Ebola virus disease

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"Ebola" redirects here. For other uses, see Ebola (disambiguation).
Ebola virus disease
Classification and eternal resources
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Ebola virus disease (E:'), Ebola hemorrhagic fever (E9F), or simply Ebola is a disease
of humans and other primates caused by an ebolavirus. 8ymptoms start t.o days to three
.eeks after contracting the virus, .ith a fever, sore throat, muscle pain and headaches.
;ypically, vomiting, diarrhea and rash follo., along .ith decreased functioning of the
liver and kidneys. *round this time, affected people may begin to bleed both .ithin the
body and eternally.<+=
;he virus may be ac>uired upon contact .ith blood or bodily fluids of an infected animal.
<+= 8preading through the air has not been documented in the natural environment.<$=
Fruit bats are believed to be a carrier and may spread the virus .ithout being affected.
?nce human infection occurs, the disease may spread bet.een people, as .ell. /ale
survivors may be able to transmit the disease via semen for nearly t.o months. ;o make
the diagnosis, typically other diseases .ith similar symptoms such as malaria, cholera
and other viral hemorrhagic fevers are first ecluded. ;o confirm the diagnosis, blood
samples are tested for viral antibodies, viral @0*, or the virus itself.<+=
(revention includes decreasing the spread of disease from infected animals to humans.
;his may be done by checking such animals for infection and killing and properly
disposing of the bodies if the disease is discovered. (roperly cooking meat and .earing
protective clothing .hen handling meat may also be helpful, as are .earing protective
clothing and .ashing hands .hen around a person .ith the disease. 8amples of bodily
fluids and tissues from people .ith the disease should be handled .ith special caution.<+=
0o specific treatment for the disease is yet available.<+= Efforts to help those .ho are
infected are supportive and include giving either oral rehydration therapy (slightly s.eet
and salty .ater to drink) or intravenous fluids.<+= ;he disease has a high risk of death,
killing bet.een 4"A and ,"A of those infected .ith the virus.<+=<6= E:' .as first
identified in 8udan (no. 8outh 8udan) and the 'emocratic @epublic of the Congo. ;he
disease typically occurs in outbreaks in tropical regions of sub%8aharan *frica.<+= From
+,!- (.hen it .as first identified) through $"+6, the World 9ealth ?rganiBation reported
a total of +,!+- cases.<+=<#= ;he largest outbreak to date is the ongoing $"+# West *frican
Ebola outbreak, .hich is affecting Cuinea, 8ierra Deone, Diberia and 0igeria.<4=<-= *s of
$- *ugust $"+#, 6,"-, suspected cases resulting in the deaths of +,44$ have been
reported.<!= Efforts are under .ay to develop a vaccine1 ho.ever, none yet eists.<+=
Contents
+ 8igns and symptoms
$ Causes
$.+ ;ransmission
$.$ @eservoir
$.6 :irology
6 (athophysiology
# 'iagnosis
#.+ Classification
#.$ 'ifferential diagnosis
4 (revention
4.+ 2nfection control and containment
4.$ Euarantine
4.6 :accine
4.# Daboratory
- ;reatment
! (rognosis
3 Epidemiology
3.+ +,!-
3.$ +,,4 to $"+6
3.6 $"+# outbreak
, 9istory
+" 8ociety and culture
+".+ Diterature
++ ?ther animals
++.+ Wild animals
++.$ 'omesticated animals
+$ @esearch
+$.+ /edications and vaccines
+$.$ 5lood transfusion
+6 8ee also
+# @eferences
+4 Eternal links
8igns and symptoms
8ymptoms of Ebola.<3=
8igns and symptoms of Ebola usually begin suddenly .ith an influenBa%like stage
characteriBed by fatigue, fever, headaches, )oint, muscle and abdominal pain.<,=<+"=
:omiting, diarrhea and loss of appetite are also common.<+"= Dess common symptoms
include the follo.ingF sore throat, chest pain, hiccups, shortness of breath and trouble
s.allo.ing.<+"= ;he average time bet.een contracting the infection and the start of
symptoms (incubation period) is 3 to +" days, but it can vary bet.een $ and $+ days.<+"=
<++= 8kin manifestations may include a maculopapular rash (in about 4"A of cases).<+$=
Early symptoms of E:' may be similar to those of malaria, dengue fever or other
tropical fevers, before the disease progresses to the bleeding phase.<,=
2n #"G4"A of cases, bleeding from puncture sites and mucous membranes (e.g.
gastrointestinal tract, nose, vagina and gums) has been reported.<+6= 2n the bleeding
phase, .hich typically starts 4 to ! days after first symptoms<+#= internal and
subcutaneous bleeding may present itself through reddening of the eyes and bloody
vomit.<,= 5leeding into the skin may create petechiae, purpura, ecchymoses and
hematomas (especially around needle in)ection sites). ;ypes of bleeding kno.n to occur
.ith Ebola virus disease include vomiting blood, coughing it up or blood in the stool.
9eavy bleeding is rare and is usually confined to the gastrointestinal tract.<+$=<+4= 2n
general, the development of bleeding symptoms often indicates a .orse prognosis and
this blood loss can result in death.<,= *ll people infected sho. some symptoms of
circulatory system involvement, including impaired blood clotting.<+$= 2f the infected
person does not recover, death due to multiple organ dysfunction syndrome occurs .ithin
! to +- days (usually bet.een days 3 and ,) after first symptoms.<+#=
Causes
/ain articlesF Ebolavirus (taonomic group) and Ebola virus (specific virus)
Dife cycles of the Ebolavirus
E:' is caused by four of five viruses classified in the genus Ebolavirus, family
Filoviridae, order /ononegavirales. ;he four disease%causing viruses are 5undibugyo
virus (5'5:), 8udan virus (8H':), ;aI Forest virus (;*F:), and one called simply,
Ebola virus (E5?:, formerly &aire Ebola virus)). Ebola virus is the sole member of the
&aire ebolavirus species, and the most dangerous of the kno.n Ebola disease%causing
viruses, as .ell as being responsible for the largest number of outbreaks.<+-= ;he fifth
virus, @eston virus (@E8;:), is not thought to be disease%causing in humans. ;he five
Ebola viruses are closely related to the /arburg viruses.
;ransmission
9uman%to%human transmission can occurs via direct contact .ith blood or bodily fluids
from an infected person (including embalming of an infected dead person) or by contact
.ith ob)ects contaminated by the virus, particularly needles and syringes.<+!= ;he
potential for .idespread E:' infections is considered lo. as the disease is only spread
by direct contact .ith the secretions from someone .ho is sho.ing signs of infection.
<+!= ;he symptoms limit a personJs ability to spread the disease as they are often too sick
to travel.<+3= 5ecause dead bodies are still infectious local traditional burial rituals may
spread the disease.<+,= 8emen may be infectious in survivors for up to 6 months.<$"= 2t is
not entirely clear ho. an Ebola outbreak is initially started.<$+= ;he initial infection is
believed to occur after ebola virus is transmitted to a human by contact .ith an infected
animalJs body fluids.
?ne of the primary reasons for spread is that the health systems in the part of *frica
.here the disease occurs function poorly.<$$= /edical .orkers .ho do not .ear
appropriate protective clothing may contract the disease.<$6= 9ospital%ac>uired
transmission has occurred in *frican countries due to the reuse of needles and lack of
universal precautions.<$#=<$4= 8ome health care centers caring for people .ith the
disease do not have running .ater.<$"=
*irborne transmission has not been documented during E:' outbreaks.<$= ;hey are,
ho.ever, infectious as breathable ".3G to +.$%Km laboratory%generated droplets.<$-= ;he
virus has been sho.n to travel, .ithout contact, from pigs to primates, although the same
study failed to demonstrate similar transmission bet.een non%human primates.<$!=
5ats drop partially eaten fruits and pulp, then land mammals such as gorillas and duikers
feed on these fallen fruits. ;his chain of events forms a possible indirect means of
transmission from the natural host to animal populations, .hich has led to research
to.ards viral shedding in the saliva of bats. Fruit production, animal behavior, and other
factors vary at different times and places that may trigger outbreaks among animal
populations.<$3=
@eservoir
5ushmeat being prepared for cooking in Chana, $"+6 9uman consumption of e>uatorial
animals in *frica in the form of bushmeat has been linked to the transmission of diseases
to people, including Ebola.<$,=
5ats are considered the most likely natural reservoir of the E5?:, plants, arthropods, and
birds .ere also considered.<+=<6"= 5ats .ere kno.n to reside in the cotton factory in
.hich the first cases for the +,!- and +,!, outbreaks .ere employed, and they have also
been implicated in /arburg virus infections in +,!4 and +,3".<6+= ?f $# plant species
and +, vertebrate species eperimentally inoculated .ith E5?:, only bats became
infected.<6$= ;he absence of clinical signs in these bats is characteristic of a reservoir
species. 2n a $""$G$""6 survey of +,"6" animals including -!, bats from Cabon and the
@epublic of the Congo, +6 fruit bats .ere found to contain E5?: @0* fragments.<66=
*s of $""4, three types of fruit bats (9ypsignathus monstrosus, Epomops fran>ueti, and
/yonycteris tor>uata) have been identified as being in contact .ith E5?:. ;hey are no.
suspected to represent the E5?: reservoir hosts.<6#=<64= *ntibodies against Ebola &aire
and @eston viruses have been found in fruit bats in 5angladesh, thus identifying potential
virus hosts and signs of the filoviruses in *sia.<6-=
5et.een +,!- and +,,3, in 6",""" mammals, birds, reptiles, amphibians and arthropods
sampled from outbreak regions, no ebolavirus .as detected apart from some genetic
traces found in si rodents (/us setulosus and (raomys) and one shre. (8ylvisore
ollula) collected from the Central *frican @epublic.<6+=<6!= ;races of E5?: .ere
detected in the carcasses of gorillas and chimpanBees during outbreaks in $""+ and $""6,
.hich later became the source of human infections. 9o.ever, the high lethality from
infection in these species makes them unlikely as a natural reservoir.<6+=
;ransmission bet.een natural reservoir and humans is rare, and outbreaks are usually
traceable to a single case .here an individual has handled the carcass of gorilla,
chimpanBee or duiker.<63= Fruit bats are also eaten by people in parts of West *frica
.here they are smoked, grilled or made into a spicy soup.<64=<6,=
:irology
/ain articlesF ebolavirus (taonomic group) and Ebola virus (specific virus)
Cenome
Electron micrograph of an Ebola virus virion
Dike all mononegaviruses, ebolavirions contain linear nonsegmented, single%strand, non%
infectious @0* genomes of negative polarity that possesses inverse%complementary 6J
and 4J termini, do not possess a 4J cap, are not polyadenylated, and are not covalently
linked to a protein.<#"= Ebolavirus genomes are approimately +, kilobase pairs long and
contain seven genes in the order 6J%H;@%0(%:(64%:(#"%C(%:(6"%:($#%D%4J%H;@.<#+=
;he genomes of the five different ebolaviruses (5'5:, E5?:, @E8;:, 8H':, and
;*F:) differ in se>uence and the number and location of gene overlaps.
8tructure
Dike all filoviruses, ebolavirions are filamentous particles that may appear in the shape of
a shepherdJs crook or in the shape of a "H" or a "-", and they may be coiled, toroid, or
branched.<#+= 2n general, ebolavirions are 3" nm in .idth, but vary some.hat in length.
2n general, the median particle length of ebolaviruses ranges from ,!# to +,"3- nm (in
contrast to marburgvirions, .hose median particle length .as measured at !,4G3$3 nm),
but particles as long as +#,""" nm have been detected in tissue culture.<#$=
@eplication
;he ebolavirus life cycle begins .ith virion attachment to specific cell%surface receptors,
follo.ed by fusion of the virion envelope .ith cellular membranes and the concomitant
release of the virus nucleocapsid into the cytosol. ;he viral @0* polymerase, encoded by
the D gene, partially uncoats the nucleocapsid and transcribes the genes into positive%
strand m@0*s, .hich are then translated into structural and nonstructural proteins.
Ebolavirus @0* polymerase (D) binds to a single promoter located at the 6J end of the
genome. ;ranscription either terminates after a gene or continues to the net gene
do.nstream. ;his means that genes close to the 6J end of the genome are transcribed in
the greatest abundance, .hereas those to.ard the 4J end are least likely to be transcribed.
;he gene order is, therefore, a simple but effective form of transcriptional regulation. ;he
most abundant protein produced is the nucleoprotein, .hose concentration in the cell
determines .hen D s.itches from gene transcription to genome replication. @eplication
results in full%length, positive%strand antigenomes that are, in turn, transcribed into
negative%strand virus progeny genome copy. 0e.ly synthesiBed structural proteins and
genomes self%assemble and accumulate near the inside of the cell membrane. :irions bud
off from the cell, gaining their envelopes from the cellular membrane they bud from. ;he
mature progeny particles then infect other cells to repeat the cycle.;he Ebola :irus
genetics are difficult to study due to its virulent nature<#6=
(athophysiology
(athogenesis schematic
Endothelial cells, mononuclear phagocytes and hepatocytes are the main targets of
infection. *fter infection, a secreted glycoprotein (sC() kno.n as the Ebola virus
glycoprotein (C() is synthesiBed. Ebola replication over.helms protein synthesis of
infected cells and host immune defenses. ;he C( forms a trimeric comple, .hich binds
the virus to the endothelial cells lining the interior surface of blood vessels. ;he sC(
forms a dimeric protein that interferes .ith the signaling of neutrophils, a type of .hite
blood cell, .hich allo.s the virus to evade the immune system by inhibiting early steps
of neutrophil activation. ;hese .hite blood cells also serve as carriers to transport the
virus throughout the entire body to places such as the lymph nodes, liver, lungs, and
spleen.<##=
;he presence of viral particles and cell damage resulting from budding causes the release
of cytokines (to be specific, ;0F%L, 2D%-, 2D%3, etc.), .hich are the signaling molecules
for fever and inflammation. ;he cytopathic effect, from infection in the endothelial cells,
results in a loss of vascular integrity. ;his loss in vascular integrity is furthered .ith
synthesis of C(, .hich reduces specific integrins responsible for cell adhesion to the
inter%cellular structure, and damage to the liver, .hich leads to coagulopathy.<#4=
'iagnosis
;he medical history, especially travel and .ork history along .ith eposure to .ildlife
are important to suspect the diagnosis of E:'. ;he diagnosis is confirmed by isolating
the virus, detecting its @0* or proteins, or detecting antibodies against the virus in a
personJs blood. 2solating the virus by cell culture, detecting the viral @0* by polymerase
chain reaction ((C@) and detecting proteins by enByme%linked immunosorbent assay
(ED28*) is effective early and in those .ho have died from the disease. 'etecting
antibodies against the virus is effective late in the disease and in those .ho recover.<#-=
'uring an outbreak, virus isolation is often not feasible. ;he most common diagnostic
methods are therefore real time (C@ and ED28* detection of proteins, .hich can be
performed in field or mobile hospitals.<#!= Filovirions can be seen and identified in cell
culture by electron microscopy due to their uni>ue filamentous shapes, but electron
microscopy cannot tell the difference bet.een the various filoviruses despite there being
some length differences.<#$=
(hylogenetic tree comparing the Ebolavirus and /arburgvirus. 0umbers indicate percent
confidence of branches.
Classification
;he genera Ebolavirus and /arburgvirus .ere originally classified as the species of the
no.%obsolete Filovirus genus. 2n /arch +,,3, the :ertebrate :irus 8ubcommittee
proposed in the 2nternational Committee on ;aonomy of :iruses (2C;:) to change the
Filovirus genus to the Filoviridae family .ith t.o specific generaF Ebola%like viruses and
/arburg%like viruses. ;his proposal .as implemented in Washington, 'C, on *pril $""+
and in (aris on Muly $""$. 2n $""", another proposal .as made in Washington, '.C., to
change the "%like viruses" to "%virus" resulting in todayJs Ebolavirus and /arburgvirus.
<#3=
@ates of genetic change are +"" times slo.er than influenBa * in humans, but on the
same magnitude as those of hepatitis 5. Etrapolating back.ards using these rates
indicates that Ebolavirus and /arburgvirus diverged several thousand years ago.<#,=
9o.ever, paleoviruses (genomic fossils) of filoviruses (Filoviridae) found in mammals
indicate that the family itself is at least tens of millions of years old.<4"= FossiliBed
viruses that are closely related to ebolaviruses have been found in the genome of the
Chinese hamster.<4+=
'ifferential diagnosis
;he symptoms of E:' are similar to those of /arburg virus disease.<4$= 2t can also
easily be confused .ith many other diseases common in E>uatorial *frica such as other
viral hemorrhagic fevers, falciparum malaria, typhoid fever, shigellosis, rickettsial
diseases such as typhus, cholera, gram%negative septicemia, borreliosis such as relapsing
fever or E9EC enteritis. ?ther infectious diseases that should be included in the
differential diagnosis include the follo.ingF leptospirosis, scrub typhus, plague, E fever,
candidiasis, histoplasmosis, trypanosomiasis, visceral leishmaniasis, hemorrhagic
smallpo, measles, and fulminant viral hepatitis.<46= 0on%infectious diseases that can be
confused .ith E:' are acute promyelocytic leukemia, hemolytic uremic syndrome,
snake envenomation, clotting factor deficiencies7platelet disorders, thrombotic
thrombocytopenic purpura, hereditary hemorrhagic telangiectasia, Na.asaki disease and
even .arfarin poisoning.<4#=<44=<4-=<4!=
(revention
* researcher .orking .ith the Ebola virus .hile .earing a 58D%# positive pressure suit
to avoid infection
2nfection control and containment
;he risk of transmission is increased among those caring for people infected.
@ecommended measures .hen caring for those .ho are infected include isolating them,
steriliBing e>uipment and surfaces, and .earing protective clothing including masks,
gloves, go.ns, and goggles.<$+= 2f a person .ith Ebola dies, direct contact .ith the body
of the deceased patient should be avoided.<$+=
2n order to reduce the spread, the World 9ealth ?rganiBation recommends raising
community a.areness of the risk factors for Ebola infection and the protective measures
individuals can take.<43= ;hese include avoiding contact .ith infected people and regular
hand .ashing using soap and .ater.<4,= ;raditional burial rituals, especially those
re>uiring .ashing or embalming of bodies, should be discouraged or modified.<-"=<-+=
*irline cre.s are instructed to isolate anyone .ho has symptoms resembling Ebola virus.
<-$=
;he Ebola virus can be eliminated .ith heat (heating for 6" to -" minutes at -" OC or
boiling for 4 minutes). ?n surfaces, some lipid solvents such as some alcohol%based
products, detergents, sodium hypochlorite (bleach) or calcium hypochlorite (bleaching
po.der), and other suitable disinfectants at appropriate concentrations can be used as
disinfectants.<-6=<-#=
Euarantine
Euarantine, also kno.n as enforced isolation, is usually effective in decreasing spread.
<-4=<--= Covernments often >uarantine areas .here the disease is occurring or
individuals .ho may be infected.<-!= 2n the Hnited 8tates, the la. allo.s >uarantine of
those infected .ith Ebola.<-3= 'uring the $"+# outbreak, Diberia closed schools.<-,=
;hose .ho have been eposed to someone .ith the disease should be closely observed
for $+ days.<!"=
:accine
0o vaccine is currently available for humans.<+=<!+=<!$= ;he most promising candidates
are '0* vaccines<!6= or vaccines derived from adenoviruses,<!#= vesicular stomatitis
2ndiana virus (:82:)<!4=<!-=<!!= or filovirus%like particles (:D(s)<!3= because these
candidates could protect nonhuman primates from ebolavirus%induced disease. '0*
vaccines, adenovirus%based vaccines, and :82:%based vaccines have entered clinical
trials.<!,=<3"=<3+=<3$=
:accines have protected nonhuman primates. 2mmuniBation takes si months, .hich
impedes the counter%epidemic use of the vaccines. 8earching for a >uicker onset of
effectiveness, in $""6, a vaccine using an adenoviral (*':) vector carrying the Ebola
spike protein .as tested on crab%eating maca>ues. ;.enty%eight days later, they .ere
challenged .ith the virus and remained resistant.<!#= * vaccine based on attenuated
recombinant vesicular stomatitis virus (:8:) vector carrying either the Ebola
glycoprotein or the /arburg glycoprotein in $""4 protected nonhuman primates,<36=
opening clinical trials in humans.<!,= ;he study by ?ctober completed the first human
trial, over three months giving three vaccinations safely inducing an immune response.
2ndividuals for a year .ere follo.ed, and, in $""-, a study testing a faster%acting, single%
shot vaccine began1 this ne. study .as completed in $""3.<3"= ;rying the vaccine on a
strain of Ebola that more resembles one that infects humans is the net step.<3#= ?n -
'ecember $"++, the development of a successful vaccine against Ebola for mice .as
reported. Hnlike the predecessors, it can be freeBe%dried and thus stored for long periods
in .ait for an outbreak.<34= *n eperimental vaccine made by researchers at CanadaJs
national laboratory in Winnipeg .as used, in $"",, to pre%emptively treat a Cerman
scientist .ho might have been infected during a lab accident.<3-= 9o.ever, actual E5?:
infection could never be demonstrated .ithout a doubt.<3!= Eperimentally, recombinant
vesicular stomatitis 2ndiana virus (:82:) epressing the glycoprotein of E5?: or 8H':
has been used successfully in nonhuman primate models as post%eposure prophylais.
<33=<3,= ;he C'CJs recommendations are currently under revie..
Daboratory
Ebola viruses are World 9ealth ?rganiBation @isk Croup # pathogens, re>uiring biosafety
level #%e>uivalent containment. Daboratory researchers must be properly trained in 58D%
# practices and .ear proper personal protective e>uipment.
;reatment
* hospital isolation .ard in Culu, Hganda, during the ?ctober $""" outbreak
0o ebolavirus%specific treatment eists.<!$= ;reatment is primarily supportive in nature.
<,"= ;hese measures may includesF pain management, medications for nausea, fever and
aniety, as .ell as fluids by mouth or by intravenous.<,"= 5lood products such as packed
red blood cells, platelets or fresh froBen plasma may also be used.<,"= ?ther regulators of
coagulation have also been tried including heparin in an effort to prevent disseminated
intravascular coagulation and clotting factors to decrease bleeding.<,"= /edication for
malaria and bacterial infections have often been used as initially the diagnosis is usually
not clear.<,"= Early treatment may increase the chance of survival.<,+=
* number of eperimental treatments are being studied.<,$= 2n the Hnited 8tates, the
F'*Js animal efficacy rule is being used to demonstrate reasonable safety to obtain
permission to treat people .ho are infected .ith Ebola. 2t is being used as the normal
path for testing drugs is not possible for diseases caused by dangerous pathogens or
toins. Eperimental drugs are made available for use .ith the approval of regulatory
agencies under named patient programs, kno.n in the H8 as "epanded access".<,6= ;he
F'* has allo.ed t.o drugs, &/app and an @0* interference drug called ;N/%Ebola, to
be used in people infected .ith Ebola under these programs during the $"+# outbreak.
<,#=
(rognosis
;he disease has a high mortality rateF often bet.een 4" percent and ," percent.<+=<6= *s
of *pril $"+#, information from W9? across all occurrences to date puts the overall
fatality rate at -"A%-4A.<+= ;here are indications based on variations in death rate
bet.een countries that early and effective treatment of symptoms (e.g., supportive care to
prevent dehydration) may reduce the fatality rate significantly.<,4= 2f an infected person
survives, recovery may be >uick and complete. (rolonged cases are often complicated by
the occurrence of long%term problems, such as inflammation of the testicles, )oint pains,
muscle pains, skin peeling, or hair loss. Eye symptoms, such as light sensitivity, ecess
tearing, iritis, iridocyclitis, choroiditis, and blindness have also been described. E5?:
and 8H': may be able to persist in the semen of some survivors for up to seven .eeks,
.hich could give rise to infections and disease via seual intercourse.<+=
Epidemiology
For more about specific outbreaks and their descriptions, see Dist of Ebola outbreaks.
C'C .orker incinerates medical .aste from Ebola patients in &aire in +,!-
;he disease typically occurs in outbreaks in tropical regions of 8ub%8aharan *frica.<+=
From +,!- (.hen it .as first identified) through $"+6, the World 9ealth ?rganiBation
reported +,!+- confirmed cases.<+=<#= ;he largest outbreak to date is the ongoing $"+#
West *frica Ebola virus outbreak, .hich is affecting Cuinea, 8ierra Deone,Diberia and
0igeria<4=<-= *s of +6 *ugust, $,+$! cases have been identified, .ith +,+#4 deaths.<4=
+,!-
;he first identified case of Ebola .as on $- *ugust +,!-, in Pambuku, a small rural
village in /ongala 'istrict in northern 'emocratic @epublic of the Congo (then kno.n
as &aire).<,-= ;he first victim, and the inde case for the disease, .as village school
headmaster /abalo Dokela, .ho had toured an area near the Central *frican @epublic
border along the Ebola river bet.een +$G$$ *ugust. ?n 3 8eptember he died of .hat
.ould become kno.n as the Ebola virus species of the ebolavirus.<,!= 8ubse>uently a
number of other cases .ere reported, almost all centered on the Pambuku mission
hospital or having close contact .ith another case.<,!= 6+3 cases and $3" deaths (a 33A
fatality rate) occurred in the '@C.<,3= ;he Ebola outbreak .as contained .ith the help of
the World 9ealth ?rganiBation and transport from the Congolese air force, by
>uarantining villagers, steriliBing medical e>uipment, and providing protective clothing.
;he virus responsible for the initial outbreak, first thought to be /arburg virus .as later
identified as a ne. type of virus related to /arburg, and named after the nearby Ebola
river. *nother ebolavirus, the 8udan virus species, .as also identified that same year
.hen an outbreak occurred in 8udan, affecting $3# people and killing +4+.<,,=
+,,4 to $"+6
;he second ma)or outbreak occurred in +,,4 in the 'emocratic @epublic of Congo,
affecting 6+4 and killing $4#. ;he net ma)or outbreak occurred in Hganda in $""",
affecting #$4 and killing $$#1 in this case the 8udan virus .as found to be the ebolavirus
species responsible for the outbreak.<+""= 2n $""6 there .as an outbreak in the @epublic
of Congo that affected +#6 and killed +$3, a death rate of ,"A, the highest to date.<+"+=
2n *ugust $""!, +"6 people .ere infected by a suspected hemorrhagic fever outbreak in
the village of Nampungu, 'emocratic @epublic of the Congo. ;he outbreak started after
the funerals of t.o village chiefs, and $+! people in four villages fell ill.<+""=<+"$=<+"6=
;he $""! outbreak eventually affected $-# individuals and resulted in the deaths of +3! .
<+=
?n 6" 0ovember $""!, the Hganda /inistry of 9ealth confirmed an outbreak of Ebola in
the 5undibugyo 'istrict in Western Hganda. *fter confirmation of samples tested by the
Hnited 8tates 0ational @eference Daboratories and the Centers for 'isease Control, the
World 9ealth ?rganiBation confirmed the presence of a ne. species of Ebolavirus, .hich
.as tentatively named 5undibugyo.<+"#= ;he W9? reported +#, cases of this ne. strain
and 6! of those led to deaths.<+=
;he W9? confirmed t.o small outbreaks in Hganda in $"+$. ;he first outbreak affected
! people and resulted in the death of # and the second affected $#, resulting in the death
of +!. ;he 8udan variant .as responsible for both outbreaks.<+=
?n +! *ugust $"+$, the /inistry of 9ealth of the 'emocratic @epublic of the Congo
reported an outbreak of the Ebola%5undibugyo variant<+"4= in the eastern region.<+"-=
<+"!= ?ther than its discovery in $""!, this .as the only time that this variant has been
identified as the ebolavirus responsible for an outbreak. ;he W9? revealed that the virus
had sickened 4! people and claimed $, lives. ;he probable cause of the outbreak .as
tainted bush meat hunted by local villagers around the to.ns of 2siro and :iadana.<+=
<+"3=
$"+# outbreak
/ain articleF $"+# West *frica Ebola virus outbreak
2ncrease over time in the cases and deaths during the $"+# outbreak
2n /arch $"+#, the World 9ealth ?rganiBation (W9?) reported a ma)or Ebola outbreak
in Cuinea, a .estern *frican nation1 it is the largest ever documented, and the first
recorded in the region.<+",= @esearchers traced the outbreak to a t.o%year old child .ho
died on - 'ecember $"+6.<++"=
?n 3 *ugust $"+#, the W9? declared the epidemic to be an international public health
emergency. Hrging the .orld to offer aid to the affected regions, the 'irector%Ceneral
said, "Countries affected to date simply do not have the capacity to manage an outbreak
of this siBe and compleity on their o.n. 2 urge the international community to provide
this support on the most urgent basis possible."<+++= 5y mid%*ugust $"+#, 'octors
Without 5orders reported the situation in DiberiaJs capital /onrovia as "catastrophic" and
"deteriorating daily". ;hey report that fears of Ebola among staff members and patients
has shut do.n much of the cityQs health system .hich has resulted in leaving many
people .ithout treatment for other conditions.<++$= 5y late *ugust $"+#, the disease had
spread to 0igeria.<++6=<++#=
5y - 8eptember $"+#, #,$,6 suspected cases including $,$,- deaths had been reported,
ho.ever the World 9ealth ?rganiBation has said that these numbers may be vastly
underestimated.<++4= *dditionally the outbreak has resulted in more than +$" healthcare
.orker deaths partly due to the lack of e>uipment and long hours.<++-= ?n 3 8eptember
$"+#, W9? .arned the number of ne. cases in Diberia .as increasing eponentially,
and .ould increase by "many thousands" in the follo.ing 6 .eeks.<++!=
*side from the human cost, the outbreak has severely eroded the economies of the
affected countries. 2n *ugust $"+#, attempts to contain the outbreak .ere enacted by
placing troops on roads to cordon off the infected areas and stop those .ho may be
infected from leaving and further spreading the virus.<++3= 5y 8eptember, .ith the
closure of borders, the cancellation of airline flights, the evacuation of foreign .orkers
and a collapse of cross%border trade, the national deficits of Cuinea, 8ierra Deone and
Diberia .ere .idening to the point .here the 2/F .as considering epanding its
financial support to the 6 countries. ;he W9?, /Rdecins 8ans FrontiSres, and H0 health
care .orkers have all criticiBed the travel restrictions saying they are not )ustified and are
potentially .orsening the crisis. <++,=<+$"= * Financial ;imes report suggested the
economic impact of the outbreak could kill more people than the virus itself.
9istory
For more about the outbreak in :irginia, H8, see @eston virus.
Cases of ebola fever in *frica from +,!, to $""3.
Ebola virus .as first isolated in +,!- during outbreaks of Ebola hemorrhagic fever in the
'emocratic @epublic of the Congo (then &aire)<+$+= and 8outhern 8udan.<+$$= ;he
name of the disease originates from the first recorded outbreak in +,!- in Pambuku,
'emocratic @epublic of the Congo, .hich lies on the Ebola @iver.<+$+=
2n late +,3,, 9aBelton @esearch (roductsJ @eston Euarantine Hnit in @eston, :irginia
suffered a mysterious outbreak of fatal illness (initially diagnosed as 8imian hemorrhagic
fever virus (89F:)) among a shipment of crab%eating maca>ue monkeys imported from
the (hilippines. 9aBeltonJs veterinary pathologist sent tissue samples from dead animals
to the Hnited 8tates *rmy /edical @esearch 2nstitute of 2nfectious 'iseases
(H8*/@22') at Fort 'etrick, /aryland, .here a laboratory test kno.n as an ED28*
assay sho.ed antibodies to Ebola virus.<+$6= *n electron microscopist from H8*/@22'
discovered filoviruses similar in appearance to Ebola in the tissue samples sent from
9aBelton @esearch (roductsJ @eston Euarantine Hnit.<+$#=
8hortly after.ard, a H8 *rmy team head>uartered at H8*/@22' .ent into action to
euthaniBe the monkeys .hich had not yet died, bringing those monkeys and those .hich
had already died of the disease to Ft. 'etrick for study by the *rmyJs veterinary
pathologists and virologists, and eventual disposal under safe conditions.<+$6=
5lood samples .ere taken from +!3 animal handlers during the incident.<+$4= ?f those,
si animal handlers eventually seroconverted. When the handlers did not become ill, the
C'C concluded that the virus had a very lo. pathogenicity to humans.<+$-=
;he (hilippines and the Hnited 8tates had no previous cases of Ebola infection, and upon
further isolation, researchers concluded it .as another strain of Ebola, or a ne. filovirus
of *sian origin, .hich they named @eston ebolavirus (@E5?:) after the location of the
incident.<+$6=
8ociety and culture
Ebolavirus is classified as a biosafety level # agent, as .ell as a Category * bioterrorism
agent by the Centers for 'isease Control and (revention. 2t has the potential to be
.eaponiBed for use in biological .arfare,<+$!=<+$3= and .as investigated by the
5iopreparat for such use, but might be difficult to prepare as a .eapon of mass
destruction because the virus becomes ineffective >uickly in open air.<+$,=
Diterature
@ichard (restonJs +,,4 book, ;he 9ot &one, dramatiBed the Ebola outbreak in @eston,
:irgina.<+6"=
;om ClancyJs +,,- novel, Eecutive ?rders, involves a /iddle Eastern terrorist attack on
the Hnited 8tates using an airborne form of a deadly Ebola virus strain named "Ebola
/ayinga" (see /ayinga 0J8eka).<+6+=
?ther animals
Wild animals
2t is .idely believed that outbreaks of E:' among human populations result from
handling infected .ild animal carcasses. 8ome research suggests that an outbreak in the
.ild animals used for consumption, bushmeat, may result in a corresponding human
outbreak. 8ince $""6, such outbreaks have been monitored through surveillance of
animal populations .ith the aim of predicting and preventing Ebola outbreaks in humans.
<+6$=
@ecovered carcasses from gorillas contain multiple Ebola virus strains, .hich suggest
multiple introductions of the virus. 5odies decompose >uickly and carcasses are not
infectious after three to four days. Contact bet.een gorilla groups is rare, suggesting
transmission among gorilla groups is unlikely, and that outbreaks result from
transmission bet.een viral reservoir and animal populations.<+66=
Ebola has a high mortality among primates.<+6#= Fre>uent outbreaks of Ebola may have
resulted in the deaths of 4,""" gorillas.<+64= ?utbreaks of Ebola may have been
responsible for an 33A decline in tracking indices of observed chimpanBee populations in
#$" s>uare kilometer Dossi 8anctuary bet.een $""$ and $""6.<+66= ;ransmission among
chimpanBees through meat consumption constitutes a significant risk factor, .hile contact
bet.een individuals, such as touching dead bodies and grooming, is not.<+6-=
'omesticated animals
@eston ebolavirus (@E5?:) can be transmitted to pigs.<+6!= ;his virus .as discovered
during an outbreak of .hat at the time .as thought to be simian hemorrhagic fever virus
(89F:) in crab%eating maca>ues in @eston, :irginia (hence the name @eston elabovirus)
in +,3,. 8ince the initial outbreak it has since been found in nonhuman primates in
(ennsylvania, ;eas, and 2taly. 2n each case, the affected animals had been imported from
a facility in the (hilippines,<-!= .here the virus had infected pigs.<+63= 'espite its status
as a Devel-# organism and its apparent pathogenicity in monkeys, @E5?: has not
caused disease in eposed human laboratory .orkers.<+6,= 2n $"+$ it .as demonstrated
that the virus can travel .ithout contact from pigs to nonhuman primates, although the
same study failed to achieve transmission in that manner bet.een primates.<+6!=
*ccording to the W9?, routine cleaning and disinfection of pig (or monkey) farms .ith
sodium hypochlorite or other detergents should be effective in inactivating the @eston
ebolavirus. 2f an outbreak is suspected, the area must be immediately >uarantined.<,,=
While pigs that have been infected .ith @E5?: tend to sho. symptoms of the disease, it
has been sho.n that dogs may become infected .ith E5?: and remain asymptomatic.
'ogs in some parts of *frica scavenge for their food and it is kno.n that they sometimes
eat infected animals and the corpses of humans. *lthough they remain asymptomatic, a
$""4 survey of dogs during an E5?: outbreak found that over 6+.3A sho.ed a
seroprevalence for E5?: closest to an outbreak versus ,A a farther distance a.ay.<+#"=
@esearch
/edications and vaccines
@esearchers looking at slides of cultures of cells that make monoclonal antibodies. ;hese
are gro.n in a lab and the researchers are analyBing the products to select the most
promising of them.
*s of *ug +#, $"+#, the F'* has not approved any medications or vaccines to treat or
prevent Ebola and advises people to .atch out for fraudulent products.<+#+= ;he
unavailability of eperimental treatments in the most affected regions during the $"+#
outbreak spurred controversy, .ith some calling for eperimental drugs to be made more
.idely available in *frica on a humanitarian basis, and others .arning that making
unproven eperimental drugs .idely available .ould be unethical, especially in light of
past eperimentation conducted in developing countries by Western drug companies.
<+#$=<+#6= ?n +$ *ugust the W9? released a statement that the use of not yet proven
treatments is ethical in certain situations in an effort to treat or prevent the disease.<+##=
&/app, a monoclonal antibody vaccine. ;he limited supply of the drug has been used to
treat a small number of individuals infected .ith the Ebola virus. *lthough some of these
have recovered the outcome is not considered statistically significant.<+#4= &/app has
proved highly effective in a trial involving @hesus maca>ue monkeys.<+#-=
Favipiravir, an anti%viral drug approved in Mapan for stockpiling against influenBa
pandemics, appears to be useful in a mouse model of Ebola.<,=<+#!= ;he Estrogen
receptor drugs used to treat infertility and breast cancer (clomiphene and toremifene)
inhibit the progress of Ebola virus in infected mice.<+#3= 0inety percent of the mice
treated .ith clomiphene and fifty percent of those treated .ith toremifene survived the
tests.<+#3= * $"+# study found that *miodarone, an ion channel blocker used in the
treatment of heart arrhythmias, blocks the entry of ebola virus into cells in vitro.<+#,=
Civen their oral availability and history of human use, these drugs .ould be candidates
for treating Ebola virus infection in remote geographical locations, either on their o.n or
together .ith other antiviral drugs.
?ther promising treatments rely on antisense technology. 5oth small interfering @0*s
(si@0*s) and phosphorodiamidate morpholino oligomers ((/?s) targeting the &aire
Ebola virus (&E5?:) @0* polymerase D protein could prevent disease in nonhuman
primates.<+4"=<+4+= ;N/%Ebola is a small%interfering @0* compound, currently tested
in a phase 2 clinical trial in people.<,#=<+4$= 8arepta ;herapeutics has completed a phase
2 clinical trial .ith its /orpholino oligo targeting Ebola.<+46=
2n *ugust $"+#, /icrosoft co%founder (aul *llenJs charitable foundation donated H8'
T$.3 million to the *merican @ed Cross for its .ork on the outbreak, then .eeks later
kicked in an additional T, million.<+4#= 2n 8eptember, the 5ill U /elinda Cates
Foundation pledged H8' T4" million that .ould be immediately released to H.0.
agencies and international organiBations to help them buy supplies and .ill .ork .ith
partners to speed up development of drugs, vaccines and diagnostics that could be
effective in treating Ebola patients and prevent further spreading.<+44=
*s of 8eptember $"+#, several pharmaceutical companies have stated that they have
made progress in the development and testing of vaccines, and intend to begin clinical
trials in humans .ithin the coming year.<+4-=<+4!= * series of international safety tests in
humans of t.o of these vaccines .as about to begin in 8eptember.<+43=<+4,=
5lood transfusion
8even of eight people .ith Ebola survived after receiving a transfusion of blood donated
by individuals .ho had previously survived the infection in an +,,, outbreak in the
'emocratic @epublic of the Congo.<,"= ;his treatment1 ho.ever, .as started late in the
disease meaning they may have already been recovering on their o.n and the rest of their
care .as better than usual.<,"= ;hus this potential treatment remains considered
controversial.<+-"= 2ntravenous antibodies appear to be protective in non%human primates
.ho have been eposed to large doses of Ebola.<+-+=
8ee also
Dist of human disease case fatality rates
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Nuhn, Mens 9. ($""3). FilovirusesF * Compendium of #" Pears of Epidemiological,
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