Ebola virus disease

Ebola redirects here.

(disambiguation).

For other uses, see Ebola body uids and tissues from people with the disease
should be handled with special caution.[1]

No specic treatment or vaccine for the virus is commercially available, although a number of potential treatments
are being studied. Eorts to help those who are infected
are supportive; they include either oral rehydration therapy (drinking slightly sweetened and salty water) or giving intravenous uids as well as treating symptoms. This
supportive care improves outcomes. EVD was rst identied in 1976 in an area of Sudan (now part of South
Sudan), and in Zaire (now the Democratic Republic of
the Congo). The disease typically occurs in outbreaks in
tropical regions of sub-Saharan Africa.[1] Through 2013,
the World Health Organization reported a total of 1,716
cases in 24 outbreaks.[1][6] The largest outbreak to date
is the ongoing epidemic in West Africa, which is centered in Guinea, Sierra Leone and Liberia.[7][8][9] As of
has 15,963 reported
The virus spreads by direct contact with blood or other 23 November 2014, this outbreak
[10][11][12]
cases
resulting
in
6,003
deaths.
[1]
body uids of an infected human or other animal. Infection with the virus may also occur by direct contact
with a recently contaminated item or surface.[1] Spread
of the disease through the air between primates, includ- 1 Signs and symptoms
ing humans, has not been documented in either laboratory or natural conditions.[3] The virus may be spread by
semen or breast milk for several weeks to months after
recovery.[1][4] Fruit bats are believed to be the normal
carrier in nature, able to spread the virus without being
aected by it. Humans become infected by contact with
the bats or with a living or dead animal that has been infected by bats. After human infection occurs, the disease
may also spread between people. Other diseases such as
malaria, cholera, typhoid fever, meningitis and other viral
hemorrhagic fevers may resemble EVD. Blood samples
are tested for viral RNA, viral antibodies or for the virus
itself to conrm the diagnosis.[1]
Ebola virus disease (EVD; also Ebola hemorrhagic
fever, or EHF), or simply Ebola, is a disease of humans and other primates caused by ebolaviruses. Signs
and symptoms typically start between two days and three
weeks after contracting the virus as a fever, sore throat,
muscle pain, and headaches. Then, vomiting, diarrhea
and rash usually follow, along with decreased function of
the liver and kidneys. At this time some people begin to
bleed both internally and externally.[1] The disease has a
high risk of death, killing between 25 percent and 90 percent of those infected with the virus, averaging out at 50
percent.[1] This is often due to low blood pressure from
uid loss, and typically follows six to sixteen days after
symptoms appear.[2]

Control of outbreaks requires coordinated medical services, along with a certain level of community engagement. The medical services include: rapid detection of
cases of disease, contact tracing of those who have come
into contact with infected individuals, quick access to laboratory services, proper care and management of those
who are infected and proper disposal of the dead through
cremation or burial.[1][5] Prevention includes limiting the
spread of disease from infected animals to humans.[1]
This may be done by handling potentially infected bush
meat only while wearing protective clothing and by thoroughly cooking it before consumption.[1] It also includes
wearing proper protective clothing and washing hands
when around a person with the disease.[1] Samples of

Signs and symptoms of Ebola[13]

The length of time between exposure to the virus and

the development of symptoms (incubation period) is between 2 to 21 days.[1][13] Most often this is between 4 to
10 days.[14] However, recent estimates based on mathematical models predict that around 5% of cases may take
1

2
greater than 21 days to develop.[15]

2 CAUSE

2.1 Transmission

Symptoms usually begin with a sudden inuenza-like

stage characterized by feeling tired, fever, weakness,
decreased appetite, muscle pain, joint pain, headache,
and sore throat.[1][14][16][17] The fever is usually higher
than 38.3 C (100.9 F).[18] This is often followed
by vomiting, diarrhea and abdominal pain.[17] Next,
shortness of breath and chest pain may occur, along with
swelling, headaches and confusion.[17] In about half of the
cases, the skin may develop a maculopapular rash (a at
red area covered with small bumps), which may be seen
5 to 7 days after symptoms begin.[14][18]
In some cases, internal and external bleeding may
occur.[1] This typically begins ve to seven days after the rst symptoms.[19] All infected people show
some decreased blood clotting.[18] Bleeding from mucous
membranes or from sites of needle punctures has been
reported in 4050 percent of cases.[20] This may result
in the vomiting of blood, coughing up of blood or blood
in stool.[21] Bleeding into the skin may create petechiae,
purpura, ecchymoses or hematomas (especially around
needle injection sites).[22] Bleeding into the whites of the
eyes may also occur. Heavy bleeding is uncommon, and
if it occurs, it is usually located within the gastrointestinal
tract.[18][23]

Life cycles of the Ebolavirus

Between people, Ebola disease spreads only by direct

contact with the blood or body uids of a person who
has developed symptoms of the disease.[29][30][31] Body
uids that may contain ebola viruses include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and
semen.[24] The WHO states that only people who are very
sick are able to spread Ebola disease in saliva, and whole
virus has not been reported to be transmitted through
sweat. Most people spread the virus through blood, feces
and vomit.[32] Entry points for the virus include the nose,
mouth, eyes, open wounds, cuts and abrasions.[24] Ebola
may be spread through large droplets; however, this is believed to occur only when a person is very sick.[33] This
can happen if a person is splashed with droplets.[33] Contact with surfaces or objects contaminated by the virus,
particularly needles and syringes, may also transmit the
infection.[34][35] The virus is able to survive on objects
for a few hours in a dried state and can survive for a few
days within body uids.[24]

Recovery may begin between 7 and 14 days after the start

of symptoms.[17] Death, if it occurs, follows typically 6 to
16 days from the start of symptoms and is often due to
low blood pressure from uid loss.[2] In general, bleeding
often indicates a worse outcome, and this blood loss may
result in death.[16] People are often in a coma near the end
of life.[17] Those who survive often have ongoing muscle
and joint pain, liver inammation, and decreased hearing among other diculties.[17] Additionally they develop
antibodies against Ebola that last at least 10 years but it is
unclear if they are immune to repeated infections.[24] If
someone survives Ebola, they can no longer transmit the The Ebola virus may be able to persist for up to 8 weeks in
disease.[24]
the semen of survivors after they recovered, which could
lead to infections via sexual intercourse.[1] Ebola may also
occur in the breast milk of women after recovery, and it
is not known when it is safe to breastfeed again.[4] Other2 Cause
wise, people who have recovered are not infectious.[34]

Main articles: Ebolavirus (taxonomic group) and Ebola The potential for widespread infections in countries with
medical systems capable of observing correct medical
virus (specic virus)
isolation procedures is considered low.[36] Usually when
someone has symptoms of the disease, they are unable to
EVD in humans is caused by four of ve viruses of travel without assistance.[37]
the genus Ebolavirus. The four are Bundibugyo virus
(BDBV), Sudan virus (SUDV), Ta Forest virus (TAFV) Dead bodies remain infectious; thus, people handling huand one simply called Ebola virus (EBOV, formerly Zaire man remains in practices such as traditional burial rituEbola virus).[25] EBOV, species Zaire ebolavirus, is the als or[36]more modern processes such as embalming are at
69% of the cases of Ebola infections in Guinea
most dangerous of the known EVD-causing viruses, and risk.
during
the
2014 outbreak are believed to have been con[26]
is responsible for the largest number of outbreaks.
tracted
via
unprotected (or unsuitably protected) conThe fth virus, Reston virus (RESTV), is not thought
tact
with
infected
corpses during certain Guinean burial
to cause disease in humans, but has caused disease in
[38][39]
rituals.
[27][28]
All ve viruses are closely related
other primates.
to marburgviruses.[25]
Health-care workers treating those who are infected are

2.3

Reservoir

at greatest risk of getting infected themselves.[34] The

risk increases when these workers do not have appropriate protective clothing such as masks, gowns, gloves
and eye protection; do not wear it properly; or handle contaminated clothing incorrectly.[34] This risk is
particularly common in parts of Africa where health
systems function poorly and where the disease mostly
occurs.[40] Hospital-acquired transmission has also occurred in some African countries resulting from the reuse
of needles.[41][42] Some health-care centers caring for
people with the disease do not have running water.[43] In
the United States the spread to two medical workers treating infected patients prompted criticism of inadequate
training and procedures.[44]
2.1.1

Airborne transmission

Human to human transmission of EBOV through the air

has not been reported to occur during EVD outbreaks[3]
and airborne transmission has only been demonstrated
in very strict laboratory conditions, and then only from
pigs to primates but not from primates to primates.[29][35]
Spread of EBOV by water or food, other than bushmeat, has also not been observed.[34][35] No spread by
mosquitos or other insects has been reported.[34]
The apparent lack of airborne transmission among humans is believed to be due to low levels of the virus in
the lungs and other parts of the respiratory system of primates, that are insucient to cause new infections.[45]
A number of studies examining airborne transmission
broadly concluded that transmission from pigs to primates could happen without direct contact, because unlike humans and primates, pigs with EVD get very high
ebolavirus concentrations in their lungs, and not their
bloodstream.[46] Therefore pigs with EVD can spread the
disease through droplets in the air or on the ground when
they sneeze or cough.[47] By contrast, humans and other
primates accumulate the virus throughout their body and
specically in their blood, but not very much in their
lungs.[47] It is believed that this is the reason researchers
have observed pig to primate transmission without physical contact, but no evidence has been found of primates
being infected without actual contact, even in experiments where infected and uninfected primates shared the
same air.[46][47]

2.2

Initial case

Although it is not entirely clear how Ebola initially

spreads from animals to humans, the spread is believed to
involve direct contact with an infected wild animal or fruit
bat.[34] Besides bats, other wild animals sometimes infected with EBOV include several monkey species, chimpanzees, gorillas, baboons and duikers.[51]
Animals may become infected when they eat fruit partially eaten by bats carrying the virus.[52] Fruit produc-

Bushmeat being prepared for cooking in Ghana. In Africa, wild

animals including fruit bats are hunted for food and are referred
to as bushmeat.[48][49] In equatorial Africa, human consumption
of bushmeat has been linked to animal-to-human transmission
of diseases, including Ebola.[50]

tion, animal behavior and other factors may trigger outbreaks among animal populations.[52]
Evidence indicates that both domestic dogs and pigs can
also be infected with EBOV.[53] Dogs do not appear to
develop symptoms when they carry the virus, and pigs
appear to be able to transmit the virus to at least some
primates.[53] Although some dogs in an area in which a
human outbreak occurred had antibodies to EBOV, it is
unclear whether they played a role in spreading the disease to people.[53]

2.3 Reservoir
The natural reservoir for Ebola has yet to be conrmed;
however, bats are considered to be the most likely candidate species.[35] Three types of fruit bats (Hypsignathus
monstrosus, Epomops franqueti and Myonycteris torquata)
were found to possibly carry the virus without getting
sick.[54] As of 2013, whether other animals are involved
in its spread is not known.[53] Plants, arthropods and birds
have also been considered possible viral reservoirs.[1]
Bats were known to roost in the cotton factory in which
the rst cases of the 1976 and 1979 outbreaks were
observed, and they have also been implicated in Marburg virus infections in 1975 and 1980.[55] Of 24 plant
and 19 vertebrate species experimentally inoculated with
EBOV, only bats became infected.[56] The bats displayed
no clinical signs of disease, which is considered evidence
that these bats are a reservoir species of EBOV. In a
20022003 survey of 1,030 animals including 679 bats
from Gabon and the Republic of the Congo, 13 fruit
bats were found to contain EBOV RNA.[57] Antibodies
against Zaire and Reston viruses have been found in fruit
bats in Bangladesh, suggesting that these bats are also
potential hosts of the virus and that the loviruses are
present in Asia.[58]

3 PATHOPHYSIOLOGY

Between 1976 and 1998, in 30,000 mammals, birds,

reptiles, amphibians and arthropods sampled from regions of EBOV outbreaks, no Ebola virus was detected
apart from some genetic traces found in six rodents (belonging to the species Mus setulosus and Praomys) and
one shrew (Sylvisorex ollula) collected from the Central
African Republic.[55][59] However, further research efforts have not conrmed rodents as a reservoir.[60] Traces
of EBOV were detected in the carcasses of gorillas and
chimpanzees during outbreaks in 2001 and 2003, which
later became the source of human infections. However,
the high rates of death in these species resulting from
EBOV infection make it unlikely that these species represent a natural reservoir for the virus.[55]

2.4

which are then translated into structural and nonstructural proteins. The most abundant protein produced is
the nucleoprotein, whose concentration in the host cell
determines when L switches from gene transcription to
genome replication. Replication of the viral genome results in full-length, positive-strand antigenomes that are,
in turn, transcribed into genome copies of negative-strand
virus progeny.[67] Newly synthesized structural proteins
and genomes self-assemble and accumulate near the inside of the cell membrane. Virions bud o from the cell,
gaining their envelopes from the cellular membrane from
which they bud from. The mature progeny particles then
infect other cells to repeat the cycle. The genetics of the
Ebola virus are dicult to study because of EBOVs virulent characteristics.[68]

Virology

Main articles: Ebolavirus (taxonomic group) and Ebola

virus (specic virus)
Ebolaviruses contain single-stranded, non-infectious

3 Pathophysiology

Electron micrograph of an Ebola virus virion

RNA genomes.[61] Ebolavirus genomes contain seven

genes including 3'-UTR-NP-VP35-VP40-GP-VP30VP24-L-5'-UTR.[22][62] The genomes of the ve
dierent ebolaviruses (BDBV, EBOV, RESTV, SUDV
and TAFV) dier in sequence and the number and
location of gene overlaps. As all loviruses, ebolavirions
are lamentous particles that may appear in the shape of
a shepherds crook, of a U or of a 6, and they may be
coiled, toroid or branched.[62][63] In general, ebolavirions
are 80 nanometers (nm) in width and may be as long as
14,000 nm.[64]
Their life cycle is thought to begin with a virion attaching
to specic cell-surface receptors such as C-type lectins,
DC-SIGN, or integrins, which is followed by fusion of
the viral envelope with cellular membranes.[65] The virions taken up by the cell then travel to acidic endosomes
and lysosomes where the viral envelope glycoprotein GP
is cleaved.[65] This processing appears to allow the virus
to bind to cellular proteins enabling it to fuse with internal
cellular membranes and release the viral nucleocapsid.[65]
The Ebolavirus structural glycoprotein (known as GP1,2)
is responsible for the virus ability to bind to and infect targeted cells.[66] The viral RNA polymerase, encoded by the L gene, partially uncoats the nucleocapsid
and transcribes the genes into positive-strand mRNAs,

Pathogenesis schematic

Similar to other loviridae, EBOV replicates very eciently in many cells, producing large amounts of virus
in monocytes, macrophages, dendritic cells and other
cells including liver cells, broblasts, and adrenal gland
cells.[69] Replication of the virus in monocytes triggers
the release of high levels of inammatory chemical sig-

5
nals.[70]

interferon-beta, and interferon gamma.[66][72]

EBOV is thought to infect humans through contact with

mucous membranes or through skin breaks.[29] Once infected, endothelial cells (cells lining the inside of blood
vessels), liver cells, and several types of immune cells
such as macrophages, monocytes, and dendritic cells
are the main targets of infection.[29] Following infection with the virus, the immune cells carry the virus to
nearby lymph nodes where further reproduction of the
virus takes place.[29] From there, the virus can enter the
bloodstream and lymphatic system and spread throughout the body.[29] Macrophages are the rst cells infected
with the virus, and this infection results in programmed
cell death.[64] Other types of white blood cells, such as
lymphocytes, also undergo programmed cell death leading to an abnormally low concentration of lymphocytes in
the blood.[29] This contributes to the weakened immune
response seen in those infected with EBOV.[29]

The VP24 and VP35 structural proteins of EBOV play a

key role in this interference. When a cell is infected with
EBOV, receptors located in the cells cytosol (such as
RIG-I and MDA5) or outside of the cytosol (such as Tolllike receptor 3 (TLR3), TLR7, TLR8 and TLR9), recognize infectious molecules associated with the virus.[66]
On TLR activation, proteins including interferon regulatory factor 3 and interferon regulatory factor 7 trigger a
signaling cascade that leads to the expression of type 1 interferons.[66] The type 1 interferons are then released and
bind to the IFNAR1 and IFNAR2 receptors expressed on
the surface of a neighboring cell.[66] Once interferon has
bound to its receptors on the neighboring cell, the signaling proteins STAT1 and STAT2 are activated and move
to the cells nucleus.[66] This triggers the expression of
interferon-stimulated genes, which code for proteins with
antiviral properties.[66] EBOVs V24 protein blocks the
production of these antiviral proteins by preventing the
STAT1 signaling protein in the neighboring cell from entering the nucleus.[66] The VP35 protein directly inhibits
the production of interferon-beta.[72] By inhibiting these
immune responses, EBOV may quickly spread throughout the body.[64]

Endothelial cells may be infected within 3 days after exposure to the virus.[64] The breakdown of endothelial cells
leading to vascular injury can be attributed to EBOV
glycoproteins. The widespread hemorrhage that occurs in
aected people causes edema and hypovolemic shock.[70]
The damage to human cells, caused by infection of the
endothelial cells, decreases the integrity of blood vessels.
This loss of vascular integrity increases with the synthesis
of GP, which reduces the availability of specic integrins
responsible for cell adhesion to the intercellular structure
and causes damage to the liver, leading to improper clotting. The dysfunction in bleeding and clotting commonly
seen in EVD has been attributed to increased activation
of the extrinsic pathway of the coagulation cascade due
to excessive production of tissue factor by macrophages
and monocytes.[14]
After infection, a secreted glycoprotein, small soluble glycoprotein (sGP) (or Ebola virus glycoprotein [GP]), is
synthesized. EBOV replication overwhelms protein synthesis of infected cells and the host immune defenses.
The GP forms a trimeric complex, which tethers the virus
to the endothelial cells. The sGP forms a dimeric protein that interferes with the signaling of neutrophils, another type of white blood cell, which enables the virus
to evade the immune system by inhibiting early steps of
neutrophil activation. The presence of viral particles and
the cell damage resulting from viruses budding out of the
cell causes the release of chemical signals (such as TNF, IL-6 and IL-8), which are molecular signals for fever
and inammation.

3.1

Immune system evasion

Filoviral infection also interferes with proper functioning of the innate immune system.[67][71] EBOV proteins
blunt the human immune systems response to viral infections by interfering with the cells ability to produce and
respond to interferon proteins such as interferon-alpha,

4 Diagnosis
When EVD is suspected in a person, his or her travel and
work history, along with an exposure to wildlife, are important factors to consider for possible further medical
examination.

4.1 Nonspecic laboratory testing

Possible laboratory indicators of EVD include a low
platelet count; an initially decreased white blood cell
count followed by an increased white blood cell count;
elevated levels of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST); and
abnormalities in blood clotting often consistent with
disseminated intravascular coagulation (DIC) such as
a prolonged prothrombin time, partial thromboplastin
time, and bleeding time.[73]

4.2 Specic laboratory testing

The diagnosis of EVD is conrmed by isolating the virus,
detecting its RNA or proteins, or detecting antibodies
against the virus in a persons blood. Isolating the virus by
cell culture, detecting the viral RNA by polymerase chain
reaction (PCR)[14] and detecting proteins by enzymelinked immunosorbent assay (ELISA) are methods best
used in the early stages of the disease and also for detecting the virus in human remains. Detecting antibodies against the virus is most reliable in the later stages of

PREVENTION

the disease and in those who recover.[74] IgM antibodies are detectable two days after symptom onset and IgG
antibodies can be detected 6 to 18 days after symptom
onset.[14]
During an outbreak, isolation of the virus via cell culture
methods is often not feasible. In eld or mobile hospitals,
the most common and sensitive diagnostic methods are
real-time PCR and ELISA.[75] In 2014, with new mobile
testing facilities deployed in parts of Liberia, test results
were obtained 35 hours after sample submission.[76]
Filovirions, such as EBOV, may be identied by their
unique lamentous shapes in cell cultures examined with
electron microscopy, but this method cannot distinguish
the various loviruses.[77]

4.3

Dierential diagnosis

Early symptoms of EVD may be similar to those of

other diseases common in Africa, including malaria and
dengue fever.[16] The symptoms are also similar to those
of Marburg virus disease and other viral hemorrhagic
fevers.[78]
The complete dierential diagnosis is extensive and
requires consideration of many other infectious diseases such as typhoid fever, shigellosis, rickettsial diseases, cholera, sepsis, borreliosis, EHEC enteritis,
leptospirosis, scrub typhus, plague, Q fever, candidiasis,
histoplasmosis, trypanosomiasis, visceral leishmaniasis,
measles and viral hepatitis among others.[79]

VHF isolation precautions poster

tective equipment (PPE); in addition, a designated person, appropriately trained in biosafety, should be watching each step of these procedures to ensure they are done
Non-infectious diseases that may result in symptoms correctly.[84] In Sierra Leone, the typical training period
similar to those of EVD include acute promyelocytic for the use of such safety equipment lasts approximately
leukemia, hemolytic uremic syndrome, snake enven- 12 days.[86]
omation, clotting factor deciencies/platelet disorders, The infected person should be in barrier-isolation from
thrombotic thrombocytopenic purpura, hereditary hem- other people.[83] All equipment, medical waste, patient
orrhagic telangiectasia, Kawasaki disease and warfarin waste and surfaces that may have come into contact with
poisoning.[75][80][81][82]
body uids need to be disinfected.[85] During the 2014

Prevention

Main article: Prevention of viral hemorrhagic fever

5.1

Infection control

People who care for those infected with Ebola should

wear protective clothing including masks, gloves, gowns
and goggles.[83] The US Centers for Disease Control
(CDC) recommend that the protective gear leaves no skin
exposed.[84] These measures are also recommended for
those who may handle objects contaminated by an infected persons body uids.[85] In 2014, the CDC began recommending that medical personnel receive training on the proper suit-up and removal of personal pro-

outbreak, kits were put together to help families treat

Ebola disease in their homes, which include protective
clothing as well as chlorine powder and other cleaning
supplies.[87] Education of those who provide care in these
techniques, and the provision of such barrier-separation
supplies has been a priority of Doctors Without Borders.[88]
Ebolaviruses can be eliminated with heat (heating for
30 to 60 minutes at 60 C or boiling for 5 minutes).
To disinfect surfaces, some lipid solvents such as some
alcohol-based products, detergents, sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder),
and other suitable disinfectants may be used at appropriate concentrations.[51][89] Education of the general public about the risk factors for Ebola infection and of the
protective measures individuals may take to prevent infection is recommended by the World Health Organization.[1] These measures include avoiding direct contact
with infected people and regular hand washing using soap

5.2

Putting on protective equipment

and water.[90]

5.2 Putting on protective equipment

Bushmeat, an important source of protein in the diet of

some Africans, should be handled and prepared with appropriate protective clothing and thoroughly cooked before consumption.[1] Some research suggests that an outbreak of Ebola disease in the wild animals used for consumption may result in a corresponding human outbreak.
Since 2003, such animal outbreaks have been monitored
to predict and prevent Ebola outbreaks in humans.[91]

Play media

If a person with Ebola disease dies, direct contact with

the body should be avoided.[83] Certain burial rituals,
which may have included making various direct contacts
with a dead body, require reformulation such that they
consistently maintain a proper protective barrier between
the dead body and the living.[92][93][94] Social anthropologists may help nd alternatives to traditional rules for
burials.[95]

Play media

Transportation crews are instructed to follow a certain

isolation procedure should anyone exhibit symptoms resembling EVD.[96] As of August 2014, the WHO does
not consider travel bans to be useful in decreasing spread
of the disease.[37] In October 2014, the CDC dened four
risk levels used to determine the level of 21-day monitoring for symptoms and restrictions on public activities.[97]
In the United States, the CDC recommends that restrictions on public activity, including travel restrictions, are
not required for the following dened risk levels:[97]

Play media

Introduction
Play media
Trained observer

Removing own clothing

Play media
Examining equipment

Hand cleaning
Play media
Boot covers
Play media
Inner gloves

having been in a country with widespread Ebola disease transmission and having no known exposure
(low risk); or having been in that country more than
21 days ago (no risk)

Play media
Coverall

encounter with a person showing symptoms; but not

within 3 feet of the person with Ebola without wearing PPE; and no direct contact of body uids

Play media

having had brief skin contact with a person showing

symptoms of Ebola disease when the person was believed to be not very contagious (low risk)

Play media

in countries without widespread Ebola disease transmission: direct contact with a person showing symptoms of the disease while wearing PPE (low risk)
contact with a person with Ebola disease before the
person was showing symptoms (no risk).

N95 respirator

Surgical hood
Play media
Outer apron
Play media
Outer gloves

The CDC recommends monitoring for the symptoms of

Ebola disease for those both at low risk and at higher
risk.[97]
In laboratories where diagnostic testing is carried out,
biosafety level 4-equivalent containment is required.[98]
Laboratory researchers must be properly trained in BSL4 practices and wear proper PPE.[98]

Play media
Face shield
Play media
Verication

5.3

Isolation

Isolation refers to separating those who are sick from

those who are not. Quarantine refers to separating those
who may have been exposed to a disease until they either show signs of the disease or are no longer at risk.[99]
Quarantine, also known as enforced isolation, is usually
eective in decreasing spread.[100][101] Governments often quarantine areas where the disease is occurring or individuals who may transmit the disease outside of an initial area.[102]
In the United States, the law allows quarantine of those infected with ebolaviruses.[103] During the 2014 Ebola disease outbreak, Liberia closed schools.[104]

PROGNOSIS

these medications.[109] Blood products such as packed

red blood cells, platelets or fresh frozen plasma may
also be used.[108] Other regulators of coagulation have
also been tried including heparin in an eort to prevent disseminated intravascular coagulation and clotting
factors to decrease bleeding.[108] Antimalarial medications and antibiotics are often used before the diagnosis
is conrmed,[108] though there is no evidence to suggest
such treatment is in any way helpful. Interferon therapies have been tried as a form of treatment for EVD, but
were found to be ineective.[64] Ribavirin is also known
to be ineective against ebolaviruses despite its eectiveness against other viral hemorrhagic fevers such as Lassa
fever.[14]

If professional care is not possible, guidelines by WHO

for care at home have been relatively successful. In such
5.4 Contact tracing
situations, recommendations include using towels soaked
in bleach solutions when moving infected people or bodContact tracing is considered important to contain an ies and applying bleach on stains. It is also recommended
outbreak. It involves nding everyone who had close that the caregivers wash hands with bleach solutions and
contact with infected individuals and watching for signs cover their mouth and nose with a cloth.[110]
of illness for 21 days. If any of these contacts comes
down with the disease, they should be isolated, tested and
treated. Then the process is repeated by tracing the con- 6.2 Intensive care
tacts contacts.[105][106]
Intensive care is often used in the developed world.[22]
This may include maintaining blood volume and electrolytes (salts) balance as well as treating any bacterial in6 Treatment
fections that may develop.[22] Dialysis may be needed for
kidney failure, and extracorporeal membrane oxygena6.1 Standard support
tion may be used for lung dysfunction.[22]

6.3 Alternative medicine

The Food and Drug Administration (FDA) advises people to be careful of advertisements making unveried or
fraudulent claims of benets supposedly gained from various anti-Ebola products.[111] The FDA has already sent
out at least one letter of warning to a seller of colloidal silver who made unveried claims of Ebola related benets,
supposedly derived from the use of their products.[112]

7 Prognosis
EVD has a high risk of death in those infected which
varies between 25 percent and 90 percent of those
infected.[1][113] As of September 2014, the average risk
No specic treatment is currently approved.[107] How- of death among those infected is 50 percent.[1] The
ever, survival is improved by early supportive care highest risk of death was 90 percent in the 20022003
with rehydration and symptomatic treatment.[1] Treat- Republic of the Congo outbreak.[114]
ment is primarily supportive in nature.[108] These measures may include management of pain, nausea, fever Death, if it occurs, follows typically six to sixteen days afand anxiety, as well as rehydration via the oral or by ter symptoms appear[2]and is often due to low blood presto prevent
intravenous route.[108] The World Health Organization sure from uid loss. Early supportive care
[115]
dehydration
may
reduce
the
risk
of
death.
recommends avoiding the use of aspirin or ibuprofen
for pain due to the bleeding risk associated with use of If an infected person survives, recovery may be quick and
A hospital isolation ward in Gulu, Uganda, during the October
2000 outbreak

8.1

1976

complete. Prolonged cases are often complicated by the

occurrence of long-term problems, such as inammation
of the testicles, joint pains, muscle pains, skin peeling,
or hair loss.[14] Eye symptoms, such as light sensitivity, excess tearing, iritis, iridocyclitis, choroiditis, and
blindness have also been described.

Epidemiology

Cases of Ebola fever in Africa from 1979 to 2008

For more about specic outbreaks and their descriptions,

see List of Ebola outbreaks.
The disease typically occurs in outbreaks in tropical regions of Sub-Saharan Africa.[1] From 1976 (when
it was rst identied) through 2013, the World Health
Organization reported 1,716 conrmed cases.[1][6] The
largest outbreak to date is the ongoing 2014 West Africa
Ebola virus outbreak, which is aecting Guinea, Sierra
Leone, Liberia, Mali, and Nigeria.[8][9] As of 23 November 2014, 15,963 suspected cases and 6,003 deaths had
been reported.[116][117]

8.1
8.1.1

1976
Sudan outbreak

The rst known outbreak of EVD was identied only after the fact, occurring between June and November 1976
in Nzara, South Sudan,[25][118] (then part of Sudan) and
was caused by Sudan virus (SUDV). The Sudan outbreak
infected 284 people and killed 151. The rst identiable
case in Sudan occurred on 27 June in a storekeeper in
a cotton factory in Nzara, who was hospitalized on 30
June and died on 6 July.[22][119] While the WHO medical
sta involved in the Sudan outbreak were aware that they
were dealing with a heretofore unknown disease, the actual positive identication process and the naming of
the virus did not occur until some months later in the
Democratic Republic of the Congo.[119]

CDC worker incinerates medical waste from Ebola patients in

Zaire in 1976.

8.1.2 Zaire outbreak

See also: Yambuku Ebola outbreak
On 26 August 1976, a second outbreak of EVD began
in Yambuku, a small rural village in Mongala District in
northern Zaire (now known as the Democratic Republic of the Congo).[120][121] This outbreak was caused by
EBOV, formerly designated Zaire ebolavirus, which is
a dierent member of the genus Ebolavirus than in the
rst Sudan outbreak. The rst person infected with the
disease was village school headmaster Mabalo Lokela,
who began displaying symptoms on 26 August 1976.[122]
Lokela had returned from a trip to Northern Zaire near
the Central African Republic border, having visited the
Ebola River between 12 and 22 August. He was originally
believed to have malaria and was given quinine. However,
his symptoms continued to worsen, and he was admitted
to Yambuku Mission Hospital on 5 September. Lokela
died on 8 September, 14 days after he began displaying
symptoms.[123][124][125]
Soon after Lokelas death, others who had been in contact with him also died, and people in the village of
Yambuku began to panic. This led the countrys Minister of Health along with Zaire President Mobutu Sese
Seko to declare the entire region, including Yambuku
and the countrys capital, Kinshasa, a quarantine zone.
No one was permitted to enter or leave the area, with

10

EPIDEMIOLOGY

roads, waterways, and airelds placed under martial

law. Schools, businesses and social organizations were
closed.[126] Researchers from the CDC, including Peter
Piot, co-discoverer of Ebola, later arrived to assess the
eects of the outbreak, observing that the whole region
was in panic.[127][128][129] Piot concluded that the Belgian
nuns had inadvertently started the epidemic by giving unnecessary vitamin injections to pregnant women, without
sterilizing the syringes and needles. The outbreak lasted
26 days, with the quarantine lasting 2 weeks. Among the
reasons that researchers speculated caused the disease to
disappear, were the precautions taken by locals, the quarantine of the area, and discontinuing the injections.[126]

Between April and August 2007, a fever epidemic[136] in

a four-village region[137] of the Democratic Republic of
the Congo was conrmed in September to have cases of
Ebola.[138] Many people who attended the recent funeral
of a local village chief died.[137] The 2007 outbreak eventually aected 264 individuals and resulted in the deaths
of 187.[1]

The virus responsible for the initial outbreak, rst thought

to be Marburg virus, was later identied as a new type
of virus related to marburgviruses. Virus strain samples isolated from both outbreaks were named as the
Ebola virus after the Ebola River, located near the
originally identied viral outbreak site in Zaire.[22] Reports conict about who initially coined the name: either Karl Johnson of the American CDC team[131] or
Belgian researchers.[132] Subsequently a number of other
cases were reported, almost all centered on the Yambuku
mission hospital or having close contact with another
case.[122] 318 cases and 280 deaths (a 88 percent fatality rate) occurred in Zaire.[133] Although it was assumed
that the two outbreaks were connected, scientists later realized that they were caused by two distinct ebolaviruses,
SUDV and EBOV.[121] The Zaire outbreak was contained
with the help of the World Health Organization and transport from the Congolese air force, by quarantining villagers, sterilizing medical equipment, and providing protective clothing.

outbreaks.[1]

On 30 November 2007, the Uganda Ministry of Health

conrmed an outbreak of Ebola in the Bundibugyo District in Western Uganda. After conrmation of samples
tested by the United States National Reference Laboratories and the Centers for Disease Control, the World
Health Organization conrmed the presence of a new
During this outbreak, Dr. Ngoy Mushola recorded the species of genus Ebolavirus, which was tentatively named
rst clinical description of EVD in Yambuku, where he Bundibugyo.[139] The WHO reported 149 cases of this
wrote the following in his daily log: The illness is char- new strain and 37 of those led to deaths.[1]
acterized with a high temperature of about 39 C (102 The WHO conrmed two small outbreaks in Uganda in
F), hematemesis, diarrhea with blood, retrosternal ab- 2012. The rst outbreak aected 7 people and resulted in
dominal pain, prostration with heavy articulations, and the death of 4 and the second aected 24, resulting in the
rapid evolution death after a mean of 3 days.[130]
death of 17. The Sudan variant was responsible for both

8.2

On 17 August 2012, the Ministry of Health of the

Democratic Republic of the Congo reported an outbreak of the Ebola-Bundibugyo variant[140] in the eastern
region.[141][142] Other than its discovery in 2007, this was
the only time that this variant has been identied as responsible for an outbreak. The WHO revealed that the
virus had sickened 57 people and claimed 29 lives. The
probable cause of the outbreak was tainted bush meat
hunted by local villagers around the towns of Isiro and
Viadana.[1][143]

8.3 2013 to 2014 West African outbreak

Main article: Ebola virus epidemic in West Africa
In March 2014, the World Health Organization (WHO)

1995 to 2012

The second major outbreak occurred in Zaire (now the

Democratic Republic of the Congo) in 1995, aecting
315 and killing 254.[1]
In 2000, Uganda had an outbreak aecting 425 and
killing 224; in this case the Sudan virus was found to be
the Ebola species responsible for the outbreak.[1]
In 2003 there was an outbreak in the Republic of the
Congo that aected 143 and killed 128, a death rate of
90 percent, the highest death rate of a genus Ebolavirus
outbreak to date.[134]

Increase over time in the cases and deaths during the 20132014
outbreak

reported a major Ebola outbreak in Guinea, a western

African nation.[144] Researchers traced the outbreak to
In 2004 a Russian scientist died from Ebola after sticking a two-year old child who died December 2013.[145][146]
herself with an infected needle.[135]
The disease then rapidly spread to the neighboring coun-

8.5

2014 spread outside of Africa

11

tries of Liberia and Sierra Leone. It is the largest Ebola 8.5 2014 spread outside of Africa
outbreak ever documented, and the rst recorded in the
region.[144]
Main articles: Ebola virus disease in the United States
On 8 August 2014, the WHO declared the epidemic and Ebola virus disease in Spain
to be an international public health emergency. Urging the world to oer aid to the aected regions, the
Director-General said, Countries aected to date simply do not have the capacity to manage an outbreak of
this size and complexity on their own. I urge the international community to provide this support on the most
urgent basis possible.[147] By mid-August 2014, Doctors Without Borders reported the situation in Liberias
capital Monrovia as catastrophic and deteriorating
daily. They reported that fears of Ebola among sta
members and patients had shut down much of the citys
health system, leaving many people without treatment
for other conditions.[148] By late August 2014, the disease had spread to Nigeria, and one case was reported
in Senegal.[149][150] [151][152] On 30 September 2014, the
rst conrmed case of Ebola in the United States was
diagnosed.[153] The patient died 8 days later.[154]
Aside from the human cost, the outbreak has severely
eroded the economies of the aected countries. A
Financial Times report suggested the economic impact
of the outbreak could kill more people than the virus
itself. As of 23 September, in the three hardest hit
countries, Liberia, Sierra Leone and Guinea, only 893
treatment beds were available even though the current
need was 2122 beds. In a 26 September statement, the
WHO said, The Ebola epidemic ravaging parts of West
Africa is the most severe acute public health emergency
seen in modern times. Never before in recorded history has a biosafety level four pathogen infected so many
people so quickly, over such a broad geographical area,
for so long.[155] The WHO reported that by 25 August
more than 216 health-care workers were among the dead,
partly due to the lack of equipment and long hours.[156]
On 23 October, the Malian government conrmed its rst
case.[157] In response, UNMEER, in cooperation with the
Logistics Cluster, air-lifted 1,050 kg of personal protective equipment (PPE) and body bags from Monrovia to
Mali.[158] As of 23 November 2014, 15,963 suspected
cases and 6,003 deaths had been reported;[10][11][12][117]
however, the WHO has said that these numbers may be
vastly underestimated.[158][159][160]

8.4

2014 DRC Congo outbreak

An outbreak in Boende District in Equatorial Province

was stopped eectively with exible organization and
funding,[161] as well as social mobilization led by
UNICEF advising action people could use.[162][163] The
DRC outbreak was from a local Ebola strain and not the
one from West Africa (WHO).[164]

As of 15 October 2014, there have been 17 cases of Ebola

treated outside of Africa, four of whom have died.[165]
In early October, Teresa Romero, a 44-year-old Spanish nurse, contracted Ebola after caring for a priest who
had been repatriated from West Africa. This was the rst
transmission of the virus to occur outside of Africa.[166]
On 20 October, it was announced that Teresa Romero
had tested negative for the Ebola virus, suggesting that
she may have recovered from Ebola infection.[167] On 19
September, Eric Duncan ew from his native Liberia to
Texas; 5 days later he began showing symptoms and visited a hospital, but was sent home. His condition worsened and he returned to the hospital on 28 September,
where he died on 8 October.[168] Health ocials conrmed a diagnosis of Ebola on 30 Septemberthe rst
case in the United States.[44] On 12 October, the CDC
conrmed that a nurse in Texas who had treated Duncan was found to be positive for the Ebola virus, the
rst known case of the disease to be contracted in the
United States.[169] On 15 October, a second Texas healthcare worker who had treated Duncan was conrmed
to have the virus.[170] Both of these people have since
recovered.[171] On 23 October, a doctor in New York
City, who returned to the United States from Guinea after
working with Doctors Without Borders, tested positive
for Ebola. His case is unrelated to the Texas cases.[172]
The person has recovered and was discharged from Bellevue Hospital Center on November 11.[171]

9 Society and culture

9.1 Weaponization
Ebolavirus is classied as a biosafety level 4 agent, as well
as a Category A bioterrorism agent by the Centers for Disease Control and Prevention.[69][173] It has the potential to
be weaponized for use in biological warfare,[174][175] and
was investigated by Biopreparat for such use, but might
be dicult to prepare as a weapon of mass destruction
because the virus becomes ineective quickly in open
air.[176] Fake emails pretending to be Ebola information
from the WHO or the Mexican Government have in 2014
been misused to spread computer malware.[177]

9.2 Literature
Richard Preston's 1995 best-selling book, The Hot Zone,
dramatized the Ebola outbreak in Reston, Virginia.[178]
William Close's 1995 Ebola: A Documentary Novel of
Its First Explosion and 2002 Ebola: Through the Eyes of

12

11 RESEARCH

the People focused on individuals reactions to the 1976 that there were potential implications for preventing and
Ebola outbreak in Zaire.[179]
controlling human outbreaks.
Tom Clancy's 1996 novel, Executive Orders, involves a
Middle Eastern terrorist attack on the United States using 10.3 Reston virus
an airborne form of a deadly Ebola virus strain named
Ebola Mayinga (see Mayinga N'Seka).[180]
For more about the outbreak in Virginia, US, see Reston
As the Ebola virus epidemic in West Africa developed virus.
in 2014, a number of popular self-published and wellreviewed books containing sensational and misleading in- In late 1989, Hazelton Research Products Reston Quarformation about the disease appeared in electronic and antine Unit in Reston, Virginia, suered an outbreak of
printed formats. The authors of some such books ad- fatal illness amongst certain lab monkeys. This lab outmitted that they lacked medical credentials and were not break was initially diagnosed as simian hemorrhagic fever
technically qualied to give medical advice. The World virus (SHFV), and occurred amongst a shipment of crabHealth Organization and the United Nations stated that eating macaque monkeys imported from the Philippines.
such misinformation had contributed to the spread of the Hazeltons veterinary pathologist sent tissue samples from
disease.[181]
dead animals to the United States Army Medical Re-

10
10.1

Other animals
Wild animals

Ebola has a high mortality among primates.[107] Frequent

outbreaks of Ebola may have resulted in the deaths of
5,000 gorillas.[182] Outbreaks of Ebola may have been responsible for an 88 percent decline in tracking indices of
observed chimpanzee populations in 420 square kilometer Lossi Sanctuary between 2002 and 2003.[183] Transmission among chimpanzees through meat consumption
constitutes a signicant risk factor, whereas contact between the animals, such as touching dead bodies and
grooming, is not.[184]

search Institute of Infectious Diseases (USAMRIID) at

Fort Detrick, Maryland, where an ELISA test indicated
the antibodies present in the tissue were a response to
Ebola virus and not SHFV.[187] An electron microscopist
from USAMRIID discovered loviruses similar in appearance to Ebola in the tissue samples sent from Hazelton Research Products Reston Quarantine Unit.[188]

A US Army team headquartered at USAMRIID

euthanized the surviving monkeys, and brought all
the monkeys to Ft. Detrick for study by the Armys
veterinary pathologists and virologists, and eventual
disposal under safe conditions.[187] Blood samples were
taken from 178 animal handlers during the incident.[189]
Of those, six animal handlers eventually seroconverted,
including one who had cut himself with a bloody
scalpel.[70][190] Despite its status as a Level4 organism
and its apparent pathogenicity in monkeys, when the
Recovered carcasses from gorillas contain multiple Ebola
handlers did not become ill, the CDC concluded that the
virus strains, which suggest multiple introductions of
virus had a very low pathogenicity to humans.[190][191]
the virus. Bodies decompose quickly and carcasses
are not infectious after 3 to 4 days. Contact between The Philippines and the United States had no previous
gorilla groups is rare, suggesting transmission among cases of Ebola infection, and upon further isolation, regorilla groups is unlikely, and that outbreaks result searchers concluded it was another strain of Ebola, or a
from transmission between viral reservoir and animal new lovirus of Asian origin, which they named Reston
ebolavirus (RESTV) after the location of the incident.[187]
populations.[183]
Reston virus (RESTV) can be transmitted to pigs.[53]
Since the initial outbreak it has since been found in nonhuman primates in Pennsylvania, Texas, and Italy,[192]
10.2 Domestic animals
where the virus had infected pigs.[193] According to
In 2012 it was demonstrated that the virus can travel with- the WHO, routine cleaning and disinfection of pig (or
out contact from pigs to nonhuman primates, although the monkey) farms with sodium hypochlorite or detergents
same study failed to achieve transmission in that manner should be eective in inactivating the Reston ebolavirus.
Pigs that have been infected with RESTV tend to show
between primates.[53][185]
symptoms of the disease.
Dogs may become infected with EBOV but not develop
symptoms. Dogs in some parts of Africa scavenge for
food, and they sometimes eat EBOV-infected animals
and also the corpses of humans. A 2005 survey of dogs 11 Research
during an EBOV outbreak found that although they remain asymptomatic, about 32 percent of dogs closest to A number of experimental treatments are being
an outbreak showed a seroprevalence for EBOV versus 9 studied.[194] In the United States, the Food and Drug Adpercent of those farther away.[186] The authors concluded ministration (FDA)'s animal ecacy rule is being used

11.1

Medications

to demonstrate reasonable safety to obtain permission to

treat people who are infected with Ebola. It is being used
because the normal path for testing drugs is not possible
for diseases caused by dangerous pathogens or toxins.
Experimental drugs are made available for use with the
approval of regulatory agencies under named patient
programs, known in the US as expanded access.[195]
On 12 August 2014 the WHO released a statement that
the use of not yet proven treatments is ethical in certain
situations in an eort to treat or prevent the disease.[196]

11.1

Medications

13
cessfully to treat 13 out of 15 Ebola-infected patients by a doctor in Liberia, as part of a combination therapy also involving intravenous uids
and antibiotics to combat opportunistic bacterial infection of Ebola-compromised internal organs.[204]
Western virologists have however expressed caution
about the results, due to the small number of patients treated and confounding factors present. Researchers at the NIH stated that lamivudine had
so far failed to demonstrate anti-Ebola activity in
preliminary in vitro tests, but that they would continue to test it under dierent conditions and would
progress it to trials if even slight evidence for ecacy is found.[205]
JK-05 is developed by the Chinese company Sihuan
Pharmaceutical along with the Chinese Academy of
Military Medical Sciences. It is reportedly being
fast tracked through human trials for Ebola treatment after successful tests in mice.[206][207]

Researchers looking at slides of cultures of cells that make monoclonal antibodies. These are grown in a lab and the researchers
are analyzing the products to select the most promising.

Lack of available treatment options has spurred research into a number of other possible antivirals targeted against Ebola,[208][209] including natural products such as scytovirin and grithsin,[210][211] as well
as synthetic drugs including DZNep,[212] FGI-103,
FGI-104, FGI-106, dUY11 and LJ-001,[213] and
other newer agents.[214][215][216][217][218][219][220]
11.1.2 Antisense technology

11.1.1

Antivirals

A number of antiviral medications are being studied.

Favipiravir, approved in Japan for stockpiling
against inuenza pandemics, appears to be useful in
a mouse model of Ebola.[16][197] On 4 October 2014,
it was reported that a French nun who contracted
Ebola while volunteering in Liberia was cured with
Favipiravir treatment.[198]
BCX4430 is a broad-spectrum small molecule antiviral drug developed by BioCryst Pharmaceuticals
and undergoing animal testing as a potential human
treatment for Ebola by USAMRIID.[199] The drug
has been approved to progress to Phase 1 trials, expected late in 2014.[200]
Brincidofovir is a broad-spectrum antiviral drug. Its
maker has been granted FDA approval to proceed
with a trial to test its safety and ecacy in Ebola
patients.[201] It has been used to treat the rst patient diagnosed with Ebola in the USA, after he had
recently returned from Liberia.[202][203]
Lamivudine, usually used to treat HIV/AIDS, was
reported in September 2014 to have been used suc-

Other promising treatments rely on antisense technology.

Both small interfering RNAs (siRNAs) and
phosphorodiamidate morpholino oligomers (PMOs) targeting EBOV RNA polymerase L protein may prevent
disease in nonhuman primates.[221][222] TKM-Ebola is a
small interfering RNA compound, currently being tested
in a Phase I clinical trial in humans.[223][224] Sarepta Therapeutics has completed a Phase I clinical trial with its
PMO protecting up to 80-100 percent of the nonhuman
primates tested.[225]
11.1.3 Antibodies
ZMapp is a monoclonal antibody vaccine. The limited
supply of the drug has been used to treat a small number of individuals infected with the Ebola virus. Although some individuals have recovered, the outcome
is not considered statistically signicant.[226] ZMapp has
proved eective in a trial involving rhesus macaque
monkeys.[223][227][228] The Bill & Melinda Gates Foundation has donated $150,000 to help Amgen increase
its production, and the U.S. Department of Health and
Human Services has asked a number of centers to also
increase production.[229] There was no conrmation or
proof that the ZMapp drug was a factor in the recovery of two American Ebola patients, however;[230] a

14

13

REFERENCES

Spanish priest with Ebola had taken ZMapp but died 11.3 Vaccine
afterward.[231]
Main article: Ebola vaccine
Researchers in Thailand claim to have developed an
antibody-based treatment for Ebola using synthesized
fragments of the virus. It has not been tested against Many Ebola vaccine candidates had been developed
Ebola itself. Scientists from the WHO and NIH have of- in the decade prior to 2014,[241] but as of October
fered to test the treatment against live Ebola virus, but 2014, none had yet been approved by the United States
there is still a great deal of development needed before Food and Drug Administration (FDA) for clinical use
in humans.[237][242][243] Several promising vaccine canhuman trials.[232]
didates have been shown to protect nonhuman primates (usually macaques) against lethal infection.[25][244]
These include replication-decient adenovirus vectors,
replication-competent vesicular stomatitis (VSV) and
11.1.4 Other
human parainuenza (HPIV-3) vectors, and virus-like
particle preparations. Conventional trials to study eTwo selective estrogen receptor modulators usually used cacy by exposure of humans to the pathogen after immuto treat infertility and breast cancer (clomiphene and nization are obviously not feasible in this case. For such
toremifene) have been found to inhibit the progress of situations, the FDA has established the animal rule alEbola virus in vitro as well as in infected mice. Ninety lowing licensure to be approved on the basis of animal
percent of the mice treated with clomiphene and 50 model studies that replicate human disease, combined
percent of those treated with toremifene survived the with evidence of safety and a potentially potent immune
tests.[233] The study authors conclude that given their oral response (antibodies in the blood) from humans given the
availability and history of human use, these drugs would vaccine. Phase I clinical trials involve the administration
be candidates for treating Ebola virus infection in remote of the vaccine to healthy human subjects to evaluate the
geographical locations, either on their own or together immune response, identify any side eects and determine
with other antiviral drugs.
the appropriate dosage.
A 2014 study found that three ion channel blockers
used in the treatment of heart arrhythmias, amiodarone,
dronedarone and verapamil, block the entry of Ebola 12 See also
virus into cells in vitro.[234]
List of human disease case fatality rates

11.2

Blood products

13 References

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The article uses public domain text from the CDC as

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14 External links
Ebola virus disease at DMOZ
CDC: Ebola hemorrhagic fever Centers for Disease Control and Prevention, Special Pathogens
Branch
WHO: Ebola haemorrhagic fever World Health
Organization, Global Alert and Response
Google Map of Ebola Outbreaks
World Health Organisation, Fact Sheet 103 Ebola
Virus Disease, Updated September 2013
WHO Ebola videos

24

15

15
15.1

TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

Text and image sources, contributors, and licenses

Text

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Allstarecho, Tins128, Cpl Syx, Sabedon, Glen, DerHexer, Valerius Tygart, Sanjay12, Djsquintz, Oren0, Read-write-services, Hdt83, MartinBot, STBot, Gandydancer, Scheuerm, NReitzel, Juansidious, Milov, Glrx, Kingofrock, Fastman99, Mschel, R'n'B, AlexiusHoratius,
Nono64, Lilac Soul, RockMFR, AlphaEta, Cold534, J.delanoy, Captain panda, Pharaoh of the Wizards, Lithui, CFCF, AAA!, Bogey97,
Nbauman, Boghog, Uncle Dick, Xris0, Colincbn, Ginsengbomb, Dr.Ballsack Phd, WarthogDemon, Milo03, Acalamari, Mathglot, Katalaveno, Cannonmc, Buhadram, Ghidorah221, McSly, Xizes, Chicken666, Trumpet marietta 45750, Mikael Hggstrm, AntiSpamBot,
Munman100010, (jarbarf), 97198, Floateruss, M-le-mot-dit, Veganaxos, Bobianite, EconomistBR, 83d40m, Mcintosh3102, Heero Kirashami, Kingcampo, Wa3pxx, Thioxane, KylieTastic, Cometstyles, STBotD, Bioform 1234, EarthRise33, Tototo7, Jaimeastorga2000,

15.1

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Inter16, Mikeeeman, Ja 62, Martial75, MikeLeeds, Spellcast, Azuriteking, PetsTheCatsh, My Core Competency is Competency, Jrugordon, Deor, Pumush, Shiggity, Cireshoe, CWii, DrMicro, Je G., Jennavecia, JohnBlackburne, Moman5, Orthologist, Rubyuser,
Naysie, Soliloquial, Prelate Zeratul, Sodapopkid, CART fan, Barneca, QuackGuru, Philip Trueman, HiraV, Oshwah, Crevox, Mxtbcca,
Dwaynebailey, Malljaja, Nikolaivich, Z.E.R.O., Anonymous Dissident, Aymatth2, Qxz, Imasleepviking, Clarince63, Leafyplant, Don4of4,
Millebe, LeaveSleaves, ^demonBot2, Raymondwinn, PDFbot, Optigan13, Sovietpride, Luuva, Maxim, Saturn star, Quindraco, Kaiketsu,
Bogus987654321, Dmickan, Petero9, Lebron15594, Hedington, Itsmeiam, Rituido, Insanity Incarnate, Otterthay, Mr. Sandy, Doc James,
Billytrousers, Steven Weston, SylviaStanley, Karthik Sarma, Unused000702, Pvanheus, Gaelen S., BP-baller, BPP-baller, Lionfan1991,
SieBot, Sonicology, Milnivri, Favouritesky, Jturner3, Graham Beards, Hertz1888, VVVBot, Da Joe, Dawn Bard, Ybidiotic, RJaguar3,
Wienandwienand, M.thoriyan, LeadSongDog, GlassCobra, Francish7, Keilana, Flyer22, Tiptoety, Captain Yankee, Oda Mari, Grimey109,
Taejin, Hiddenfromview, Stylesjx, Madam Sillyface, Mimihitam, Lanzarotemaps, Oxymoron83, Antonio Lopez, Faradayplank, Nuttycoconut, Bagatelle, Thirdeyeopen33, Lightmouse, Techman224, Johndheathcote, PbBot, Afernand74, Pediainsight, Adragon111, Cheesefondue, Crazycasta, Dabomb87, Nn123645, Dolphin51, Hordaland, Denisarona, Pgokey, Vanyo, Jamesdreherjr, TheCatalyst31, Zurppies, ClueBot, CiudadanoGlobal, Foxj, Colorado Dave, The Thing That Should Not Be, Sematimba, Jan1nad, Nnemo, Ohcrapitsdevvii,
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Gralgrathor, Psinu, Bcrossiter, Falco11 2011, Iohannes Animosus, Bidimensional, Indians99, CowboySpartan, Morel, Razorame, Gciriani, Dekisugi, MedicRoo, Ottawa4ever, Kakofonous, Light show, Thingg, Aitias, Tuberculosishivaids, Jdiplacidi, Versus22, Rabid bee, IJA,
Tezero, SoxBot III, Wnt, Vanished User 1004, DumZiBoT, XLinkBot, ViperNerd, Spitre, Jytdog, Licourtrix, ChyranandChloe, Stickee,
Marco369, Rror, Corker1, Ericloewe, Revancher, WikiDao, Jinxed4ever, Ikihi123, Jpboia, Dsulkar, Jinnatun, Yameogo, Addbot, Proofreader77, Jianrong95, Some jerk on the Internet, Imeriki al-Shimoni, Causecausecause, DOI bot, Blechnic, AliasMe, Ocdnctx, Wda, Elishabet, Ronhjones, Hockeyspeed, Hondamx267, MartinezMD, Dela01241, Szico VII, CanadianLinuxUser, Fluernutter, Mentisock, Chamal
N, CarsracBot, Awanta, Glane23, Lihaas, Stuttermullet1, AnnaFrance, Keepcalmandcarryon, Danman999, Pantherfreak12, 5 albert square,
Megamike345, Ehend661, 84user, JennieMacGuire, Matthias of redwall, Tide rolls, Lightbot, OlEnglish, Pietrow, 55, Ettrig, Mayamussa, LuK3, Ben Ben, Legobot, Luckas-bot, Vedran12, Yobot, GRLant1, 2D, Kartano, Mcdennis13, Tohd8BohaithuGh1, Tmwerty,
Legobot II, Welshdragon0586, II MusLiM HyBRiD II, Jason Recliner, Esq., Yngvadottir, Andreiwest, ArchonMagnus, THEN WHO WAS
PHONE?, Coachuponnow, RotogenRay, Telekineticturtle, R500Mom, Tempodivalse, Anonymous from the 21th century, Bbarney, DiverDave, AnomieBOT, LordShonus, KDS4444, Popezilla, Archon 2488, SwiftlyTilt, Williamsu95, IsabelleHubert, Jim1138, IRP, Dwayne,
Neptune5000, Blokeice, Biosafety 4 Exert, Kingpin13, Tommoxyz, Materialscientist, The High Fin Sperm Whale, Citation bot, Rickjames20000, Futur3g4ry, GB fan, Quebec99, LilHelpa, Najarro, Sluchy523, Bryantwilson91, Obersachsebot, Zad68, , Character.assassin, The sock that should not be, Capricorn42, Gigemag76, Renaissancee, Ktwalker01, Locos epraix, Kalieroxs567, RadManCF,
NOrbeck, DrShane, Laurel.jensen, Gatorgirl7563, Anonymous from the 21st century, Ruy Pugliesi, A dullard, INick3, Omnipaedista,
Frankie0607, Queen Rhana, Doulos Christos, Taylornate, Moxy, GNRY09, Shortelz, Miyagawa, Nciszdabest, SchnitzelMannGreek,
Mishka.medvezhonok, SD5, Snurg, Spongefrog, FrescoBot, Surv1v4l1st, Tobby72, Charlie1volley, Mu Mind, StaticVision, RoyGoldsmith,
Alxeedo, Saxifrage853, Bullgarbage, Goldentolken, BenzolBot, CanadianNine, Citation bot 2, Raikirisenpai, Cannolis, Citation bot 1, Citation bot 4, Pizik, Amplitude101, DrilBot, DKMell, RubiksMaster110, Cubs197, JKDw, Pinethicket, Abductive, Ericbourland, Jonesey95,
Lolaxoxo, Geogene, Dhomya, Jschnur, Francescad, VenomousConcept, Salvidrim!, Shanmugamp7, SW3 5DL, Ce-boHemFe, Salsaman22,
Kgrad, Andrewmwolfe, Ryckpage, Nickpost05, Evert:Meulie, Dinamik-bot, Sangjinhwa, Vrenator, Zvn, Mannaro85, Clarkcj12, MrX, Mtmulch, Raidon Kane, Ink Falls, Reaper Eternal, Kitfoxxe, Weedwhacker128, Colton.eastman, Reach Out to the Truth, RobertMfromLI,
DARTH SIDIOUS 2, Sojoho09, Lozion, RjwilmsiBot, 7mike5000, Protenpinner, Thedues, Agent Smith (The Matrix), Power t, Shaktal,
DASHBot, Karin127, Helwr, Mukogodo, EmausBot, Bobjoejrthethird, Francophile124, Insorak, Echokilocharlie, Heracles31, Katherine, Dewritech, Racerx11, Tinss, RA0808, JohnValeron, Borovi4ok, NotAnonymous0, Willjones98, Slightsmile, Wikipelli, K6ka, Lucas
Thoms, CrimsonBlue (Rollback), Mz7, Ronk01, John Cline, Bongoramsey, Ncboy2010, Jonpatterns, , Redav, Medeis, Iseecowboys, Marcofontes, Manwhatsup, Ewa5050, G-FINN22, Wingman4l7, Sbmeirow, Scotware, Brandmeister, Lorem Ip, Danmuz, Donner60,
DeCausa, Fanyavizuri, CSMasick, Waugh Bacon, Olivia Francois, Guitarguy949, Hubertus.j, Bpickett, Llightex, Sven Manguard, DASHBotAV, Spicemix, FeatherPluma, Sp4cetiger, Teaktl17, GoGeo, Mixer98, ClueBot NG, Gareth Grith-Jones, Jack Greenmaven, TorstenMandal, This lousy T-shirt, 4Jmaster, Pizza1016, Clarkdn, Viveleroux, Wimpus, Armouredduck, Snotbot, Delusion23, O.Koslowski, Saintfevrier, Hwiseley, Widr, Warm Worm, FiesTyPanDA, Pbmaise, GuyHimGuy, Pragmaticstatistic, Helpful Pixie Bot, WEWEE, Jamie
Tubers, Tholme, Tarikupu, Wbm1058, Bibcode Bot, Jamesthecat, BG19bot, Rodakarth, GruntUltra567, EvilResident, Kimchi1333, Mrjohncummings, Kaltenmeyer, Wzrd1, Patrug, CatPath, Huhshyeh, Kendall-K1, Badon, Mark Arsten, Moocow119, Bigdogbigdog52, Floating Boat, Jeancey, Swampdonkeyxx, Sodaant, The Almightey Drill, Smbrizendine, Sparkie82, MrBill3, AnselaJonla, Sdesalas, Zedshort,
Joshua4157, Zorecchi, Duxwing, Kalkeeli, Barrett at central college, Daviscentralcollege, Void900, BattyBot, Factsearch, Biosthmors,
Metsfreak2121, Tutelary, Happy1892, Pete.clat, W.D., The Illusive Man, Ravikantc, Vincent Le Ho, Sermadison, Foxtrot620, Layzeeboi,
Tietomanni, Khazar2, TylerDurden8823, Siuenti, Thecudder15, IjonTichyIjonTichy, Thundermoose18, Dexbot,
, Cheeseface101,
Wolfblade0, Webclient101, Mogism, OscarK878, Inayity, Ptrw08, Cornelius90, Lugia2453, Vanished user jerij2o2, Frosty, Electronsaregreen, Tianyshi, Jmoney90, Wywin, ZX95, Coachlover1000, Epicgenius, Rwhite2366, Pdecalculus, Lokmac, Biomedicinal, American
In Brazil, Jmisasi, Jodosma, VoiceOfTheCommons, Everymorning, War&passion, Jake stranzl, Randomer679, EvergreenFir, Nodove,
Froglich, Nijoakim, Kintamanimatt, Adiecoly, Prokaryotes, YiFeiBot, GvacWP, 3AlarmLampscooter, Wolfscopez, Tshuva, Kind Tennis
Fan, Glenburne, Anrnusna, Vigo1100, Jeremyb-phone, Jonnywidefoot, Lexanglopaddy, Impsswoon, AH999, Drkvncnt, Drsoumyadeepb,
Biggem001, Craigrottman, Slenderdan, Lagoset, Monkbot, LeoLi1234, Kingrain1, Ddluv09, Vieque, AntiqueReader, NewEnglandDr,
Ydanay, Coeedrinker115, TheQ Editor, BernieGordon, Dwade64, Amw2017, Lgkkitkat, Qwertyxp2000, Nowzer, Georsche, Badnaam,
Elchap, Biblioworm, 59Ballons, Plantduets, Itztony, Kirby777, Anguskhan01, Trololololololol321, Amortias, Wontsilence, NQ, Signedzzz,
ClaudioUEC, Wikicology, Malerisch, Joneys Joes, Artsipan, Lemos the Mad scientist, MissKatie89, Wikipedian 2, Homomnius, Ryubyss,
Emily1015, Pigi5, Davidjconnolly, Dragonmagicediter, ExoSuho, Bhavinderrao9, Omodeletobi, 93notes, Eftonia, Harrismark, Doc Ayomide, Ebola guy, Wrsa, Chizzy92, Inemudom, Chibike94, RealPyro, Fakecolepoland, Crlaozwyn, Dylang010, 2manyJimmiesRustled, BrianGroen, EoRdE6, FriarTuck1981, Starstr, Xqxf, Wikipedianorthernireland, Kieran P. Clark, Bkcunningham, Yellow Dingo, 21 bruh, Asracing120, Jsoik, Iwalrusfriend, Theebola, Daqueenonmypeen, Pizzaguy232roundhouse, Clinton227, EpicistLamaEver, Jamesrowland008
and Anonymous: 1959

26

15

15.2

TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

Images

File:Bushmeat_-_Buschfleisch_Ghana.JPG
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