Ebola Virus Disease

Ebola is a serious, life-threatening type of viral hemorrhagic fever — a viral infection that damages your blood vessels. Ebola symptoms start off like the flu (influenza). But they can progress to:

• Severe bleeding (hemorrhage)
• Neurological disorders (conditions that affect your brain and nerves)
• Severe vomiting

Ebola is rare. But outbreaks occur regularly ever since experts first recognized orthoebolaviruses (the viruses that cause Ebola) in 1976 in Zaire (now the Democratic Republic of Congo) in Africa. The largest Ebola outbreak was between 2013 and 2016. In total, there were 28,652 cases worldwide, with 11,325 reported deaths in 10 countries.

If you believe you could have been exposed to Ebola and have symptoms, go to the ER or seek immediate medical attention.

Types of Ebola

There are four different Ebola strains that affect people. Experts name the viruses that cause Ebola after the location in which they were first identified (even if outbreaks have occurred in other locations since then). They differ in their ability to cause symptoms and their severity. They include:

• Bundibugyo ebolavirus (Bundibugyo virus). This causes Bundibugyo virus disease (BDBV). It’s less likely to cause death than other types.
• Sudan ebolavirus (Sudan virus). This causes Sudan virus disease (SVD). It’s more likely to be deadly.
• Taï Forest ebolavirus (Taï Forest virus). This causes Taï Forest virus disease (TAFV). This is the rarest cause of Ebola.
• Zaire ebolavirus (Ebola virus). This causes Ebola virus disease (EVD). EVD is the most common cause of Ebola outbreaks and deaths.

What happens if you have Ebola?

Each type of Ebola causes similar symptoms. The symptoms may come in phases. You may have flu-like symptoms at first, including:

• Chills
• Feeling very tired (fatigue) and weak
• Fever
• Loss of appetite
• Muscle pain
• Severe headache
• Sore throat

Severe Ebola symptoms can develop a few days later, including:

• Black, tarry stool (melena)
• Bleeding or bruising
• Confusion
• Diarrhea that may be bloody
• Rash or spots of blood under your skin (petechiae or purpura)
• Red or bloodshot eyes
• Vomiting that may be bloody or look like coffee grounds (coffee ground emesis)

Later Ebola stages can be severe. They may include:

• Brain inflammation (encephalitis)
• Organ failure
• Seizures
• Your body doesn’t get enough blood flow (shock)

How long does it take Ebola symptoms to show up?

Ebola symptoms may appear as early as two days after exposure to as late as three weeks.

Ebola outbreak causes

Ebola outbreaks develop in countries of West, Central and East Africa. Ebola viruses start in:

• Antelope
• Fruit bats
• Nonhuman primates (apes and monkeys)

Each type of Ebola spreads in the same way.

How does Ebola spread?

Orthoebolaviruses spread through contact with body fluids of infected animals (spillover event) or humans. Body fluids include:

• Amniotic fluid
• Breast milk
• Pee (urine)
• Poop (stool)
• Semen
• Spit (saliva)
• Sweat

You can get Ebola from surfaces, objects or medical devices that come into contact with the virus. You may even get it from eating the meat of infected animals.

Can you get Ebola from sex?

Yes, Ebola can transfer through sexual intercourse that involves the semen of an infected person. It’s possible to get Ebola from:

• Anal sexual intercourse
• Oral sexual intercourse
• Vaginal sexual intercourse

There’s no evidence that Ebola can transfer through the vaginal fluids of an infected person.

Is Ebola airborne?

It’s very unlikely that Ebola is an airborne infection. Airborne infections spread through small respiratory droplets that hang in the air after:

• Coughing
• Heavy breathing
• Laughing
• Sneezing

Who is most at risk for Ebola?

You’re most at risk for Ebola if you’re in close contact with an infected person. This includes healthcare workers and family members.

If you’re in close contact with someone who has Ebola, it’s important to use proper personal protective equipment (PPE), like eye protection, face shields and masks.

Complications of Ebola

Even after you recover from Ebola, you may have long-term (chronic) complications. These may include:

• Abdominal pain
• Eye pain or redness
• Fatigue
• Headache
• Muscle and joint pain
• Numbness and tingling (peripheral neuropathy)
• Peeling skin
• Vision problems, including blindness, blurred vision and light sensitivity (photophobia)

How doctors diagnose Ebola

Ebola can be difficult to diagnose because it shares symptoms with other illnesses, including yellow fever, malaria and typhoid fever. Healthcare providers will first:

• Review your health history
• Ask about your symptoms
• Ask about any recent travel or contact with people or animals that may have had Ebola

If they suspect you have Ebola, they’ll recommend a PCR test to diagnose Ebola. PCR tests are a type of blood test.

Can you get rid of Ebola?

Yes, there are Ebola treatments. Healthcare providers use two monoclonal antibody treatments for Ebola virus disease. Monoclonal antibodies work like your immune system’s natural antibodies. They help fight off the infection while your body builds its own defenses. The monoclonal antibody treatments include:

• Ebanga®. This is a single monoclonal antibody.
• Inmazeb®. This is a combination of three monoclonal antibodies.

Experts have only tested these treatments in Zaire ebolavirus infections.

Providers will also work to manage your symptoms and treat any potential complications. They may give you:

• IV fluids to prevent dehydration
• Oxygen therapy
• Pain relievers
• Vasopressors to raise low blood pressure

When should I see my healthcare provider?

If you’re at risk of Ebola exposure and you develop symptoms, see a healthcare provider right away. You may be at risk if you live in an area with animals that carry it, or you’ve traveled to an area with an outbreak.

You may wish to ask a provider the following questions during your appointment:

• What symptoms should I look out for?
• How can I avoid spreading Ebola to others?
• What treatment do you recommend?
• How long will I be contagious?

Can Ebola be prevented?

The Ervebo® vaccine helps protect people who are at high risk of contracting Ebola virus. This includes people who work with orthoebolaviruses in a lab and healthcare workers who treat people who have Ebola. It can also act as a type of pre-exposure prophylaxis for people traveling to areas with Ebola outbreaks. It’s effective during outbreaks, too.

The Zabdeno®/Mvabea® vaccines also help protect adults and children 1 and up against Ebola virus. Zabdeno is the first vaccine dose, and Mvabea is a booster dose that you receive about two months later.

Public health organizations work to contain Ebola outbreaks by looking out for new cases and keeping providers safe who care for people who have Ebola. You can help protect yourself from getting Ebola by:

• Avoiding contact with body fluids and tissues of people and animals (dead or alive) who may have Ebola
• Avoiding sexual intercourse entirely or using condoms until tests confirm you no longer have Ebola in your semen
• Isolating from others if you have Ebola
• Not eating wild animal meat
• Not touching the body fluids of anyone with Ebola and washing your hands after contact, even if you wear gloves
• Not traveling to areas where there’s an Ebola outbreak
• Using PPE when caring for someone with Ebola

What can I expect if I have Ebola?

It’s important to get a proper diagnosis and treatment as soon as you can to increase your chances of a full recovery.

If you’re sick with Ebola, it’s best to avoid being around other people (isolate) until you’re no longer capable of spreading the virus. Healthcare providers and others caring for you must use proper PPE to keep themselves and others safe.

After a full recovery, your immune system develops antibodies that will keep you immune from Ebola for about 10 years.

How long does Ebola stay in my body?

Ebola can stay in certain parts of your body for weeks or months, even after your symptoms go away. These include your:

• Central nervous system (including the cerebrospinal fluid that surrounds your brain and spinal cord)
• Eyes
• Semen

How long can Ebola live in semen?

Ebola can live in semen for a long time — between two and three months after you recover. Providers will conduct tests so you can know when you’re no longer contagious. But until then, use condoms during sexual intercourse to protect your partners from infection, or abstain from sex entirely.

Can you recover from Ebola?

Yes, you can recover from Ebola. But the different types have different survival rates:

• Without treatment, up to 9 out of 10 people who have the Ebola virus can die
• The Sudan virus is deadly in about half of all cases
• The Bundibugyo virus is deadly in about 3 out of 10 cases
• Taï Forest virus has caused Ebola in one person, and it wasn’t fatal

The average survival rate from all Ebola outbreaks is over 50%.

If you have Ebola, it’s important to get treatment as soon as possible.

Is Ebola still around?

Yes, Ebola still exists between outbreaks. It lives in infected animals. But it sometimes spreads to humans.

Has Ebola ever been in the U.S.?

Yes. During the 2013-2016 outbreak that started in Guinea, experts reported Ebola cases in the U.S. and some European countries. Most cases affected medical aid workers whose symptoms started after returning to the U.S. from West Africa. Or they flew to the U.S. for medical treatment after contracting Ebola.

No Ebola strains that can affect people have ever started in the U.S.