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  • Ebola virus disease

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness affecting humans and other primates.

The virus is transmitted to people from wild animals (such as fruit bats, porcupines and non-human primates) and then spreads in the human population through direct contact with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.

The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.

The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests. The 2014–2016 outbreak in West Africa was the largest and most complex Ebola outbreak since the virus was first discovered in 1976. There were more cases and deaths in this outbreak than all others combined. It also spread between countries, starting in Guinea then moving across land borders to Sierra Leone and Liberia.

It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts.

The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is from 2 to 21 days. A person infected with Ebola cannot spread the disease until they develop symptoms.

Symptoms of EVD can be sudden and include: fever, fatigue, muscle, pain, headache, and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

It can be difficult to clinically distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis. A range of diagnostic tests have been developed to confirm the presence of the virus.

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  • About Viral Hemorrhagic Fevers

Ebola Disease Basics

  • Ebola disease is caused by an infection with an orthoebolavirus.
  • Orthoebolaviruses are found primarily in sub-Saharan Africa.
  • Orthoebolaviruses can cause serious and often deadly disease, with a mortality rate as high as 80 to 90 percent.
  • There is an FDA-approved vaccine for the prevention of Ebola virus (species Zaire orthoebolavirus).

Microscopic image of the Ebola virus

Ebola disease is caused by a group of viruses, known as orthoebolaviruses (formally ebolavirus) 1 . These viruses can cause serious illness that, without treatment, can cause death. Orthoebolaviruses were discovered in 1976 in the Democratic Republic of the Congo and are found primarily in sub-Saharan Africa.

There are four orthoebolaviruses that cause illness in people:

  • Ebola virus (species orthoebolavirus zairense ) causes Ebola virus disease.
  • Sudan virus (species orthoebolavirus sudanense ) causes Sudan virus disease.
  • Taï Forest virus (species orthoebolavirus taiense ) causes Taï Forest virus disease.
  • Bundibugyo virus (species orthoebolavirus bundibugyoense ) causes Bundibugyo virus disease.

Some orthoebolaviruses do not cause illness in people. Reston virus (species Orthoebolavirus restonense ) can cause illness in nonhuman primates and pigs. Bombali virus (species Orthoebolavirus bombaliense ) was identified in bats, but scientists don't know if it causes illness in animals or people.

Signs and symptoms

People with Ebola disease may experience "dry" symptoms early in the course of illness. These symptoms may include fever, aches, pains, and fatigue. As the person becomes sicker, the illness typically progresses to "wet" symptoms and may include diarrhea, vomiting, and unexplained bleeding.

How long it takes for signs to show

Someone with Ebola disease may start getting sick 2 to 21 days after contact with an orthoebolavirus. However, on average, symptoms begin 8 to 10 days after exposure.

Risk factors

Healthcare providers and family members caring for someone with Ebola disease without proper infection control methods have the highest risk of infection.

The viruses that cause Ebola disease pose little risk to travelers or the general public.

How it spreads

People can get Ebola disease through contact with the body fluids of an infected sick or dead person. Rarely, some people can get the disease from contact with an infected animal, like a bat or primate.

When living in or traveling to regions where viruses that spread Ebola disease may be present, protect yourself from Ebola disease.

Avoid contact with:

  • Blood and body fluids, like urine, feces, saliva, sweat, vomit, breast milk, amniotic fluid, semen, and vaginal fluid from people who are sick.
  • Semen from someone who has recovered from Ebola disease, until testing shows that the virus is no longer in the semen.
  • Clothes, bedding, needles, medical equipment, or other items that may have touched an infected person's blood or body fluids.
  • The body of someone who is suspected or confirmed to have had Ebola disease (such as during a funeral or burial practices).
  • Bats, forest antelopes, primates, and blood, fluids, or raw meat from these or unknown animals.

Wear protective equipment if you come in contact with people who are sick or have died from Ebola disease, their blood and bodily fluids, or objects covered with their blood or body fluids.

If you return from an area with an ongoing Ebola outbreak, monitor your health for 21 days. Seek medical care immediately if you develop symptoms of Ebola disease.

Ebola Vaccine

The U.S. Food and Drug Administration has approved ERVEBO ® for the prevention of Ebola disease (species O rthoebolavirus zairense only ) . Vaccination is recommended for U.S. adults 18 years and older who are at potential risk of exposure to the Ebola virus.

Testing and diagnosis

Healthcare providers use polymerase chain reaction (PCR) testing to diagnose Ebola disease. Healthcare providers can also test for orthoebolavirus antibodies.

Someone being tested for Ebola disease should be separated from other people in a healthcare facility until results are confirmed.

Two FDA-approved treatments 2 are currently available to treat an Ebola virus (species orthoebolavirus zairense ) infection: Inmazeb™ and Ebanga™ .

Supportive care:

Patients have a much better chance of surviving Ebola infection if they receive:

  • Fluids and electrolytes (body salts) by mouth or into their veins.
  • Medicine to support blood pressure, reduce vomiting and diarrhea, and to manage fever and pain.
  • Treatment for other infections, if they occur.
  • 1 In an effort to decrease confusion of genus, species, and virus names, the International Committee on Taxonomy of Viruses (ICTV) changed the genus name Ebolavirus to Orthoebolavirus. Genus: Orthoebolavirus | ICTV
  • 2 Disclaimer: The mention of any product names or non-United States Government entities on CDC Ebola websites is not meant to serve as an official endorsement of any such product or entity by the CDC, the Department of Health and Human Service, or the United States Government.

Learn about Ebola disease, caused by an infection with one of a group of viruses, known as ebolaviruses, that are found primarily in sub-Saharan Africa.

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  • Factsheet about Ebola virus disease

Factsheet about Ebola disease

Ebola disease is caused by a group of viruses within the genus Ebolavirus . This is a rare disease, but can cause outbreaks with high case fatality rates. So far, most outbreaks have occurred in sub-Saharan countries; the largest outbreak having occurred in three West African countries (Guinea, Liberia, and Sierra Leone) between 2013 and 2016, with over 28 000 cases and 11 000 deaths.

Ebola disease is not an airborne disease and is generally not considered to be contagious before the onset of symptoms. Transmission requires direct contact with the organs, blood, secretions or other bodily fluids of infected people/animals or their dead bodies. Therefore, the risk of infection is considered to be very low if strict infection prevention and control precautions are followed.

Clinical illness starts as a flu-like syndrome, often rapidly evolving to severe disease with haemorrhagic symptoms. Two vaccines against Ebola disease due to Zaire ebolavirus have been granted market authorisations by the EU. There are no licensed vaccines against Ebola disease due to the other ebolavirus species.

The pathogen

The Ebolavirus genus is a member of the  Filoviridae  family.

It includes four distinct species that are pathogenic to humans:  Zaire ebolavirus ,  Bundibugyo ebolavirus ,  Taï Forest ebolavirus   and  Sudan ebolavirus . All four species are found in Africa and cause serious illness in humans. In addition,  Reston ebolavirus can cause epizootics, but only causes asymptomatic infection in humans. So far, Reston ebolavirus outbreaks have only been reported in Asia.

Ebolaviruses are classified as a biosafety level 4 (BSL-4) pathogen and require special containment and barrier protection measures for laboratory personnel and  anyone taking care of potentially infected patients or handling dead bodies [1].

Clinical features and sequelae

In most cases, an infected patient experiences a sudden onset of flu-like illness, with

  • general malaise and weakness
  • muscle and joint pains

This is followed by

  • progressive weakness
  • diarrhoea (watery stools that sometimes contain blood and mucus)
  • nausea and vomiting.

This first set of symptoms corresponds to the prodromal phase (duration up to 10 days).

The next stage of the disease is characterised by symptoms and clinical manifestations from several organ systems. Symptoms can be

  • gastrointestinal (vomiting, diarrhoea, anorexia and abdominal pain)
  • neurological (headaches and confusion)
  • vascular (conjunctival/pharyngeal injections)
  • cutaneous (maculopapular rash)
  • respiratory (cough, chest pain and shortness of breath) and can include complete exhaustion (prostration).

Haemorrhagic manifestations can also appear (e.g. bloody diarrhoea, nosebleeds, haematemesis, petechiae, ecchymoses and prolonged bleeding from needle-puncture sites). Certain patients develop profuse internal and external haemorrhages and disseminated intravascular coagulation.

Patients in the final stage of the disease die from a combination of multi-organ failure and hypovolemic shock due to severe fluid losses. Based on one systematic review, the weighted case fatality rate (CFR) for Ebola disease (all species included but Reston ebolavirus ) was assessed to be 65.0% [95% CI (54.0–76.0%)] [2]. The CFR varies depending on the virus species, with Zaire ebolavirus exhibiting the highest fatality rate (75%), followed by Sudan ebolavirus (53%) [2].

In rare instances, infected individuals may remain asymptomatic or paucisymptomatic [2,3].

Transmission 

A spill-over from animal to human is a rare event, but subsequent human-to-human transmission can sustain large outbreaks. The typical incubation period ranges from 2 to 21 days and the mean incubation period has been estimated at 6.3 days [4]. Short incubation periods are likely due to exposure to highly contaminated materials (e.g. occupational exposure through needle-stick injuries).

Transmission modes

Ebolaviruses are highly transmissible by direct contact with the blood (e.g. through mucous membranes or broken skin), or other bodily fluids (e.g. saliva, urine or vomit) of infected people, their dead bodies, or any surfaces and materials soiled by infectious fluids [5].

Transmission can also occur through contact with infected animals (living or dead), including the consumption and/or handling of bushmeat (e.g. monkeys, apes, forest antelopes and bats) or by visiting caves or mines colonised by bats [6].

Healthcare workers can be infected by nosocomial transmissions which can occur as a result of contact with infected patients without wearing the proper protection. Healthcare settings can play a substantial role in the amplification of the disease, particularly at the beginning of an outbreak of Ebola disease before a definitive diagnosis is available and infection prevention and control (IPC) measures have been implemented [7]. The risk of infection can be significantly reduced through the appropriate use of infection control precautions and adequate barrier protection. This is especially important when performing invasive procedures.

Ebolaviruses can persist in immune-privileged sites (e.g. testicles, central nervous system and aqueous humour) of some survivors and, as a result, new transmissions can potentially arise, notably through sexual transmission [6,8,9].

Asymptomatic infections are a limited phenomenon and probably do not contribute significantly to human-to-human transmission [8-13].

The presence of the virus in the blood and, consequently, the organs and tissues of asymptomatic, infected or recovered individuals indicates that transmission of the virus via transfusion and transplantation is possible, although this has not been reported to date.

Filoviruses can survive in liquid or dried material for many days. They are inactivated by gamma irradiation, heating for 60 minutes at 60°C or boiling for five minutes, and are sensitive to lipid solvents, sodium hypochlorite, and other disinfectants. Freezing or refrigeration does not inactivate filoviruses.

Reservoirs of ebolaviruses

Several fruit bats of the Pteropodidae family in central and western Africa, particularly the hammer-headed bat species ( Hypsignathus monstrosus ), Franquet's epauletted fruit bat ( Epomops franqueti ) and the little collared fruit bat ( Myonycteris torquata ) are considered natural reservoirs for ebolaviruses [14].

In Africa, human infections have been linked to direct contact with wild gorillas, chimpanzees, monkeys, forest antelopes and porcupines found dead in the rainforest. Zaire ebolavirus and Sudan ebolavirus have been detected in the wild in the carcasses of chimpanzees in Côte d’Ivoire and the Republic of the Congo; gorillas in Gabon and the Republic of the Congo; and forest antelopes in the Republic of the Congo. Reston   ebolavirus has caused major outbreaks in macaque monkeys in the Philippines, while asymptomatic infections have been reported in pigs.

Epidemiology

In 1976, epidemics of severe haemorrhagic fever occurred simultaneously in southern Sudan and the northern part of the Democratic Republic of the Congo, where a new virus was identified and named after a small river called Ebola, in the Mongala province. Later studies showed some differences between the virus isolated in the Democratic Republic of the Congo ( Zaire ebolavirus ) and the virus isolated in Sudan ( Sudan ebolavirus ). Multiple outbreaks of Ebola disease have been identified since its initial discovery [15].

Ebola disease due to Zaire ebolavirus is referred as Ebola virus disease. Large autochthonous outbreaks of Ebola virus disease have so far been reported in the Democratic Republic of the Congo, Gabon, Guinea, Liberia, the Republic of the Congo and Sierra Leone.

To date, the largest reported outbreak of Ebola virus disease occurred in the three West African countries (Guinea, Liberia and Sierra Leone) from 2013 through 2016, with over 28 000 cases and 11 000 deaths [15,16].

Ebola disease due to Sudan ebolavirus is referred as Sudan virus disease. Outbreaks of Sudan virus disease have been reported in Sudan and Uganda [15].

Ebola disease due to Bundibugyo ebolavirus and Taï Forest ebolavirus is referred to as Bundibugyo virus disease and Taï Forest virus disease, respectively. Outbreaks of Bundibugyo virus disease have been reported in the Democratic Republic of the Congo and Uganda; and outbreaks of Taï Forest virus disease have been reported in Côte d’Ivoire [15].

Sporadic imported cases of Ebola virus disease have also been reported in several non-endemic African and non-African countries. In some instances, short chains of transmission have occurred in countries such as Mali, Nigeria, Senegal, Uganda, South Africa, Spain, Italy, the United Kingdom and the United States [15].

Diagnostics

Laboratory tests on blood specimens detect viral material (viral genome or antigen) or specific antibodies. Ebola disease is diagnosed by the detection of ebolavirus ribonucleic acid (RNA) in whole blood, plasma or serum during the acute phase of illness, using reverse transcription polymerase chain reaction (RT-PCR) tests. Viral RNA can usually be detected up to a few days after the disappearance of symptoms.

Viral RNA may also be detected in other bodily fluids, such as semen, saliva or urine [17,18]. Throat swabs are suitable for virus detection in deceased patients. Viral RNA has been detected in seminal fluid and in the breast milk of survivors, months to years after acute illness. This poses a risk of sexual or mother-to-child transmission. Identification of acute infections based on serology is uncommon.

Only a few diagnostic tests are commercially available for Ebola disease and these are specific to Ebola virus disease. According to Directive 2000/54/EC of the European Parliament and of the Council, the ebolaviruses are group 4 biological agents [1]. Therefore, samples from infected patients should be handled under strict biological containment conditions in biosafety level 3 (e.g. RT-PCR and enzyme-linked immunosorbent assay on non-inactivated samples) or level 4 laboratories (virus isolation). Any attempt at viral replication should be handled in biosafety level 4 laboratories [19] [20]. For inactivated samples, RT-PCR and ELISA testing can be performed at a laboratory with BSL-2 facilities.

Case management and treatment

Advances have been made in the treatment of the Ebola virus disease. Two drugs were trialled in the PALM study (‘Pamoja Tulinde Maisha’, which in Kiswahili means ‘Together Save Lives’) during the 2018–20 Ebola outbreak in the Democratic Republic of the Congo [20]. The study showed that both the drugs drastically reduce death rates of Ebola virus disease due to ZEBOV and can be used for both adults and children [21].

The first of the two treatments, Inmazeb (formerly REGN-EB3), is manufactured by Regeneron Pharmaceuticals. It is a mixture of three monoclonal antibodies (atoltivimab, maftivimab, and odesivimab-ebgn). The drug was approved for use in the US in October 2020 [22].

Ebanga (Ansuvimab-zykl), the second drug used in the PALM study, is manufactured by Ridgeback Biotherapeutics. It is a human monoclonal antibody (mAb114). The drug was approved for use in the US on 21 December 2020 [23].

To date there are no treatments approved against Ebola virus disease due to species other than ZEBOV.

Public health control measures

The goal of Ebola disease outbreak control is to interrupt direct human-to-human transmission. Outbreak control activities are based on the early identification and systematic rapid isolation of cases, through

  • appropriate infection prevention and control (IPC) measures
  • timely and comprehensive contact tracing
  • disinfection of infectious materials
  •  use of personal protective equipment.

In previous outbreaks, isolation of infected patients and the implementation of appropriate IPC measures has been shown to effectively stop the spread of disease.

Early and culturally-relevant community engagement and social mobilisation is essential for the support of outbreak response activities. This is also useful in enhancing the knowledge of affected populations on the risk factors of viral infection and the individual protective measures that they can adopt, especially regarding safe and dignified burial practices.

It is advisable to avoid habitats that may be populated by bats, such as caves or mines in areas/countries where ebolaviruses might be present. The handling or consumption of any type of bushmeat should be avoided, as should close contact with wild animals (such as monkeys, forest antelopes, rodents and bats - alive or dead).

Infection control, personal protection and prevention

Healthcare settings.

Healthcare workers have frequently been infected while treating patients with cases of suspected or confirmed Ebola disease. This occurs through close contact with patients where IPC measures are not strictly implemented or viral aetiology has not yet been recognised.

The appropriate use of infection control precautions and the application of strict barrier nursing procedures are critical to preventing nosocomial transmission. Implementation of appropriate infection control measures in healthcare settings, including use of personal protective equipment, will minimise the risk of transmission of ebolaviruses.

Sexual contact

For Zaire ebolavirus transmission by sexual contact has been documented and the World Health Organization (WHO) recommends that male survivors practise safe sex for at least 12 months after clinical recovery, unless their semen has tested negative on two separate occasions [6,25,26]. Sexual transmission events have also been reported in male survivors with documented Zaire ebolavirus RNA persistence in semen after 12 months [3,9], indicating the need to document the absence of the virus in semen through repeated testing after clinical recovery.

Substances of human origin

Individuals with evidence of Ebola disease should not donate blood and other substances of human origin (SoHO). Potentially exposed individuals (those being monitored, asymptomatic travellers or residents returning from an Ebola disease-affected area) should defer donation of SoHO for eight weeks after return or from the beginning of the monitoring period.

Due to the possibility of intermittent low-level viraemia after recovery from illness, permanent deferral of the donation of blood, cells and tissues is suggested for donors who have recovered from Ebola disease.

Organ donation from deceased individuals or live donors who have recovered from Ebola disease should be evaluated individually by assessing the urgency of the recipients’ need; obtaining donor laboratory tests to flag the presence of filovirus; acquiring informed consent from the recipient and performing specific post-transplant monitoring. The risk to healthcare workers should also be considered.

Significant developments have been made for the prevention of Ebola disease (Zaire ebolavirus) , with two vaccines now licensed for use in several countries [27].

The first of these vaccines is the Ervebo vaccine, which is a recombinant rVSVΔG-ZEBOV-GP live vaccine manufactured by Merck. It is a vector vaccine, expressing the surface glycoprotein of Zaire ebolavirus in a recombinant vesicular stomatitis virus construct [28]. It is administered as a single-dose vaccine by intramuscular injection, and was prequalified by WHO on 12 November 2019. This means that the vaccine meets the standards required by WHO in terms of quality, safety and efficacy, facilitating its procurement for at-risk countries.

The EU has authorised the use of the vaccine [29], as has the United States [30], Burundi, Central African Republic, the Democratic Republic of the Congo, Ghana, Guinea, Rwanda, Uganda and Zambia [31]. Over 40 000 individuals in the Democratic Republic of the Congo were vaccinated with Ervebo during the tenth and eleventh Ebola disease outbreaks, which occurred August 2018 − June 2020 and June − November 2020 respectively [32].

The second vaccine is a two-component vaccine manufactured by Janssen: the prime component is Zabdeno (Ad26.ZEBOV) and the booster component is Mvabea (MVA-BN-Filo) [33] [34]. These first and second components are vector vaccines using primate adenovirus and modified vaccinia Ankara (MVA) viruses as backbones, respectively. This two-dose vaccine regimen was licensed for use in the EU on 1 July 2020.

To date there are no vaccines approved against Ebola disease due to species other than Zaire ebolavirus .

Further reading

Institutional resources.

  • Technical guidance on risk assessment guidelines for diseases transmitted on aircraft (RAGIDA) - ECDC .
  • Ebola virus disease - WHO
  • Ebola and Marburg virus disease epidemics: preparedness, alert, control, and evaluation - WHO

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 - WHO

1. Consolidated text: Directive 2000/54/EC of the European Parliament and of the Council of 18 September 2000 on the protection of workers from risks related to exposure to biological agents at work (seventh individual directive within the meaning of Article 16(1) of Directive 89/391/EEC). Brussels: EC. Available at: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A02000L0054-20200624

2. Nyakarahuka L, Kankya C, Krontveit R, Mayer B, Mwiine FN, Lutwama J, et al. How severe and prevalent are Ebola and Marburg viruses? A systematic review and meta-analysis of the case fatality rates and seroprevalence. BMC Infect Dis. 2016 Nov 25;16(1):708. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27887599

3. Diallo MSK, Rabilloud M, Ayouba A, Toure A, Thaurignac G, Keita AK, et al. Prevalence of infection among asymptomatic and paucisymptomatic contact persons exposed to Ebola virus in Guinea: a retrospective, cross-sectional observational study. Lancet Infect Dis. 2019 Mar;19(3):308-16. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30765243

4. Van Kerkhove MD, Bento AI, Mills HL, Ferguson NM, Donnelly CA. A review of epidemiological parameters from Ebola outbreaks to inform early public health decision-making. Sci Data. 2015;2:150019. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26029377

5. Brainard J, Hooper L, Pond K, Edmunds K, Hunter PR. Risk factors for transmission of Ebola or Marburg virus disease: a systematic review and meta-analysis. Int J Epidemiol. 2016 Feb;45(1):102-16. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26589246

6. World Health Organization. Ebola virus disease fact sheet. Geneva: WHO; 2021. Available at: https://www.who.int/en/news-room/fact-sheets/detail/ebola-virus-disease

7. Selvaraj SA, Lee KE, Harrell M, Ivanov I, Allegranzi B. Infection Rates and Risk Factors for Infection Among Health Workers During Ebola and Marburg Virus Outbreaks: A Systematic Review. J Infect Dis. 2018 Nov 22;218(suppl_5):S679-S89. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30202878

8. Diallo B, Sissoko D, Loman NJ, Bah HA, Bah H, Worrell MC, et al. Resurgence of Ebola Virus Disease in Guinea Linked to a Survivor With Virus Persistence in Seminal Fluid for More Than 500 Days. Clin Infect Dis. 2016 Nov 15;63(10):1353-6. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27585800

9. Den Boon S, Marston BJ, Nyenswah TG, Jambai A, Barry M, Keita S, et al. Ebola Virus Infection Associated with Transmission from Survivors. Emerg Infect Dis. 2019 Feb;25(2):249-55. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30500321

10. Glynn JR, Bower H, Johnson S, Houlihan CF, Montesano C, Scott JT, et al. Asymptomatic infection and unrecognised Ebola virus disease in Ebola-affected households in Sierra Leone: a cross-sectional study using a new non-invasive assay for antibodies to Ebola virus. Lancet Infect Dis. 2017 Jun;17(6):645-53. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28256310

11. Mbala P, Baguelin M, Ngay I, Rosello A, Mulembakani P, Demiris N, et al. Evaluating the frequency of asymptomatic Ebola virus infection. Philos Trans R Soc Lond B Biol Sci. 2017 May 26;372(1721) Available at: https://www.ncbi.nlm.nih.gov/pubmed/28396474

12. Group PIS, Sneller MC, Reilly C, Badio M, Bishop RJ, Eghrari AO, et al. A Longitudinal Study of Ebola Sequelae in Liberia. N Engl J Med. 2019 Mar 7;380(10):924-34. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30855742

13. Schindell BG, Webb AL, Kindrachuk J. Persistence and Sexual Transmission of Filoviruses. Viruses. 2018 Dec 2;10(12) Available at: https://www.ncbi.nlm.nih.gov/pubmed/30513823

14. Emanuel J, Marzi A, Feldmann H. Filoviruses: Ecology, Molecular Biology, and Evolution. Adv Virus Res. 2018;100:189-221. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29551136

15. Centers for Disease Control and Prevention. History of Ebola Virus Disease (EVD) Outbreaks. Atlanta: US CDC; 2022.

16. European Centre for Disease Prevention and Control. Ebola outbreak in West Africa (2013-2016). Stockholm: ECDC Available at: https://www.ecdc.europa.eu/en/ebola-and-marburg-fevers/threats-and-outbreaks/ebola-outbreak

17. Vetter P, Fischer WA, 2nd, Schibler M, Jacobs M, Bausch DG, Kaiser L. Ebola Virus Shedding and Transmission: Review of Current Evidence. J Infect Dis. 2016 Oct 15;214(suppl 3):S177-S84. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27443613

18. Brainard J, Pond K, Hooper L, Edmunds K, Hunter P. Presence and Persistence of Ebola or Marburg Virus in Patients and Survivors: A Rapid Systematic Review. PLoS Negl Trop Dis. 2016 Feb;10(2):e0004475. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26927697

19. Centers for Disease Control and Prevention. Biosafety in Microbiological and Biomedical Laboratories (BMBL) 6th Edition. Atlanta: US CDC.

20. Health and Safety Executive. The Approved List of biological agents, Advisory Committee on Dangerous Pathogens. London: HSE; 2021. Available at: https://www.hse.gov.uk/pUbns/misc208.pdf

21. World Health Organisation. Update on Ebola drug trial: two strong performers identified, 12 Aug 2019. Geneva: WHO. Available at: https://www.who.int/news/item/12-08-2019-update-on-ebola-drug-trial-two-strong-performers-identified

22. Dyer O. Two Ebola treatments halve deaths in trial in DRC outbreak. BMJ. 2019 Aug 13;366:l5140. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31409588

23. US Food and Drug Administration. FDA Approves First Treatment for Ebola Virus, 14 Oct 2020. Maryland: FDA. Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-ebola-virus

24. US Food and Drug Administration. FDA approves treatment for ebola virus, 21 Dec 2020. Maryland: FDA. Available at: https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-ebola-virus

25. World Health Organization. Interim advice on the sexual transmission of the Ebola virus disease, 21 Jan 2016. Geneva: WHO. Available at: https://www.who.int/publications/m/item/interim-advice-on-the-sexual-transmission-of-the-ebola-virus-disease

26. World Health Organization. Clinical care for survivors of Ebola virus disease: interim guidance. Geneva: WHO; 2016. Available at: https://apps.who.int/iris/handle/10665/204235

27. World Health Organization. Ebola virus disease: Vaccines, 11 Jan 2020. Geneva: WHO. Available at: https://www.who.int/news-room/questions-and-answers/item/ebola-vaccines

28. Regules JA, Beigel JH, Paolino KM, Voell J, Castellano AR, Hu Z, et al. A Recombinant Vesicular Stomatitis Virus Ebola Vaccine. N Engl J Med. 2017 Jan 26;376(4):330-41. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25830322

29. European Medicines Agency (EMA). Ervebo, 12 Dec 2019. Amsterdam: EMA. Available at: https://www.ema.europa.eu/en/medicines/human/EPAR/ervebo

30. US Food and Drug Administration. First FDA-approved vaccine for the prevention of Ebola virus disease, marking a critical milestone in public health preparedness and response, 19 Dec 2019. Maryland: FDA. Available at: https://www.fda.gov/news-events/press-announcements/first-fda-approved-vaccine-prevention-ebola-virus-disease-marking-critical-milestone-public-health

31. World Health Organization (WHO). Ebola Vaccine Frequently Asked Questions, 11 Jan 2020. Available at: www.who.int/news-room/questions-and-answers/item/ebola-vaccines

32. World Health Organization - Regional Office for Africa. 11th Ebola outbreak in the Democratic Republic of the Congo declared over, 18 Nov 2020. Brazzaville: WHO; 2020. Available at: https://staging.afro.who.int/countries/democratic-republic-of-congo/news/1th-ebola-outbreak-democratic-republic-congo-declared-over

33. European Medicines Agency (EMA). Zabdeno. Amsterdam: EMA; 2020. Available at: https://www.ema.europa.eu/en/medicines/human/EPAR/zabdeno

34. European Medicines Agency (EMA). Mvabea. Amsterdam: EMA; 2020. Available at: https://www.ema.europa.eu/en/medicines/human/EPAR/mvabea

presentation of ebola virus

  • Ebola Virus Infection
  • Author: John W King, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
  • Sections Ebola Virus Infection
  • Practice Essentials
  • Pathophysiology and Etiology
  • Epidemiology
  • Physical Examination
  • Complications
  • Approach Considerations
  • Laboratory Studies
  • Histologic Findings
  • Supportive Care
  • Pharmacologic Therapy
  • Diet and Activity
  • Consultations
  • Medication Summary
  • Monoclonal Antibodies
  • Vaccines, Live, Viral

Ebola virus is one of at least 30 known viruses capable of causing viral hemorrhagic fever syndrome. The genus Ebolavirus  currently is classified into 5 separate species: Sudan ebolavirus , Zaire ebolavirus , Tai Forest (Ivory Coast) ebolavirus , Reston ebolavirus , and Bundibugyo ebolavirus . [ 1 ] The outbreak of Ebola virus disease in West Africa from 2014 to 2016, involving Zaire ebolavirus , was the largest outbreak of Ebola virus disease in history.

Ebola virus. Courtesy of the US Centers for Diseas

As of September 17, 2019, an active outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) had resulted in 3,034 confirmed and 111 probable cases of Ebola virus disease, including 2,103 attributable deaths. [ 2 , 3 ] An experimental vaccine has been credited with limiting the outbreak’s scope. [ 4 ]

Signs and symptoms

The following 2 types of exposure history are recognized:

  • Primary exposure – This typically involves travel to or work in an Ebola-endemic area.
  • Secondary exposure – This refers to human-to-human exposure (eg, medical caregivers, family caregivers, or persons who prepared deceased patients for burial), primate-to-human exposure (eg, animal care workers who provide care for primates), or persons who collect or prepare bush meat for human consumption.

Physical findings depend on the stage of disease at the time of presentation. With African-derived Ebolavirus infection, there is an incubation period (typically 3-8 days in primary cases and slightly longer in secondary cases).

Early findings may include the following [ 5 ] :

  • Pharyngitis
  • Severe constitutional signs and symptoms
  • Maculopapular rash (best seen in White patients)
  • Bilateral conjunctival injection

Later findings may include the following [ 5 ] :

  • Expressionless facies
  • Bleeding from intravenous (IV) puncture sites and mucous membranes
  • Myocarditis and pulmonary edema
  • In terminally ill patients, tachypnea, hypotension, anuria, and coma

Survivors of Ebola virus disease have developed the following late manifestations [ 5 ] :

  • Asymmetric and migratory arthralgias
  • Hearing loss
  • Unilateral orchitis
  • Suppurative parotitis

Diagnostic studies that may be helpful include the following:

  • Basic blood tests – Complete blood count (CBC) with differential, bilirubin, liver enzymes, blood urea nitrogen (BUN), creatinine, pH
  • Studies for isolating the virus – Tissue culture (only to be performed in one of a few high-containment laboratories throughout the world), reverse-transcription polymerase chain reaction (RT-PCR) assay
  • Serologic testing – Enzyme-linked immunosorbent assay (ELISA) for antigens or for immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies
  • Other studies – Immunochemical testing of postmortem skin, electron microscopy

General principles of care are as follows:

  • Supportive therapy with attention to intravascular volume, electrolytes, nutrition, and comfort care is of benefit to the patient.
  • Such therapy must be administered with strict attention to barrier isolation; all body fluids contain infectious virions and should be handled with great care.
  • No specific therapy is available that has demonstrated efficacy in the treatment of Ebola hemorrhagic fever.
  • Ebola Zaire vaccine is approved in Europe and the United States. The live recombinant vaccine has shown effectiveness of 97.5% in preventing infection among 90,000 individuals in an active Ebola virus outbreak in the Democratic Republic of Congo. [ 3 ]
  • The FDA approved atoltivimab/maftivimab/odesivimab (Inmazeb), a recombinant human monoclonal antibody combination. These antibodies target the glycoprotein (GP) on the Ebola virus surface, thereby blocking attachment and entry of the virus on host cell membranes. [ 6 ]  

Other agents that have been studied for the treatment or prevention of Ebola virus disease include the following:

  • Ribavirin (possesses no demonstrable anti- Ebolavirus activity in vitro and has failed to protect Ebolavirus -infected primates)
  • Nucleoside analogue inhibitors of S-adenosylhomocysteine hydrolase (SAH)
  • Interferon beta
  • Horse- or goat-derived immune globulins
  • Human-derived convalescent immune globulin preparations
  • Recombinant human monoclonal antibodies
  • Recombinant human interferon alfa-2
  • Activated protein C [ 7 ]
  • Recombinant inhibitor of factor VIIa/tissue factor [ 8 ]

In those patients who do recover, recovery often requires months, and delays may be expected before full resumption of normal activities. Weight gain and return of strength are slow. Ebola virus continues to be present for many weeks after resolution of the clinical illness.

Ebola virus is one of at least 30 known viruses capable of causing viral hemorrhagic fever syndrome. Although agents that cause viral hemorrhagic fever syndrome constitute a geographically diverse group of viruses, all of those identified to date are RNA viruses with a lipid envelope, all are considered zoonoses, all damage the microvasculature (resulting in increased vascular permeability), and all are members of 1 of the following 4 families:

Arenaviridae

Bunyaviridae

Flaviviridae

Filoviridae

Although some of the hemorrhagic fever viruses are normally spread by ticks or mosquitoes, all but one (ie, dengue hemorrhagic fever) are capable of being spread by aerosols, and this capability makes these viruses potential bioterrorism agents.

The family Filoviridae resides in the order Mononegavirales and contains the largest genome within the order. This family contains 2 genera: Ebolavirus (containing 5 species) and the antigenically distinct Marburgvirus (containing a single species).

In patients who have Ebola virus infection, exposure to the virus may be either primary (involving presence in an Ebolavirus -endemic area) or secondary (involving human-to-human or primate-to-human transmission). Physical findings depend on the stage of disease at the time of presentation. 

Studies have demonstrated that patients who die of Ebola viral infection do not develop a humoral immune response. However, in survivors neutralizing antibody can be detected. It is likely that a broad humoral immune response can increase the likelihood of an infected patient surviving Ebola.

No specific therapy is available that has demonstrated efficacy in the treatment of Ebola hemorrhagic fever, and there are no commercially available Ebola virus vaccines. General medical support is critical. Care must be administered with strict attention to barrier isolation. Because the source of Ebola virus is unknown, education and prevention of primary cases is problematic. Education of communities at risk, especially healthcare workers, can greatly reduce the number of secondary person-to-person transmissions.

Ultrastructure and pathogenesis

The known members of the family Filoviridae are the genera Ebolavirus (Ebola virus) and Marburgvirus (Marburg virus). According to the 2012 virus taxonomy of the International Committee on Taxonomy of Viruses , Ebolavirus is classified into the following 5 separate species:

Sudan ebolavirus

Zaire ebolavirus

Tai Forest ebolavirus (formerly and perhaps still more commonly Ivory Coast ebolavirus or Côte d’Ivoire ebolavirus )

Reston ebolavirus

Bundibugyo ebolavirus

Filoviruses such as Ebola virus share a characteristic filamentous form, with a uniform diameter of approximately 80 nm but a highly variable length. [ 1 ] Filaments may be straight, but they are often folded on themselves.

Ebola virus has a nonsegmented negative-stranded RNA genome containing 7 structural and regulatory genes. The Ebola genome codes for 4 virion structural proteins (VP30, VP35, nucleoprotein, and a polymerase protein [L]) and 3 membrane-associated proteins (VP40, glycoprotein [GP], and VP24). The GP gene is positioned fourth from the 3′ end of the 7 linearly arranged genes.

After infection, human and nonhuman primates experience an early period of rapid viral multiplication that, in lethal cases, is associated with an ineffective immunologic response. Although a full understanding of Ebola virus disease must await further investigations, part of the pathogenesis has been elucidated.

Most filovirus proteins are encoded in single reading frames; the surface GP is encoded in 2 frames (open reading frame [ORF] I and ORF II). The ORF I (amino-terminal) of the gene encodes for a small (50-70 kd), soluble, nonstructural secretory glycoprotein (sGP) that is produced in large quantities early in Ebola virus infection. [ 9 ]

The sGP binds to neutrophil CD16b, a neutrophil-specific Fc g receptor III, and inhibits early neutrophil activation. The sGP also may be responsible for the profound lymphopenia that characterizes Ebola infection. Thus, sGP is believed to play pivotal roles in the ability of Ebola to prevent an early and effective host immune response. One hypothesis is that the lack of sGP production by Marburg virus may explain why this agent is less virulent than African-derived Ebola virus.

Leroy and colleagues reported their observations of 24 close contacts of symptomatic patients actively infected with Ebola. [ 10 ] Eleven of the 24 contacts developed evidence of asymptomatic infection associated with viral replication. Viral replication was proven by the authors’ ability to amplify positive-stranded Ebola virus RNA from the blood of the asymptomatic contacts.

A detailed study of these infected but asymptomatic individuals revealed that they had an early (4-6 days after infection) and vigorous immunologic response with production of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF), resulting in enhanced cell-mediated and humoral-mediated immunity. In patients who eventually died, proinflammatory cytokines were not detected even after 2 to 3 days of symptomatic infection.

A second, somewhat larger (120-150 kd) GP, transmembrane glycoprotein, is incorporated into the Ebola virion and binds to endothelial cells but not to neutrophils. Ebola virus is known to invade, replicate in, and destroy endothelial cells. Destruction of endothelial surfaces is associated with disseminated intravascular coagulation, and this may contribute to the hemorrhagic manifestations that characterize many, but not all, Ebola infections.

Clinical infection in human and nonhuman primates is associated with rapid and extensive viral replication in all tissues. Viral replication is accompanied by widespread and severe focal necrosis. The most severe necrosis occurs in the liver, and this is associated with the formation of Councilman-like bodies similar to those seen in yellow fever . In fatal infections, the host’s tissues and blood contain large numbers of Ebola virions, and the tissues and body fluids are highly infectious.

The 5 Ebolavirus species were named for the locations where they caused documented human or animal disease. Two African species, Sudan ebolavirus and Zaire ebolavirus , have been responsible for most of the reported deaths. Clinical disease due to African-derived Ebola virus is severe and, with the exception of a patient who survived infection with a third African species, Ivory Coast ebolavirus , is associated with a mortality ranging from 65% (Sudan, 1979) to 89% (Democratic Republic of the Congo [DRC], December 2002-April 2003).

A fourth Ebolavirus species, Reston ebolavirus, was first isolated in 1989 in monkeys imported from a single Philippine exporter. A virtually identical isolate imported from the same Philippine exporter was detected in 1992 in Siena, Italy. To date, this species has not been documented to cause human disease.

The fifth Ebolavirus species, also of African lineage, is Bundibugyo ebolavirus , which caused an outbreak in Uganda in 2007 to 2008, with a mortality of 25%. [ 11 ]

Between 1994 and 1997, a stable strain of Ebola virus caused 3 successive outbreaks of hemorrhagic fever in Gabon (mortality, 60%-74%). [ 12 ] Because the Gabon strain shares a greater than 99% homology of the nucleoprotein and GP gene regions with Zaire ebolavirus , it has not been considered a distinct species.

A likely reservoir for filoviruses has been identified. In 1996, members of the National Institute for Virology of South Africa went to Kikwit, DRC, and evaluated the infectivity of Ebola virus for 24 species of plants and 19 species of vertebrates and invertebrates. [ 13 ] Insectivorous bats and fruit bats were found to support Ebola virus replication without dying. Furthermore, serum Ebola titers in infected fruit bats reached as high as 10 6 fluorescent focus-forming units/mL, and feces contained viable Ebola virus.

Mechanisms of dispersion

African-derived filovirus infections are characterized by transmission from an unknown host (possibly bats) to humans or nonhuman primates, presumably via direct contact with body fluids such as saliva or blood or other infected tissues. Evidence in nonhuman primates indicates that Sudan ebolavirus and Zaire ebolavirus may be transmitted by contact with mucous membranes, conjunctiva, pharyngeal and gastrointestinal surfaces; through small breaks in the skin; and, at least experimentally, by aerosol. [ 14 ]

Dogs have been shown to acquire asymptomatic Ebola virus infections, possibly by contact with virus-laden droplets of urine, feces, or blood of unknown hosts. [ 15 ] Of epidemiologic significance was the observation that seroprevalence rates in dogs rose in a linear fashion as sampling approached areas of human cases, reaching as high as 31.8%. Thus, an increase in canine seroprevalence may serve as an indicator of increasing Ebola virus circulation in primary vectors within specific geographical areas.

Human infection with African-derived strains has often occurred in caregivers (either family or medical) and in family members who have prepared dead relatives for burial. Late stages of Ebola virus disease are associated with the presence of large numbers of virions in body fluids, tissues, and, especially, skin. Individuals who are exposed to patients infected with Ebola without proper barrier protection are at high risk of becoming infected.

A report from the DRC identified Ebola virus RNA in 100% of oral secretions from patients who had the viral RNA in their serum. Both serum and oral secretions were tested with reverse-transcriptase polymerase chain reaction (RT-PCR) assay. Thus, oral secretions may be capable of transmitting Ebola virus.

Among infection survivors, only males had been shown to transmit the virus, via semen, in which the virus can persist for up to 2 years. However, a 2018 study found that previously infected women may also harbor a reservoir of dormant virus, which is theorized to have reactivated upon immunosuppression (suspected to result from pregnancy in the study case). [ 16 ]

The first recorded outbreak occurred in 1976, in Yambuku, DRC, where 316 patients were infected. In the largest recorded urban outbreak to date (DRC, 1995; 318 cases), admission to a hospital greatly amplified the frequency of transmission. The lack of proper barrier protection and the use and reuse of contaminated medical equipment, especially needles and syringes, resulted in rapid nosocomial spread of infection. Only after adequate barrier protection and alteration in burial rituals were implemented was the outbreak contained.

Unlike Asian-derived Ebola virus (ie, Reston ebolavirus, traced to a Philippine supplier of primates), African-derived species appear to be spread more often by direct contact than via the respiratory route. However, the Reston species has repeatedly been demonstrated to spread among nonhuman primates and possibly from primates to humans via the respiratory route. Fortunately, although the Reston species has been documented to be capable of infecting humans, it does not appear to be pathogenic to humans.

Ebola virus is not endemic in the United States, although, during the 2014-2016 Ebola outbreak, several US healthcare personnel were in Africa and were transported to the United States for treatment, in addition to a traveller from Liberia who became ill and sought treatment while visiting Texas. The patient later died of the infection. One of his treating nurses then presented with a low-grade fever and tested positive for Ebola virus infection. In addition, individuals in several US states who travelled to West Africa developed fever and other symptoms, prompting evaluation for Ebola virus infection at US hospitals. [ 17 ]

Before the 2014 - 2016 outbreak, several human infections with the Reston strain of Ebola had been acquired by animal care workers at primate holding facilities within the United States. Fortunately, the Reston strain has not demonstrated pathogenic effects in humans. Others at potential risk are laboratory workers who work with inf ected animals or with the virus in tissue culture.

International statistics

On May 8, 2018, a new outbreak of Ebola virus disease was declared in the Democratic Republic of the Congo (DRC) following laboratory confirmation of 2 cases of EVD. [ 18 ] Before confirmation of the outbreak, 21 patients with signs of hemorrhagic fever had recently been reported in the country, 17 of whom died. [ 19 ] As of September 17, 2019, 3,034 confirmed cases had been reported and 111 probable cases, including 2,103 attributable deaths. [ 2 , 3 ]

Ebola and Marburg viruses are responsible for well-documented outbreaks of severe human hemorrhagic fever, with resultant case mortalities ranging from 23% for Marburg virus to 89% for Ebola virus in which more than one case occurred.

The 2014-2016 Ebola virus outbreak was significant and primarily involved 3 African countries—Guinea, Liberia, and Sierra Leone. Localized transmission was been reported in Nigeria. Based on genetic analysis, the virus was 97% identical to the Zaire ebolavirus identified in cases in Gabon and the Democratic Republic of the Congo earlier in 2014. [ 20 , 21 ]

At least 3 Americans in Africa were infected with Ebola in the 2014-2016 outbreak, 1 of whom died of the disease. [ 22 ]

Table 1. History of Sudan Ebola Virus Outbreaks (Open Table in a new window)

2012

Uganda

7

4

57%

2012

Uganda

24

17

71%

2011

Uganda

1

1

100%

2004

Sudan

17

7

41%

2000

Uganda

425

224

53%

1979

Sudan

34

22

65%

1976

Sudan

284

151

53%

Data from 

Table 2. History of Zaire Ebola Virus Outbreaks (Open Table in a new window)

2018-2019

Democratic Republic of the Congo (DRC)

Ongoing

   

2018

DRC

54 

33 

61% 

2017

DRC 

50% 

2015

Italy

1

0

0%

2014

Spain

1

0

0%

2014

UK

1

0

0%

2014

USA

4

1

25%

2014

Senegal

1

0

0%

2014

Mali

8

6

75%

2014

Nigeria

20

8

40%

2014-2016

Sierra Leone

14,124*

3,956*

28%

2014-2016

Liberia

10,675*

4,809*

45%

2014-2016

Guinea

3,811*

2,543*

67%

2008

DRC

32

14

44%

2007

DRC

264

187

71%

2005

Republic of the Congo

12

10

83%

2003 (Nov-Dec)

Republic of the Congo

35

29

83%

2003 (Jan-Apr)

Republic of the Congo

143

128

90%

2001-2002

Republic of the Congo

59

44

75%

2001-2002

Gabon

65

53

82%

1996

South Africa (ex-Gabon)

1

1

100%

1996 (Jul-Dec)

Gabon

60

45

75%

1996 (Jan-Apr)

Gabon

31

21

68%

1995

DRC

315

254

81%

1994

Gabon

52

31

60%

1977

DRC

1

1

100%

1976

DRC

318

280

88%

*Includes suspected, probable, and confirmed EVD cases. Data from .

Table 3. History of Tai Forest (Ivory Coast, Côte-d’Ivoire) Ebola Virus Outbreaks (No Deaths Reported) (Open Table in a new window)

1994

Côte-d’Ivoire

1

 

Data from and .

Table 4. History of Reston Ebola Virus Outbreaks (No Deaths Reported) (Open Table in a new window)

Cases Reported, No.

1989

Virginia, Texas, Pennsylvania

0

1990

Virginia and Texas

4

1989-1990

Philippines

3

1992

Italy

0

1990

Alice, TX

0

1996

Philippines

0

Nov 2008

Philippines

6

 

Data from and .

Humans with serologic evidence of infection but without clinical disease.

Associated with pig farming. , ]

Table 5. History of Bundibugyo Ebola Virus Outbreak (Open Table in a new window)

Dec 2007 to Jan 2008

Uganda

149

37 (25)

Jun to Nov 2012

Democratic Republic of the Congo

57

29 (50.1)

 

Data from and .

Individuals considered at risk for Ebola hemorrhagic fever include persons with a travel history to sub-Saharan Africa, persons who have recently cared for infected patients, and animal workers who have worked with primates infected with African-derived Ebola subtypes. In 2011, Uganda experienced a reemergence of the disease. [ 25 ]

Age-related demographics

In the 1995 outbreak in Kikwit, DRC, infection rates were significantly lower in children than in adults. During this outbreak, only 27 (8.6%) of the 315 patients diagnosed with Ebola virus infection were 17 years of age or younger. This apparent sparing of children occurs even though 50% of the population of the DRC is younger than 16 years. Although definitive evidence is lacking, epidemiologic evidence suggests that children are less likely to come into direct contact with ill patients than adults are.

Other viral hemorrhagic syndromes, such as Crimean-Congo hemorrhagic fever and hantavirus infections, also show a predominance of adult patients and a relative sparing of young children.

Sex-related demographics

Ebola virus infection has no sexual predilection, but men and women differ with respect to the manner in which direct exposure occurs.

Men, by the nature of their work exposure in forest and savanna regions, may be at increased risk of acquiring a primary infection from gathering “bush meat” (primate carcasses) for food, as well as an unknown vector or vectors. Evidence from Africa and the Philippines is compatible with bats being a principal vector of Ebola virus.

Because women provide much of the direct care for ill family members and are involved in the preparation of the bodies of the deceased, they may be at increased risk of acquiring Ebola virus infection through their participation in these activities; however, men and women who are medical healthcare providers seem to share a high and equal risk for infection.

Race-related demographics

Because most cases of Ebola virus infection have occurred in sub-Saharan Africa, most patients have been black. However, no evidence exists for a specific racial predilection.

The overall prognosis for patients with Ebola virus infection is poor. [ 5 ] However, those who survive for 2 weeks often make a slow recovery.

With the exception of the Reston strain, Ebola virus is associated with very high morbidity and mortality among patients who present with clinical illness, though these vary according to the causative species. The most highly lethal Ebolavirus species is Zaire ebolavirus , which has been reported to have a mortality rate as high as 89%. Sudan ebolavirus also has high reported mortality, ranging from 41% to 65%.

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  • Ebola virus. Courtesy of the US Centers for Disease Control and Prevention.
  • Table 1. History of Sudan Ebola Virus Outbreaks
  • Table 2. History of Zaire Ebola Virus Outbreaks
  • Table 3. History of Tai Forest (Ivory Coast, Côte-d’Ivoire) Ebola Virus Outbreaks (No Deaths Reported)
  • Table 4. History of Reston Ebola Virus Outbreaks (No Deaths Reported)
  • Table 5. History of Bundibugyo Ebola Virus Outbreak

2012

Uganda

7

4

57%

2012

Uganda

24

17

71%

2011

Uganda

1

1

100%

2004

Sudan

17

7

41%

2000

Uganda

425

224

53%

1979

Sudan

34

22

65%

1976

Sudan

284

151

53%

Data from 

2018-2019

Democratic Republic of the Congo (DRC)

Ongoing

   

2018

DRC

54 

33 

61% 

2017

DRC 

50% 

2015

Italy

1

0

0%

2014

Spain

1

0

0%

2014

UK

1

0

0%

2014

USA

4

1

25%

2014

Senegal

1

0

0%

2014

Mali

8

6

75%

2014

Nigeria

20

8

40%

2014-2016

Sierra Leone

14,124*

3,956*

28%

2014-2016

Liberia

10,675*

4,809*

45%

2014-2016

Guinea

3,811*

2,543*

67%

2008

DRC

32

14

44%

2007

DRC

264

187

71%

2005

Republic of the Congo

12

10

83%

2003 (Nov-Dec)

Republic of the Congo

35

29

83%

2003 (Jan-Apr)

Republic of the Congo

143

128

90%

2001-2002

Republic of the Congo

59

44

75%

2001-2002

Gabon

65

53

82%

1996

South Africa (ex-Gabon)

1

1

100%

1996 (Jul-Dec)

Gabon

60

45

75%

1996 (Jan-Apr)

Gabon

31

21

68%

1995

DRC

315

254

81%

1994

Gabon

52

31

60%

1977

DRC

1

1

100%

1976

DRC

318

280

88%

*Includes suspected, probable, and confirmed EVD cases. Data from .

1994

Côte-d’Ivoire

1

 

Data from and .

Cases Reported, No.

1989

Virginia, Texas, Pennsylvania

0

1990

Virginia and Texas

4

1989-1990

Philippines

3

1992

Italy

0

1990

Alice, TX

0

1996

Philippines

0

Nov 2008

Philippines

6

 

Data from and .

Humans with serologic evidence of infection but without clinical disease.

Associated with pig farming. , ]

Dec 2007 to Jan 2008

Uganda

149

37 (25)

Jun to Nov 2012

Democratic Republic of the Congo

57

29 (50.1)

 

Data from and .

Contributor Information and Disclosures

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University School of Medicine in Shreveport; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center John W King, MD is a member of the following medical societies: American Association for the Advancement of Science , American College of Physicians , American Federation for Medical Research , American Society for Microbiology , Association of Subspecialty Professors, Infectious Diseases Society of America , Sigma Xi, The Scientific Research Honor Society Disclosure: Nothing to disclose.

Hashmi Rafeek, MBBS Fellow in Infectious Diseases, Louisiana State University School of Medicine in Shreveport Disclosure: Nothing to disclose.

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians , American Society for Microbiology , International Immunocompromised Host Society , Infectious Diseases Society of America Disclosure: Nothing to disclose.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha , American College of Physicians , American Public Health Association , American Society for Microbiology , American Society of Tropical Medicine and Hygiene , Infectious Diseases Society of America , Medical Society of Virginia , and Wilderness Medical Society

Disclosure: Nothing to disclose.

Amir A Khan, MD Fellow in Infectious Diseases, Louisiana State University School of Medicine in Shreveport

Amir A Khan, MD is a member of the following medical societies: American College of Physicians and American Medical Association

Rushdah Malik, MD Fellow, Department of Infectious Diseases, Louisiana State University Health Science Center

Rushdah Malik, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Clinical presentation and management of severe Ebola virus disease

Affiliation.

  • 1 1 Division of Pulmonary & Critical Care Medicine, Department of Medicine, and.
  • PMID: 25369317
  • DOI: 10.1513/AnnalsATS.201410-481PS

Clinicians caring for patients infected with Ebola virus must be familiar not only with screening and infection control measures but also with management of severe disease. By integrating experience from several Ebola epidemics with best practices for managing critical illness, this report focuses on the clinical presentation and management of severely ill infants, children, and adults with Ebola virus disease. Fever, fatigue, vomiting, diarrhea, and anorexia are the most common symptoms of the 2014 West African outbreak. Profound fluid losses from the gastrointestinal tract result in volume depletion, metabolic abnormalities (including hyponatremia, hypokalemia, and hypocalcemia), shock, and organ failure. Overt hemorrhage occurs infrequently. The case fatality rate in West Africa is at least 70%, and individuals with respiratory, neurological, or hemorrhagic symptoms have a higher risk of death. There is no proven antiviral agent to treat Ebola virus disease, although several experimental treatments may be considered. Even in the absence of antiviral therapies, intensive supportive care has the potential to markedly blunt the high case fatality rate reported to date. Optimal treatment requires conscientious correction of fluid and electrolyte losses. Additional management considerations include searching for coinfection or superinfection; treatment of shock (with intravenous fluids and vasoactive agents), acute kidney injury (with renal replacement therapy), and respiratory failure (with invasive mechanical ventilation); provision of nutrition support, pain and anxiety control, and psychosocial support; and the use of strategies to reduce complications of critical illness. Cardiopulmonary resuscitation may be appropriate in certain circumstances, but extracorporeal life support is not advised. Among other ethical issues, patients' medical needs must be carefully weighed against healthcare worker safety and infection control concerns. However, meticulous attention to the use of personal protective equipment and strict adherence to infection control protocols should permit the safe provision of intensive treatment to severely ill patients with Ebola virus disease.

Keywords: Ebola virus disease; critical illness; disease outbreaks; infection control; intensive care.

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Ebola Virus Presentation

Ebola Virus Disease (EVD) Outbreak 2014 (Template slide set designed to be edited to meet VAMC needs) Created DATE/MONTH

presentation of ebola virus

Answers to Your Questions about EBOLA What is EBOLA? Ebola is a virus that lives in bats and some other animals who live in Africa.

presentation of ebola virus

What is Ebola? 10/12/2014. What is Ebola? Filoviridae Ebolavirus – 5 viruses/species – Ebola (Zaire) – Sudan – Bundibugyo – Tai Forest – Reston Marburgvirus.

presentation of ebola virus

Ebola. What is Ebola?? Ebola is a rare and deadly disease caused by the infection of the Ebola Virus (5 strands) Ebola viruses are found in several African.

presentation of ebola virus

EVD is a preventable but often fatal viral infection An EVD outbreak is affecting countries in West Africa where disease control resources are very limited.

presentation of ebola virus

What is Ebola? Ebola is a rare and deadly disease caused by infection with the Ebola virus. It is only spread by direct contact with an infected person's.

presentation of ebola virus

Ebola Virus Disease. EVD Description Hemorrhagic fever with case fatality rate up to 90% Endemic areas: Central and West Africa Wildlife reservoir: bats.

presentation of ebola virus

Ebola Virus. What is Ebola hemorrhagic fever? Ebola hemorrhagic fever (Ebola HF) is a severe, often-fatal disease in humans and nonhuman primates (monkeys,

presentation of ebola virus

 Ebola is a virus, or a microscopic organism consisting of genetic material in Africa that has caused many deaths, and is named after the Ebola River.

presentation of ebola virus

EBOLA OUTBREAK 2014 There has never been an outbreak this size and severity.

presentation of ebola virus

VERMONT EMS EBOLA VIRUS DISEASE EDUCATION Patsy Kelso PhD, Vermont Department of Health State Epidemiologist and Vermont EMS.

presentation of ebola virus

Ebola Virus "Ebola hemorrhagic fever" Created by: Lexington Pittman Michael Trent Jake.

presentation of ebola virus

Ebola: Getting the Facts. What do you know about Ebola?

presentation of ebola virus

2014 Ebola Virus Outbreak. What is a Virus? Viruses are microscopic particles (10 – 400 nm). Viruses are made of genetic material (DNA or RNA) surrounded.

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INTEGRIS Preparedness Plan: Ebola Virus Disease (EVD) With the spread of Ebola to the U.S., ensuring our employees and communities are safe is the utmost.

presentation of ebola virus

Ebola Virus Disease (EVD) Updated 11:30 a.m

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Ebola Viral Disease Outbreak 1. Ebola Viral Disease How does Ebola present? The common signs and symptoms of Ebola are: – Fever – Vomiting – Diarrhea.

presentation of ebola virus

TITLE. Ebola is: o a virus first discovered in 1976 o spread through direct contact (through broken skin or mucous membranes) with infected blood and.

presentation of ebola virus

Ebola Virus Outbreak This presentation has been prepared by Christine H. Herrmann, Ph.D. of the Department of Molecular Virology and Microbiology at Baylor.

presentation of ebola virus

Topic : Ebola Fever Name : Muhammad Habib Bin Ismail Period : 3rd H/R : A642.

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Ebola Virus Breakthrough

It seems that you like this template, ebola virus breakthrough presentation, free google slides theme, powerpoint template, and canva presentation template.

At the moment, the Ebola virus disease has no treatment other than supportive care, but hope is what drives humans to keep researching! Has there been any news about how to treat the Ebola virus disease? Any information, no matter how little, is good information. Use this dark-colored template and its 3D illustrations to share with other doctors any findings on the matter. You can add data from a clinical trial, tips on how to prevent the disease, add references from other publications, and more!

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ebola virus disease

Ebola Virus Disease

Nov 08, 2014

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Ebola Virus Disease. Dr. Oluwafemi Akinyele Popoola Lecturer and Consultant Community Physician. Session Objectives. Describe the epidemiology of Ebola virus Highlight past outbreaks State main symptoms

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Ebola Virus Disease Dr. Oluwafemi Akinyele Popoola Lecturer and Consultant Community Physician Lecture delivered at Bodija-Ashi Baptist Church 14thSeptember, 2014.

Session Objectives • Describe the epidemiology of Ebola virus • Highlight past outbreaks • State main symptoms • Describe how knowledge of the epidemiology and transmission dynamics of Ebola Virus informs its control strategies

What is Ebola Virus Disease • Ebola Virus Disease: is one of the numerous viral Hemorrhagic Fevers. It is a severe, often fatal disease in humans and nonhuman primates – CDC • Incubation period 2-21days (usual 8 – 10 days) • Causation: infection with a virus • Family Filoviridae and genus Ebolavirus • Five subspecies of Ebolavirus • Zaire ebolavirus; Sudan ebolavirus; Tai Forest ebolavirus; and Bundibugyo ebolavirus • Reston ebolavirus (disease only in nonhuman primates)

History of Ebola outbreaks in the African Region

Ebola outbreak in Guinea, Liberia and Sierra Leone, Epicurve by week of onset, December 2013 to 19 July 2014 (n=1002) 23 March WHO deployed multi-diciplinary international experts 23 March Mobile laboratory deployed through EDPLN Outbreak response operations started 21 March Labortory Confirmation 26 May Sierra Leone declared outbreak Alert 13 March 15 cases inc. 9 deaths 31 March Liberia declared outbreak Alert from Méliandou 26 January 5 death w diarrhoea

Case Definitions Suspected (clinical) case: Any person ill or deceased with fever and hemorrhage. Documented prior contact with an EVD case is not required • Confirmed Case A case with laboratory confirmed diagnostic evidence of ebola virus infection.

Probable case (with or without bleeding): Any person (living or dead) with contact with a clinical case of EVD and a history of acute fever. OR Any person (living or dead) with a history of acute fever and three or more of the following - headache/ vomiting/nausea/ loss of appetite/ diarrhea/ intense fatigue/ abdominal pain/ general muscular or articular pain/ difficulty in swallowing/ difficulty in breathing/ hiccoughs OR Any unexplained death. • Distinction between a suspected case and a probable case in practice relatively unimportant as far as outbreak control is concerned.

Definition of contact • A person without any symptoms has had physical contact with a case or the body fluids of a case within the last three weeks. The notion of physical contact may be proven or highly suspected such as having shared the same room/bed, cared for a patient, touched body fluids, or closely participated in a burial ceremony (physical contact with the corpse).

Current Status by August 9, 2014 (WHO) *New cases were reported between 7 and 9 August, 2014.

Transmission Cycles • Animal to Man • Initial source of outbreak in human populations • Often occurs in rural areas • Man to Man • Source of epidemic propagation in human populations • All body fluids are infected • Infected humans only transmit the virus AFTER THEY BECOME SICK!!! • Risk is increased during hospital care of infected individuals • Improper disposal of dead bodies also transmits disease

Routes of Transmission • Direct contact • Blood or secretions of infected person • Infected needles and other equipments contaminated with infected secretions • Others • Through families and friends contact with infectious secretions of ill person • Virus can still be present in semen 6 weeks after illness • Factors aiding transmission • Hospital settings: inappropriate use of PPE; Lack of point of care risk assessment • Community settings: burial rites; treatment seeking delays/denials

Transmission dynamics • Natural reservoir not conclusive • However, WHO believes fruit bats may be the natural host • First patient in outbreaks most likely infected by animal • Health workers more susceptible to infection • Higher risk of transmission (high viral loads) • Later stages : vomiting, diarrhoea, shock, haemorrhage

Hypothesis of Ebola Virus transmission at the human-animal interface

Symptoms of Ebola Virus Disease MAIN • Fever – at least 38C • Weakness • Diarrhoea • Vomiting • Headache • Joint and muscle aches • Stomach pain • Lack of appetite ADDITIONAL • A Rash • Red Eyes • Hiccups • Cough • Sore throat • Chest pain • Difficulty breathing • Difficulty swallowing • Bleeding inside and outside of the body

Definitive Diagnosis • LABORATORY BASED • Antibody-capture enzyme-linked immunosorbent assay (ELISA) • Antigen detection tests • Serum neutralization test • Reverse transcriptase polymerase chain reaction (RT-PCR) assay • Electron microscopy • Virus isolation by cell culture

HOW DO WE PREVENT EBOLA DISEASE INFECTIONS

Facts about the Virus? • Easily destroyed – soaps, detergent, chlorine, heat. • Highly infectious • Highly pathogenic – causes a serious disease with high risk of death • Humans only become infectious when sick • Virus shed in ALL body fluids • No evidence of air borne transmission • No licensed vaccine or specific treatment • Can only be diagnosed via specialised lab tests

Prevention Strategies • Prevention of Community infections/HE • Prevention of new infections • Early recognition of infected individuals • Tracing and surveillance of contacts of infected individuals • Prevention of hospital infections • Isolation of infected individuals • Supportive treatment of infected individuals

Community Prevention during Outbreaks • Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes/other bush meats and the consumption of their raw meat. • Animals should be handled with gloves and other appropriate protective clothing. • Animal products (blood and meat) should be thoroughly cooked before consumption.

Community Prevention during Outbreaks • Close physical contact with Ebola patients should be avoided. • Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. • Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home

Community Prevention during Outbreaks • Communities affected by Ebola should inform the population about the nature of the disease and about outbreak containment measures, including burial of the dead. • People who have died from Ebola should be promptly and safely buried • Manage rumours during outbreak • Do not hide cases or contacts

Control in Hospital Settings • Ebola is highly infectious and must be treated in specialised isolation centres • Standard precautions for all patients • Infection based precautions for probable or confirmed cases • Proper decontamination of all surfaces

Summary • Ebola causes a serious disease with high risk of death • Cases present with fever and other symptoms diagnosis requires specialised lab tests • Prevention strategies • Practice good personal hygiene, frequent hand washing with soap and water • Avoid close contact with possibly infected individuals • Proper investigation and isolation of all cases • Tracing and surveillance of contacts of Ebola patients

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Gavi announces launch of preventive Ebola, routine multivalent meningitis, human rabies, and hepatitis B birth dose vaccination programmes

Gavi/2019/Frederique Tissandier

In historic step, preventive Ebola vaccination to become norm in highest-risk countries

Gavi will also support lower-income countries for routine administration of human rabies vaccine for post-exposure prophylaxis, as well as multivalent meningococcal conjugate and hepatitis b birth dose vaccines, dr sania nishtar, ceo of gavi: “gavi’s ability as an alliance to protect health and save lives hinges on its ability to ensure vaccines are accessible, as quickly as possible, to who that need them the most. the new programmes launching today demonstrate the impact of this work. for example, ebola is a terrible disease that can lay waste to whole communities. in one decade we have been able to progress from having no approved vaccines during a deadly outbreak, to having a global stockpile that has helped cut down cases and deaths – and now vaccines even used preventively to protect those at highest risk.”.

Geneva, 13 June 2024 – Gavi, the Vaccine Alliance today announced that the lower-income countries it supports can  now apply  to introduce four additional vaccines: preventive Ebola, human rabies vaccine for post-exposure prophylaxis, multivalent meningococcal conjugate and hepatitis B birth dose. These four vaccine programmes were previously approved by the Gavi Board but put on hold either due to the COVID-19 pandemic (in the case of human rabies for post-exposure prophylaxis and hepatitis B birth dose); pending availability of suitable products (multivalent meningococcal conjugate); or appropriate policy recommendations (preventive Ebola).

The latest expansion of Gavi’s vaccine portfolio is in line with Gavi’s commitment to ensure lower-income countries have access to impactful vaccines as soon as possible. The portfolio will be further expanded in Gavi’s next strategic period, from 2026–2030 , which will seek to protect more people, against more diseases, faster than ever before. The continuation of all Gavi-supported programmes after 2025 is contingent upon successful fundraising for the Alliance’s next strategic period.

Historic progress against Ebola

In an historic milestone for global health security and the protection of health care workers and frontline workers, Gavi will begin funding preventive vaccination against Ebola in countries most at risk of outbreaks of the deadly viral disease. The move was made possible by a decision by the World Health Organization’s Strategic Advisory Group of Experts on Immunization (SAGE) last month to officially recommend the use of the two licensed Ebola vaccines for preventive use in populations at high risk of being exposed to Ebola through their duties as frontline care providers and in response to outbreaks. The decision was based on new data on effectiveness, duration of protection and supply availability.

Gavi first committed to supporting Ebola vaccination in 2014 , during the deadly 2014–2016 West Africa outbreak – thereafter facilitating the use of investigational doses for outbreak response and accelerating the pathway to prequalification and the establishment of a global stockpile, which was launched in 2021. In addition to supporting outbreak response from the Gavi-funded global stockpile, Gavi will now make available vaccines for preventive vaccination, and will continue to additionally fund operational costs for vaccination delivery in lower-income countries.

Ebola virus is a rare but severe illness in humans, with the average Ebola case fatality rate around 60% – in some cases much higher depending on the response to an outbreak. However, the availability of safe and effective vaccines has dramatically reduced the number of cases and deaths during outbreaks – helping to bring them quickly under control. The additional support for preventive vaccination of those at highest risk is significant, as data increasingly indicates that, in addition to risk of spillover events from infected animals to humans, viral resurgence in survivors of Ebola virus disease can also trigger new outbreaks several years later. Preventive vaccination will ensure critical frontline professionals are already protected against infections and death before outbreaks begin – saving lives and avoiding the disruption of services in health care facilities – thus decreasing the risk of further spread among communities.

“Gavi’s ability as an Alliance to protect health and save lives hinges on its ability to ensure vaccines are accessible, as quickly as possible, to who that need them the most. The new programmes launching today demonstrate the impact of this work,” said Dr Sania Nishtar, CEO of Gavi, the Vaccine Alliance . “For example, Ebola is a terrible disease that can lay waste to whole communities. In one decade, we have been able to progress from having no approved vaccines during a deadly outbreak, to having a global stockpile that has helped cut down cases and deaths – and now vaccines even used preventively to protect those at highest risk.”

New tools against deadly infectious diseases

In July 2023, a new multivalent meningococcal conjugate vaccine that protects against the five main serogroups of meningococcal meningitis impacting Africa – meningococcal serogroups A, C, W, Y, and X – received WHO prequalification. It is the only vaccine that protects against serogroup X. The vaccine, MenFive®, is available in the global Gavi-funded stockpile of meningococcal vaccines and has already been used in campaigns aiming to protect over 5 million people in response to meningococcus serogroups C and W outbreaks in Nigeria and Niger. With the opening of today’s application window, countries at high risk can officially roll out this new vaccine through routine programmes and preventive campaigns.

Meningococcal disease causes hearing loss, brain damage, seizures, limb loss or other disabilities and death every year. It is particularly prevalent in sub-Saharan Africa's " meningitis belt” of 26 countries. Over the years, Gavi has worked with countries to support vaccination against meningococcus serogroup A, reaching nearly 400 million people through campaigns and routine immunisation. These efforts have helped Africa defeat meningitis A , with no new cases detected since 2017. The addition of MenFive® into health systems’ toolkits holds out the possibility that the other circulating serogroups could also one day be defeated.

Gavi’s 2018 Vaccine Investment Strategy (VIS) also identified human rabies vaccines for post exposure prophylaxis (PEP) as a highly impactful vaccine to add to the portfolio. With implementation delayed due to the COVID-19 pandemic, Gavi and partners have been working since 2018 to prepare for the launch of the programme, which will support the provision of human rabies for PEP in Gavi-supported countries which are rabies endemic. Rabies is a serious public health problem in more than 150 countries, mainly in Asia and Africa, causing tens of thousands of deaths each year. Children between 5 and 14 years account for almost half of all fatalities. Once someone is symptomatic after exposure to the rabies virus, the disease is 100% fatal – meaning that vaccination in high-risk areas is critical, especially as access to rabies immunoglobulins is unlikely in most countries.

Similarly, Gavi’s 2018 VIS recommended the inclusion of the hepatitis B birth dose vaccine within the Gavi portfolio. Gavi-supported countries already provide routine vaccination against hepatis B through the pentavalent and hexavalent vaccines, which are delivered to children as part of the primary series of vaccinations. However, increasing evidence has shown that a dose given at birth provides critical additional protection. Hepatitis B kills an estimated 884,000 people a year. Newborn babies are most at risk of hepatitis B; and nine out of ten infected infants will develop chronic hepatitis B, while a quarter develop severe liver disease. Vaccination is critical, because while the virus can be transmitted in body fluids, many infants become infected in the womb or during delivery when their mother is carrying the virus. Children can be silent carriers of the infection that doesn’t become symptomatic until their 40s or 50s, when they discover they have liver failure (as the inflammation causes cirrhosis) or liver cancer.

In 2014, during the deadly 2014–2016 West Africa Ebola outbreak, which took over 11,000 lives and created global health security concerns as cases spread to countries outside the African continent, Gavi announced its commitment to purchase any suitable vaccine candidates. Subsequently, Gavi invested in the acceleration of development of vaccines and the global stockpile – to ensure vaccines were available to countries as quickly as possible.

In 2016 Gavi signed an Advance Purchase Commitment (APC) with Merck that enabled 300,000 investigational doses to be deployed in outbreaks, pending the availability of a WHO-prequalified product. In 2019, upon recommendation by WHO SAGE, Gavi formally approved the launch of an Ebola vaccination programme and establishment of a global Ebola vaccine stockpile of 500,000 doses. The stockpile was established in 2021 , once vaccines received WHO prequalification. In approving an Ebola vaccination programme, Gavi also committed to supporting preventive vaccination in the countries at highest risk, pending a better understanding about the durability of the immunological protection of the vaccine and a WHO SAGE recommendation for preventive use – both of which are now in place.

To date, more than 130,000 doses of the Merck ERVEBO® vaccine from the global stockpile have been shipped for preventive vaccination campaigns in the Democratic Republic of the Congo, Guinea-Bissau and Uganda, in addition to the ~7,000 vaccines shipped for outbreak response vaccination. The International Coordinating Group (ICG) on Vaccine Provision, hosted by WHO, makes decisions on allocation and deployment of Ebola vaccines from the global stockpile based on country requests for outbreak response; countries can now apply to Gavi for preventive vaccination support. Gavi's role is to fund doses, transport and vaccination activities, while UNICEF manages procurement of doses and delivery of vaccines to countries. Gavi also funds global stockpiles of cholera, meningococcal and yellow fever vaccines, and in the future will look to establish stockpiles of vaccines against mpox and hepatitis E.

ICG had approved using these doses preventively based on strong evidence: successful clinical trials, real-world use showing high effectiveness and safety, and existing interim SAGE recommendations to use the vaccine in advance for at-risk populations. Consequently, given availability of doses in the stockpile, and with Gavi and WHO support, some frontline service providers and health workers have already received a single dose. With the new SAGE recommendation, this can now become standard practice.

  • Brief history of the Ebola vaccine and the establishment of the global stockpile: https://www.gavi.org/vaccineswork/biodefence-drc-how-ebola-vaccine-became-one-fastest-vaccines-license-history
  • About Ebola virus disease: https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease  
  • About the two licensed Ebola vaccines: https://www.who.int/news-room/questions-and-answers/item/ebola-vaccines
  • Stories from the community about Ebola: https://www.gavi.org/vaccineswork/tag/ebola
  • WHO SAGE recommendations (draft report): https://cdn.who.int/media/docs/default-source/immunization/sage/2024/may/sage-ebola-report-final-draft.pdf?sfvrsn=325acc6_1
  • Gavi support for meningitis A vaccine: https://www.gavi.org/types-support/vaccine-support/meningitis-a
  • Stories from the community: https://www.gavi.org/vaccineswork/tag/meningitis
  • “How Africa defeated meningitis A”: https://www.gavi.org/vaccineswork/how-africa-defeated-meningitis
  • “Cloudy with a chance of meningitis: Using the weather to predict outbreaks in Africa”: https://www.gavi.org/vaccineswork/cloudy-chance-meningitis-using-weather-predict-outbreaks-africa
  • WHO Rabies fact sheet: https://www.who.int/news-room/fact-sheets/detail/rabies
  • United Against Rabies Forum: https://www.unitedagainstrabies.org/
  • Rabies Today podcast: https://www.unitedagainstrabies.org/news/rabies-today-podcast/

Hepatitis B

  • Articles and stories on hepatitis B: https://www.gavi.org/vaccineswork/tag/hepatitis
  • WHO hepatitis B fact sheet: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
  • Coalition for Global Hepatitis Elimination on hepatitis B birth dose: https://www.globalhep.org/projects-research/hep-b-birth-dose

Notes to editors

About Gavi, the Vaccine Alliance

Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate more than half the world’s children against some of the world’s deadliest diseases. The Vaccine Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill & Melinda Gates Foundation and other private sector partners. View the full list of donor governments and other leading organisations that fund Gavi’s work here .

Since its inception in 2000, Gavi has helped to immunise a whole generation – over 1 billion children – and prevented more than 17.3 million future deaths, helping to halve child mortality in 78 lower-income countries. Gavi also plays a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningococcal and yellow fever vaccines. After two decades of progress, Gavi is now focused on protecting the next generation, above all the zero-dose children who have not received even a single vaccine shot. The Vaccine Alliance employs innovative finance and the latest technology – from drones to biometrics – to save lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency. Learn more at www.gavi.org and connect with us on Facebook and Twitter .

MEDIA CONTACTS

Meg Sharafudeen +41 79 711 55 54 [email protected]

Cirũ Kariũki +41 79 913 94 41 [email protected]

Laura Shevlin + 41 79 529 92 87 [email protected]

Collins Weru Mwai +25 078 783 66 38 [email protected]

Matthew Grek +44 77 38 46 64 53 [email protected]

Eunice Kilonzo-Muraya +41 76 424 85 03 [email protected]

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Mpox Update: Clinical Management and Outbreaks

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“Please note special time of this COCA Call.”

This COCA Call will be held on Friday, March 27, 2020

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The Centers for Disease Control and Prevention has been supporting the Democratic Republic of the Congo (DRC) in responding to its largest surge of clade I mpox (MPVX) cases ever recorded. Since January 1, 2023, DRC has reported more than 20,000 suspect mpox cases and more than 1,000 deaths. Clade IIb mpox continues to circulate in the United States but at much lower levels. The 2022 global clade IIb mpox outbreak caused more than 97,000 illnesses around the world, including more than 32,000 cases and 58 deaths in the United States.

During this COCA call, presenters will give updates on the clade I outbreak in DRC and remind clinicians to be alert for cases of mpox in patients with recent travel to DRC. Presenters will discuss when to suspect a case of mpox, provide updates on the clinical management and prevention of clade II mpox, discuss the epidemiology of clade II mpox, and cite vaccination data. They will also discuss the commercialization of the JYNNEOS vaccine and outline the update to the expanded access Investigational New Drug (EA-IND) for Tecovirimat (TPOXX).

Agam Rao, MD CAPT, U.S. Public Health Service Medical Officer, Poxvirus and Rabies Branch Division of High-Consequence Pathogens and Pathology Centers for Disease Control and Prevention

Yon Yu, PharmD CAPT, U.S. Public Health Service Chief, Regulatory Affairs Immediate Office of the Director Centers for Disease Control and Prevention

Meghan Pennini, PhD Chief Science Officer HHS Coordination Operations and Response Element Administration for Strategic Preparedness and Response U.S. Department of Health and Human Services

Call Materials

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When: Tuesday, July 26, 2022, 2:00 PM – 3:00 PM ET

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When: Thursday, June 27, 2024 2:00 PM – 3:00 PM ET

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Date: Thursday, June 27, 2024

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COCA Call Objectives

At the conclusion of the session, the participant will be able to accomplish the following:

  • Cite background information on the topic covered during the presentation.
  • Discuss CDC’s role in the topic covered during the presentation.
  • Describe the topic’s implications for clinicians.
  • Discuss concerns and/or issues related to preparedness for and/or response to urgent public health threats.
  • Promote health improvement, wellness, and disease prevention in cooperation with patients, communities, at-risk populations, and other members of an interprofessional team of healthcare providers.

Activity-Specific Objectives

  • Discuss the epidemiology of clade II MPXV and U.S. clinical and vaccine.
  • Describe the JYNNEOS vaccine commercialization.
  • Explain TPOXX EA-IND eligibility criteria for treating mpox.

Instructions for Obtaining Continuing Education (CE)  

To receive continuing education (CE) for WC4520R-062724— Mpox Update: Clinical Management and Outbreaks , please visit CDC TRAIN and search for the course in the Course Catalog using WC4520R-062724 . Follow the steps below by July 29, 2024 .  The registration code is COCA062724 .

To receive continuing education (CE) for WD4520R-062724— Mpox Update: Clinical Management and Outbreaks , please visit CDC TRAIN and search for the course in the Course Catalog using WD4520R-062724 . Follow the steps below between July 30, 2024 , and July 30, 2026 .

  • Register for and complete the course.
  • Pass the post-assessment at 75%.
  • Complete the evaluation.
  • Visit Your Learning to access your certificates and transcript.

ACCREDITATION STATEMENTS

Jointly Accredited Provider - Interprofessional Continuing Education

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It could cure the incurable, revolutionize vaccines and immortalize cells: RNA explained

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Ask a friend what DNA is and, chances are, they have a general idea.

Seventy years after scientists discovered the two-stranded helix, DNA (deoxyribonucleic acid) is widely understood as the keeper of our genetic information and a window into our ancestry. It has become a household word.

Not so with RNA.

A picture of the book The Catalyst by Tom Cech

Book cover of “The Catalyst: RNA and the Quest to Unlock Life’s Deepest Secrets” by Tom Cech, winner of the Nobel Prize

“RNA was never the star of the show,” writes Tom Cech, a distinguished professor of biochemistry at CU Boulder who won the Nobel Prize in Chemistry in 1989 for his research on RNA. “It was like a biochemical backup singer slaving away in the shadows of the diva.”

As Cech reveals in his new book “The Catalyst: RNA and the Quest to Unlock Life’s Deepest Secrets,” RNA (ribonucleic acid) is having its moment, with research surging globally and more than 400 RNA-based drugs in development.

One variety, known as messenger RNA, could ultimately lead to a one-shot immunization that renders seasonal flu shots obsolete. Another guides CRISPR, a molecular set of scissors that can edit out mutations in the genetic code to prevent or cure deadly diseases. An RNA-powered enzyme called telomerase can also—for better or worse—forestall aging in human cells, a tantalizing but misunderstood idea for those seeking the Fountain of Youth.

CU Boulder Today sat down with Cech to discuss CU Boulder’s rich heritage of RNA research and the oft-overlooked molecule he has dedicated his career to.

What prompted you to write this book?

During the pandemic, my lab was shut down but my subject was suddenly on the tip of everyone’s tongue. People started hearing more about what RNA was and what messenger RNA might be able to do. Some were excited; some were hesitant. I thought that more information is always a good thing, so I decided to reach out to the non-scientific public and try to explain it.

In a nutshell, what is RNA?

RNA is a copy of one of the two strands in DNA. It is best known as a messenger that carries the information from DNA out of the cell nucleus to orchestrate the synthesis of proteins. It is tiny: If you stacked molecules of RNA side by side, you could fit 50,000 of them within the breadth of a single human hair. What it lacks in size it makes up for in versatility. Because it is a single strand, RNA can fold itself in myriad different ways that give it a huge list of roles beyond just being a messenger.

What did your Nobel-winning team discover in 1989?

We revealed that RNA could also be a catalyst. That means it could cut and join biochemical bonds, speeding up reactions necessary for life to exist. There are dozens of other equally thrilling things that RNA is capable of. But it was one of the moments in science when people woke up to thinking they had underestimated RNA, and they should keep their eyes open for new things it could do.

They found them. Since 2000, RNA-related breakthroughs have led to 11 Nobel prizes (including the 2020 prize to Jennifer Doudna , who did her postdoctoral work at CU Boulder, for the co-development of CRISPR).

What’s the connection between COVID and RNA?

The coronavirus itself is an RNA virus. It doesn’t have a genome made of DNA like we do. Instead, it uses RNA both to store its genetic information (yes RNA can do that, too) and as a messenger to make the proteins it needs to continue its infectious cycle. Ebola, polio and influenza are also RNA viruses.

What was so revolutionary about the ‘mRNA’ COVID vaccines?

To vaccinate against a virus, we typically inject a person with a disabled form of a virus. That can be a little frightening to think about. mRNA vaccines take that concern away because they are not made of virus. Instead, they are made of messenger RNA that instructs the body itself to make a protein—the spike protein in the case of COVID.

It gives the immune system a heads up and says, “If you ever see anything that looks like this, it's gonna be bad, so you need to mount a cellular response to kill it.”

Nobel Prize winners Thomas Cech and Jennifer Doudna

Cech, left, with Jennifer Doudna, who won the Nobel Prize in chemistry in 2020 for co-designing the RNA-guided gene-editing tool CRISPR.

Could this improve vaccines in general?

That is the hope. For instance, believe it or not, we currently inject about a million chicken eggs annually with the flu virus to make the seasonal flu vaccine. It takes so long that we have to guess what strain will be prominent during the next flu season and sometimes we are wrong. That’s why it’s only between 30% and 60% efficacious.

With mRNA vaccines, the process is so simple, someone could design the vaccine in about a week. The hope is that vaccine manufacturers could wait until they know what strain was going around and then design a much more effective vaccine or design a one-and-done and the seasonal shot would become a thing of the past.

Telomerase has become a darling of the biotech and supplement industries. Is it really an anti-aging miracle?

Chromosomes are like little strings of DNA pearls. In the absence of telomerase, the pearl at the end is lost each time a cell divides, and the string becomes shorter and shorter. Telomerase is a collaboration between RNA and a protein called telomerase reverse transcriptase, which was discovered at CU Boulder. It continually adds pearls to the end of the necklace (known as the telomere) rendering cells forever young.

Multiple diseases have been traced to low levels of telomerase. These individuals would greatly benefit from a way to lengthen the telomeres of their stem cells. But on the other hand, what is a tumor cell? Well, it’s immortal. So an anti-telomerase therapy could be useful in treating cancer.

The fact that telomerase can immortalize human cells is a scientific fact, but to suggest that an increase in the level of telomerase could extend human life span generally is overly simplistic.

Can you provide a few examples of RNA-based medications in use today?

Spinal muscular atrophy (SMA) is a reasonably common and deadly childhood disease that has been treated successfully with an RNA therapy. The first CRISPR therapy was approved late last year for sickle cell disease. CU Boulder scientists have developed RNA-based therapies for macular degeneration, and some are trying to tackle Alzheimer’s disease.

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CU Boulder Today regularly publishes Q&As with our faculty members weighing in on news topics through the lens of their scholarly expertise and research/creative work. The responses here reflect the knowledge and interpretations of the expert and should not be considered the university position on the issue. All publication content is subject to edits for clarity, brevity and  university style guidelines .

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IMAGES

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