Ebola is one of the world’s deadliest diseases.

It is a highly infectious virus that can kill up to 90 percent of the people who catch it, causing terror among infected communities.

Ebola is so infectious that patients need to be treated in isolation by staff wearing protective clothing.

Spotlight: Democratic Republic of Congo

On 1 June 2020, a new Ebola outbreak was declared in Équateur province, western Democratic Republic of Congo (DRC), the country’s eleventh recorded epidemic.

Declared while DRC was still grappling with the tenth Ebola epidemic in the country’s northeast, and amidst the COVID-19 pandemic, this new Ebola outbreak has already spread to 11 health zones in the province, in a very hard-to-reach region where some villages are only accessible by river.

While the response to this new Ebola epidemic does not face the kind of security challenges that affected the response to the tenth Ebola outbreak between August 2018 and June 2020, the area nevertheless poses significant logistical challenges.

Équateur province is five times the size of Wales, with some health areas only accessible by river using canoes or after hours of difficult transport by rough roads through the forest. Only one helicopter is available to humanitarian organisations to move around the region.

As of 1 September 2020, MSF teams are supporting nine treatment and isolation centres in five health zones to provide care as close as possible to the active hotspots of the disease.

As of 2 September, a total of 110 Ebola cases had been recorded in Équateur province – 104 confirmed, six probable – with 47 deaths.

West Africa Ebola outbreak, 2014-16

The Ebola outbreak in West Africa killed 11,315 people after being officially declared on 22 March 2014 in Guinea.

During the Ebola emergency, 28 of our staff members caught Ebola. Fourteen recovered but 14 died. The vast majority of these infections were found to have occurred in the community.

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Ebola management: interactive guides

Ebola history

The Ebola virus was first associated with an outbreak of 318 cases of a haemorrhagic disease in Zaire (now the Democratic Republic of Congo [DRC]) in 1976. Of the 318 cases, 280 died — and died quickly.

That same year, 284 people in Sudan also became infected with the virus, killing 156.

There are five different strains of the Ebola virus: Bundibugyo, Ivory Coast, Reston, Sudan and Zaire, named after their places of origin.

Four of these five have caused disease in humans. While the Reston virus can infect humans, no illnesses or deaths have been reported.

Before the 2014 outbreak, MSF had treated hundreds of people affected by Ebola in Uganda, Republic of Congo, DRC, Sudan, Gabon and Guinea.

In 2007, MSF entirely contained an epidemic of Ebola in Uganda by placing a control area around the treatment centre.

What causes Ebola?

Ebola can be caught from both humans and animals. It is transmitted through close contact with blood, secretions, or other bodily fluids.

Healthcare workers have frequently been infected while treating Ebola patients. This has occurred through close contact without the use of gloves, masks or protective goggles.

In areas of Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found dead or ill in the rainforest.

Burials where mourners have direct contact with the deceased can also transmit the virus, whereas transmission through infected semen can occur up to seven weeks after clinical recovery.

Hear more stories from our staff on the MSF podcast, Everyday Emergency

Symptoms of Ebola

Early on, symptoms are non-specific, making it difficult to diagnose.

The disease is often characterised by the sudden onset of fever, feeling weak, muscle pain, headaches and a sore throat. This is followed by vomiting, diarrhoea, rashes, impaired kidney and liver function and, in some cases, internal and external bleeding.

Symptoms can appear from two to 21 days after exposure. Some patients may go on to experience rashes, red eyes, hiccups, chest pains, difficulty breathing and swallowing.

MSF UK doctor Javid Abdelmoneim reflects on his time battling Ebola in Sierra Leone in this powerful and painful TEDxAthens talk

Diagnosing Ebola

Diagnosing Ebola is difficult because the early symptoms, such as red eyes and rashes, are common.

Ebola infections can only be diagnosed definitively in the laboratory by five different tests.

Such tests are an extreme biohazard risk and should be conducted under maximum biological containment conditions. A number of human-to-human transmissions have occurred due to a lack of protective clothing.

“Health workers are particularly susceptible to catching it so, along with treating patients, one of our main priorities is training health staff to reduce the risk of them catching the disease whilst caring for patients,” said Henry Gray, MSF’s emergency coordinator, during an Ebola outbreak in Uganda in 2012. Henry also worked on the 2014 outbreak.

“We have to put in place extremely rigorous safety procedures to ensure that no health workers are exposed to the virus – through contaminated material from patients or medical waste infected with Ebola.”

Treating Ebola

When a person has Ebola, medical teams can help to manage the symptoms of the virus – for example by keeping patients hydrated, and by using medication to help with pain, fever and blood pressure.

A patient who recovers from Ebola is immune to the strain of the virus they contracted.

An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.

Is there a vaccine for Ebola?

There are currently two trial vaccines for Ebola.

The Merck vaccine is estimated to offer effective protection for 97.5 percent of participants 10 days after vaccination.

This vaccine is already in use in DRC, but due to limited availability and the fact that its still being trialled, it's currently only offered to the people most at risk. That means frontline health workers and people who have been in contact with someone who has (or probably has) Ebola.

However, tracing people who have been in contact with Ebola patients is notoriously difficult in DRC, and MSF supports recommendations to expand vaccination activities to cover the entire population that is at risk.

A second experimental vaccine, produced by Johnson & Johnson, has been given the green light in DRC as part of an extended clinical trial. MSF is part of the global consortium leading the rollout.