Ebola Virus Disease

The largest recorded outbreak of EVD occurred in 2014. Starting in West Africa, many countries worldwide were affected by the outbreak, including the United States. Several U.S. citizens contracted Ebola, became symptomatic while in Africa, and were transported back to the United States for care. One individual died; the rest recovered and are now Ebola free. There have been no active U.S. cases of Ebola since 2014. More recently, an outbreak of Ebola (Sudan virus) was confirmed in western Uganda on Sept. 20, 2022. The U.S. Centers for Disease Control and Prevention (CDC) provided support to the Ugandan Ministry of Health to control the outbreak.

EVD is a disease caused by infection with one of the Ebola virus strains and it typically affects people and nonhuman primates including monkeys, gorillas, and chimpanzees. Ebola viruses are found primarily in sub-Saharan African countries. It was first discovered in 1976 near the Ebola River in the Democratic Republic of the Congo. Since then, outbreaks have appeared in multiple African countries.

Researchers do not know where Ebola comes from, but based on evidence and the nature of similar viruses, they believe the virus is animal-borne and that bats or non-human primates are the most likely reservoir.

Signs and Symptoms of EVD

Symptoms may begin between 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days. Infected individuals may have the following symptoms:

• Fever
• Severe headache
• Muscle and joint pain
• Weakness and fatigue
• Sore throat
• Loss of appetite
• Diarrhea, vomiting and abdominal (stomach) pain
• Unexplained hemorrhaging, bleeding or bruising

Transmission

When an infection occurs in humans, the virus can spread to others in several ways. Ebola spreads through direct contact (via broken skin or mucous membranes) with:

• Blood or body fluids (including but not limited to urine, saliva, feces, vomit and semen) of a person who is sick with or who has died from EVD
• Objects that have been contaminated with the virus (like needles and syringes)
• Infected animals (by contact with blood or infected meat from wild primates or bats—this has only occurred in Africa)
• Semen from a man who has recovered from EVD (this includes through vaginal, oral or anal sex); this is because the virus can remain in certain bodily fluids of a patient who has recovered from EVD, even if they are symptom free
  Note: There is no evidence that Ebola viruses can spread through contact with vaginal fluids from a woman who has been infected with Ebola.

Ebola is not spread through air, water, or in general, food (except in cases where people eat wild animals). Similarly, there is no evidence that mosquitos or other insects can transmit Ebola virus.

Diagnosis

EVD symptoms, such as headache, fever and fatigue are common symptoms of many illnesses—and this can make early diagnosis difficult. When considering EVD as a diagnosis, a doctor will look for a combination of EVD symptoms and opportunities for potential exposure within 21 days before symptoms start.

An exposure includes coming into contact with the following:

• Blood or bodily fluids with a person who has or who died from EVD
• Objects contaminated with bodily fluids or blood from a person with or who died from EVD
• Infected nonhuman primates or fruit bats
• Semen from a man who has recovered from EVD

A person who has been exposed to EVD and is showing symptoms should isolate from others and public health should be notified. EVD can be detected in the blood of a person infected with EVD, so blood samples will need to be taken. Ebola virus can show up in a person’s blood after symptoms start—sometimes taking up to three days to reach detectable levels. A polymerase chain reaction (PCR) test is the most commonly used test to detect Ebola virus particles.

Treatment

The U.S. Food and Drug Administration (FDA) has approved two treatments for use in treating EVD caused by the Zaire ebolavirus species in adults and children. Both approved in 2020, these drugs are the monoclonal antibody treatments Inmazeb and Ebanga. Inmazeb combines three monoclonal antibodies, and Ebanga contains one. Monoclonal antibodies are lab-produced proteins that work in the same way as your natural antibodies to help fight off infections. The treatments listed here work to prevent the Ebola virus from replicating.

Care

In the absence of or in addition to treatments for Ebola virus, other steps can be taken to care for a person who is sick and improve their chances of survival. Care recommendations for individuals sick with Ebola include the following:

• Providing fluids and electrolytes (body salts) orally or intravenously (in the veins)
• Treating any other infections that occur
• Using medication to reduce vomiting and diarrhea, manage fever and pain and support blood pressure

Recovery from Ebola depends on the care a patient receives and the patient’s immune response. Once someone recovers from Ebola, they can no longer spread the virus. People who recover from Ebola infection develop antibodies that last for at least 10 years. People who have had Ebola are believed to have some protection from future infection with the type of Ebola that they had previously.

Ebola virus persistence in the body

After acute infection, Ebola viruses can stay in certain areas of the body where the individual’s immune system cannot clear them. These areas include the testes, interior of the eyes, placenta, and central nervous system—particularly the cerebrospinal fluid. Because of this, Ebola viruses can persist in bodily fluids including semen, breast milk, ocular fluid and spinal column fluid for a period of time after recovery. Ebola virus has been found in semen for up to 12 months. All Ebola survivors and their sexual partners should receive counseling to ensure safer sexual practices until their semen has twice tested negative.

Complications

While reinfection with Ebola is unlikely, many Ebola survivors experience health issues after their initial recovery, including the following:

• Tiredness
• Headaches
• Muscle and joint pain
• Eye and vision problems such as blurry vision, pain, redness and light sensitivity
• Weight gain
• Stomach pain or loss of appetite

Other additional health concerns have been associated with Ebola virus survivors. See a full list on the CDC website.

Risk of Exposure

Ebola is not spread through casual contact, so the risk of an outbreak in the United States is very low. Healthcare providers treating Ebola patients, as well as family and friends in close contact with Ebola patients, are at the highest risk of getting sick because they may encounter infected blood or bodily fluids. Similarly, travelers to locations where Ebola is circulating are not at high risk of exposure unless they have cared for or been in close contact (within three feet) of someone sick with Ebola.

At this time, Ebola poses no substantial risk to the general U.S. population. There have been no active cases of Ebola in the United States since 2014. Health officials know that Ebola causes public concern, and U.S. public health agencies continue to monitor the situation abroad and contact travelers arriving from locations where Ebola is circulating.

Is there danger of Ebola spreading in Spokane County?

Ebola does not naturally occur in the United States and there have been no active travel-related cases since 2014. Health officials, including those in Spokane County, know how to stop Ebola’s spread. Their methods include:

• Searching for at-risk people and isolating ill people
• Contacting people exposed to ill individuals
• Isolating those who have encountered ill individuals if they develop symptoms

Here in Spokane County, Providence Sacred Heart Medical Center’s Special Pathogens Unit (SPU) is one of a small number of units nationwide that are uniquely equipped to isolate and care for patients suspected to have EVD throughout the course of the illness. Health officials, medical staff and emergency medical services constantly train and plan for the possibility that an Ebola-infected patient could arrive at a Spokane County medical facility.

Is there danger of Ebola spreading widely in the United States?

In 2014, four cases were diagnosed in the United States. One was a person who was infected in Liberia who didn’t have any symptoms until several days after arriving in Dallas. The individual later died. Two others were healthcare workers who encountered the original patient and tested positive. They were treated and eventually cleared the virus. The fourth case was a medical aid worker who returned to New York City from Guinea, where he served with Doctors Without Borders. That individual also made a full recovery.

Several other U.S. citizens became sick with Ebola while in Africa, started showing symptoms, and were transported to the United States for care. Infection control procedures were followed during the patients’ transport to prevent the disease from being transmitted to others. One of these patients died after returning to the United States.

All other cases of human illness or death from Ebola occurred outside the United States, mostly in countries in Africa.

Are people who are on planes with suspected patients at risk?

A person must have symptoms to spread Ebola to others. If an ill person shows symptoms of Ebola during a flight, CDC will recommend monitoring other passengers for signs of infection.

Prevention

Ebola vaccine rVSV-ZEBOV, marketed as Ervebo®, was the first vaccine approved by the Food and Drug Administration (FDA) for the prevention of Ebola. This single-dose vaccine provides protection from Zaire ebolavirus, which has caused the largest and most deadly outbreaks.

rVSV-ZEBOV was later recommended by the Advisory Committee on Immunization Practices (ACIP) for use in pre-exposure prophylaxis vaccination for adults 18 and older in the United States who are at risk for occupational exposure to Zaire ebolavirus, including the following:

• Individuals responding or planning to respond to an EVD outbreak
• Laboratory staff working at biosafety-level 4 facilities that work with live Ebola virus in the United States
• Healthcare personnel working at federally designated Ebola Treatment Centers

Ervebo® has also received approvals and recommendations from other countries and agencies, including the WHO, worldwide. While Ervebo® is approved for use in the prevention of Zaire ebolavirus and, according to the CDC, it does not provide protection from the Sudan ebolavirus, which was responsible for the 2022 Ebola outbreak in Uganda.

Another vaccine, Johnson & Johnson/Bavarian Nordic’s two-dose vaccine regimen, Zabdeno® (Ad26.ZEBOV) and Mvabea® (MVA-BN-Filo), has also received a recommendation from the European Medicines Agency (EMA) for marketing authorization in the European Union for individuals ages 1 year and older and provides protection from the Zaire ebolavirus.

However, other vaccines that are not yet approved are being investigated for their effectiveness against the Sudan ebolavirus.

Learn more

Travel

If a person travels to or is in an area affected by an Ebola outbreak, they should do the following:

• Practice careful hygiene. Avoid contact with blood and bodily fluids.
• Do not handle items that may be contaminated by an infected person’s blood or bodily fluids.
• Avoid funeral or burial rituals that require handling the body of someone who has died from Ebola.
• Avoid contact with bats and nonhuman primates or blood, fluids and raw meat prepared from these animals.
• Avoid hospitals where Ebola patients are being treated. The U.S. embassy or consulate may provide advice on facilities.
• After returning to Spokane, contact Spokane Regional Health District at 509.324.1442. Staff will assist individuals in monitoring their health for 21 days and provide guidance on how to seek medical care if Ebola symptoms develop.

Visit the CDC Travel Center for more information about current travel health notices pertaining to Ebola and other emerging concerns.

During Travel

CDC works with international public health organizations, federal agencies, and the travel industry to identify sick travelers arriving in the United States and take public health actions to prevent the spread of communicable diseases. Airlines are required to report any onboard deaths or ill travelers meeting certain criteria to CDC before arriving in the United States. If an ill traveler landed in Spokane County, Spokane Regional Health District would work with CDC and other partners to determine whether any public health action is needed.

If a traveler is infectious or exhibiting symptoms during or after a flight, CDC investigates exposed travelers and works with Spokane Regional Health District, the airline, federal partners and the state health department to notify them and take any necessary public health action.

In the United States

CDC’s Division of Global Migration and Quarantine (DGMQ) prevents the importation and spread of infectious diseases into the United States. DGMQ medical and public health officers work within 20 quarantine stations located at the busiest U.S. international airports, land borders, and seaports, and provide coverage for 300 ports of entry throughout the United States.

Quarantine stations respond to sick travelers arriving in the United States; restrict the importation of animals and products that may carry diseases; support hospitals caring for patients with diseases such as malaria, botulism, or diphtheria by sending medications and treatments; notify travelers at airports about disease outbreaks abroad and provide steps they can take to protect themselves and others.

When returning to the United States from an area where an outbreak is occurring

Contact Spokane Regional Health District at 509.324.1442 for information about monitoring. This is especially important for those who:

• Were in an area with an Ebola outbreak, particularly if there was contact with blood, bodily fluids or items contaminated by blood or bodily fluids
• Visited a hospital or clinic where Ebola patients were being treated or participated in burial rituals/practices
• Had contact with wild animals or raw meat

Seek medical care immediately if a fever (temperature of 100.4°F/ 38.0°C) develops along with any of the following symptoms: headache, muscle pain, diarrhea, vomiting, stomach pain or unexplained bruising or bleeding.

Call a doctor before going to the office or emergency room and tell them about recent travel and symptoms. This information is important because it helps the doctor provide care to those who are ill and protect other people who are in the same medical setting.

According to the CDC's "2014-2016 Ebola Outbreak in West Africa" report, there have been only four cases of Ebola diagnosed in the United States.