-url=https://web.archive.org/web/20200531182238/http://ebolavirusnet.com/epidemiology.html |url-status=dead }}</ref> === 2018 Équateur province === {{Main|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."<ref name="first 2018 DRC outbreak report">{{Cite web |title=WHO says 19 dead, 39 infected so far in Congo Ebola outbreak |url=https://www.msn.com/en-us/health/medical/who-says-19-dead-39-infected-so-far-in-congo-ebola-outbreak/ar-AAxfhX9?ocid=ientp |access-date=14 May 2018 |publisher=MSN}}</ref> 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,<ref name="first 2018 DRC outbreak report" /> including in the large city of [[Mbandaka]]. The DRC Ministry of Public Health approved the use of an experimental vaccine.<ref>{{Cite web |title=WHO planning for 'worst case scenario' over DRC Ebola outbreak |url=https://www.aljazeera.com/news/2018/05/planning-worst-case-scenario-drc-ebola-outbreak-180511153458973.html |access-date=14 May 2018 |publisher=[[Al Jazeera English|Al Jazeera]]}}</ref><ref>{{Cite web |title=19 dead in latest Congo Ebola outbreak: WHO |url=https://www.reuters.com/video/2018/05/14/19-dead-in-latest-congo-ebola-outbreak-w?videoId=426863714&videoChannel=118261 |access-date=14 May 2018 |website=[[Reuters]]}}</ref><ref>{{Cite news |date=14 May 2018 |title=Update 1 – WHO gets approval to use Ebola vaccine in Democratic… |work=Reuters |url=https://www.reuters.com/article/health-ebola-who/update-1-who-gets-approval-to-use-ebola-vaccine-in-democratic-republic-of-congo-idUSL5N1SL554 |access-date=5 August 2018}}</ref> On 13 May 2018, WHO Director-General [[Tedros Adhanom Ghebreyesus]] visited Bikoro.<ref>{{Cite web |title=WHO Director General visits Ebola-affected areas in DR Congo |url=https://www.who.int/news-room/detail/13-05-2018-who-director-general-visits-ebola-affected-areas-in-dr-congo |access-date=14 May 2018 |publisher=[[World Health Organization]] (WHO)}}</ref> Reports emerged that maps of the area were inaccurate, not so much hampering medical providers as [[epidemiologist]]s and officials trying to assess the outbreak and containment efforts.<ref>{{Cite web | vauthors = Yong E |date=21 May 2018 |title=Most Maps of the New Ebola Outbreak Are Wrong: Villages, and sometimes whole regions of the Congo, are misplaced – but the ministry of health and a team of cartographers are racing to get better data |url=https://www.theatlantic.com/health/archive/2018/05/most-maps-of-the-new-ebola-outbreak-are-wrong/560777/ |website=[[The Atlantic]]}}</ref> The 2018 outbreak in the DRC was declared over on 24 July 2018.<ref name=WHO2018DRCOver/> === 2018–2020 Kivu === {{Main|Kivu Ebola epidemic}} 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.<ref>{{Cite news | vauthors = Beaubien J |date=2 August 2018 |title=Ebola In A Conflict Zone |work=NPR |publisher=[[National Public Radio]] (NPR) |url=https://www.npr.org/sections/goatsandsoda/2018/08/02/635016034/ebola-in-a-conflict-zone |access-date=5 August 2018}}</ref><ref>{{Cite news | vauthors = Specia M |date=2 August 2018 |title=The Latest Ebola Outbreak Is Centered in a War Zone |work=The New York Times |url=https://www.nytimes.com/2018/08/02/world/africa/ebola-outbreak-congo-war-zone.html |access-date=5 August 2018}}</ref> By November 2018, nearly 200 Congolese had died of Ebola, about half of them from the city of [[Beni, Democratic Republic of the Congo|Beni]], where armed groups are fighting over the region's mineral wealth, impeding medical relief efforts.<ref>{{Cite web |date=13 November 2018 |title=DRC: Ebola Outbreak Worst in Country's History, Kills Almost 200 |url=https://www.democracynow.org/2018/11/13/headlines/drc_ebola_outbreak_worst_in_countrys_history_kills_almost_200 |access-date=14 November 2018 |publisher=Democracy Now}}</ref> 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.<ref name="CDC24March2019">{{Cite press release |title=Ebola outbreak in eastern Democratic Republic of Congo tops 1,000 cases |date=29 March 2019 |publisher=[[Centers for Disease Control and Prevention]] (CDC) |url=https://www.cdc.gov/media/releases/2019/s0322-ebola-congo.html |access-date=12 May 2019}}</ref><ref name="WHOMay2019">{{Cite web |title=Ebola virus disease – Democratic Republic of the Congo |url=https://www.who.int/csr/don/02-may-2019-ebola-drc/en/ |url-status=dead |archive-url=https://web.archive.org/web/20190505054446/https://www.who.int/csr/don/02-may-2019-ebola-drc/en/ |archive-date=5 May 2019 |access-date=12 May 2019 |publisher=[[World Health Organization]] (WHO)}}</ref> {{As of|2019|6|4}}, the WHO reported 2025 confirmed and probable cases with 1357 deaths.<ref>{{Cite web |date=6 June 2019 |title=Ebola virus disease – Democratic Republic of the Congo – Disease outbreak news: Update 6 June 2019 |url=https://www.who.int/csr/don/06-june-2019-ebola-drc/en/ |archive-url=https://web.archive.org/web/20190607113738/https://www.who.int/csr/don/06-june-2019-ebola-drc/en/ |archive-date=7 June 2019 |access-date=7 June 2019 |publisher=[[World Health Organization]] (WHO)}}</ref> In June 2019, two people died of Ebola in neighbouring [[Uganda]].<ref>{{Cite news |date=13 June 2019 |title=Ebola outbreak: Grandmother dies in Uganda |work=[[BBC News Online]] |url=https://www.bbc.co.uk/news/world-africa-48622635 |access-date=15 June 2019}}</ref> In July 2019, an infected man travelled to [[Goma]], home to more than two million people.<ref>{{Cite web | vauthors = Larson K |date=15 July 2019 |title=Congo tracing contacts of first Ebola case in eastern city |url=https://apnews.com/7ae99b8b4e414467b9139abde98684ee |access-date=17 July 2019 |website=AP News}}</ref> One week later, on 17 July 2019, the WHO declared the Ebola outbreak a [[Public Health Emergency of International Concern|global health emergency]], the fifth time such a declaration has been made by the organisation.<ref>{{Cite web | vauthors = Cheng M, Keaten J |date=17 July 2019 |title=Ebola outbreak in Congo declared a global health emergency |url=https://apnews.com/204fc739fc5846cdba4093ee65c4f7db |access-date=17 July 2019 |website=AP News}}</ref> 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.<ref>{{Cite news |date=2 August 2019 |title=Half of Ebola cases in DR Congo 'unidentified' |work=BBC News Online |url=https://www.bbc.com/news/world-africa-49212116 |access-date=3 August 2019}}</ref> On 25 June 2020, the second biggest EVD outbreak ever was declared over.<ref name="finish">{{Cite web |date=25 June 2020 |title=DR Congo's deadliest Ebola outbreak declared over |url=https://www.bbc.com/news/world-africa-53179323 |access-date=25 June 2020 |website=BBC News}}</ref> === 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.<ref>{{Cite web |date=5 June 2020 |title=Ebola virus disease case in Equateur Province, DRC is a new spillover |url=https://virological.org/t/ebola-virus-disease-case-in-equateur-province-drc-is-a-new-spillover/504 |access-date=8 June 2020 |website=Virological.org}}</ref> By 15 June the case count had increased to 17 with 11 deaths, with more than 2,500 people having been vaccinated.<ref>{{Cite web |title=17 infected, 11 dead in new Ebola outbreak in DR Congo |url=https://www.aljazeera.com/news/2020/06/17-infected-11-dead-ebola-outbreak-dr-congo-200615112609457.html |access-date=15 June 2020 |website=www.aljazeera.com}}</ref> The 11th EVD outbreak was officially declared over on 19 November 2020.<ref>{{Cite web |date=19 November 2020 |title=Democratic Republic of the Congo declares the end to its 11th Ebola outbreak |url=https://edition.cnn.com/2020/11/18/health/drc-ebola-outbreak-over-intl-hnk/index.html |access-date=19 November 2020 |website=www.cnn.com}}</ref> 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.<ref>{{Cite web |title=New Ebola case detected in eastern DRC |url=https://www.aljazeera.com/news/2021/2/7/new-ebola-case-detected-in-eastern-dr-congo-health-ministry |access-date=17 February 2021 |website=www.aljazeera.com |language=en}}</ref><ref name=":2">{{Cite web |date=15 February 2021 |title=Outbreak of Ebola virus disease in North Kivu – Democratic Republic of the Congo – 2021 |url=https://www.ecdc.europa.eu/en/news-events/outbreak-ebola-virus-disease-north-kivu-democratic-republic-congo-2021 |access-date=17 February 2021 |website=European Centre for Disease Prevention and Control |language=en}}</ref> 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.<ref>{{Cite web |title=DRC confirms two Ebola deaths in resurgence of outbreak |url=https://www.aljazeera.com/news/2021/2/11/drc-confirms-two-ebola-deaths-in-resurgence-of-outbreak |access-date=17 February 2021 |website=www.aljazeera.com |language=en}}</ref> A day after, a third case was detected in Butembo.<ref>{{Cite web |title=DRC confirms third Ebola case in North Kivu province |url=https://www.aljazeera.com/news/2021/2/12/drc-confirms-third-ebola-case-in-north-kivu-province |access-date=17 February 2021 |website=www.aljazeera.com |language=en}}</ref> On 3 May 2021, the 12th EVD outbreak was declared over, resulting in 12 cases and six deaths.<ref name=":3">{{Cite web |date=7 May 2021 |title=Communicable Disease Threats Report |url=https://www.ecdc.europa.eu/sites/default/files/documents/Communicable-disease-threats-report-8-may-2021.pdf |access-date=10 May 2021 |website=[[European Centre for Disease Prevention and Control]]}}</ref><ref>{{Cite web |date=3 May 2021 |title=Latest deadly Ebola virus outbreak in DR Congo declared over |url=https://news.un.org/en/story/2021/05/1091162 |access-date=10 May 2021 |website=UN News |language=en}}</ref> Heightened surveillance will continue for 90 days after the declaration, in case of resurgence.<ref name=":3" /> ==== 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.<ref>{{Cite web |date=14 February 2021 |title=Guinea records first Ebola deaths since 2016 |url=https://www.bbc.co.uk/news/world-africa-56060728 |access-date=14 February 2021 |website=BBC News}}</ref> On 14 February, the Guinean government declared an Ebola epidemic.<ref>{{Cite web |title=Guinea declares Ebola epidemic after three deaths |url=https://www.aljazeera.com/news/2021/2/14/guinea-sees-first-ebola-deaths-since-2016 |access-date=15 February 2021 |website=www.aljazeera.com |language=en}}</ref> The outbreak may have started following reactivation of a [[viral latency|latent case]] in a survivor of an earlier outbreak.<ref name="KuperschmidtReactivation">{{Cite journal |vauthors=Kupferschmidt, K |date=March 2021 |title=Ebola virus may lurk in survivors for many years |journal=Science |volume=371 |issue=6535 |pages=1188 |bibcode=2021Sci...371.1188K |doi=10.1126/science.371.6535.1188 |issn=0036-8075 |pmid=33737465 |s2cid=232303082}}</ref><ref name="VirologicalKeitaGuinea21">{{Cite web | vauthors = Keita AK, Düx A, Diallo H, Calvignac-Spencer S, Sow MS, Keita MB, Sidibe Y, Ayouba A, Lemarcis F, Marí Saéz A | display-authors = 6 |date=12 March 2021 |title=Resurgence of Ebola virus in Guinea after 5 years calls for careful attention to survivors without creating further stigmatization |url=https://virological.org/t/guinea-2021-ebov-genomes/651 |access-date=23 March 2021 |website=virological.org |language=en}}</ref> As of 4 May 2021, 23 cases were reported, with no new cases or deaths since 3 April 2021.<ref name=":3" /> A 42-day countdown period was started on 8 May 2021, and on 19 June, the outbreak was declared over.<ref name=":3" /><ref>{{Cite tweet |number=1406227793281757189 |user=WHOAFRO |title=The #Ebola outbreak in #Guinea was declared over today! Here is a look back at the hard work of communities, health workers, partners & Guinea's health authorities to bring this outbreak to an end while also fighting #COVID19.}}</ref> ==== 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.<ref>{{Cite web |date=14 August 2021 |title=Cote d'Ivoire declares first Ebola outbreak in more than 25 years |url=https://www.afro.who.int/news/cote-divoire-declares-first-ebola-outbreak-more-25-years |access-date=15 August 2021 |website=afro.who.int}}</ref> 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.<ref>{{Cite web |title=New test finds no evidence of Ebola virus in Cote d'Ivoire case |url=https://www.afro.who.int/news/new-test-finds-no-evidence-ebola-virus-cote-divoire-case |access-date=3 October 2021 |website=WHO {{!}} Regional Office for Africa |language=en}}</ref> === 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.<ref>{{Cite web |date=23 April 2022 |title=New case of Ebola hemorrhagic fever found in DR Congo |url=https://www.aljazeera.com/news/2022/4/23/new-case-of-ebola-hemorrhagic-fever-found-in-dr-congo |access-date=24 April 2022 |website=[[Al Jazeera English|Al Jazeera]] |language=en}}</ref> By 24 May 2022, there were 5 recorded deaths in the DRC.<ref>{{Cite web |date=24 May 2022 |title=All reported DR Congo Ebola patients dead: WHO |url=https://gazettengr.com/all-reported-dr-congo-ebola-patients-dead-who/ |access-date=25 May 2022 |website=[[Peoples Gazette]]}}</ref> On 15 August, the fifth case was buried, and the outbreak was declared over, 42 days after, on 4 July 2022.<ref>{{Citation |title=Ebola virus disease – Democratic Republic of the Congo |date=4 July 2022 |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON398 |work=[[World Health Organization]] |language=en |access-date=15 September 2022}}</ref> In September 2022, [[2022 Uganda Ebola outbreak|Uganda reported 7 cases infected with the Ebola Sudan strain]],<ref>{{Cite news | vauthors = Biryabarema E |date=22 September 2022 |title=Uganda has confirmed seven Ebola cases so far, one death |language=en |work=Reuters |url=https://www.reuters.com/world/africa/uganda-ebola-cases-stand-seven-so-far-2022-09-22/ |access-date=23 September 2022}}</ref> but by mid-October the count had increased to 63.<ref>{{Cite web |date=10 October 2022 |title=Uganda is battling Ebola again – and the world doesn't have a vaccine {{!}} Devi Sridhar |url=https://www.theguardian.com/commentisfree/2022/oct/10/uganda-ebola-vaccine |access-date=12 October 2022 |website=the Guardian |language=en}}</ref> In November 2022, the outbreak in Uganda continued - still without a vaccine.<ref name="Guiliani 2022" /> 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.<ref>{{Cite web |date=10 January 2023 |title=Ebola outbreak in Uganda declared over |url=https://bnonews.com/index.php/2023/01/ebola-outbreak-in-uganda-declared-over/ |access-date=12 January 2023 |website=BNO News |language=en-US}}</ref> ==Society and culture== {{see also|Cultural effects of the Ebola crisis}} ===Weaponisation=== ''Ebolavirus'' is classified as a [[Biosafety level#Levels|biosafety level 4]] agent, as well as a [[Bioterrorism#Category A|Category A bioterrorism]] agent by the Centers for Disease Control and Prevention.<ref name="Ansari2014" /><ref name="MacNeil2012">{{Cite journal |vauthors=MacNeil A, Rollin PE |date=June 2012 |title=Ebola and Marburg hemorrhagic fevers: neglected tropical diseases? |journal=PLOS Negl Trop Dis |volume=6 |issue=6 |pages=e1546 |doi=10.1371/journal.pntd.0001546 |pmc=3385614 |pmid=22761967 |doi-access=free }}</ref> It has the potential to be weaponised for use in [[biological warfare]],<ref name="pmid11988060">{{Cite journal |display-authors=6 |vauthors=Borio L, Inglesby T, Peters CJ, Schmaljohn AL, Hughes JM, Jahrling PB, Ksiazek T, Johnson KM, Meyerhoff A, O'Toole T, Ascher MS, Bartlett J, Breman JG, Eitzen EM, Hamburg M, Hauer J, Henderson DA, Johnson RT, Kwik G, Layton M, Lillibridge S, Nabel GJ, Osterholm MT, Perl TM, Russell P, Tonat K |date=May 2002 |title=Hemorrhagic fever viruses as biological weapons: medical and public health management |journal=Journal of the American Medical Association |volume=287 |issue=18 |pages=2391–405 |doi=10.1001/jama.287.18.2391 |pmid=11988060}}</ref><ref>{{Cite journal |vauthors=Salvaggio MR, Baddley JW |date=July 2004 |title=Other viral bioweapons: Ebola and Marburg hemorrhagic fever |journal=Dermatologic Clinics |volume=22 |issue=3 |pages=291–302, vi |doi=10.1016/j.det.2004.03.003 |pmid=15207310}}</ref> 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.<ref name="Zubray">{{Cite book | vauthors = Zubray G |url=https://books.google.com/books?id=AwkVgNPRnKoC&pg=PA73 |title=Agents of Bioterrorism: Pathogens and Their Weaponization |publisher=Columbia University Press |year=2013 |isbn=978-0231518130 |location=New York |pages=73–74 |archive-url=https://web.archive.org/web/20160504004715/https://books.google.com/books?id=AwkVgNPRnKoC&pg=PA73 |archive-date=4 May 2016 |url-status=live |name-list-style=vanc }}</ref> Fake emails pretending to be Ebola information from the WHO or the Mexican government have, in 2014, been misused to spread computer malware.<ref>{{Cite web |date=24 October 2014 |title=Malicious Ebola-Themed Emails Are on the Rise |url=http://bits.blogs.nytimes.com/2014/10/24/malicious-ebola-themed-emails-are-on-the-rise/ |url-status=live |archive-url=https://web.archive.org/web/20170707125209/https://bits.blogs.nytimes.com/2014/10/24/malicious-ebola-themed-emails-are-on-the-rise/?action=click&contentCollection=US%20Open®ion=Article&module=Promotron |archive-date=7 July 2017 |access-date=26 October 2014 |website=The New York Times }}</ref> 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."<ref>{{Cite news |date=23 February 2015 |title=North Korea bans foreigners from Pyongyang marathon over Ebola |work=BBC News Online |url=https://www.bbc.com/news/world-asia-31581935 |url-status=live |access-date=23 February 2015 |archive-url=https://web.archive.org/web/20150224061401/http://www.bbc.com/news/world-asia-31581935 |archive-date=24 February 2015}}</ref> ===Literature=== [[Richard Preston]]'s 1995 [[best-selling]] book, ''[[The Hot Zone]]'', dramatised the Ebola outbreak in Reston, Virginia.<ref>{{Cite book | vauthors = Preston R |url=https://books.google.com/books?id=E6BKpf2tSkoC |title=The Hot Zone, A Terrifying True Story |publisher=Anchor Books |year=1995 |isbn=978-0385479561 |oclc=32052009 |author-link=Richard Preston |archive-url=https://web.archive.org/web/20160513222825/https://books.google.com/books?id=E6BKpf2tSkoC |archive-date=13 May 2016 |url-status=live }}</ref><ref>{{Cite news |date=4 June 1995 |title=Best Sellers: 4 June 1995 |work=[[The New York Times Book Review]] |url= https://www.nytimes.com/1995/06/04/books/best-sellers-june-4-1995.html |access-date=10 September 2014}}</ref><ref>{{Cite web |title=About The Hot Zone |url= http://www.randomhouse.com/features/richardpreston/bookshelf/hz.html |url-status=dead |archive-url= https://web.archive.org/web/20141007011934/http://www.randomhouse.com/features/richardpreston/bookshelf/hz.html |archive-date=7 October 2014 |access-date=10 September 2014 |publisher=Random House}}</ref> [[William Close]]'s 1995 ''Ebola: A Documentary Novel of Its First Explosion''<ref>{{Cite book | vauthors = Close WT |url=https://archive.org/details/eboladocumentary00clos |title=Ebola: A Documentary Novel of Its First Explosion |publisher=[[Ivy Books]] |year=1995 |isbn=978-0804114325 |location=New York |oclc=32753758 |author-link=William Close |url-access=registration}}</ref><ref>{{Cite web | vauthors = Grove R |date=2 June 2006 |title=More about the people than the virus |url=https://www.amazon.com/Ebola-documentary-novel-first-explosion/dp/B007HEJSE6 |url-status=live |archive-url=https://web.archive.org/web/20141021075254/http://www.amazon.com/Ebola-documentary-novel-first-explosion/dp/B007HEJSE6 |archive-date=21 October 2014 |access-date=17 September 2014 |website=Review of Close, William T., Ebola: A Documentary Novel of Its First Explosion}}</ref> and 2002 ''Ebola: Through the Eyes of the People'' focused on individuals' reactions to the 1976 Ebola outbreak in Zaire.<ref>{{Cite book | vauthors = Close WT |url=https://books.google.com/books?id=BX0gAQAAIAAJ |title=Ebola: Through the Eyes of the People |publisher=Meadowlark Springs Productions |year=2002 |isbn=978-0970337115 |location=Marbleton, Wyoming |oclc=49193962 |author-link=William Close |archive-url=https://web.archive.org/web/20160617210838/https://books.google.com/books?id=BX0gAQAAIAAJ |archive-date=17 June 2016 |url-status=live}}</ref><ref>{{Cite web | vauthors = Pink B |date=24 June 2008 |title=A fascinating perspective |url=https://www.amazon.com/Ebola-Through-William-T-Close/product-reviews/0970337116 |url-status=live |archive-url=https://web.archive.org/web/20141021075312/http://www.amazon.com/Ebola-Through-William-T-Close/product-reviews/0970337116 |archive-date=21 October 2014 |access-date=17 September 2014 |website=Review of Close, William T., Ebola: Through the Eyes of the People}}</ref> [[Tom Clancy]]'s 1996 novel, ''[[Executive Orders]]'', involves a [[Middle East]]ern terrorist attack on the United States using an airborne form of a deadly Ebola virus strain named "Ebola Mayinga" (see [[Mayinga N'Seka]]).<ref>{{Cite book | vauthors = Clancy T |url=https://archive.org/details/executiveorders00clan |title=Executive Orders |publisher=Putnam |year=1996 |isbn=978-0399142185 |location=New York |oclc=34878804 |author-link=Tom Clancy |url-access=registration}}</ref><ref>{{Cite news | vauthors = Stone O |author-link=Oliver Stone |date=2 September 1996 |title=Who's That in the Oval Office? |work=The New York Times |url=https://www.nytimes.com/books/97/08/17/bsp/20141.html |access-date=10 September 2014 |archive-url=https://web.archive.org/web/20090410091107/http://www.nytimes.com/books/97/08/17/bsp/20141.html |archive-date=10 April 2009}}</ref> 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.<ref>{{Cite news | vauthors = Dewey C |date=2 October 2014 |title=Popular on Amazon: Wildly misleading self-published books about Ebola, by random people without medical degrees |newspaper=[[The Washington Post]] |url=https://www.washingtonpost.com/news/the-intersect/wp/2014/10/02/popular-on-amazon-wildly-misleading-self-published-books-about-ebola-by-random-people-without-medical-degrees/ |url-status=live |access-date=27 October 2014 |archive-url=https://web.archive.org/web/20141022174054/http://www.washingtonpost.com/news/the-intersect/wp/2014/10/02/popular-on-amazon-wildly-misleading-self-published-books-about-ebola-by-random-people-without-medical-degrees/ |archive-date=22 October 2014}}</ref> ==Other animals== ===Wild animals=== Ebola has a high mortality rate among primates.<ref name="Choi2013">{{Cite journal |vauthors=Choi JH, Croyle MA |date=December 2013 |title=Emerging targets and novel approaches to Ebola virus prophylaxis and treatment |journal=BioDrugs |volume=27 |issue=6 |pages=565–583 |doi=10.1007/s40259-013-0046-1 |pmc=3833964 |pmid=23813435}}</ref> Frequent outbreaks of Ebola may have resulted in the deaths of 5,000 gorillas.<ref>{{Cite news |date=8 December 2006 |title=Ebola 'kills over 5,000 gorillas' |work=BBC News Online |url=http://news.bbc.co.uk/2/hi/science/nature/6220122.stm |url-status=live |access-date=31 May 2009 |archive-url=https://web.archive.org/web/20090329013552/http://news.bbc.co.uk/2/hi/science/nature/6220122.stm |archive-date=29 March 2009}}</ref> Outbreaks of Ebola may have been responsible for an 88% decline in tracking indices of observed chimpanzee populations in the 420 km<sup>2</sup> Lossi Sanctuary between 2002 and 2003.<ref name="doi10.1126/science.1092528" /> 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.<ref>{{Cite journal |display-authors=6 |vauthors=Formenty P, Boesch C, Wyers M, Steiner C, Donati F, Dind F, Walker F, Le Guenno B |date=February 1999 |title=Ebola virus outbreak among wild chimpanzees living in a rain forest of Côte d'Ivoire |journal=The Journal of Infectious Diseases | volume = 179 |issue= Suppl 1 |pages=S120–S126 |citeseerx=10.1.1.484.5782 |doi=10.1086/514296 |pmid=9988175 |s2cid=18658117}}</ref> 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.<ref name="doi10.1126/science.1092528">{{Cite journal |display-authors=6 |vauthors=Leroy EM, Rouquet P, Formenty P, Souquière S, Kilbourne A, Froment JM, Bermejo M, Smit S, Karesh W, Swanepoel R, Zaki SR, Rollin PE |date=January 2004 |title=Multiple Ebola virus transmission events and rapid decline of central African wildlife |journal=Science |volume=303 |issue=5656 |pages=387–390 |bibcode=2004Sci...303..387L |doi=10.1126/science.1092528 |pmid=14726594 |s2cid=43305484}}</ref> ===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.<ref name="Weingartl_2013" /><ref name="Weingartl2012">{{Cite journal |vauthors=Weingartl HM, Embury-Hyatt C, Nfon C, Leung A, Smith G, Kobinger G |date=November 2012 |title=Transmission of Ebola virus from pigs to non-human primates |journal=Sci Rep |volume=2 |page=811 |bibcode=2012NatSR...2E.811W |doi=10.1038/srep00811 |pmc=3498927 |pmid=23155478}}</ref> 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.<ref name="pmid15757552">{{Cite journal |display-authors=6 |vauthors=Allela L, Boury O, Pouillot R, Délicat A, Yaba P, Kumulungui B, Rouquet P, Gonzalez JP, Leroy EM |date=March 2005 |title=Ebola virus antibody prevalence in dogs and human risk |journal=Emerg. Infect. Dis. |volume=11 |issue=3 |pages=385–390 |doi=10.3201/eid1103.040981 |pmc=3298261 |pmid=15757552}}</ref> The authors concluded that there were "potential implications for preventing and controlling human outbreaks." ===Reston virus=== {{For|more about the outbreak in Virginia, US|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.<ref name="Preston">{{Cite book | vauthors = Preston R |url=https://archive.org/details/hotzone00pres |title=The Hot Zone |publisher=Random House |year=1994 |isbn=978-0679437840 |location=New York |page=[https://archive.org/details/hotzone00pres/page/300 300] |url-access=registration}}</ref> 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.<ref name="McCormick 1999 277–279">{{harvnb|McCormick|Fisher-Hoch|Horvitz|1999|pp=277–279}}</ref> A [[US Army]] team headquartered at USAMRIID [[Euthanisia|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.<ref name="Preston" /> Blood samples were taken from 178 animal handlers during the incident.<ref name="Waterman 1999">{{Cite book | vauthors = Waterman T |url=http://www.stanford.edu/group/virus/filo/ebor.html |title=Ebola Reston Outbreaks |publisher=Stanford University |year=1999 |access-date=2 August 2008 |archive-url=https://web.archive.org/web/20080616192533/http://www.stanford.edu/group/virus/filo/ebor.html |archive-date=16 June 2008 |url-status=live}}</ref> Of those, six animal handlers eventually [[seroconversion|seroconverted]], including one who had cut himself with a bloody scalpel.<ref name="isbn0-7910-8505-8">{{Cite book | vauthors = Smith T |url=https://archive.org/details/ebola0000smit |title=Ebola (Deadly Diseases and Epidemics) |publisher=Chelsea House Publications |year=2005 |isbn=978-0791085059 |url-access=registration}}</ref><ref name="McCormick 1999 298–299">{{harvnb|McCormick|Fisher-Hoch|Horvitz|1999|pp=298–299}}</ref> Despite its status as a [[Biosafety level 4|Level‑4]] organism and its apparent [[pathogen]]icity in monkeys, when the handlers did not become ill, the CDC concluded that the virus had a very low pathogenicity to humans.<ref name="McCormick 1999 298–299" /><ref>{{harvnb|McCormick|Fisher-Hoch|Horvitz|1999|p=300}}</ref> 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.<ref name="Preston" /> Reston virus (RESTV) can be transmitted to pigs.<ref name="Weingartl_2013" /> Since the initial outbreak it has since been found in nonhuman [[primate]]s in Pennsylvania, Texas, and Italy,<ref name="KnownCasesCDC">{{Cite web |title=Outbreaks Chronology: Ebola Virus Disease |url=http://origin.glb.cdc.gov/vhf/ebola/outbreaks/history/chronology.html |url-status=dead |archive-url=https://web.archive.org/web/20141026230925/http://origin.glb.cdc.gov/vhf/ebola/outbreaks/history/chronology.html |archive-date=26 October 2014 |access-date=26 October 2014 |publisher=[[Centers for Disease Control and Prevention]] (CDC).gov}}</ref> where the virus had infected pigs.<ref>{{Cite news | vauthors = McNeil Jr DG |date=24 January 2009 |title=Pig-to-Human Ebola Case Suspected in Philippines |work=The New York Times |url=https://www.nytimes.com/2009/01/24/health/24ebola.html |url-status=live |access-date=26 January 2009 |archive-url=https://web.archive.org/web/20090310113731/http://www.nytimes.com/2009/01/24/health/24ebola.html |archive-date=10 March 2009}}</ref> 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.<ref>{{Cite journal | vauthors = Lee J |date=2009 |title=Ebola-Reston virus in pigs |journal=Microbiology Australia |volume=30 |issue=4 |pages=140 |doi=10.1071/ma09140 |issn=1324-4272 |doi-access=free}}</ref> ==Research== ===Treatments=== {{Main|Ebola virus disease treatment research}} [[File:monoclonal antibodies3.jpg|thumb|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|2015|7}}, 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.<ref>{{Cite web |title=Final trial results confirm Ebola vaccine provides high protection against disease |url=https://www.who.int/mediacentre/news/releases/2016/ebola-vaccine-results/en/ |url-status=live |archive-url=https://web.archive.org/web/20170401042946/http://who.int/mediacentre/news/releases/2016/ebola-vaccine-results/en/ |archive-date=1 April 2017 |access-date=29 March 2017 |publisher=[[World Health Organization]] (WHO)}}</ref> {{As of|2019|8}}, two experimental treatments known as [[atoltivimab/maftivimab/odesivimab]] and [[ansuvimab]] were found to be 90% effective.<ref>{{Cite journal |vauthors=Maxmen A |date=12 August 2019 |title=Two Ebola drugs show promise amid ongoing outbreak |journal=Nature |doi=10.1038/d41586-019-02442-6 |issn=0028-0836 |pmid=32778704 |s2cid=201975390}}</ref><ref>{{Cite journal |vauthors=Hoenen T, Groseth A, Feldmann H |date=24 July 2019 |title=Therapeutic strategies to target the Ebola virus life cycle |journal=Nature Reviews. Microbiology |volume=17 |issue=10 |pages=593–606 |doi=10.1038/s41579-019-0233-2 |issn=1740-1526 |pmid=31341272 |doi-access=free}}</ref><ref>{{Cite press release |title=Investigational Monoclonal Antibody to Treat Ebola Is Safe in Adults |date=24 January 2019 |publisher=[[National Institute of Allergy and Infectious Diseases]] (NIAID) |url=https://www.niaid.nih.gov/news-events/investigational-monoclonal-antibody-treat-ebola-safe-adults |access-date=12 August 2019}}</ref> ===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.<ref>{{Cite magazine | vauthors = Butler D |title=Ebola Experts Seek to Expand Testing |url=http://www.scientificamerican.com/article/ebola-experts-seek-to-expand-testing/ |url-status=live |magazine=[[Scientific American]] |archive-url=https://web.archive.org/web/20141213012943/http://www.scientificamerican.com/article/ebola-experts-seek-to-expand-testing/ |archive-date=13 December 2014 |access-date=11 December 2014}}</ref> 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.<ref>{{Cite news | vauthors = Buchanan RT |date=29 November 2014 |title=Ebola outbreak: New 15-minute test offers hope for thousands |work=The Independent |url=https://www.independent.co.uk/news/world/africa/ebola-outbreak-new-15minute-test-trialled-in-guinea-offers-hope-for-thousands-9892543.html |url-status=live |access-date=1 December 2014 |archive-url=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 |archive-date=1 December 2014}}</ref> On 29 December 2014, the U.S. [[Food and Drug Administration]] (FDA) approved the LightMix Ebola Zaire [[Reverse transcription polymerase chain reaction|rRT-PCR]] test for patients with symptoms of Ebola.<ref>{{Cite news | vauthors = Falconi M |date=29 December 2014 |title=Roche Secures Emergency Approval by U.S. Regulators for Ebola Test |work=[[The Wall Street Journal]] |url=https://www.wsj.com/articles/roche-secures-emergency-approval-by-u-s-regulators-for-ebola-test-1419840858 |url-status=live |url-access=subscription |access-date=29 December 2014 |archive-url=https://web.archive.org/web/20141229163045/http://www.wsj.com/articles/roche-secures-emergency-approval-by-u-s-regulators-for-ebola-test-1419840858 |archive-date=29 December 2014}}</ref> ===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.<ref>{{cite journal | vauthors = Junaid A, Tang H, van Reeuwijk A, Abouleila Y, Wuelfroth P, van Duinen V, Stam W, van Zonneveld AJ, Hankemeier T, Mashaghi A | display-authors = 6 | title = Ebola Hemorrhagic Shock Syndrome-on-a-Chip | journal = iScience | volume = 23 | issue = 1 | pages = 100765 | date = January 2020 | pmid = 31887664 | pmc = 6941864 | doi = 10.1016/j.isci.2019.100765 | bibcode = 2020iSci...23j0765J }}</ref> ==See also== * [[Bibliography of Ebola]] ==Notes== {{reflist|group=note}} ==References== {{Reflist|refs= <ref name="WHO2014_12_28">{{Cite report |url=http://apps.who.int/ebolaweb/sitreps/20141231/20141231.pdf |title=Ebola response roadmap situation report |date=31 December 2014 |publisher=WHO |quote=The reported case fatality rate in the three intense-transmission countries among all cases for whom a definitive outcome is known is 71%. |access-date=1 January 2015 |archive-url=https://web.archive.org/web/20141231222250/http://apps.who.int/ebolaweb/sitreps/20141231/20141231.pdf |archive-date=31 December 2014 |url-status=dead}}</ref> }} * ''The article uses public domain text from the CDC as cited.'' === Bibliography === {{Refbegin}} * {{Cite book | vauthors = McCormick J, Fisher-Hoch S, Horvitz LA |url=https://books.google.com/books?id=QEvR3aJX2m0C |title=Level 4: Virus Hunters of the CDC |date=1999 |publisher=Barnes & Noble |isbn=978-0760712085 |edition=Updated [3rd] |format=Limited preview |orig-year=1996}} {{Refend}} == Further reading == {{Refbegin}} * {{Cite book | vauthors = Wilson F |url=https://books.google.com/books?id=yMQNBQAAQBAJ&pg=PP1 |title=CDC Guidance on Ebola Virus (EVD) |publisher=International Publications Media Group |year=2014 |isbn=978-1632670113}} * {{Cite book |url=https://books.google.com/books?id=nLA4W5IjJpwC&pg=PP1 |title=Ebola Virus: New Insights for the Healthcare Professional: 2011 Edition: ScholarlyPaper |publisher=Scholarly Editions |year=2012 |isbn=978-1464914935}} * {{Cite book | vauthors = Klenk HD |title=Marburg and Ebola Viruses |date=January 1999 |publisher=Springer-Verlag Telos |isbn=978-3540647294 |series=Current Topics in Microbiology and Immunology 235 |location=Berlin}} * {{Cite book | vauthors = Klenk HD, Feldmann H |url=https://books.google.com/books?id=EV_mFgnyPoMC |title=Ebola and Marburg viruses: molecular and cellular biology |publisher= Horizon Bioscience |year=2004 |isbn=978-0954523237 |location=Wymondham, Norfolk |format=Limited preview}} * {{Cite book | vauthors = Kuhn JH |url=https://books.google.com/books?id=LaOue0F9Ns4C |title=Filoviruses: A Compendium of 40 Years of Epidemiological, Clinical, and Laboratory Studies. Archives of Virology Supplement | volume = 20 |publisher=SpringerWienNewYork |year=2008 |isbn=978-3211206706 |location=Vienna |format=Limited preview}} * {{Cite book | vauthors = Pattyn SR |url=http://www.itg.be/ebola/ |title=Ebola Virus Haemorrhagic Fever |publisher=Elsevier/North-Holland Biomedical Press |year=1978 |isbn=978-0444800602 |edition=1st |location=Amsterdam |format=Full free text |archive-url=https://web.archive.org/web/20101211083855/http://www.itg.be/ebola/ |archive-date=11 December 2010 |url-status=dead}} * {{Cite book | vauthors = Ryabchikova EI, Price BB |title=Ebola and Marburg Viruses: A View of Infection Using Electron Microscopy |publisher=Battelle Press |year=2004 |isbn=978-1574771312 |location=Columbus, Ohio}} {{Refend}} ==External links== * [https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease WHO fact sheet on Ebola] * [https://www.cdc.gov/vhf/ebola/ Ebola (Ebola Virus Disease)] – Centers for Disease Control and Prevention, Viral Special Pathogens Branch. * [https://web.archive.org/web/20140823072115/http://www.who.int/csr/disease/ebola/videos/en/ Videos: Ebola outbreak response] – World Health Organization. * {{Cite web |date=13 January 2021 |title=Ebola Preparedness and Response |url=https://www.fda.gov/emergency-preparedness-and-response/mcm-issues/ebola-preparedness-and-response-updates-fda |website=U.S. [[Food and Drug Administration]] (FDA)}} * [https://www.scientificamerican.com/report/ebola-what-you-need-to-know1/ Ebola: What You Need to Know] – ''[[Scientific American]]'' articles related to Ebola; note these are general reading articles, they are not scientific peer-reviewed research articles. {{Medical condition classification and resources| DiseasesDB = 18043 | ICD10 = {{ICD10|A|98|4|a|90}} | ICD9 = {{ICD9|078.89}} | MedlinePlus = 001339 | eMedicineSubj = med | eMedicineTopic = 626 | MeshID = D019142 }} {{Subject bar |commons=y |commons-search=Ebola |wikt=y |wikt-search=Ebola |q=y |v=y |v-search=Ebola |n=y |n-search=Category:Ebola virus |d=y |d-search=Q51993 }} {{Ebola|state=autocollapse}} {{Zoonotic viral diseases}} {{Portal bar | Medicine | Viruses }} {{incubator|vai/ꔤꕷꕞ}} {{Authority control}} [[Category:Ebola| ]] [[Category:Animal viral diseases]] [[Category:Arthropod-borne viral fevers and viral haemorrhagic fevers]] [[Category:Articles containing video clips]] [[Category:Bat virome]] [[Category:Biological weapons]] [[Category:Health in Africa]] [[Category:Hemorrhagic fevers]] [[Category:Wikipedia medicine articles ready to translate]] [[Category:Wikipedia infectious disease articles ready to translate]] [[Category:Sexually transmitted diseases and infections]] [[Category:Tropical diseases]] [[Category:Virus-related cutaneous conditions]] [[Category:West African Ebola virus epidemic]] [[Category:Wikipedia pages referenced by the press]] [[Category:Zoonoses]] [[Category:Vaccine-preventable diseases]] [[so:Ebola virus disease]] Summary: Please note that all contributions to Christianpedia may be edited, altered, or removed by other contributors. 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