Ebola Hemorrhagic Fever: What You Need to Know

What is Ebola hemorrhagic fever?
Ebola hemorrhagic fever [Ebola HF] is a severe, often-fatal disease in humans and nonhuman primates [monkeys, gorillas, and chimpanzees] that has appeared sporadically since its initial recognition in 1976.

Treating patients with Ebola HF during outbreak of the disease in Kikwit, Democratic Republic of the Congo, in 1995.

Where is Ebola virus found in nature?
The exact origin, locations, and natural habitat [known as the "natural reservoir"] of Ebola virus remain unknown. However, on the basis of available evidence and the nature of similar viruses, researchers believe that the virus is zoonotic [animal-borne] and is normally maintained in an animal host that is native to the African continent. A similar host is probably associated with Ebola-Reston which was isolated from infected cynomolgous monkeys that were imported to the United States and Italy from the Philippines. The virus is not known to be native to other continents, such as North America.

Where do cases of Ebola hemorrhagic fever occur?
Confirmed cases of Ebola HF have been reported in the Democratic Republic of the Congo, Gabon, Sudan, the Ivory Coast, Uganda, and the Republic of the Congo. An individual with serologic evidence of infection but showing no apparent illness has been reported in Liberia, and a laboratory worker in England became ill as a result of an accidental needle-stick. No case of the disease in humans has ever been reported in the United States. Ebola-Reston virus caused severe illness and death in monkeys imported to research facilities in the United States and Italy from the Philippines; during these outbreaks, several research workers became infected with the virus, but did not become ill.

Ebola HF typically appears in sporadic outbreaks, usually spread within a health-care setting [a situation known as amplification]. It is likely that sporadic, isolated cases occur as well, but go unrecognized.

How is Ebola virus spread?
Infections with Ebola virus are acute. There is no carrier state. Because the natural reservoir of the virus is unknown, the manner in which the virus first appears in a human at the start of an outbreak has not been determined. However, researchers have hypothesized that the first patient becomes infected through contact with an infected animal.

After the first case-patient in an outbreak setting is infected, the virus can be transmitted in several ways. People can be exposed to Ebola virus from direct contact with the blood and/or secretions of an infected person. Thus, the virus is often spread through families and friends because they come in close contact with such secretions when caring for infected persons. People can also be exposed to Ebola virus through contact with objects, such as needles, that have been contaminated with infected secretions.

Nosocomial transmission refers to the spread of a disease within a health-care setting, such as a clinic or hospital. It occurs frequently during Ebola HF outbreaks. It includes both types of transmission described above. In African health-care facilities, patients are often cared for without the use of a mask, gown, or gloves. Exposure to the virus has occurred when health care workers treated individuals with Ebola HF without wearing these types of protective clothing. In addition, when needles or syringes are used, they may not be of the disposable type, or may not have been sterilized, but only rinsed before reinsertion into multi-use vials of medicine. If needles or syringes become contaminated with virus and are then reused, numerous people can become infected.
Ebola-Reston appeared in a primate research facility in Virginia, where it may have been transmitted from monkey to monkey through the air. While all Ebola virus species have displayed the ability to be spread through airborne particles [aerosols] under research conditions, this type of spread has not been documented among humans in a real-world setting, such as a hospital or household.

What are the symptoms of Ebola hemorrhagic fever?
The incubation period for Ebola HF ranges from 2 to 21 days. The onset of illness is abrupt and is characterized by fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. A rash, red eyes, hiccups and internal and external bleeding may be seen in some patients.

Researchers do not understand why some people are able to recover from Ebola HF and others are not. However, it is known that patients who die usually have not developed a significant immune response to the virus at the time of death.
How is Ebola hemorrhagic fever clinically diagnosed?
Diagnosing Ebola HF in an individual who has been infected only a few days is difficult because early symptoms, such as red eyes and a skin rash, are nonspecific to the virus and are seen in other patients with diseases that occur much more frequently. However, if a person has the constellation of symptoms described above, and infection with Ebola virus is suspected, isolate the patient and notify local and state health departments and the CDC.

What laboratory tests are used to diagnose Ebola hemorrhagic fever?
Antigen-capture enzyme-linked immunosorbent assay [ELISA] testing, IgM ELISA, polymerase chain reaction [PCR], and virus isolation can be used to diagnose a case of Ebola HF within a few days of the onset of symptoms. Persons tested later in the course of the disease or after recovery can be tested for IgM and IgG antibodies; the disease can also be diagnosed retrospectively in deceased patients by using immunohistochemistry testing, virus isolation, or PCR.

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