Ebola
Ebola | |
---|---|
Other names | Ebola haemorrhagic fever (EHF), Ebola virus disease |
Supportive care[1] | |
Medication | Atoltivimab/maftivimab/odesivimab (Inmazeb) |
Prognosis | 25–90% mortality[1] |
Ebola, also known as Ebola virus disease (EVD) and Ebola hemorrhagic fever (EHF), is a
The virus spreads through direct contact with
Control of outbreaks requires coordinated medical services and community engagement,
History and name
Ebola was first identified in 1976, in two simultaneous outbreaks, one in
Signs and symptoms
Onset
The length of time between exposure to the virus and the development of symptoms (incubation period) is between 2 and 21 days,[1][24] and usually between 4 and 10 days.[25] However, recent estimates based on mathematical models predict that around 5% of cases may take longer than 21 days to develop.[26]
Symptoms usually begin with a sudden
Bleeding
In some cases, internal and external bleeding may occur.
Recovery or death
Recovery may begin between seven and 14 days after first symptoms.[28] Death, if it occurs, follows typically six to sixteen days from first symptoms and is often due to shock from fluid loss.[2] In general, bleeding often indicates a worse outcome, and blood loss may result in death.[27] People are often in a coma near the end of life.[28]
Those who survive often have ongoing muscular and joint pain, liver inflammation, and decreased hearing, and may have continued tiredness, continued weakness, decreased appetite, and difficulty returning to pre-illness weight.[28][40] Problems with vision may develop.[41] It is recommended that survivors of EVD wear condoms for at least twelve months after initial infection or until the semen of a male survivor tests negative for Ebola virus on two separate occasions.[42]
Survivors develop
Cause
EVD in humans is caused by four of six viruses of the genus
Virology
Ebolaviruses contain single-stranded, non-infectious
Their
Transmission
It is believed that between people, Ebola disease spreads only by direct contact with the blood or other
The Ebola virus may be able to persist for more than three months in the semen after recovery, which could lead to infections via sexual intercourse.[6][65][66] Virus persistence in semen for over a year has been recorded in a national screening programme.[67] Ebola may also occur in the breast milk of women after recovery, and it is not known when it is safe to breastfeed again.[7] The virus was also found in the eye of one patient in 2014, two months after it was cleared from his blood.[68] Otherwise, people who have recovered are not infectious.[62]
The potential for
Dead bodies remain infectious; thus, people handling human remains in practices such as traditional burial rituals or more modern processes such as embalming are at risk.[69] Of the cases of Ebola infections in Guinea during the 2014 outbreak, 69% are believed to have been contracted via unprotected (or unsuitably protected) contact with infected corpses during certain Guinean burial rituals.[71][72]
Health-care workers treating people with Ebola are at greatest risk of infection.
Human-to-human transmission of EBOV through the air has not been reported to occur during EVD outbreaks,
Airborne transmission among humans is theoretically possible due to the presence of Ebola virus particles in saliva, which can be discharged into the air with a cough or sneeze, but observational data from previous epidemics suggests the actual risk of airborne transmission is low.[78] 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.[79] Therefore, pigs with EVD can spread the disease through droplets in the air or on the ground when they sneeze or cough.[80] By contrast, humans and other primates accumulate the virus throughout their body and specifically in their blood, but not very much in their lungs.[80] 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.[79][80]
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.
Animals may become infected when they eat fruit partially eaten by bats carrying the virus.[85] Fruit production, animal behavior and other factors may trigger outbreaks among animal populations.[85]
Evidence indicates that both domestic dogs and pigs can also be infected with EBOV.[86] 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.[86] 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.[86]
Reservoir
The
Bats were known to roost in the cotton factory in which the first cases of the 1976 and 1979 outbreaks were observed, and they have also been implicated in Marburg virus infections in 1975 and 1980.[88] Of 24 plant and 19 vertebrate species experimentally inoculated with EBOV, only bats became infected.[89] The bats displayed no clinical signs of disease, which is considered evidence that these bats are a reservoir species of EBOV. In a 2002–2003 survey of 1,030 animals including 679 bats from Gabon and the Republic of the Congo, immunoglobulin G (IgG) immune defense molecules indicative of Ebola infection were found in three bat species; at various periods of study, between 2.2 and 22.6% of bats were found to contain both RNA sequences and IgG molecules indicating Ebola infection.[90] 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 filoviruses are present in Asia.[91]
Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians and
Pathophysiology
Like other filoviruses, EBOV replicates very efficiently in many cells, producing large amounts of virus in monocytes, macrophages, dendritic cells and other cells including liver cells, fibroblasts, and adrenal gland cells.[96] Viral replication triggers high levels of inflammatory chemical signals and leads to a septic state.[40]
EBOV is thought to infect humans through contact with mucous membranes or skin breaks.
Endothelial cells may be infected within three days after exposure to the virus.
After infection, a secreted
Immune system evasion
Filoviral infection also interferes with proper functioning of the
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 cell's
Diagnosis
When EVD is suspected, travel, work history, and exposure to wildlife are important factors with respect to further diagnostic efforts.[100]
Laboratory testing
Possible non-specific laboratory indicators of EVD include a
The specific diagnosis of EVD is confirmed by isolating the virus, detecting its
Differential diagnosis
Early symptoms of EVD may be similar to those of other diseases common in Africa, including
The complete
Non-infectious diseases that may result in symptoms similar to those of EVD include
Prevention
Vaccines
An
Infection control
Community awareness of the benefits on survival chances of admitting cases early is important for the infected and infection control [4]
Caregivers
People who care for those infected with Ebola should wear protective clothing including masks, gloves, gowns and goggles.
Patients and household members
The infected person should be in
Disinfection
Ebolaviruses can be
General population
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 and water.[122]
Bushmeat
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.[123]
Corpses, burial
If a person with Ebola disease dies, direct contact with the body should be avoided.
Transport, travel, contact
Transportation crews are instructed to follow a certain isolation procedure, should anyone exhibit symptoms resembling EVD.[128] As of August 2014[update], the WHO does not consider travel bans to be useful in decreasing spread of the disease.[70] In October 2014, the CDC defined four risk levels used to determine the level of 21-day monitoring for symptoms and restrictions on public activities.[129] In the United States, the CDC recommends that restrictions on public activity, including travel restrictions, are not required for the following defined risk levels:[129]
- 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)
- encounter with a person showing symptoms; but not within three feet of the person with Ebola without wearing PPE; and no direct contact with body fluids
- 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)
- 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).
The CDC recommends monitoring for the symptoms of Ebola disease for those both at "low risk" and at higher risk.[129]
Laboratory
In laboratories where diagnostic testing is carried out, biosafety level 4-equivalent containment is required.[130] Laboratory researchers must be properly trained in BSL-4 practices and wear proper PPE.[130]
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.[131] Quarantine, also known as enforced isolation, is usually effective in decreasing spread.[132][133] Governments often quarantine areas where the disease is occurring or individuals who may transmit the disease outside of an initial area.[134] In the United States, the law allows quarantine of those infected with ebolaviruses.[135][136]
Contact tracing
Contact tracing is considered important to contain an outbreak. It involves finding everyone who had close contact with infected individuals and monitoring them for signs 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, tracing the contacts' contacts.[137][138]
Management
As of 2019[update] two treatments (atoltivimab/maftivimab/odesivimab and ansuvimab) are associated with improved outcomes.[11][12] The U.S. Food and Drug Administration (FDA) advises people to be careful of advertisements making unverified or fraudulent claims of benefits supposedly gained from various anti-Ebola products.[139][140]
In October 2020, the U.S. Food and Drug Administration (FDA) approved atoltivimab/maftivimab/odesivimab with an indication for the treatment of infection caused by Zaire ebolavirus.[13]
Standard support
Treatment is primarily supportive in nature.[141] Early supportive care with rehydration and symptomatic treatment improves survival.[1] Rehydration may be via the oral or intravenous route.[141] These measures may include pain management, and treatment for nausea, fever, and anxiety.[141] The World Health Organization (WHO) recommends avoiding aspirin or ibuprofen for pain management, due to the risk of bleeding associated with these medications.[142]
Blood products such as
Where hospital care is not possible, the WHO's guidelines for home care have been relatively successful. Recommendations include using towels soaked in a bleach solution when moving infected people or bodies and also applying bleach on stains. It is also recommended that the caregivers wash hands with bleach solutions and cover their mouth and nose with a cloth.[144]
Intensive care
Prognosis
EVD has a risk of death in those infected of between 25% and 90%.[1][145] As of September 2014[update], the average risk of death among those infected is 50%.[1] The highest risk of death was 90% in the 2002–2003 Republic of the Congo outbreak.[146] Early admission significantly increases survival rates [4]
Death, if it occurs, follows typically six to sixteen days after symptoms appear and is often due to low blood pressure from fluid loss.[2] Early supportive care to prevent dehydration may reduce the risk of death.[143]
Post-Ebola virus syndrome
If an infected person survives, recovery may be quick and complete.[25][147] However, a large portion of survivors develop post-Ebola virus syndrome after the acute phase of the infection.[148]
Prolonged cases are often complicated by the occurrence of long-term problems, such as
Ebola can stay in some body parts like the eyes,[150] breasts, and testicles after infection.[6][151] Sexual transmission after recovery has been suspected.[152][153] If sexual transmission occurs following recovery it is believed to be a rare event.[154] One case of a condition similar to meningitis has been reported many months after recovery, as of October 2015[update].[155]
Epidemiology
The disease typically occurs in outbreaks in tropical regions of
1976
Sudan
The first known outbreak of EVD was identified only after the fact. It occurred between June and November 1976, in
Zaire
On 26 August 1976, the second outbreak of EVD began in
Soon after Lokela's death, others who had been in contact with him also died, and people in Yambuku began to panic. The country's Minister of Health and Zaire President Mobutu Sese Seko declared the entire region, including Yambuku and the country's capital, Kinshasa, a quarantine zone. No-one was permitted to enter or leave the area, and roads, waterways, and airfields were placed under martial law. Schools, businesses and social organisations were closed.[163] The initial response was led by Congolese doctors, including Jean-Jacques Muyembe-Tamfum, one of the discoverers of Ebola. Muyembe took a blood sample from a Belgian nun; this sample would eventually be used by Peter Piot to identify the previously unknown Ebola virus.[164] Muyembe was also the first scientist to come into direct contact with the disease and survive.[165] Researchers from the Centers for Disease Control and Prevention (CDC), including Piot, co-discoverer of Ebola, later arrived to assess the effects of the outbreak, observing that "the whole region was in panic."[166][167][168]
Piot concluded that 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 and the quarantine lasted two weeks. Researchers speculated that the disease disappeared due to the precautions taken by locals, the quarantine of the area, and discontinuing of the injections.[163]
During this outbreak, Ngoy Mushola recorded the first clinical description of EVD in
The virus responsible for the initial outbreak, first thought to be the Marburg virus, was later identified as a new type of virus related to the genus Marburgvirus. Virus strain samples isolated from both outbreaks were named "Ebola virus" after the Ebola River, near the first-identified viral outbreak site in Zaire.[35] Reports conflict about who initially coined the name: either Karl Johnson of the American CDC team[170] or Belgian researchers.[171] Subsequently, a number of other cases were reported, almost all centred on the Yambuku mission hospital or close contacts of another case.[160] In all, 318 cases and 280 deaths (an 88% fatality rate) occurred in Zaire.[172] Although the two outbreaks were at first believed connected, scientists later realised that they were caused by two distinct ebolaviruses, SUDV and EBOV.[159]
1995–2014
The second major outbreak occurred in Zaire (now the Democratic Republic of the Congo, DRC), in 1995, affecting 315 and killing 254.[1]
In 2000, Uganda had an outbreak infecting 425 and killing 224; in this case, the Sudan virus was found to be the Ebola species responsible for the outbreak.[1]
In 2003, an outbreak in the DRC infected 143 and killed 128, a 90% death rate, the highest of a genus Ebolavirus outbreak to date.[173]
In 2004, a Russian scientist died from Ebola after sticking herself with an infected needle.[174]
Between April and August 2007, a fever epidemic[175] in a four-village region[176] of the DRC was confirmed in September to have been cases of Ebola.[177] Many people who attended the recent funeral of a local village chief died.[176] The 2007 outbreak eventually infected 264 individuals and killed 187.[1]
On 30 November 2007, the Uganda Ministry of Health confirmed an outbreak of Ebola in the Bundibugyo District in Western Uganda. After confirming samples tested by the United States National Reference Laboratories and the Centers for Disease Control, the World Health Organization (WHO) confirmed the presence of a new species of genus Ebolavirus, which was tentatively named Bundibugyo.[178] The WHO reported 149 cases of this new strain and 37 of those led to deaths.[1]
The WHO confirmed two small outbreaks in Uganda in 2012, both caused by the Sudan variant. The first outbreak affected seven people, killing four, and the second affected 24, killing 17.[1]
On 17 August 2012, the Ministry of Health of the DRC reported an outbreak of the Ebola-Bundibugyo variant
In 2014, an outbreak occurred in the DRC.
2013–2016 West Africa
In March 2014, the
Intense contact tracing and strict isolation largely prevented further spread of the disease in the countries that had imported cases.
It caused significant mortality, with a considerable case fatality rate.[192][193][194][note 1] By the end of the epidemic, 28,616 people had been infected; of these, 11,310 had died, for a case-fatality rate of 40%.[195] As of 8 May 2016[update], 28,646 suspected cases and 11,323 deaths were reported;[15][196] however, the WHO said that these numbers may be underestimated.[197] Because they work closely with the body fluids of infected patients, healthcare workers were especially vulnerable to infection; in August 2014, the WHO reported that 10% of the dead were healthcare workers.[198]
In September 2014, it was estimated that the countries' capacity for treating Ebola patients was insufficient by the equivalent of 2,122 beds; by December there were a sufficient number of beds to treat and isolate all reported Ebola cases, although the uneven distribution of cases was causing serious shortfalls in some areas.[199] On 28 January 2015, the WHO reported that for the first time since the week ending 29 June 2014, there had been fewer than 100 new confirmed cases reported in a week in the three most-affected countries. The response to the epidemic then moved to a second phase, as the focus shifted from slowing transmission to ending the epidemic.[200] On 8 April 2015, the WHO reported only 30 confirmed cases, the lowest weekly total since the third week of May 2014.[201]
On 29 December 2015, 42 days after the last person tested negative for a second time, Guinea was declared free of Ebola transmission.[202] At that time, a 90-day period of heightened surveillance was announced by that agency. "This is the first time that all three countries – Guinea, Liberia and Sierra Leone – have stopped the original chains of transmission ...", the organisation stated in a news release.[203] A new case was detected in Sierra Leone on 14 January 2016.[204] However, the outbreak was declared no longer an emergency on 29 March 2016.[18]
2014 spread outside West Africa
On 19 September, Eric Duncan flew from his native Liberia to Texas; five 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. Health officials confirmed a diagnosis of Ebola on 30 September – the first case in the United States.[205]
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 first transmission of the virus to occur outside Africa.[206] Romero tested negative for the disease on 20 October, suggesting that she may have recovered from Ebola infection.[207]
On 12 October, the
On 29 December 2014,
2017 Democratic Republic of the Congo
On 11 May 2017, the DRC Ministry of Public Health notified the WHO about an outbreak of Ebola. Four people died, and four people survived; five of these eight cases were laboratory-confirmed. A total of 583 contacts were monitored. On 2 July 2017, the WHO declared the end of the outbreak.[215]
2018 Équateur province
On 14 May 2018, the World Health Organization reported that "the Democratic Republic of Congo reported 39 suspected, probable or confirmed cases of Ebola between 4 April and 13 May, including 19 deaths."
2018–2020 Kivu
On 1 August 2018, the world's 10th Ebola outbreak was declared in North Kivu province of the Democratic Republic of the Congo. It was the first Ebola outbreak in a military conflict zone, with thousands of refugees in the area.[222][223] By November 2018, nearly 200 Congolese had died of Ebola, about half of them from the city of Beni, where armed groups are fighting over the region's mineral wealth, impeding medical relief efforts.[224]
By March 2019, this became the second largest Ebola outbreak ever recorded, with more than 1,000 cases and insecurity continuing to be the major resistance to providing an adequate response.[225][226] As of 4 June 2019[update], the WHO reported 2025 confirmed and probable cases with 1357 deaths.[227] In June 2019, two people died of Ebola in neighbouring Uganda.[228]
In July 2019, an infected man travelled to
On 25 June 2020, the second biggest EVD outbreak ever was declared over.[232]
2020 Équateur province
On 1 June 2020, the Congolese health ministry announced a new DRC outbreak of Ebola in
2021
North Kivu
On 7 February 2021, the Congolese health ministry announced a new case of Ebola near Butembo, North Kivu detected a day before. The case was a 42-year-old woman who had symptoms of Ebola in Biena on 1 February 2021. A few days after, she died in a hospital in Butembo. The WHO said that more than 70 people with contact with the woman had been tracked.[236][237]
On 11 February 2021, another woman who had contact with the previous woman died in the same town, and the number of traced contacts increased to 100.[238] A day after, a third case was detected in Butembo.[239]
On 3 May 2021, the 12th EVD outbreak was declared over, resulting in 12 cases and six deaths.[240][241] Heightened surveillance will continue for 90 days after the declaration, in case of resurgence.[240]
Guinea
In February 2021, Sakoba Keita, head of Guinea's national health agency confirmed that three people had died of Ebola in the south-eastern region near the city of Nzérékoré. A further five people also tested positive. Keita also confirmed more testing was underway, and attempts to trace and isolate further cases had begun.
Ivory Coast
On 14 August 2021, The Ministry of Health of
However, on 31 August 2021, the WHO found that, after further tests in a laboratory in Lyon, the patient did not have Ebola. The cause of her disease is still being analyzed.[248]
2022
On 23 April 2022, a case of Ebola was confirmed in the DRC in the Equateur province. The case was a 31-year-old man whose symptoms began on 5 April, but did not seek treatment for over a week. On 21 April, he was admitted to an Ebola treatment centre and died later that day.[249] By 24 May 2022, there were 5 recorded deaths in the DRC.[250] On 15 August, the fifth case was buried, and the outbreak was declared over, 42 days after, on 4 July 2022.[251]
In September 2022,
Society and culture
Weaponisation
Ebolavirus is classified as a biosafety level 4 agent, as well as a Category A bioterrorism agent by the Centers for Disease Control and Prevention.[96][255] It has the potential to be weaponised for use in biological warfare,[256][257] and was investigated by Biopreparat for such use, but might be difficult to prepare as a weapon of mass destruction because the virus becomes ineffective quickly in open air.[258] Fake emails pretending to be Ebola information from the WHO or the Mexican government have, in 2014, been misused to spread computer malware.[259] The BBC reported in 2015 that "North Korean state media has suggested the disease was created by the U.S. military as a biological weapon."[260]
Literature
William Close's 1995 Ebola: A Documentary Novel of Its First Explosion[264][265] and 2002 Ebola: Through the Eyes of the People focused on individuals' reactions to the 1976 Ebola outbreak in Zaire.[266][267]
Tom Clancy's 1996 novel, Executive Orders, involves a Middle Eastern terrorist attack on the United States using an airborne form of a deadly Ebola virus strain named "Ebola Mayinga" (see Mayinga N'Seka).[268][269]
As the Ebola virus epidemic in West Africa developed in 2014, a number of popular self-published and well-reviewed books containing sensational and misleading information about the disease appeared in electronic and printed formats. The authors of some such books admitted that they lacked medical credentials and were not technically qualified to give medical advice. The World Health Organization and the United Nations stated that such misinformation had contributed to the spread of the disease.[270]
Other animals
Wild animals
Ebola has a high mortality rate among primates.[271] Frequent outbreaks of Ebola may have resulted in the deaths of 5,000 gorillas.[272] Outbreaks of Ebola may have been responsible for an 88% decline in tracking indices of observed chimpanzee populations in the 420 km2 Lossi Sanctuary between 2002 and 2003.[273] Transmission among chimpanzees through meat consumption constitutes a significant risk factor, whereas contact between the animals, such as touching dead bodies and grooming, is not.[274]
Recovered gorilla carcasses have contained multiple Ebola virus strains, suggesting multiple introductions of the virus. Bodies decompose quickly and carcasses are not infectious after three to four days. Contact between gorilla groups is rare, suggesting that transmission among gorilla groups is unlikely, and that outbreaks result from transmission between viral reservoirs and animal populations.[273]
Domestic animals
In 2012, it was demonstrated that the virus can travel without contact from pigs to nonhuman primates, although the same study failed to achieve transmission in that manner between primates.[86][275]
Dogs may become infected with EBOV but not develop symptoms. Dogs in some parts of Africa
Reston virus
In late 1989, Hazelton Research Products' Reston Quarantine Unit in
A
The Philippines and the United States had no previous cases of Ebola infection, and upon further isolation, researchers concluded it was another strain of Ebola, or a new filovirus of Asian origin, which they named
Research
Treatments
As of July 2015[update], no medication has been proven safe and effective for treating Ebola. By the time the
As of August 2019[update], two experimental treatments known as atoltivimab/maftivimab/odesivimab and ansuvimab were found to be 90% effective.[286][287][288]
Diagnostic tests
The diagnostic tests currently available require specialised equipment and highly trained personnel. Since there are few suitable testing centres in West Africa, this leads to delay in diagnosis.[289]
On 29 November 2014, a new 15-minute Ebola test was reported that if successful, "not only gives patients a better chance of survival, but it prevents transmission of the virus to other people." The new equipment, about the size of a laptop and solar-powered, allows testing to be done in remote areas.[290]
On 29 December 2014, the U.S. Food and Drug Administration (FDA) approved the LightMix Ebola Zaire rRT-PCR test for patients with symptoms of Ebola.[291]
Disease models
Animal models and in particular non-human primates are being used to study different aspects of Ebola virus disease. Developments in organ-on-a-chip technology have led to a chip-based model for Ebola haemorrhagic syndrome.[292]
See also
Notes
- ^ The mortality (number of dead per number of healthy per time frame) recorded in Liberia up to 26 August 2014 was 70%.[194] However, due to the estimation method used, the estimated case fatality rate (70.8%) for this particular epidemic differs from the actual ratio between the number of deaths and the number of cases.
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Bibliography
- McCormick J, Fisher-Hoch S, Horvitz LA (1999) [1996]. Level 4: Virus Hunters of the CDC (Limited preview) (Updated [3rd] ed.). Barnes & Noble. ISBN 978-0760712085.
Further reading
- Wilson F (2014). CDC Guidance on Ebola Virus (EVD). International Publications Media Group. ISBN 978-1632670113.
- Ebola Virus: New Insights for the Healthcare Professional: 2011 Edition: ScholarlyPaper. Scholarly Editions. 2012. ISBN 978-1464914935.
- Klenk HD (January 1999). Marburg and Ebola Viruses. Current Topics in Microbiology and Immunology 235. Berlin: Springer-Verlag Telos. ISBN 978-3540647294.
- Klenk HD, Feldmann H (2004). Ebola and Marburg viruses: molecular and cellular biology (Limited preview). Wymondham, Norfolk: Horizon Bioscience. ISBN 978-0954523237.
- Kuhn JH (2008). Filoviruses: A Compendium of 40 Years of Epidemiological, Clinical, and Laboratory Studies. Archives of Virology Supplement (Limited preview). Vol. 20. Vienna: SpringerWienNewYork. ISBN 978-3211206706.
- Pattyn SR (1978). Ebola Virus Haemorrhagic Fever (1st ed.). Amsterdam: Elsevier/North-Holland Biomedical Press. ISBN 978-0444800602. Archived from the original(Full free text) on 11 December 2010.
- Ryabchikova EI, Price BB (2004). Ebola and Marburg Viruses: A View of Infection Using Electron Microscopy. Columbus, Ohio: Battelle Press. ISBN 978-1574771312.
External links
- WHO fact sheet on Ebola
- Ebola (Ebola Virus Disease) – Centers for Disease Control and Prevention, Viral Special Pathogens Branch.
- Videos: Ebola outbreak response – World Health Organization.
- "Ebola Preparedness and Response". U.S. Food and Drug Administration (FDA). 13 January 2021.
- Ebola: What You Need to Know – Scientific American articles related to Ebola; note these are general reading articles, they are not scientific peer-reviewed research articles.