Ebola Virus Disease: Key Facts

Ebola Virus Disease
Fact sheet N103

Updated September 2014
Key Facts
Ebola virus disease (EVD), formerly known as Ebola hemorrhagic 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
mobilization.
Early supportive care with rehydration, symptomatic treatment improves survival.
There is as yet no licensed treatment proven to neutralize 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 traveler only) to Nigeria, and by land (1 traveler) 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 Director-General
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 non-inactivated
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 mobilization. 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 meter) of patients with EBV, health-care workers should wear face protection (a
face shield or a medical mask and goggles), a clean, non-sterile long-sleeved 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 hemorrhagic fever in health-care settings, with focus on Ebola
Reference: http://www.who.int/mediacentre/factsheets/fs103/en/

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Ebola Virus Disease

Fact sheet N103

Symptoms of Ebola Virus Disease

Treatment and Vaccines

Prevention and Control

Reducing the risk of wildlife-to-human transmission from contact with infected

Controlling Infection in Health-care Settings:

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