Ebola, in full Ebola virus disease, formerly called Ebola hemorrhagic fever, contagious disease

caused by a virus of the family Filoviridae that is responsible for a severe and often fatal viral
hemorrhagic fever; outbreaks in primates, including gorillas, chimpanzees, and humans, and
domestic pigs have been recorded. The disease is characterized by extreme fever, rash, and
profuse hemorrhaging. In humans, certain species of the virus can cause fatality in 50 to 90
percent of cases.
Species of ebola viruses
Ebola viruses take their name from the Ebola River in the northern Congo basin of central
Africa, where they first emerged in 1976. Ebola viruses are closely related to species in the
genus Marburg virus, which was discovered in 1967, and the two are the only members of the
Filoviridae that cause epidemic human disease. Five species of ebola viruses, known as Zaire
ebola virus (EBOV), Sudan ebola virus (SUDV), Ta Forest ebola virus (TAFV), Reston ebola
virus (RESTV), and Bundibugyo ebola virus (BDBV), named for their outbreak locations, have
been described.
EBOV causes death in 80 to 90 percent of cases, and SUDV causes death in 50 percent of cases.
TAFV, found in dead chimpanzees in Ta National Park in southwestern Cte dIvoire, can infect
humans, although only two human cases have been documented, and both individuals survived.
RESTV, which was originally discovered in laboratory monkeys in Reston, Virginia, in 1989,
was also detected in laboratory monkeys in other locations in the United States in 1990 and
1996, as well as in Siena, Italy, in 1992. All the monkeys infected with RESTV have been traced
to one export facility located in the Philippines, although the origin of the strain has not been
identified. Similar to TAFV, RESTV does not appear to cause death in humans. The fifth
species, BDBV, was discovered in November 2007 in an outbreak in Bundibugyo district of
Uganda, near the border with the Democratic Republic of the Congo; it causes death in about 25
percent of cases.
Outbreaks
The first outbreaks, in 1976 in Zaire (now the Democratic Republic of the Congo) and Sudan
(including what is now South Sudan), resulted in more than 400 deaths. A subsequent outbreak
in the Democratic Republic of the Congo in May 1995 prompted temporary quarantine of the
Kikwit region, and more than 250 people died. Later outbreaks in Uganda in 2000 and in the
Democratic Republic of the Congo in 2002 also resulted in several hundred deaths. Other notable
outbreaks include those in Yambio county (2004) of South Sudan and in the Bundibugyo (2007)
and Kibale (2012) districts of Uganda.
In September 2007 an outbreak was confirmed in the Democratic Republic of the Congoin
Kasai-Occidental (West Kasai) province, located in the south-central region of the country.
However, while Ebola was detected in blood samples from some people that fell ill, other people
were found to be infected with Shigella, the bacterium that causes dysenterya disease whose
symptoms are similar to the early symptoms of Ebola. As a result, although several hundred
people became ill and more than 160 people died during the Ebola outbreak, it was unclear how
many of the deaths were actually caused by Ebola. Less than two years later, in December 2008,
a second outbreak of the disease was confirmed in West Kasai. Ebola had been detected in just
four people by early 2009. However, another 42 cases were suspected, and some 200 people
were under close observation for infection. Although 13 deaths were reported in association with
the outbreak, samples collected from the victims did not test positive for Ebola.
In 2008, tissue samples from pigs that died of unknown causes in the Philippines were analyzed
and found to contain RESTV. This was the first time that the virus was found in a mammalian
species other than primates. Infections in pigs were unexpected and raised concerns about
transmission of the virus from pigs to humans. In January 2009, antibodies to RESTV were
found in five Filipinos, four of whom worked on pig farms and one of whom worked in a
slaughterhouse. All five individuals were believed to have been infected with the virus through
direct contact with infected pigs. The infected people were healthy and did not show signs of
infection at the time antibodies to the virus were detected. In order to stop the spread of RESTV
among pigs, Philippines officials authorized the slaughter of thousands of potentially infected
swine.
A large outbreak occurred in western Africa in 2014, affecting people in Guinea, Sierra Leone,
Liberia, and Nigeria. Nearly 1,800 cases, over half of which resulted in death, had been reported
by early August of that year. Though outbreaks were normally brought under control effectively
through existing prevention and treatment strategies, the 2014 outbreak was complicated by a
limited health workforce and particularly by misperceptions of the disease among some people
living in affected regions, and public health experts anticipated the spread of the disease to other
countries in Africa; there was concern that it could reach distant areas, including the United
Kingdom and the United States, as a result of travel by infected individuals. On August 8,
following a sudden rise in cases that severely compromised aid efforts, the director general of
the World Health Organization, Margaret Chan, announced the decision to declare the outbreak a
public health emergency of international concern.
Course of infection
Viewed through an electron microscope, ebola viruses appear as long filaments, sometimes
branched or intertwined. The virion (virus particle) contains one molecule of noninfectious
single-stranded RNA (ribonucleic acid). It is not known how the viruses attack cells; it has been
postulated that they produce proteins that suppress the immune system, allowing reproduction of
virus to continue unhindered. Viral hemorrhagic fevers similar to Ebola typically are carried by
arthropods and rodents, but the natural reservoirs for ebola viruses are yet to be discovered.
Among the suspected reservoirs for Ebola are bats, primates, rodents, and insects that inhabit
tropical forests in Africa and Asia. Ebola can be transmitted through contact with infected blood
and bodily fluids as well as through contact with surfaces or objects contaminated by those
fluids. The virus has also been detected in the organs of patients after recovery from the fever. In
men, the virus may remain infectious in semen for as long as two months following return to
health. Unsanitary conditions and lack of adequate medical supplies may be factors in the spread
of the disease. Burial rituals that involve close contact with the body of a person who has died
from the disease also can result in the spread of Ebola.
Ebola viruses have an incubation period of 2 to 21 days. The onset of illness is sudden and harsh.
Infected persons develop fever, severe headaches and muscle aches, and loss of appetite. Within
a few days the virus causes a condition known as disseminated intravascular coagulation, which
is marked by both blood clots and hemorrhaging. In the case of Ebola, clots are concentrated in
the liver, spleen, brain, and other internal organs, forcing capillaries to bleed into surrounding
tissue. Nausea, vomiting and diarrhea with blood and mucus, conjunctivitis, and sore throat soon
follow. A maculapapular rash (discoloured elevations of the skin) appears on the trunk and
quickly spreads to the limbs and head. The patient is then beset by spontaneous bleeding from
body orifices and any breaks in the skin, such as injection sites, and within the gastrointestinal
tract, skin, and internal organs. Death is usually brought on by hemorrhaging, shock, or renal
failure and occurs within 8 to 17 days.
Treatment
There is no known treatment for Ebola, although immune plasma may be beneficial. Current
therapy consists of maintenance of fluid and electrolyte balance and administration of blood and
plasma to control bleeding.
Drugs designed to disrupt ebola virus replication have been developed and tested in Ebola-
infected monkeys. One such therapy was found to protect more than 60 percent of rhesus
monkeys infected with EBOV when the agent was administered within 30 to 60 minutes
following infection. The treatment, which in 2010 was approved for safety trials in humans, was
promising for persons who become accidentally infected in laboratory or hospital settings.
Another treatment under development was ZMapp, a mixture of three antibodies that bind to
proteins on ebola viruses. It was administered to infected individuals during the 2014 outbreak,
though its effectiveness was unclear.
The spread of ebola viruses can be contained by barrier nursing, handling of infected blood and
tissue in isolated laboratory units, and proper decontamination of reusable equipment.