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Epidemiology and pathogenesis of Ebola virus disease

Mike Bray, MD, MPH
Daniel S Chertow, MD, MPH
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH


The family Filoviridae consists of two genera, the Ebola and Marburg viruses, which are among the most virulent pathogens in humans [1]. The Zaire species of Ebola virus is the causative agent of the 2014-2015 epidemic in West Africa, in which the case fatality rate has been reported to be as high as 70 percent [2]; rates in earlier outbreaks have reached 80 to 90 percent [3]. Marburg virus has caused a similar disease in a smaller number of outbreaks in Central Africa [4].

The epidemiology and pathogenesis of Ebola virus disease will be presented here, including new knowledge emerging from the 2014-2015 epidemic of Ebola virus disease in West Africa. The clinical manifestations, diagnosis, treatment, and prevention of Ebola virus disease are discussed elsewhere. (See "Clinical manifestations and diagnosis of Ebola virus disease" and "Treatment and prevention of Ebola virus disease".)


Ebola virus is a nonsegmented, negative-sense, single-stranded RNA virus that resembles rhabdoviruses (eg, rabies) and paramyxoviruses (eg, measles, mumps) in its genome organization and replication mechanisms. It is a member of the family Filoviridae, taken from the Latin "filum," meaning thread-like, based upon their filamentous structure.

In the past, Ebola and Marburg viruses were classified as "hemorrhagic fever viruses", based upon their clinical manifestations, which include coagulation defects, bleeding, and shock [5,6]. However, the term "hemorrhagic fever" is no longer used to refer to Ebola virus disease since only a small percentage of Ebola patients actually develop significant hemorrhage, and it usually occurs in the terminal phase of fatal illness, when the individual is already in shock. (See "Clinical manifestations and diagnosis of Ebola virus disease", section on 'Clinical manifestations'.)

The genus Ebola virus is divided into five species (Zaire, Sudan, Ivory Coast, Bundibugyo, and Reston) [7]. The following four species cause disease in humans:


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