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Treatment and prevention 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: Ebolavirus and Marburgvirus, which are among the most virulent pathogens of humans [1-3], and Cuevavirus, which has to date only been detected as viral RNA in bats in Spain [4]. The Zaire species of Ebolavirus was the causative agent of the 2014-2016 epidemic in West Africa [5], where there were nearly 29,000 total cases (suspected, probable, or confirmed), of which more than 15,000 were laboratory-confirmed. During this epidemic, there were approximately 11,000 deaths [6]; based on the total estimated case count, the overall case fatality rate was approximately 40 percent. In earlier outbreaks in Central Africa caused by the same virus species, case fatality rates reached 80 to 90 percent.

Outbreaks of Ebola virus disease appear to begin when a human comes into contact with an infected animal or its body fluids. Subsequent person-to-person transmission is based on direct physical contact with the body fluids of a living or deceased 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 begin to 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".)

The experience of the 2014-2016 West African epidemic indicates that the mortality associated with Ebola virus disease may be reduced through adequate supportive care. 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.


Approach to therapy — All health care workers involved in the care of patients with suspected or confirmed Ebola virus disease should use infection control precautions, including the proper use of personal protective equipment. (see 'Infection control precautions during acute illness' below)


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Literature review current through: Apr 2017. | This topic last updated: May 11, 2017.
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