Ebola virus disease

Fact sheet N103

Updated September 2014

Key facts

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a

severe, often fatal illness in humans.
The virus is transmitted to people from wild animals and spreads in the human
population through human-to-human transmission.
The average EVD case fatality rate is around 50%. Case fatality rates have varied
from 25% to 90% in past outbreaks.
The first EVD outbreaks occurred in remote villages in Central Africa, near tropical
rainforests, but the most recent outbreak in west Africa has involved major urban as well
as rural areas.
Community engagement is key to successfully controlling outbreaks. Good
outbreak control relies on applying a package of interventions, namely case
management, surveillance and contact tracing, a good laboratory service, safe burials
and social mobilisation.
Early supportive care with rehydration, symptomatic treatment improves survival.
There is as yet no licensed treatment proven to neutralise the virus but a range of blood,
immunological and drug therapies are under development.
There are currently no licensed Ebola vaccines but 2 potential candidates are
undergoing evaluation.

Background
The Ebola virus causes an acute, serious illness which is often fatal if untreated. Ebola
virus disease (EVD) first appeared in 1976 in 2 simultaneous outbreaks, one in Nzara,
Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a
village near the Ebola River, from which the disease takes its name.
The current outbreak in west Africa, (first cases notified in March 2014), is the largest and
most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There
have been more cases and deaths in this outbreak than all others combined. It has also
spread between countries starting in Guinea then spreading across land borders to Sierra
Leone and Liberia, by air (1 traveller only) to Nigeria, and by land (1 traveller) to Senegal.
The most severely affected countries, Guinea, Sierra Leone and Liberia have very weak
health systems, lacking human and infrastructural resources, having only recently
emerged from long periods of conflict and instability. On August 8, the WHO DirectorGeneral declared this outbreak a Public Health Emergency of International Concern.
A separate, unrelated Ebola outbreak began in Boende, Equateur, an isolated part of the
Democratic Republic of Congo.
The virus family Filoviridae includes 3 genera: Cuevavirus, Marburgvirus, and Ebolavirus.
There are 5 species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Ta
Forest. The first 3, Bundibugyo ebolavirus, Zaire ebolavirus, and Sudan ebolavirus have

been associated with large outbreaks in Africa. The virus causing the 2014 west African
outbreak belongs to the Zaire species.

Transmission

It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola
is introduced into the human population through close contact with the blood, secretions,
organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats,
monkeys, forest antelope and porcupines found ill or dead or in the rainforest.
Ebola then spreads through human-to-human transmission via direct contact (through
broken skin or mucous membranes) with the blood, secretions, organs or other bodily
fluids of infected people, and with surfaces and materials (e.g. bedding, clothing)
contaminated with these fluids.
Health-care workers have frequently been infected while treating patients with suspected
or confirmed EVD. This has occurred through close contact with patients when infection
control precautions are not strictly practiced.
Burial ceremonies in which mourners have direct contact with the body of the deceased
person can also play a role in the transmission of Ebola.
People remain infectious as long as their blood and body fluids, including semen and
breast milk, contain the virus. Men who have recovered from the disease can still
transmit the virus through their semen for up to 7 weeks after recovery from illness.

Symptoms of Ebola virus disease

The incubation period, that is, the time interval from infection with the virus to onset of
symptoms is 2 to 21 days. Humans are not infectious until they develop symptoms. First
symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat.
This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver
function, and in some cases, both internal and external bleeding (e.g. oozing from the
gums, blood in the stools). Laboratory findings include low white blood cell and platelet
counts and elevated liver enzymes.

Diagnosis

It can be difficult to distinguish EVD from other infectious diseases such as malaria,
typhoid fever and meningitis. Confirmation that symptoms are caused by Ebola virus
infection are made using the following investigations:
antibody-capture enzyme-linked immunosorbent assay (ELISA)
antigen-capture detection tests
serum neutralization test
reverse transcriptase polymerase chain reaction (RT-PCR) assay
electron microscopy
virus isolation by cell culture.
Samples from patients are an extreme biohazard risk; laboratory testing on noninactivated samples should be conducted under maximum biological containment
conditions.

Treatment and vaccines

Supportive care-rehydration with oral or intravenous fluids- and treatment of specific

symptoms, improves survival. There is as yet no proven treatment available for EVD.
However, a range of potential treatments including blood products, immune therapies

and drug therapies are currently being evaluated. No licensed vaccines are available yet,
but 2 potential vaccines are undergoing human safety testing.

Prevention and control

Good outbreak control relies on applying a package of interventions, namely case

management, surveillance and contact tracing, a good laboratory service, safe burials
and social mobilisation. Community engagement is key to successfully controlling
outbreaks. Raising awareness of risk factors for Ebola infection and protective measures
that individuals can take is an effective way to reduce human transmission. Risk
reduction messaging should focus on several factors:
Reducing the risk of wildlife-to-human transmission from contact with
infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals
should be handled with gloves and other appropriate protective clothing. Animal products
(blood and meat) should be thoroughly cooked before consumption.
Reducing the risk of human-to-human transmission from direct or close
contact with people with Ebola symptoms, particularly with their bodily fluids. Gloves and
appropriate personal protective equipment should be worn when taking care of ill
patients at home. Regular hand washing is required after visiting patients in hospital, as
well as after taking care of patients at home.
Outbreak containment measures including prompt and safe burial of the dead,
identifying people who may have been in contact with someone infected with Ebola,
monitoring the health of contacts for 21 days, the importance of separating the healthy
from the sick to prevent further spread, the importance of good hygiene and maintaining
a clean environment.

Controlling infection in health-care settings:

Health-care workers should always take standard precautions when caring for patients,
regardless of their presumed diagnosis. These include basic hand hygiene, respiratory
hygiene, use of personal protective equipment (to block splashes or other contact with
infected materials), safe injection practices and safe burial practices.
Health-care workers caring for patients with suspected or confirmed Ebola virus should
apply extra infection control measures to prevent contact with the patients blood and
body fluids and contaminated surfaces or materials such as clothing and bedding. When
in close contact (within 1 metre) of patients with EBV, health-care workers should wear
face protection (a face shield or a medical mask and goggles), a clean, non-sterile longsleeved gown, and gloves (sterile gloves for some procedures).
Laboratory workers are also at risk. Samples taken from humans and animals for
investigation of Ebola infection should be handled by trained staff and processed in
suitably equipped laboratories.

WHO response

WHO aims to prevent Ebola outbreaks by maintaining surveillance for Ebola virus disease
and supporting at-risk countries to developed preparedness plans. The document
provides overall guidance for control of Ebola and Marburg virus outbreaks:
Ebola and Marburg virus disease epidemics: preparedness, alert, control, and
evaluation
When an outbreak is detected WHO responds by supporting surveillance, community
engagement, case management, laboratory services, contact tracing, infection control,
logistical support and training and assistance with safe burial practices.
WHO has developed detailed advice on Ebola infection prevention and control:

Infection prevention and control guidance for care of patients with suspected or
confirmed Filovirus haemorrhagic fever in health-care settings, with focus on Ebola
Table: Chronology of previous Ebola virus disease outbreaks

Year

Country

Ebolavirus
species

Democratic
2012 Republic of Congo

Bundibugyo

2012 Uganda

Cas
es

Deat
hs

Case
fatality

57

29

51%

Sudan

57%

2012 Uganda

Sudan

24

17

71%

2011 Uganda

Sudan

100%

Democratic
2008 Republic of Congo

Zaire

32

14

44%

2007 Uganda

Bundibugyo

149

37

25%

Democratic
2007 Republic of Congo

Zaire

264

187

71%

2005 Congo

Zaire

12

10

83%

2004 Sudan

Sudan

17

41%

2003
(Nov-Dec) Congo

Zaire

35

29

83%

2003 (JanApr) Congo

Zaire

143

128

90%

20012002 Congo

Zaire

59

44

75%

20012002 Gabon

Zaire

65

53

82%

425

224

53%

2000 Uganda

Sudan

South Africa (ex1996 Gabon)

Zaire

100%

1996 (JulDec) Gabon

Zaire

60

45

75%

1996 (JanApr) Gabon

Zaire

31

21

68%

Year

Country

Ebolavirus
species

Democratic
1995 Republic of Congo

Zaire

1994 Cote d'Ivoire

Ta Forest

1994 Gabon

Cas
es

Deat
hs

Case
fatality

315

254

81%

0%

Zaire

52

31

60%

1979 Sudan

Sudan

34

22

65%

Democratic
1977 Republic of Congo

Zaire

100%

1976 Sudan

Sudan

284

151

53%

Democratic
1976 Republic of Congo

Zaire

318

280

88%