Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness affecting humans and other primates.
The virus is transmitted to people from wild animals (such as fruit bats, porcupines and non-human primates) and then spreads in the human population through direct contact 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.
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. The 2014–2016 outbreak in West Africa was the largest and most complex Ebola outbreak since the virus was first discovered in 1976. There were more cases and deaths in this outbreak than all others combined. It also spread between countries, starting in Guinea then moving across land borders to Sierra Leone and Liberia.
It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts.
The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is from 2 to 21 days. A person infected with Ebola cannot spread the disease until they develop symptoms.
Symptoms of EVD can be sudden and include: fever, fatigue, muscle, pain, headache, and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases 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.
It can be difficult to clinically distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis. A range of diagnostic tests have been developed to confirm the presence of the virus.
Treatment and prevention
Supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms improves survival. A range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated.
In the 2018-2020 Ebola outbreak in DRC, the first-ever multi-drug randomized control trial was conducted to evaluate the effectiveness and safety of drugs used in the treatment of Ebola patients under an ethical framework developed in consultation with experts in the field and the DRC.
Two monoclonal antibodies (Inmazeb and Ebanga) were approved for the treatment of Zaire ebolavirus (Ebolavirus) infection in adults and children by the US Food and Drug Administration in late 2020.
The Ervebo vaccine has been shown to be effective in protecting people from the species Zaire ebolavirus, and is recommended by the Strategic Advisory Group of Experts on Immunization as part of a broader set of Ebola outbreak response tools. In December 2020, the vaccine was approved by the US Food and Drug Administration and prequalified by WHO for use in individuals 18 years of age and older (except for pregnant and breastfeeding women) for protection against Ebola virus disease caused by Zaïre Ebola virus.
In May 2020, the European Medicines Agency recommended granting marketing authorization for a 2-component vaccine called Zabdeno-and-Mvabea for individuals 1 year and older.
The vaccine is delivered in 2 doses: Zabdeno is administered first and Mvabea is given approximately 8 weeks later as a second dose. This prophylactic 2-dose regimen is therefore not suitable for an outbreak response where immediate protection is necessary.
• Équateur, Democratic Republic of the Congo, 2020
• North Kivu/Ituri, Democratic Republic of the Congo, 2018-2020
• Équateur, Democratic Republic of the Congo, 2018
• Bas-Uélé, Democratic Republic of the Congo, 2017
• West Africa, 2014-2016