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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 three genera, including Ebolavirus and Marburgvirus, which are among the most virulent pathogens in humans [1-3], and Cuevavirus, which has only been isolated as viral RNA from bats in Spain [4]. The Zaire species of Ebolavirus was the causative agent of the 2014-2016 epidemic in West Africa, where there were nearly 29,000 total cases (suspected, probable, or confirmed), more than 15,000 laboratory-confirmed cases, and 11,000 deaths [5]. Based on the total estimated case count, the overall case fatality rate was approximately 40 percent. In earlier outbreaks caused by the same virus species in Central Africa, case fatality rates reached 80 to 90 percent [6]. Marburg virus has caused a similar disease in a smaller number of outbreaks in Central Africa [7]. (See "Marburg virus".)

The epidemiology and pathogenesis of Ebola virus disease will be presented here, including knowledge that emerged during and after the West African epidemic of Ebola virus disease. 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 [8,9]. However, the term "hemorrhagic fever" is no longer used to refer to Ebola virus disease because 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 Ebolavirus is divided into five species (Zaire, Sudan, Tai Forest, Bundibugyo, and Reston) [3]. The following four species cause disease in humans:


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