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Treatment and prevention of Ebola virus disease

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

INTRODUCTION

The family Filoviridae consists of two genera, the Ebola and Marburg viruses, which are among the most virulent pathogens of humans [1]. The Zaire species of Ebola virus is the causative agent of the current epidemic in West Africa. In earlier outbreaks caused by the same virus species in Central Africa, case fatality rates reached 80 to 90 percent [2], but in West Africa, the overall case fatality rate has been less than 50 percent [3]. Marburg virus has caused a similar disease in a smaller number of outbreaks in Central Africa [4]. Most cases have resulted from an unsuspected exposure to an infected animal, or direct physical contact with the body fluids of a patient. Detailed discussions of the epidemiology and pathogenesis of Ebola virus disease are found elsewhere. (See "Epidemiology and pathogenesis of Ebola virus disease".)

Patients with Ebola virus disease typically present with a nonspecific febrile syndrome that may include headache, muscle aches, and fatigue. Vomiting and diarrhea frequently develop during the first few days of illness, and may lead to significant volume losses. A maculopapular rash is sometimes observed. Despite the traditional name of "Ebola hemorrhagic fever," major bleeding is not found in the majority of patients, and severe hemorrhage tends to be observed only in the late stages of disease. Some patients develop progressive hypotension and shock with multiorgan failure, which typically results in death during the second week of illness. By comparison, patients who survive infection commonly show signs of clinical improvement during the second week of illness. A review of the clinical manifestations of Ebola virus disease is found elsewhere. (See "Clinical manifestations and diagnosis of Ebola virus disease".)

Reports from the 2014-2016 West African epidemic indicate that with adequate supportive care, the mortality associated with Ebola virus disease may be reduced. In the future, specific antiviral therapy may further diminish the morbidity and mortality of Ebola and Marburg virus diseases, and virus-specific vaccination may be able to protect humans against these conditions.

TREATMENT

Approach to therapy — Whenever possible, patients with Ebola virus disease should receive care in designated treatment centers and by clinicians trained to care for such patients [5]. Treating patients with Ebola requires a multidisciplinary approach [6]. All health care workers involved in the care of infected or potentially infected patients should use infection control precautions, including the proper use of personal protective equipment. (See 'Infection control precautions' below.)

The mainstay of treatment for Ebola virus disease involves supportive care to maintain adequate cardiovascular function while the immune system mobilizes an adaptive response to eliminate the infection [1,7-13]. (See 'Supportive care' below.)

                        

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References
Top
  1. Feldmann H, Geisbert TW. Ebola haemorrhagic fever. Lancet 2011; 377:849.
  2. Bray M, Murphy FA. Filovirus research: knowledge expands to meet a growing threat. J Infect Dis 2007; 196 Suppl 2:S438.
  3. WHO Ebola Response Team. Ebola virus disease in West Africa--the first 9 months of the epidemic and forward projections. N Engl J Med 2014; 371:1481.
  4. Kortepeter MG, Bausch DG, Bray M. Basic clinical and laboratory features of filoviral hemorrhagic fever. J Infect Dis 2011; 204 Suppl 3:S810.
  5. Centers for Disease Control and Prevention. Interim guidance for U.S. hospital preparedness for patients with possible or confirmed Ebola virus disease: a framework for a tiered approach. http://www.cdc.gov/vhf/ebola/hcp/us-hospital-preparedness.html (Accessed on December 03, 2014).
  6. Decker BK, Sevransky JE, Barrett K, et al. Preparing for critical care services to patients with Ebola. Ann Intern Med 2014; 161:831.
  7. Mahanty S, Bray M. Pathogenesis of filoviral haemorrhagic fevers. Lancet Infect Dis 2004; 4:487.
  8. World Health Organization. Clinical management of patients with viral haemorrhagic fever: A pocket guide for the front-line health worker. http://apps.who.int/iris/bitstream/10665/130883/2/WHO_HSE_PED_AIP_14.05.pdf?ua=1 (Accessed on August 18, 2014).
  9. Ribner BS. Treating patients with Ebola virus infections in the US: lessons learned. Presented at IDWeek, October 8, 2014. Philadelphia PA
  10. Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med 2014; 190:733.
  11. Kreuels B, Wichmann D, Emmerich P, et al. A case of severe Ebola virus infection complicated by gram-negative septicemia. N Engl J Med 2014; 371:2394.
  12. Lamontagne F, Clément C, Fletcher T, et al. Doing today's work superbly well--treating Ebola with current tools. N Engl J Med 2014; 371:1565.
  13. Chertow DS, Kleine C, Edwards JK, et al. Ebola virus disease in West Africa--clinical manifestations and management. N Engl J Med 2014; 371:2054.
  14. Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical Management of Ebola Virus Disease in the United States and Europe. N Engl J Med 2016; 374:636.
  15. Bah EI, Lamah MC, Fletcher T, et al. Clinical presentation of patients with Ebola virus disease in Conakry, Guinea. N Engl J Med 2015; 372:40.
  16. Schieffelin JS, Shaffer JG, Goba A, et al. Clinical illness and outcomes in patients with Ebola in Sierra Leone. N Engl J Med 2014; 371:2092.
  17. Lyon GM, Mehta AK, Varkey JB, et al. Clinical care of two patients with Ebola virus disease in the United States. N Engl J Med 2014; 371:2402.
  18. Chertow DS, Uyeki TM, DuPont HL. Loperamide therapy for voluminous diarrhea in Ebola virus disease. J Infect Dis 2015; 211:1036.
  19. Perner A, Fowler RA, Bellomo R, Roberts I. Ebola care and research protocols. Intensive Care Med 2015; 41:111.
  20. Hunt L, Gupta-Wright A, Simms V, et al. Clinical presentation, biochemical, and haematological parameters and their association with outcome in patients with Ebola virus disease: an observational cohort study. Lancet Infect Dis 2015; 15:1292.
  21. Wolf T, Kann G, Becker S, et al. Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care. Lancet 2015; 385:1428.
  22. West TE, von Saint André-von Arnim A. Clinical presentation and management of severe Ebola virus disease. Ann Am Thorac Soc 2014; 11:1341.
  23. Johnson DW, Sullivan JN, Piquette CA, et al. Lessons learned: critical care management of patients with Ebola in the United States. Crit Care Med 2015; 43:1157.
  24. Connor MJ Jr, Kraft C, Mehta AK, et al. Successful delivery of RRT in Ebola virus disease. J Am Soc Nephrol 2015; 26:31.
  25. Centers for Disease Control and Prevention. Recommendations for safely performing acute hemodialysis in patients with Ebola virus disease in U.S. hospitals. http://www.cdc.gov/vhf/ebola/hcp/guidance-dialysis.html (Accessed on October 24, 2014).
  26. Centers for Disease Control and Prevention. Guidance for U.S. laboratories for managing and testing routine clinical specimens when there is a concern about Ebola virus disease http://www.cdc.gov/vhf/ebola/healthcare-us/laboratories/safe-specimen-management.html (Accessed on February 02, 2015).
  27. Ansumana R, Jacobsen KH, Sahr F, et al. Ebola in Freetown area, Sierra Leone--a case study of 581 patients. N Engl J Med 2015; 372:587.
  28. Kraft CS, Hewlett AL, Koepsell S, et al. The Use of TKM-100802 and Convalescent Plasma in 2 Patients With Ebola Virus Disease in the United States. Clin Infect Dis 2015; 61:496.
  29. Jacobs M, Aarons E, Bhagani S, et al. Post-exposure prophylaxis against Ebola virus disease with experimental antiviral agents: a case-series of health-care workers. Lancet Infect Dis 2015; 15:1300.
  30. Florescu DF, Kalil AC, Hewlett AL, et al. Administration of Brincidofovir and Convalescent Plasma in a Patient With Ebola Virus Disease. Clin Infect Dis 2015; 61:969.
  31. Geisbert TW. Medical research: Ebola therapy protects severely ill monkeys. Nature 2014; 514:41.
  32. Furuta Y, Gowen BB, Takahashi K, et al. Favipiravir (T-705), a novel viral RNA polymerase inhibitor. Antiviral Res 2013; 100:446.
  33. Oestereich L, Lüdtke A, Wurr S, et al. Successful treatment of advanced Ebola virus infection with T-705 (favipiravir) in a small animal model. Antiviral Res 2014; 105:17.
  34. Smither SJ, Eastaugh LS, Steward JA, et al. Post-exposure efficacy of oral T-705 (Favipiravir) against inhalational Ebola virus infection in a mouse model. Antiviral Res 2014; 104:153.
  35. Sissoko D, Laouenan C, Folkesson E, et al. Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea. PLoS Med 2016; 13:e1001967.
  36. Bai CQ, Mu JS, Kargbo D, et al. Clinical and Virological Characteristics of Ebola Virus Disease Patients Treated With Favipiravir (T-705)-Sierra Leone, 2014. Clin Infect Dis 2016; 63:1288.
  37. World Health Organization.Statement on the WHO consultation on potential Ebola therapies and vaccines. http://www.who.int/mediacentre/news/statements/2014/ebola-therapies-consultation/en/ (Accessed on September 09, 2014).
  38. World Health Organization. Experimental therapies: growing interest in the use of whole blood or plasma from recovered Ebola patients (convalescent therapies). http://www.who.int/mediacentre/news/ebola/26-september-2014/en/ (Accessed on September 29, 2014).
  39. World Health Organization. Use of convalescent whole blood or plasma collected from patients recovered from Ebola virus disease for transfusion, as an empirical treatment during outbreaks http://apps.who.int/iris/bitstream/10665/135591/1/WHO_HIS_SDS_2014.8_eng.pdf (Accessed on October 03, 2014).
  40. van Griensven J, Edwards T, de Lamballerie X, et al. Evaluation of Convalescent Plasma for Ebola Virus Disease in Guinea. N Engl J Med 2016; 374:33.
  41. Sadek RF, Khan AS, Stevens G, et al. Ebola hemorrhagic fever, Democratic Republic of the Congo, 1995: determinants of survival. J Infect Dis 1999; 179 Suppl 1:S24.
  42. Jahrling PB, Geisbert TW, Geisbert JB, et al. Evaluation of immune globulin and recombinant interferon-alpha2b for treatment of experimental Ebola virus infections. J Infect Dis 1999; 179 Suppl 1:S224.
  43. Mupapa K, Massamba M, Kibadi K, et al. Treatment of Ebola hemorrhagic fever with blood transfusions from convalescent patients. International Scientific and Technical Committee. J Infect Dis 1999; 179 Suppl 1:S18.
  44. Emond RT, Evans B, Bowen ET, Lloyd G. A case of Ebola virus infection. Br Med J 1977; 2:541.
  45. Dye JM, Herbert AS, Kuehne AI, et al. Postexposure antibody prophylaxis protects nonhuman primates from filovirus disease. Proc Natl Acad Sci U S A 2012; 109:5034.
  46. Qiu X, Wong G, Fernando L, et al. mAbs and Ad-vectored IFN-α therapy rescue Ebola-infected nonhuman primates when administered after the detection of viremia and symptoms. Sci Transl Med 2013; 5:207ra143.
  47. Pettitt J, Zeitlin L, Kim DH, et al. Therapeutic intervention of Ebola virus infection in rhesus macaques with the MB-003 monoclonal antibody cocktail. Sci Transl Med 2013; 5:199ra113.
  48. Qiu X, Wong G, Audet J, et al. Reversion of advanced Ebola virus disease in nonhuman primates with ZMapp. Nature 2014; 514:47.
  49. PREVAIL II Writing Group, Multi-National PREVAIL II Study Team. A Randomized, Controlled Trial of ZMapp for Ebola Virus Infection. N Engl J Med 2016; 375:1448.
  50. Madrid PB, Chopra S, Manger ID, et al. A systematic screen of FDA-approved drugs for inhibitors of biological threat agents. PLoS One 2013; 8:e60579.
  51. Gignoux E, Azman AS, de Smet M, et al. Effect of Artesunate-Amodiaquine on Mortality Related to Ebola Virus Disease. N Engl J Med 2016; 374:23.
  52. Warren TK, Shurtleff AC, Bavari S. Advanced morpholino oligomers: a novel approach to antiviral therapy. Antiviral Res 2012; 94:80.
  53. Iversen PL, Warren TK, Wells JB, et al. Discovery and early development of AVI-7537 and AVI-7288 for the treatment of Ebola virus and Marburg virus infections. Viruses 2012; 4:2806.
  54. Heald AE, Iversen PL, Saoud JB, et al. Safety and pharmacokinetic profiles of phosphorodiamidate morpholino oligomers with activity against ebola virus and marburg virus: results of two single-ascending-dose studies. Antimicrob Agents Chemother 2014; 58:6639.
  55. Sarepta Therapeutics. http://www.sarepta.com/ (Accessed on November 19, 2014).
  56. Taylor R, Kotian P, Warren T, et al. BCX4430 - A broad-spectrum antiviral adenosine nucleoside analog under development for the treatment of Ebola virus disease. J Infect Public Health 2016; 9:220.
  57. Warren TK, Wells J, Panchal RG, et al. Protection against filovirus diseases by a novel broad-spectrum nucleoside analogue BCX4430. Nature 2014; 508:402.
  58. Geisbert TW, Lee AC, Robbins M, et al. Postexposure protection of non-human primates against a lethal Ebola virus challenge with RNA interference: a proof-of-concept study. Lancet 2010; 375:1896.
  59. Geisbert TW, Hensley LE, Kagan E, et al. Postexposure protection of guinea pigs against a lethal ebola virus challenge is conferred by RNA interference. J Infect Dis 2006; 193:1650.
  60. Thi EP, Mire CE, Lee AC, et al. Lipid nanoparticle siRNA treatment of Ebola-virus-Makona-infected nonhuman primates. Nature 2015; 521:362.
  61. Jamieson DJ, Uyeki TM, Callaghan WM, et al. What obstetrician-gynecologists should know about Ebola: a perspective from the Centers for Disease Control and Prevention. Obstet Gynecol 2014; 124:1005.
  62. Mupapa K, Mukundu W, Bwaka MA, et al. Ebola hemorrhagic fever and pregnancy. J Infect Dis 1999; 179 Suppl 1:S11.
  63. Baggi FM, Taybi A, Kurth A, et al. Management of pregnant women infected with Ebola virus in a treatment centre in Guinea, June 2014. Euro Surveill 2014; 19.
  64. Centers for Disease Control and Prevention. Guidance for screening and caring for pregnant women with Ebola virus disease for healthcare providers in U.S. Hospitals http://www.cdc.gov/vhf/ebola/hcp/guidance-maternal-health.html (Accessed on November 13, 2014).
  65. The American College of Obstetricians and Gynecologists. Practice advisory: care of obstetric patients during an Ebola virus outbreak. http://www.acog.org/About-ACOG/News-Room/Statements-and-Advisories/2014/Care-of-Obstetric-Patients-During-an-Ebola-Virus-Outbreak (Accessed on November 13, 2014).
  66. Liddell AM, Davey RT Jr, Mehta AK, et al. Characteristics and Clinical Management of a Cluster of 3 Patients With Ebola Virus Disease, Including the First Domestically Acquired Cases in the United States. Ann Intern Med 2015; 163:81.
  67. Fitzpatrick G, Vogt F, Moi Gbabai OB, et al. The Contribution of Ebola Viral Load at Admission and Other Patient Characteristics to Mortality in a Médecins Sans Frontières Ebola Case Management Centre, Kailahun, Sierra Leone, June-October 2014. J Infect Dis 2015; 212:1752.
  68. WHO Ebola Response Team. Ebola Virus Disease among Male and Female Persons in West Africa. N Engl J Med 2016; 374:96.
  69. Sanchez A, Lukwiya M, Bausch D, et al. Analysis of human peripheral blood samples from fatal and nonfatal cases of Ebola (Sudan) hemorrhagic fever: cellular responses, virus load, and nitric oxide levels. J Virol 2004; 78:10370.
  70. Ksiazek TG, Rollin PE, Williams AJ, et al. Clinical virology of Ebola hemorrhagic fever (EHF): virus, virus antigen, and IgG and IgM antibody findings among EHF patients in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis 1999; 179 Suppl 1:S177.
  71. McElroy AK, Erickson BR, Flietstra TD, et al. Ebola hemorrhagic Fever: novel biomarker correlates of clinical outcome. J Infect Dis 2014; 210:558.
  72. McElroy AK, Erickson BR, Flietstra TD, et al. Biomarker correlates of survival in pediatric patients with Ebola virus disease. Emerg Infect Dis 2014; 20:1683.
  73. Sanchez A, Wagoner KE, Rollin PE. Sequence-based human leukocyte antigen-B typing of patients infected with Ebola virus in Uganda in 2000: identification of alleles associated with fatal and nonfatal disease outcomes. J Infect Dis 2007; 196 Suppl 2:S329.
  74. Rasmussen AL, Okumura A, Ferris MT, et al. Host genetic diversity enables Ebola hemorrhagic fever pathogenesis and resistance. Science 2014; 346:987.
  75. Centers for Disease Control and Prevention. Ebola virus disease information for clinicians in U.S. healthcare settings http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html (Accessed on October 17, 2014).
  76. World Health Organization.Laboratory guidance for the diagnosis of Ebola virus disease, interim recommendations. http://apps.who.int/iris/bitstream/10665/134009/1/WHO_EVD_GUIDANCE_LAB_14.1_eng.pdf (Accessed on October 03, 2014).
  77. O'Dempsey T, Khan SH, Bausch DG. Rethinking the discharge policy for Ebola convalescents in an accelerating epidemic. Am J Trop Med Hyg 2015; 92:238.
  78. Spengler JR, McElroy AK, Harmon JR, et al. Relationship Between Ebola Virus Real-Time Quantitative Polymerase Chain Reaction-Based Threshold Cycle Value and Virus Isolation From Human Plasma. J Infect Dis 2015; 212 Suppl 2:S346.
  79. World Health Organization (WHO). Clinical care for survivors of Ebola virus disease. http://apps.who.int/csr/resources/publications/ebola/ (Accessed on October 20, 2016).
  80. Centers for Disease Control and Prevention. Infection prevention and control recommendations for hospitalized patients with known or suspected Ebola hemorrhagic fever in U.S. hospitals. http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html (Accessed on October 21, 2014).
  81. World Health Organization. Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings. http://www.who.int/csr/resources/who-ipc-guidance-ebolafinal-09082014.pdf with Focus on Ebola (Accessed on October 21, 2014).
  82. Centers for Disease Control and Prevention. Safe management of patients with Ebola virus disease (EVD) in U.S. hospitals. http://www.cdc.gov/vhf/ebola/hcp/patient-management-us-hospitals.html (Accessed on October 22, 2014).
  83. Emory Healthcare Ebola preparedness protocols. http://www.emoryhealthcare.org/ebola-protocol/ehc-message.html (Accessed on October 21, 2014).
  84. Centers for Disease Control and Prevention. Guidance on personal protective equipment (PPE) to be used by healthcare workers during management of patients with confirmed Ebola or persons under investigation (PUIs) for Ebola who are clinically unstable or have bleeding, vomiting, or diarrhea in U.S. Hospitals, including procedures for donning and doffing PPE. http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html (Accessed on August 31, 2015).
  85. World Health Organization. personal protective equipment in the context of filovirus disease outbreak response. Rapid advice guideline. http://apps.who.int/iris/bitstream/10665/137410/1/WHO_EVD_Guidance_PPE_14.1_eng.pdf?ua=1 (Accessed on November 03, 2014).
  86. World Health Organization. Personal protective equipment in the context of filovirus disease outbreak response. Technical specifications for PPE equipment to be used by health workers providing clinical care for patients. http://apps.who.int/iris/bitstream/10665/137410/1/WHO_EVD_Guidance_PPE_14.1_eng.pdf?ua=1 (Accessed on November 03, 2014).
  87. Centers for Disease Control and Prevention. For US healthcare settings: donning and doffing personal protective equipment (PPE) for evaluating persons under investigation (PUIs) for Ebola who are clinically stable and do not have bleeding, vomiting, or diarrhea http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance-clinically-stable-puis.html (Accessed on August 31, 2015).
  88. Centers for Disease Control and Prevention. Interim guidance for healthcare workers providing care in West African countries affected by the Ebola outbreak: limiting heat burden while wearing personal protective equipment. http://www.cdc.gov/vhf/ebola/hcp/limiting-heat-burden.html (Accessed on October 21, 2014).
  89. Centers for Disease Control and Prevention. Prevent heat-related illness. http://www.cdc.gov/vhf/ebola/pdf/prevent-heat-related-illness.pdf (Accessed on October 21, 2014).
  90. Centers for Disease Control and Prevention. Interim guidance for management of survivors of Ebola virus disease in U.S. healthcare settings. http://www.cdc.gov/vhf/ebola/healthcare-us/evaluating-patients/guidance-for-management-of-survivors-ebola.html (Accessed on March 24, 2016).
  91. Akerlund E, Prescott J, Tampellini L. Shedding of Ebola Virus in an Asymptomatic Pregnant Woman. N Engl J Med 2015; 372:2467.
  92. Centers for Disease Control and Prevention. Interim guidance for environmental infection control in hospitals for Ebola virus. http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html (Accessed on October 09, 2014).
  93. Centers for Disease Control and Prevention. Ebola medical waste management. http://www.cdc.gov/vhf/ebola/hcp/medical-waste-management.html (Accessed on October 23, 2014).
  94. Centers for Disease Control and Prevention. For general healthcare settings in West Africa: safely cleaning and disinfecting areas used by patients with confirmed or suspected Ebola. http://www.cdc.gov/vhf/ebola/hcp/international/cleaning-up-safely.html (Accessed on December 01, 2014).
  95. Poliquin PG, Vogt F, Kasztura M, et al. Environmental Contamination and Persistence of Ebola Virus RNA in an Ebola Treatment Center. J Infect Dis 2016; 214:S145.
  96. Centers for Disease Control and Prevention. Interim Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure. http://www.cdc.gov/vhf/ebola/hcp/monitoring-and-movement-of-persons-with-exposure.html (Accessed on October 09, 2015).
  97. World Heatlh Organization: Travel and transport risk assessment: interim guidance for public health authorities and the transport sector. http://www.who.int/csr/resources/publications/ebola/travel-guidance/en/ (Accessed on October 23, 2014).
  98. Centers for Disease Control and Prevention. Recommendations for breastfeeding/infant feeding in the context of Ebola. http://www.cdc.gov/vhf/ebola/hcp/recommendations-breastfeeding-infant-feeding-ebola.html (Accessed on April 17, 2015).
  99. Vetter P, Fischer WA 2nd, Schibler M, et al. Ebola Virus Shedding and Transmission: Review of Current Evidence. J Infect Dis 2016; 214:S177.
  100. Martini GA. Marburg virus disease. Postgrad Med J 1973; 49:542.
  101. Christie A, Davies-Wayne GJ, Cordier-Lassalle T, et al. Possible sexual transmission of Ebola virus - Liberia, 2015. MMWR Morb Mortal Wkly Rep 2015; 64:479.
  102. Mate SE, Kugelman JR, Nyenswah TG, et al. Molecular Evidence of Sexual Transmission of Ebola Virus. N Engl J Med 2015; 373:2448.
  103. Diallo B, Sissoko D, Loman NJ, et al. Resurgence of Ebola Virus Disease in Guinea Linked to a Survivor With Virus Persistence in Seminal Fluid for More Than 500 Days. Clin Infect Dis 2016; 63:1353.
  104. World Health Organization. Sexual transmission of the Ebola Virus: evidence and knowledge gaps http://www.who.int/reproductivehealth/topics/rtis/ebola-virus-semen/en/ (Accessed on April 17, 2015).
  105. Centers for Disease Control. Transmission. http://www.cdc.gov/vhf/ebola/transmission/index.html (Accessed on April 24, 2015).
  106. Bausch DG, Towner JS, Dowell SF, et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J Infect Dis 2007; 196 Suppl 2:S142.
  107. Rodriguez LL, De Roo A, Guimard Y, et al. Persistence and genetic stability of Ebola virus during the outbreak in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis 1999; 179 Suppl 1:S170.
  108. Deen GF, Knust B, Broutet N, et al. Ebola RNA Persistence in Semen of Ebola Virus Disease Survivors - Preliminary Report. N Engl J Med 2015.
  109. Galvani AP, Ndeffo-Mbah ML, Wenzel N, Childs JE. Ebola vaccination: if not now, when? Ann Intern Med 2014; 161:749.
  110. Hampton T. Largest-ever outbreak of Ebola virus disease thrusts experimental therapies, vaccines into spotlight. JAMA 2014; 312:987.
  111. Levine MM, Tapia M, Hill AV, Sow SO. How the current West African Ebola virus disease epidemic is altering views on the need for vaccines and is galvanizing a global effort to field-test leading candidate vaccines. J Infect Dis 2015; 211:504.
  112. Hoenen T, Groseth A, Feldmann H. Current ebola vaccines. Expert Opin Biol Ther 2012; 12:859.
  113. Stanley DA, Honko AN, Asiedu C, et al. Chimpanzee adenovirus vaccine generates acute and durable protective immunity against ebolavirus challenge. Nat Med 2014; 20:1126.
  114. Martin JE, Sullivan NJ, Enama ME, et al. A DNA vaccine for Ebola virus is safe and immunogenic in a phase I clinical trial. Clin Vaccine Immunol 2006; 13:1267.
  115. Ledgerwood JE, Costner P, Desai N, et al. A replication defective recombinant Ad5 vaccine expressing Ebola virus GP is safe and immunogenic in healthy adults. Vaccine 2010; 29:304.
  116. Sarwar UN, Costner P, Enama ME, et al. Safety and immunogenicity of DNA vaccines encoding Ebolavirus and Marburgvirus wild-type glycoproteins in a phase I clinical trial. J Infect Dis 2015; 211:549.
  117. Ledgerwood JE, DeZure AD, Stanley DA, et al. Chimpanzee Adenovirus Vector Ebola Vaccine - Preliminary Report. N Engl J Med 2014.
  118. Ewer K, Rampling T, Venkatraman N, et al. A Monovalent Chimpanzee Adenovirus Ebola Vaccine Boosted with MVA. N Engl J Med 2016; 374:1635.
  119. Regules JA, Beigel JH, Paolino KM, et al. A Recombinant Vesicular Stomatitis Virus Ebola Vaccine - Preliminary Report. N Engl J Med 2015.
  120. Agnandji ST, Huttner A, Zinser ME, et al. Phase 1 Trials of rVSV Ebola Vaccine in Africa and Europe. N Engl J Med 2016; 374:1647.
  121. Milligan ID, Gibani MM, Sewell R, et al. Safety and Immunogenicity of Novel Adenovirus Type 26- and Modified Vaccinia Ankara-Vectored Ebola Vaccines: A Randomized Clinical Trial. JAMA 2016; 315:1610.
  122. Henao-Restrepo AM, Longini IM, Egger M, et al. Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomised trial. Lancet 2015; 386:857.
  123. Feldmann H, Jones SM, Daddario-DiCaprio KM, et al. Effective post-exposure treatment of Ebola infection. PLoS Pathog 2007; 3:e2.
  124. Marzi A, Hanley PW, Haddock E, et al. Efficacy of Vesicular Stomatitis Virus-Ebola Virus Postexposure Treatment in Rhesus Macaques Infected With Ebola Virus Makona. J Infect Dis 2016; 214:S360.
  125. Cnops L, Gerard M, Vandenberg O, et al. Risk of Misinterpretation of Ebola Virus PCR Results After rVSV ZEBOV-GP Vaccination. Clin Infect Dis 2015; 60:1725.
  126. Lai L, Davey R, Beck A, et al. Emergency postexposure vaccination with vesicular stomatitis virus-vectored Ebola vaccine after needlestick. JAMA 2015; 313:1249.
  127. World Health Organization. Ebola situation report-21 October 2015. http://apps.who.int/ebola/current-situation/ebola-situation-report-21-october-2015 (Accessed on October 23, 2015).
  128. Breman JG, Johnson KM. Ebola then and now. N Engl J Med 2014; 371:1663.
  129. Logan G, Vora NM, Nyensuah TG, et al. Establishment of a community care center for isolation and management of Ebola patients - Bomi County, Liberia, October 2014. MMWR Morb Mortal Wkly Rep 2014; 63:1010.
  130. Pillai SK, Nyenswah T, Rouse E, et al. Developing an incident management system to support Ebola response -- Liberia, July-August 2014. MMWR Morb Mortal Wkly Rep 2014; 63:930.
  131. Jeffs B, Roddy P, Weatherill D, et al. The Medecins Sans Frontieres intervention in the Marburg hemorrhagic fever epidemic, Uige, Angola, 2005. I. Lessons learned in the hospital. J Infect Dis 2007; 196 Suppl 2:S154.
  132. Roddy P, Weatherill D, Jeffs B, et al. The Medecins Sans Frontieres intervention in the Marburg hemorrhagic fever epidemic, Uige, Angola, 2005. II. lessons learned in the community. J Infect Dis 2007; 196 Suppl 2:S162.
  133. Fallah M, Dahn B, Nyenswah TG, et al. Interrupting Ebola Transmission in Liberia Through Community-Based Initiatives. Ann Intern Med 2016; 164:367.
  134. Cancedda C, Davis SM, Dierberg KL, et al. Strengthening Health Systems While Responding to a Health Crisis: Lessons Learned by a Nongovernmental Organization During the Ebola Virus Disease Epidemic in Sierra Leone. J Infect Dis 2016; 214:S153.
  135. Frieden TR, Damon I, Bell BP, et al. Ebola 2014--new challenges, new global response and responsibility. N Engl J Med 2014; 371:1177.
  136. Boumandouki P, Formenty P, Epelboin A, et al. [Clinical management of patients and deceased during the Ebola outbreak from October to December 2003 in Republic of Congo]. Bull Soc Pathol Exot 2005; 98:218.
  137. Hewlett BL, Hewlett BS. Providing care and facing death: nursing during Ebola outbreaks in central Africa. J Transcult Nurs 2005; 16:289.
  138. Hewlett BS, Amola RP. Cultural contexts of Ebola in northern Uganda. Emerg Infect Dis 2003; 9:1242.
  139. World Health Organization. Statement on the meeting of the International Health Regulations Emergency Committee regarding the 2014 Ebola outbreak in West Africa http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/ (Accessed on August 15, 2014).
  140. World Health Organization. Statement on the second meeting of the International Health Regulations Emergency Committee regarding the 2014 Ebola outbreak in west Africa. http://www.who.int/mediacentre/news/statements/2014/ebola-2nd-ihr-meeting/en/ (Accessed on September 23, 2014).
  141. Gostin LO, Lucey D, Phelan A. The Ebola epidemic: a global health emergency. JAMA 2014; 312:1095.
  142. Briand S, Bertherat E, Cox P, et al. The international Ebola emergency. N Engl J Med 2014; 371:1180.
  143. World Health Oganizations. WHO welcomes decision to establish United Nations Mission for Ebola Emergency Response. http://www.who.int/mediacentre/news/releases/2014/ebola-emergency-response/en/ (Accessed on September 23, 2014).
  144. Centers for Disease Control. CDC announces active post-arrival monitoring for travelers from impacted countries http://www.cdc.gov/media/releases/2014/p1022-post-arrival-monitoring.html (Accessed on October 23, 2014).
  145. Washington ML, Meltzer ML, Centers for Disease Control and Prevention (CDC). Effectiveness of Ebola treatment units and community care centers - Liberia, September 23-October 31, 2014. MMWR Morb Mortal Wkly Rep 2015; 64:67.
  146. Kortepeter MG, Kwon EH, Hewlett AL, et al. Containment Care Units for Managing Patients With Highly Hazardous Infectious Diseases: A Concept Whose Time Has Come. J Infect Dis 2016; 214:S137.