(disambiguation). Ebola virus disease (EVD), Ebola hemorrhagic fever (EHF) or simply Ebola is a disease of humans and other primates caused by an ebolavirus. Symptoms start two days to three weeks after contracting the virus, with a fever, sore throat, muscle pain and headaches. Typically, vomiting, diarrhea and rash follow, along with decreased function of the liver and kidneys. Around this time, af- fected people may begin to bleed both within the body and externally. [1] The virus may be acquired upon contact with blood or other bodily uids of an infected human or other animal. [1] Spreading through the air has not been docu- mented in the natural environment. [2] Fruit bats are be- lieved to be a carrier and may spread the virus without being aected. Once human infection occurs, the dis- ease may spread between people as well. Male survivors may be able to transmit the disease via semen for nearly two months. To diagnose EVD, other diseases with sim- ilar symptoms such as malaria, cholera and other viral hemorrhagic fevers are rst excluded. Blood samples are tested for viral antibodies, viral RNA, or the virus itself to conrm the diagnosis. [1] Outbreak control requires community engagement, case management, surveillance and contact tracing, appropri- ate laboratory service, and proper disposal of remains through cremation or burial. [1][3] Prevention includes de- creasing the spread of disease from infected animals to humans. This may be done by checking such animals for infection and killing and properly disposing of the bodies if the disease is discovered. Properly cooking meat and wearing protective clothing when handling meat may also be helpful, as are wearing protective clothing and washing hands when around a person with the disease. Samples of bodily uids and tissues from people with the disease should be handled with special caution. [1] No specic treatment for the disease is yet available. [1] Eorts to help those who are infected are supportive and include giving either oral rehydration therapy (slightly sweet and salty water to drink) or intravenous uids. [1] This supportive care improves outcomes. [1] The disease has a high risk of death, killing between 25% and 90% of those infected with the virus (average is 50%). [1] EVD was rst identied in an area of Sudan that is now part of South Sudan, as well as in Zaire (now the Democratic Republic of the Congo). The disease typically occurs in outbreaks in tropical regions of sub-Saharan Africa. [1] From 1976 (when it was rst identied) through 2013, the World Health Organization reported a total of 1,716 cases. [1][4] The largest outbreak to date is the ongoing 2014 West African Ebola outbreak, which is aecting Guinea, Sierra Leone, Liberia, and Nigeria. [5][6] As of 3 October 2014, 7,497 suspected cases resulting in the deaths of 3,439 have been reported. [7] Eorts are under way to develop a vaccine; however, none yet exists. [1] 1 Signs and symptoms Signs and symptoms of Ebola. [8] Signs and symptoms of Ebola virus disease (EVD) usually begin suddenly with an inuenza-like stage characterized by fatigue, fever, headaches, and pain in the joints, mus- cles, and abdomen. [9][10] Vomiting, diarrhea, and loss of appetite are also common. [10] Less common symptoms include the following: sore throat, chest pain, hiccups, shortness of breath, and trouble swallowing. [10] The aver- age time between contracting the infection and the start of symptoms (incubation period) is 8 to 10 days, but it can vary between 2 and 21 days. [10][11] Skin manifesta- tions may include a maculopapular rash (in about 50% of cases). [12] Early symptoms of EVD may be similar to those of malaria, dengue fever, or other tropical fevers, before the disease progresses to the bleeding phase. [9] In 4050% of cases, bleeding from puncture sites and 1 2 2 CAUSES mucous membranes (e.g., gastrointestinal tract, nose, vagina, and gums) has been reported. [13] In the bleeding phase, which typically begins ve to seven days after rst symptoms, [14] internal and subcutaneous bleeding may present itself in the form of reddened eyes and bloody vomit. [9] Bleeding into the skin may create petechiae, purpura, ecchymoses, and hematomas (especially around needle injection sites). [15] Suerers may cough up blood, vomit it, or excrete it in their stool. [16] Heavy bleeding is rare and is usually conned to the gas- trointestinal tract. [12][17] In general, the development of bleeding symptoms often indicates a worse prognosis and this blood loss can result in death. [9] All people infected show some signs of circulatory system involvement, in- cluding impaired blood clotting. [12] If the infected person does not recover, death due to multiple organ dysfunction syndrome occurs within 7 to 16 days (usually between days 8 and 9) after rst symptoms. [14] 2 Causes Main articles: Ebolavirus (taxonomic group) and Ebola virus (specic virus) EVD is caused by four of ve viruses classied Life cycles of the Ebolavirus in the genus Ebolavirus, family Filoviridae, order Mononegavirales. The four disease-causing viruses are Bundibugyo virus (BDBV), Sudan virus (SUDV), Ta Forest virus (TAFV), and one called, simply, Ebola virus (EBOV, formerly Zaire Ebola virus). Ebola virus is the sole member of the Zaire ebolavirus species and the most dangerous of the known EVD-causing viruses, as well as being responsible for the largest number of outbreaks. [18] The fth virus, Reston virus (RESTV), is not thought to be disease-causing in humans. These ve viruses are closely related to marburgviruses. 2.1 Transmission Human-to-human transmission can occur via direct con- tact with blood or body uid from an infected person (including embalming of an infected dead person) or by contact with objects contaminated by the virus, particu- larly needles and syringes. [19] Other body uids that may transmit ebolaviruses include saliva, mucus, vomit, fe- ces, sweat, tears, breast milk, urine, and semen. Entry points include the nose, mouth, eyes, or open wounds, cuts and abrasions. [20] The potential for widespread EVD infections is considered low as the disease is only spread by direct contact with the secretions from someone who is showing signs of infection. [19] The symptoms limit a persons ability to spread the disease as they are often too sick to travel. [21] Because dead bodies are still in- fectious, traditional burial rituals may spread the disease. Nearly two thirds of the cases of Ebola in Guinea dur- ing the 2014 outbreak are believed to be due to burial practices. [22][23] Semen may be infectious in survivors for up to 7 weeks. [1] It is not entirely clear how an outbreak is initially started. [24] The initial infection is believed to occur after an ebolavirus is transmitted to a human by contact with an infected animals body uids. One of the primary reasons for spread is that the health systems in the part of Africa where the disease occurs function poorly. [25] Medical workers who do not wear ap- propriate protective clothing may contract the disease. [26] Hospital-acquired transmission has occurred in African countries due to the reuse of needles and lack of universal precautions. [27][28] Some healthcare centers caring for people with the disease do not have running water. [29] Airborne transmission has not been documented dur- ing EVD outbreaks. [2] They are, however, infectious as breathable 0.81.2 m laboratory-generated droplets. [30] The virus has been shown to travel, without contact, from pigs to primates, although the same study failed to demonstrate similar transmission between non-human primates. [31] Bats drop partially eaten fruits and pulp, then land mam- mals such as gorillas and duikers feed on these fallen fruits. This chain of events forms a possible indirect means of transmission from the natural host to animal populations, which has led to research towards viral shed- ding in the saliva of bats. Fruit production, animal behav- ior, and other factors vary at dierent times and places that may trigger outbreaks among animal populations. [32] 2.2 Reservoir Bats are considered the most likely natural reservoir of EBOV. Plants, arthropods, and birds were also considered. [1][34] Bats were known to reside in the cotton factory in which the rst cases for the 1976 and 1979 out- breaks were observed, and they have also been implicated in Marburg virus infections in 1975 and 1980. [35] Of 24 plant species and 19 vertebrate species experimentally inoculated with EBOV, only bats became infected. [36] The absence of clinical signs in these bats is character- istic of a reservoir species. In a 20022003 survey of 2.3 Virology 3 Bushmeat being prepared for cooking in Ghana, 2013. Human consumption of equatorial animals in Africa in the formof bush- meat has been linked to the transmission of diseases to people, including Ebola. [33] 1,030 animals including 679 bats from Gabon and the Republic of the Congo, 13 fruit bats were found to contain EBOV RNA fragments. [37] As of 2005, three types of fruit bats (Hypsignathus monstrosus, Epomops franqueti, and Myonycteris torquata) have been identied as being in contact with EBOV. They are now suspected to repre- sent the EBOV reservoir hosts. [38][39] Antibodies against Zaire and Reston viruses have been found in fruit bats in Bangladesh, thus identifying potential virus hosts and signs of the loviruses in Asia. [40] Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians and arthropods sampled from out- break regions, no Ebola virus was detected apart from some genetic traces found in six rodents (Mus setulo- sus and Praomys) and one shrew (Sylvisorex ollula) col- lected from the Central African Republic. [35][41] Traces of EBOV were detected in the carcasses of gorillas and chimpanzees during outbreaks in 2001 and 2003, which later became the source of human infections. However, the high lethality from infection in these species makes them unlikely as a natural reservoir. [35] Transmission between natural reservoir and humans is rare, and outbreaks are usually traceable to a single case where an individual has handled the carcass of gorilla, chimpanzee or duiker. [42] Fruit bats are also eaten by peo- ple in parts of West Africa where they are smoked, grilled or made into a spicy soup. [39][43] 2.3 Virology Main articles: Ebolavirus (taxonomic group) and Ebola virus (specic virus) Electron micrograph of an Ebola virus virion 2.3.1 Genome Like all mononegaviruses, ebolavirions contain lin- ear nonsegmented, single-strand, non-infectious RNA genomes of negative polarity that possesses inverse- complementary 3' and 5' termini, do not possess a 5' cap, are not polyadenylated, and are not covalently linked to a protein. [44] Ebolavirus genomes are ap- proximately 19 kilobase pairs long and contain seven genes in the order 3'-UTR-NP-VP35-VP40-GP-VP30- VP24-L-5'-UTR. [45] The genomes of the ve dier- ent ebolaviruses (BDBV, EBOV, RESTV, SUDV, and TAFV) dier in sequence and the number and location of gene overlaps. 2.3.2 Structure Like all loviruses, ebolavirions are lamentous particles that may appear in the shape of a shepherds crook or in the shape of a U or a 6, and they may be coiled, toroid, or branched. [45] In general, ebolavirions are 80 nm in width, but vary somewhat in length. In general, the me- dian particle length of ebolaviruses ranges from 974 to 1,086 nm (in contrast to marburgvirions, whose median particle length was measured at 795828 nm), but par- ticles as long as 14,000 nm have been detected in tissue culture. [46] 2.3.3 Replication The ebolavirus life cycle begins with virion attachment to specic cell-surface receptors, followed by fusion of the virion envelope with cellular membranes and the concomitant release of the virus nucleocapsid into the cytosol. The viral RNA polymerase, encoded by the L gene, partially uncoats the nucleocapsid and transcribes the genes into positive-strand mRNAs, which are then translated into structural and nonstructural pro- teins. Ebolavirus RNA polymerase (L) binds to a sin- gle promoter located at the 3' end of the genome. Tran- scription either terminates after a gene or continues to the next gene downstream. This means that genes close to the 3' end of the genome are transcribed in the great- est abundance, whereas those toward the 5' end are least likely to be transcribed. The gene order is, therefore, a 4 4 DIAGNOSIS simple but eective form of transcriptional regulation. The most abundant protein produced is the nucleopro- tein, whose concentration in the cell determines when L switches from gene transcription to genome replica- tion. Replication results in full-length, positive-strand antigenomes that are, in turn, transcribed into negative- strand virus progeny genome copy. Newly synthesized structural proteins and genomes self-assemble and accu- mulate near the inside of the cell membrane. Virions bud o fromthe cell, gaining their envelopes fromthe cellular membrane they bud from. The mature progeny particles then infect other cells to repeat the cycle. The Ebola virus genetics are dicult to study due to its virulent nature. [47] 3 Pathophysiology Pathogenesis schematic Endothelial cells, macrophages, monocytes, and liver cells are the main targets of infection. After infection, a secreted glycoprotein (sGP) known as the Ebola virus glycoprotein (GP) is synthesized. Ebolavirus replication overwhelms protein synthesis of infected cells and host immune defenses. The GP forms a trimeric complex, which binds the virus to the endothelial cells lining the in- terior surface of blood vessels. The sGP forms a dimeric protein that interferes with the signaling of neutrophils, a type of white blood cell, which allows the virus to evade the immune systemby inhibiting early steps of neutrophil activation. These white blood cells also serve as carriers to transport the virus throughout the entire body to places such as the lymph nodes, liver, lungs, and spleen. [48] The presence of viral particles and cell damage result- ing from budding causes the release of chemical sig- nals (TNF-, IL-6, IL-8, etc.), which are the signaling molecules for fever and inammation. The cytopathic ef- fect, from infection in the endothelial cells, results in a loss of vascular integrity. This loss in vascular integrity is furthered with synthesis of GP, which reduces spe- cic integrins responsible for cell adhesion to the inter- cellular structure, and damage to the liver, which leads to improper clotting. [49] 4 Diagnosis The travel and work history along with exposure to wildlife are important to consider when the diagnosis of EVD is suspected. The diagnosis is conrmed by isolat- ing the virus, detecting its RNA or proteins, or detecting antibodies against the virus in a persons blood. Isolat- ing the virus by cell culture, detecting the viral RNA by polymerase chain reaction (PCR) and detecting proteins by enzyme-linked immunosorbent assay (ELISA) works best early and in those who have died from the disease. Detecting antibodies against the virus works best late in the disease and in those who recover. [50] During an outbreak, virus isolation is often not feasi- ble. The most common diagnostic methods are therefore real-time PCR and ELISA detection of proteins, which can be performed in eld or mobile hospitals. [51] Filoviri- ons can be seen and identied in cell culture by electron microscopy due to their unique lamentous shapes, but electron microscopy cannot tell the dierence between the various loviruses despite there being some length dierences. [46] Marburg Ebola .5 subst/site 100 94 99/94 94 98 99/58 90 96 100 100 100 100 09 DRC 1999 Ravn , Kenya 1987 Ozonlins, Zimbabwe 1975 Popp, Uganda/Germany 1967 Musoke, Kenya 1980 Zaire, Yambuku 1976 Zaire, Kikwit 1995 Cote dIvoire, 1994 Bundibugyo, Uganda 2007 Reston, USA 1989 Sudan, Gulu Uganda 2000 07 DRC 1999 05 DRC 1999 1379c Angola 2005 Phylogenetic tree comparing the Ebolavirus and Marburgvirus. Numbers indicate percent condence of branches. 5.2 Quarantine 5 4.1 Classication The genera Ebolavirus and Marburgvirus were originally classied as the species of the now-obsolete Filovirus genus. In March 1998, the Vertebrate Virus Subcom- mittee proposed in the International Committee on Tax- onomy of Viruses (ICTV) to change the Filovirus genus to the Filoviridae family with two specic genera: Ebola- like viruses and Marburg-like viruses. This proposal was implemented in Washington, DC, on April 2001 and in Paris on July 2002. In 2000, another proposal was made in Washington, D.C., to change the extquotedbl- like viruses to extquotedbl-virus resulting in todays Ebolavirus and Marburgvirus. [52] Rates of genetic change are 100 times slower than inuenza A in humans, but on the same magnitude as those of hepatitis B. Extrapolating backwards us- ing these rates indicates that ebolaviruses and mar- burgviruses diverged several thousand years ago. [53] However, paleoviruses (genomic fossils) of loviruses (Filoviridae) found in mammals indicate that the family itself is at least tens of millions of years old. [54] Fossilized viruses that are closely related to ebolaviruses have been found in the genome of the Chinese hamster. [55] 4.2 Dierential diagnosis The symptoms of EVD are similar to those of Marburg virus disease. [56] It can also easily be confused with many other diseases common in Equatorial Africa such as other viral hemorrhagic fevers, falciparum malaria, typhoid fever, shigellosis, rickettsial diseases such as typhus, cholera, gram-negative septicemia, borreliosis such as relapsing fever or EHEC enteritis. Other infectious dis- eases that should be included in the dierential diagnosis include the following: leptospirosis, scrub typhus, plague, Q fever, candidiasis, histoplasmosis, trypanosomiasis, visceral leishmaniasis, hemorrhagic smallpox, measles, and fulminant viral hepatitis. [57] Non-infectious diseases that can be confused with EVD are acute promye- locytic leukemia, hemolytic uremic syndrome, snake envenomation, clotting factor deciencies/platelet disor- ders, thrombotic thrombocytopenic purpura, hereditary hemorrhagic telangiectasia, Kawasaki disease, and even warfarin poisoning. [58][59][60][61] 5 Prevention 5.1 Infection control and containment The risk of transmission is increased among those car- ing for people infected. Recommended measures when caring for those who are infected include isolating them, sterilizing equipment and surfaces, and wearing pro- tective clothing including masks, gloves, gowns, and A researcher working with the Ebola virus while wearing a BSL- 4 positive pressure suit to avoid infection goggles. [24] If a person with Ebola dies, direct con- tact with the body of the deceased patient should be avoided. [24] In order to reduce the spread, the World Health Organi- zation recommends raising community awareness of the risk factors for Ebola infection and the protective mea- sures individuals can take. [62] These include avoiding con- tact with infected people and regular hand washing us- ing soap and water. [63] Traditional burial rituals, espe- cially those requiring washing or embalming of bodies, should be discouraged or modied. [64][65] Social anthro- pologists may help nd alternatives to traditional rules for burials. [66] Airline crews are instructed to isolate anyone who has symptoms resembling Ebola virus disease. [67] Ebolaviruses can be eliminated with heat (heating for 30 to 60 minutes at 60 C or boiling for 5 minutes). On surfaces, some lipid solvents such as some alcohol- based products, detergents, sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder), and other suitable disinfectants at appropriate concentrations can be used as disinfectants. [68][69] In laboratories where diagnostic testing is carried out, biosafety level 4-equivalent containment is required, since ebolaviruses are World Health Organization Risk Group 4 pathogens. Laboratory researchers must be properly trained in BSL-4 practices and wear proper per- sonal protective equipment. 5.2 Quarantine Quarantine, also known as enforced isolation, is usu- ally eective in decreasing spread. [70][71] Governments often quarantine areas where the disease is occurring or individuals who may be infected. [72] In the United States, the law allows quarantine of those infected with ebolaviruses. [73] During the 2014 outbreak, Liberia closed schools. [74] 6 8 EPIDEMIOLOGY 5.3 Contact tracing Contact tracing is regarded as important to contain an outbreak. It involves nding everyone who had close contact with infected individuals and watching for signs of illness for 21 days. If any of these contacts comes down with the disease, they should be isolated, tested, and treated. Then repeat the process by tracing the contacts contacts. [75][76] 6 Treatment 6.1 Standard support A hospital isolation ward in Gulu, Uganda, during the October 2000 outbreak No ebolavirus-specic treatment is currently approved. [77] However, survival is improved by early supportive care with rehydration and symptomatic treatment. [1] Treatment is primarily supportive in nature. [78] These measures may include management of pain, nausea, fever and anxiety, as well as rehydration via the oral or by intravenous route. [78] Blood products such as packed red blood cells, platelets or fresh frozen plasma may also be used. [78] Other regulators of coagulation have also been tried including heparin in an eort to prevent disseminated intravascular coagulation and clotting factors to decrease bleeding. [78] Antimalarial medications and antibiotics are often used before the diagnosis is conrmed, [78] though there is no evidence to suggest such treatment is in any way helpful. 6.2 Intensive care Intensive care is often used in the developed world. [15] This may include maintaining blood volume and elec- trolytes (salts) balance as well as treating any bacterial infections that may develop. [15] Dialysis may be needed for kidney failure while extracorporeal membrane oxy- genation may be used for lung dysfunction. [15] 6.3 Alternative medicine The Food and Drug Administration (FDA) advises peo- ple to watch out for fraudulent products to treat Ebola. [79] They have send out a warning letter to a seller of colloidal silver who makes claims of benet. [80] 7 Prognosis The disease has a high mortality rate which varies be- tween 25 percent and 90 percent of those infected. [1][81] As of September 2014, information from WHO puts the average mortality among those infected at 50%. [1] The 90% rate was just reported in a single outbreak. [82] There are indications based on variations in death rate between countries that early and eective treatment of symptoms (e.g., supportive care to prevent dehydration) may re- duce the fatality rate signicantly. [83] If an infected per- son survives, recovery may be quick and complete. Pro- longed cases are often complicated by the occurrence of long-termproblems, such as inammation of the testicles, joint pains, muscle pains, skin peeling, or hair loss. Eye symptoms, such as light sensitivity, excess tearing, iritis, iridocyclitis, choroiditis, and blindness have also been de- scribed. EBOV and SUDV may be able to persist in the semen of some survivors for up to seven weeks, which could give rise to infections and disease via sexual inter- course. [1] 8 Epidemiology For more about specic outbreaks and their descriptions, see List of Ebola outbreaks. The disease typically occurs in outbreaks in tropical re- gions of Sub-Saharan Africa. [1] From 1976 (when it was rst identied) through 2013, the World Health Organi- zation reported 1,716 conrmed cases. [1][4] The largest outbreak to date is the ongoing 2014 West Africa Ebola virus outbreak, which is aecting Guinea, Sierra Leone, Liberia and Nigeria. [5][6] As of 8 October, 8,033 sus- pected cases have been identied, with 3,865 deaths. [7] 8.1 1976 An outbreak of Ebola virus disease (EVD) occurred between June and November 1976 in southern Sudan and was caused by Sudan virus (SUDV), one of the ebolaviruses. The Sudan outbreak infected 284 people and killed 151. The rst identiable case in Sudan oc- curred on 27 June in a storekeeper in a cotton factory in Nzara, who was hospitalized on 30 June and died on 6 July. [84] In August 1976, an outbreak of EVD caused by Ebola virus (formerly called Zaire ebolavirus) began in Yam- 8.3 2014 outbreak 7 CDC worker incinerates medical waste from Ebola patients in Zaire in 1976 buku, a small rural village in Mongala District in north- ern Democratic Republic of the Congo (then known as Zaire), with the rst case identied on 26 August. [85] The rst victim, and the index case for the disease, was vil- lage school headmaster Mabalo Lokela, who had toured an area near the Central African Republic border along the Ebola River between 1222 August. On 8 September he died of what would become known as the Ebola virus (EBOV) member of the ebolaviruses. [86] Subsequently a number of other cases were reported, almost all centered on the Yambuku mission hospital or having close contact with another case. [86] 318 cases and 280 deaths (a 88%fa- tality rate) occurred in the DRC. [87] The Zaire outbreak was contained with the help of the World Health Orga- nization and transport from the Congolese air force, by quarantining villagers, sterilizing medical equipment, and providing protective clothing. The virus responsible for the initial outbreak, rst thought to be Marburg virus, was later identied as a new type of virus related to Marburg, and named after the nearby Ebola river. 8.2 1995 to 2013 The second major outbreak occurred in 1995 in the Democratic Republic of Congo, aecting 315 and killing 254. The next major outbreak occurred in Uganda in 2000, aecting 425 and killing 224; in this case the Su- dan virus was found to be the ebolavirus species responsi- ble for the outbreak. [88] In 2003 there was an outbreak in the Republic of Congo that aected 143 and killed 128, a death rate of 90%, the highest to date. [89] In 2004 a Russian scientist died from Ebola after sticking herself with an infected needle. [90] In August 2007, 103 people were infected by a suspected hemorrhagic fever outbreak in the village of Kampungu, Democratic Republic of the Congo. The outbreak started after the funerals of two village chiefs, and 217 people in four villages fell ill. [88][91][92] The 2007 outbreak eventu- ally aected 264 individuals and resulted in the deaths of 187. [1] On 30 November 2007, the Uganda Ministry of Health conrmed an outbreak of Ebola in the Bundibugyo Dis- trict in Western Uganda. After conrmation of sam- ples tested by the United States National Reference Laboratories and the Centers for Disease Control, the World Health Organization conrmed the presence of a new species of Ebolavirus, which was tentatively named Bundibugyo. [93] The WHO reported 149 cases of this new strain and 37 of those led to deaths. [1] The WHO conrmed two small outbreaks in Uganda in 2012. The rst outbreak aected 7 people and resulted in the death of 4 and the second aected 24, resulting in the death of 17. The Sudan variant was responsible for both outbreaks. [1] On 17 August 2012, the Ministry of Health of the Demo- cratic Republic of the Congo reported an outbreak of the Ebola-Bundibugyo variant [94] in the eastern region. [95][96] Other than its discovery in 2007, this was the only time that this variant has been identied as the ebolavirus re- sponsible for an outbreak. The WHO revealed that the virus had sickened 57 people and claimed 29 lives. The probable cause of the outbreak was tainted bush meat hunted by local villagers around the towns of Isiro and Viadana. [1][97] 8.3 2014 outbreak Main article: 2014 West Africa Ebola virus outbreak In March 2014, the World Health Organization (WHO) reported a major Ebola outbreak in Guinea, a west- ern African nation. [98] Researchers traced the outbreak to a two-year old child who died on 28 December 2013. [99][100] The disease then rapidly spread to the neigh- boring countries of Liberia and Sierra Leone. It is the largest Ebola outbreak ever documented, and the rst recorded in the region. [98] On 8 August 2014, the WHO declared the epidemic to be an international public health emergency. Urg- ing the world to oer aid to the aected regions, the Director-General said, Countries aected to date sim- ply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the inter- national community to provide this support on the most 8 9 HISTORY Increase over time in the cases and deaths during the 2014 out- break urgent basis possible. [101] By mid-August 2014, Doc- tors Without Borders reported the situation in Liberias capital Monrovia as catastrophic and deteriorating daily. They reported that fears of Ebola among sta members and patients had shut down much of the citys health system, leaving many people without treatment for other conditions. [102] By late August 2014, the dis- ease had spread to Nigeria, and one case was reported in Senegal. [103][104] [105][106] On 30 September 2014, the rst conrmed case of Ebola in the United States was diagnosed. [107] The patient died eight days later. [108] Aside from the human cost, the outbreak has severely eroded the economies of the aected countries. A Financial Times report suggested the economic impact of the outbreak could kill more people than the virus itself. As of 23 September, in the three hardest hit countries, Liberia, Sierra Leone, and Guinea, there were only 893 treatment beds available while the current need was 2122. In a 26 September statement, the WHO said, The Ebola epidemic ravaging parts of West Africa is the most se- vere acute public health emergency seen in modern times. Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long. [109] By 8 October, 8,033 suspected cases and 3,865 deaths had been reported; [7] however, the World Health Or- ganization has said that these numbers may be vastly underestimated. [110] The WHO reports that more than 216 healthcare workers are among the dead, partly due to the lack of equipment and long hours. [111][112] 9 History For more about the outbreak in Virginia, US, see Reston virus. The rst recorded outbreak of EVD occurred in Southern Sudan in June 1976. A second outbreak soon followed in the Democratic Republic of the Congo (then Zaire). [113] Virus isolated from both outbreaks was Cases of ebola fever in Africa from 1979 to 2008. named Ebola virus after the Ebola River, located near the Zaire outbreak. [114] Reports conict about who ini- tially coined the name: either Karl Johnson of the Amer- ican CDC team [115] or Belgian researchers. [116] Although it was assumed that the two outbreaks were connected, scientists later realized that they were caused by distinct species of loviruses, Sudan virus and Ebola virus. [113] In late 1989, Hazelton Research Products Reston Quar- antine Unit in Reston, Virginia, suered a mysterious outbreak of fatal illness (initially diagnosed as Simian hemorrhagic fever virus (SHFV)) among a shipment of crab-eating macaque monkeys imported from the Philip- pines. Hazeltons veterinary pathologist sent tissue sam- ples from dead animals to the United States Army Med- ical Research Institute of Infectious Diseases (USAM- RIID) at Fort Detrick, Maryland, where a laboratory test known as an ELISA assay showed antibodies to Ebola virus. [117] An electron microscopist from USAMRIID discovered loviruses similar in appearance to Ebola in the tissue samples sent fromHazelton Research Products Reston Quarantine Unit. [118] Shortly afterward, a US Army team headquartered at USAMRIID went into action to euthanize the monkeys which had not yet died, bringing those monkeys and those which had already died of the disease to Ft. Detrick for study by the Armys veterinary pathologists and virolo- gists, and eventual disposal under safe conditions. [117] Blood samples were taken from 178 animal handlers dur- ing the incident. [119] Of those, six animal handlers even- tually seroconverted, including one who had cut himself with a bloody scalpel. [48][120] When the handlers did not become ill, the CDC concluded that the virus had a very low pathogenicity to humans. [120] The Philippines and the United States had no previous cases of Ebola infection, and upon further isolation, re- searchers concluded it was another strain of Ebola, or a new lovirus of Asian origin, which they named Reston ebolavirus (RESTV) after the location of the incident. [117] 11.2 Domesticated animals 9 10 Society and culture Ebolavirus is classied as a biosafety level 4 agent, as well as a Category A bioterrorism agent by the Centers for Disease Control and Prevention. It has the potential to be weaponized for use in biological warfare, [121][122] and was investigated by the Biopreparat for such use, but might be dicult to prepare as a weapon of mass de- struction because the virus becomes ineective quickly in open air. [123] 10.1 Literature Richard Preston's 1995 best-selling book, The Hot Zone, dramatized the Ebola outbreak in Reston, Virginia. [124] William Close's 1995 Ebola: A Documentary Novel of Its First Explosion and 2002 Ebola: Through the Eyes of the People focused on individuals reactions to the 1976 Ebola outbreak in Zaire. [125] Tom Clancy's 1996 novel, Executive Orders, involves a Middle Eastern terrorist attack on the United States using an airborne form of a deadly Ebola virus strain named Ebola Mayinga (see Mayinga N'Seka). [126] 11 Other animals 11.1 Wild animals It is widely believed that outbreaks of EVD among hu- man populations result from handling infected wild ani- mal carcasses. Some research suggests that an outbreak in the wild animals used for consumption, bushmeat, may result in a corresponding human outbreak. Since 2003, such outbreaks have been monitored through surveillance of animal populations with the aim of predicting and pre- venting Ebola outbreaks in humans. [127] Recovered carcasses fromgorillas contain multiple Ebola virus strains, which suggest multiple introductions of the virus. Bodies decompose quickly and carcasses are not infectious after three to four days. Contact between gorilla groups is rare, suggesting transmission among gorilla groups is unlikely, and that outbreaks re- sult from transmission between viral reservoir and animal populations. [128] Ebola has a high mortality among primates. [129] Frequent outbreaks of Ebola may have resulted in the deaths of 5,000 gorillas. [130] Outbreaks of Ebola may have been responsible for an 88% decline in tracking indices of ob- served chimpanzee populations in 420 square kilometer Lossi Sanctuary between 2002 and 2003. [128] Transmis- sion among chimpanzees through meat consumption con- stitutes a signicant risk factor, while contact between in- dividuals, such as touching dead bodies and grooming, is not. [131] 11.2 Domesticated animals Reston virus (RESTV) can be transmitted to pigs. [132] This virus was discovered during an outbreak of what at the time was thought to be simian hemorrhagic fever virus (SHFV) in crab-eating macaques in Reston, Vir- ginia (hence the name Reston elabavirus) in 1989. Since the initial outbreak it has since been found in nonhuman primates in Pennsylvania, Texas, and Italy. In each case, the aected animals had been imported from a facility in the Philippines, [72] where the virus had infected pigs. [133] Despite its status as a Level4 organism and its apparent pathogenicity in monkeys, RESTV has not caused dis- ease in exposed human laboratory workers. [134] In 2012 it was demonstrated that the virus can travel without contact frompigs to nonhuman primates, although the same study failed to achieve transmission in that manner between primates. [132] According to the WHO, routine cleaning and disinfection of pig (or monkey) farms with sodium hypochlorite or other detergents should be eective in inactivating the Reston ebolavirus. If an outbreak is sus- pected, the area must be immediately quarantined. [135] While pigs that have been infected with RESTV tend to show symptoms of the disease, it has been shown that dogs may become infected with EBOV and remain asymptomatic. Dogs in some parts of Africa scavenge for their food and it is known that they sometimes eat infected animals and the corpses of humans. Although they remain asymptomatic, a 2005 survey of dogs dur- ing an EBOV outbreak found that over 31.8% showed a seroprevalence for EBOV closest to an outbreak versus 9% a farther distance away. [136] 12 Research A number of experimental treatments are being studied. [137] In the United States, the Food and Drug Ad- ministration (FDA)'s animal ecacy rule is being used to demonstrate reasonable safety to obtain permission to treat people who are infected with Ebola. It is being used because the normal path for testing drugs is not possible for diseases caused by dangerous pathogens or toxins. Experimental drugs are made available for use with the approval of regulatory agencies under named patient programs, known in the US as expanded access. [138] On 12 August 2014 the WHO released a statement that the use of not yet proven treatments is ethical in certain situations in an eort to treat or prevent the disease. [139] 12.1 Medications 12.1.1 Antivirals A number of antiviral medications are being studied. 10 12 RESEARCH Researchers looking at slides of cultures of cells that make mon- oclonal antibodies. These are grown in a lab and the researchers are analyzing the products to select the most promising of them. Favipiravir, an anti-viral drug approved in Japan for stockpiling against inuenza pandemics, appears to be useful in a mouse model of Ebola. [9][140] On 4 October 2014, it was reported that a French nun who contracted Ebola while volunteering in Liberia was cured with Favipiravir treatment. [141] BCX4430 is a broad-spectrum small molecule antiviral drug developed by BioCryst Pharmaceuti- cals and undergoing animal testing as a potential hu- man treatment for Ebola by USAMRIID. [142] The drug has been approved to progress to Phase 1 tri- als, expected late in 2014. [143] Brincidofovir, another broad-spectrum antiviral drug, has been granted an emergency FDA approval as an investigational new drug for the treatment of Ebola, after in vitro tests found it to be eective against Ebola virus. [144] It has subsequently been used to treat the rst patient diagnosed with Ebola in the USA, after he had recently returned from Liberia. [145][146] Lamivudine, an antiviral drug which is usually used to treat HIV / AIDS, was reported in September 2014 to have been used successfully to treat 13 out of 15 Ebola-infected patients by a doctor in Liberia, as part of a combination therapy also involving intra- venous uids and antibiotics to combat opportunis- tic bacterial infection of Ebola-compromised inter- nal organs. [147] Western virologists have however ex- pressed caution about the results, due to the small number of patients treated and confounding factors present. Researchers at the NIH stated that lamivu- dine had so far failed to demonstrate anti-Ebola ac- tivity in preliminary in vitro tests, but that they would continue to test it under dierent conditions and would progress it to trials if even slight evidence for ecacy is found. [148] Lack of available treatment options has spurred re- search into a number of other possible antivirals targeted against Ebola, including natural products such as scytovirin and grithsin, [149][150] as well as synthetic drugs including FGI-103, FGI-104, FGI-106, dUY11 and LJ-001, [151] and other newer agents. [152][153][154] 12.1.2 Antisense technology Other promising treatments rely on antisense technol- ogy. Both small interfering RNAs (siRNAs) and phosphorodiamidate morpholino oligomers (PMOs) tar- geting Ebola virus (EBOV) RNA polymerase L pro- tein could prevent disease in nonhuman primates. [155][156] TKM-Ebola is a small interfering RNA compound, currently being tested in a Phase I clinical trial in humans. [157][158] Sarepta Therapeutics has completed a Phase I clinical trial with its Morpholino oligo targeting Ebola virus. [159] 12.1.3 Other Two selective estrogen receptor modulators used to treat infertility and breast cancer (clomiphene and toremifene) have been found to inhibit the progress of Ebola virus in vitro as well as in infected mice. Ninety percent of the mice treated with clomiphene and fty percent of those treated with toremifene survived the tests. [160] The study authors conclude that given their oral availability and his- tory of human use, these drugs would be candidates for treating Ebola virus infection in remote geographical lo- cations, either on their own or together with other antivi- ral drugs. A 2014 study found that three ion channel blockers used in the treatment of heart arrhythmias, amiodarone, dronedarone and verapamil, block the entry of Ebola virus into cells in vitro. [161] Melatonin has also been suggested as a potential treat- ment for Ebola based on promising in vitro results. [162] ZMapp is a monoclonal antibody vaccine. The limited supply of the drug has been used to treat a small num- ber of individuals infected with the Ebola virus. Al- though some individuals have recovered, the outcome is not considered statistically signicant. [163] ZMapp has proved eective in a trial involving Rhesus macaque monkeys. [164][157] 12.2 Blood products The WHO has stated that transfusion of whole blood or puried serum from Ebola survivors is the therapy with the greatest potential to be implemented immediately, al- though there is little information as to its ecacy. [165] September 2014, WHO issued an interim guideline for this therapy. [166] The blood serum from those who have survived an infection is currently being studied to see 11 if it is an eective treatment. [167] During a meeting ar- ranged by WHO this research was deemed to be a top priority. [167] Seven of eight people with Ebola survived after receiving a transfusion of blood donated by in- dividuals who had previously survived the infection in an 1999 outbreak in the Democratic Republic of the Congo. [78][168] This treatment, however, was started late in the disease meaning they may have already been re- covering on their own and the rest of their care was bet- ter than usual. [78] Thus this potential treatment remains controversial. [15] Intravenous antibodies appear to be pro- tective in non-human primates who have been exposed to large doses of Ebola. [169] The World Health Organisation has approved the use of convalescent serum and whole blood products to treat people with Ebola. [170] 12.3 Vaccine As of September 2014, no vaccine was approved by the United States Food and Drug Administration (FDA) for clinical use in humans. [171][167] It was hoped that one would be initially available by November 2014. [167] The most promising candidates are DNA vac- cines [172] or vaccines derived from adenoviruses, [173] vesicular stomatitis Indiana virus (VSIV) [174][175][176] or lovirus-like particles (VLPs) [177] because these candi- dates could protect nonhuman primates from ebolavirus- induced disease. DNA vaccines, adenovirus-based vac- cines, and VSIV-based vaccines have entered clinical trials. [178][179][180][181] Vaccines have protected nonhuman primates. Immu- nization takes six months, which impedes the counter- epidemic use of the vaccines. Searching for a quicker onset of eectiveness, in 2003, a vaccine using an adenoviral (ADV) vector carrying the Ebola spike pro- tein was tested on crab-eating macaques. Twenty-eight days later, they were challenged with the virus and re- mained resistant. [173] A vaccine based on attenuated re- combinant vesicular stomatitis virus (VSV) vector carry- ing either the Ebola glycoprotein or the Marburg glyco- protein in 2005 protected nonhuman primates, [182] open- ing clinical trials in humans. [178] Over a three month hu- man trial, three vaccinations safely induced an immune response. Individuals for a year were followed, and, in 2006, a study testing a faster-acting, single-shot vaccine began; this new study was completed in 2008. [179] Try- ing the vaccine on a strain of Ebola that more resembles one that infects humans is the next step. [183] On 6 De- cember 2011, the development of a successful vaccine against Ebola for mice was reported. Unlike the prede- cessors, it can be freeze-dried and thus stored for long periods in wait for an outbreak. [184] An experimental vac- cine made by researchers at Canadas national labora- tory in Winnipeg was used, in 2009, to pre-emptively treat a German scientist who might have been infected during a lab accident. [185] However, actual EBOV infec- tion was never demonstrated beyond doubt. [186] Experi- mentally, recombinant vesicular stomatitis Indiana virus (VSIV) expressing the glycoprotein of EBOV or SUDV has been used successfully in nonhuman primate models as post-exposure prophylaxis. [187][188] The CDCs recom- mendations are currently under review. Simultaneous phase 1 trials of an experimental vac- cine known as the NIAID/GSK vaccine commenced in September 2014. [189] GlaxoSmithKline and the NIH jointly developed the vaccine, [189] based on a modied chimpanzee adenovirus, and contains parts of the Zaire and Sudan ebola strains. [189] If this phase is completed successfully, the vaccine will be fast tracked for use in West Africa. In preparation for this, GSK is preparing a stockpile of 10,000 doses. [190][191] 13 See also List of human disease case fatality rates 14 References Notes [1] Ebola virus disease Fact sheet N103. World Health Or- ganization. 2014-03-01. Retrieved 2014-04-12. [2] 2014 Ebola Virus Disease (EVD) outbreak in West Africa. WHO. 2014-04-21. Retrieved 2014-08-03. [3] http://www.cdc.gov/vhf/ebola/hcp/ guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries. html [4] Ebola Viral Disease Outbreak West Africa, 2014. CDC. 2014-06-27. Retrieved 2014-06-26. [5] CDCurges all US residents to avoid nonessential travel to Liberia, Guinea and Sierra Leone because of an unprece- dented outbreak of Ebola.. CDC. 2014-07-31. Retrieved 2014-08-02. [6] Outbreak of Ebola in Guinea, Liberia and Sierra Leone. CDC. 2014-08-04. Retrieved 2014-08-05. [7] 2014 Ebola Outbreak in West Africa - Case Counts. 2014 Ebola Outbreak in West Africa. CDC (Centers for Disease Control and Prevention). 2014-Oct-07. Re- trieved 2014-Oct-08. [8] Ebola Hemorrhagic Fever: Signs and Symptoms. United States Centers for Disease Control and Prevention. [9] Gatherer D (2014). The 2014 Ebola virus disease out- break in West Africa. J. Gen. Virol. 95 (Pt 8): 1619 1624. doi:10.1099/vir.0.067199-0. PMID 24795448. [10] Ebola Hemorrhagic Fever Signs and Symptoms. CDC. 2014-01-28. Retrieved 2014-08-02. [11] Ebola virus disease. Fact sheet N103. World Health Organization. 2014-04-01. 12 14 REFERENCES [12] Hoenen T, Groseth A, Falzarano D, Feldmann H (May 2006). Ebola virus: unravelling pathogenesis to combat a deadly disease. Trends in Molecular Medicine 12 (5): 206215. doi:10.1016/j.molmed.2006.03.006. PMID 16616875. [13] Ebola Virus, Clinical Presentation. Medscape. Re- trieved 2012-07-30. [14] Simpson DIH (1977). Marburg and Ebola virus infec- tions: a guide for their diagnosis, management, and con- trol (PDF). WHO Oset Publication No. 36. p. 10f. [15] Feldmann, H; Geisbert, TW (2011 Mar 5). Ebola haem- orrhagic fever.. Lancet 377 (9768): 84962. PMID 21084112. [16] Appendix A: Disease-Specic Chapters. Chapter: Hemorrhagic fevers caused by: i) Ebola virus and ii) Marburg virus and iii) Other viral causes including bun- yaviruses, arenaviruses, and aviviruses. Ministry of Health and Long-TermCare. Retrieved 09 October 2014. [17] Fisher-Hoch SP, Platt GS, Neild GH, Southee T, Baskerville A, Raymond RT, Lloyd G, Simpson DI (1985). Pathophysiology of shock and hemorrhage in a fulminating viral infection (Ebola) extquotedbl. J. Infect. Dis. 152 (5): 887894. doi:10.1093/infdis/152.5.887. PMID 4045253. [18] Kuhn JH, Becker S, Ebihara H, Geisbert TW, Johnson KM, Kawaoka Y, Lipkin WI, Negredo AI, Netesov SV, Nichol ST, Palacios G, Peters CJ, Tenorio A, Volchkov VE, Jahrling PB (2010). Proposal for a revised taxon- omy of the family Filoviridae: Classication, names of taxa and viruses, and virus abbreviations. Archives of Virology 155 (12): 2083103. doi:10.1007/s00705-010- 0814-x. PMC 3074192. PMID 21046175. [19] CDC Telebrieng on Ebola outbreak in West Africa. CDC. 2014-07-28. Retrieved 2014-08-03. [20] Q&A on Transmission, Ebola, CDC SEPT. 2014, access date 3rd October 2014 http://www.cdc.gov/vhf/ebola/ transmission/qas.html [21] WHO: Air travel is low-risk for Ebola transmission. WHO. 14 August 2014. Retrieved 8 September 2014. [22] Chan, M (Aug 20, 2014). Ebola Virus Disease in West Africa - No Early End to the Outbreak.. The New Eng- land journal of medicine. PMID 25140856. [23] Sierra Leone: a traditional healer and a funeral. World Health Organization. Retrieved 6 October 2014. [24] Ebola Hemorrhagic Fever Prevention. CDC. July 31, 2014. Retrieved 2014-08-02. [25] Tiaji Salaam-Blyther (August 26, 2014). The 2014 Ebola Outbreak: International and U.S. Responses (pdf). Retrieved 9 September 2014. [26] Mayo Clinic Sta. Ebola virus and Marburg virus: Causes. Mayo Clinic. [27] Lashley, Felissa R.; Durham, Jerry D., eds. (2007). Emerging infectious diseases trends and issues (2nd ed.). New York: Springer. p. 141. ISBN 9780826103505. [28] Alan J. Magill, G. Thomas Strickland, James H. Maguire, Edward TRyan, TomSolomon, ed. (2013). Hunters trop- ical medicine and emerging infectious disease (9th ed.). London, New York: Elsevier. pp. 170172. OCLC 822525408. [29] Questions and Answers on Ebola | Ebola Hemorrhagic Fever | CDC. CDC. [30] Johnson E, Jaax N, White J, Jahrling P (Aug 1995). Lethal experimental infections of rhesus monkeys by aerosolized Ebola virus. International journal of exper- imental pathology 76 (4): 227236. ISSN 0959-9673. PMC 1997182. PMID 7547435. [31] Weingartl HM, Embury-Hyatt C, Nfon C, Leung A, Smith G, Kobinger G (2012). Transmission of Ebola virus from pigs to non-human primates. Sci Rep 2: 811. doi:10.1038/srep00811. PMC 3498927. PMID 23155478. [32] Gonzalez JP, Pourrut X, Leroy E (2007). Ebolavirus and other loviruses. Current topics in microbiology and im- munology. Current Topics in Microbiology and Immunol- ogy 315: 363387. doi:10.1007/978-3-540-70962-6_15. ISBN 978-3-540-70961-9. PMID 17848072. [33] Williams E. African monkey meat that could be behind the next HIV. Health News - Health & Families. The Independent. 25 people in Bakaklion, Cameroon killed due to eating of ape [34] Fruit bats may carry Ebola virus. BBC News. 2005-12- 11. Retrieved 2008-02-25. [35] Pourrut X, Kumulungui B, Wittmann T, Moussavou G, Dlicat A, Yaba P, Nkoghe D, Gonzalez JP, Leroy EM (2005). The natural history of Ebola virus in Africa. Microbes and infection / Institut Pasteur 7 (78): 10051014. doi:10.1016/j.micinf.2005.04.006. PMID 16002313. [36] Swanepoel R, Leman PA, Burt FJ, Zachariades NA, Braack LE, Ksiazek TG, Rollin PE, Zaki SR, Peters CJ (Oct 1996). Experimental inoculation of plants and an- imals with Ebola virus. Emerging Infectious Diseases 2 (4): 321325. doi:10.3201/eid0204.960407. ISSN 1080-6040. PMC 2639914. PMID 8969248. [37] Leroy EM, Kumulungui B, Pourrut X, Rouquet P, Hassanin A, Yaba P, Dlicat A, Paweska JT, Gonzalez JP, Swanepoel R (2005). Fruit bats as reservoirs of Ebola virus. Nature 438 (7068): 575576. Bibcode:2005Natur.438..575L. doi:10.1038/438575a. PMID 16319873. [38] Pourrut X, Dlicat A, Rollin PE, Ksiazek TG, Gonzalez JP, Leroy EM (2007). Spatial and temporal patterns of Zaire ebolavirus antibody prevalence in the possible reservoir bat species. The Journal of infectious diseases. Suppl 2 (s2): S176S183. doi:10.1086/520541. PMID 17940947. [39] Starkey, Jerome (5 April 2014). 90 killed as fruit bats spread Ebola virus across West Africa. The Times. Re- trieved 2014-04-01. 13 [40] Olival KJ, Islam A, Yu M, Anthony SJ, Epstein JH, Khan SA, Khan SU, Crameri G, Wang LF, Lipkin WI, Luby SP, Daszak P (2013). Ebola virus antibodies in fruit bats, bangladesh. Emerging Infect. Dis. 19 (2): 270 3. doi:10.3201/eid1902.120524. PMC 3559038. PMID 23343532. [41] Morvan JM, Deubel V, Gounon P, Nakoun E, Barrire P, Murri S, Perpte O, Selekon B, Coudrier D, Gautier- Hion A, Colyn M, Volehkov V (1999). Identication of Ebola virus sequences present as RNA or DNA in or- gans of terrestrial small mammals of the Central African Republic. Microbes and Infection 1 (14): 11931201. doi:10.1016/S1286-4579(99)00242-7. PMID10580275. [42] Peterson AT, Bauer JT, Mills JN (2004). Ecologic and Geographic Distribution of Filovirus Dis- ease. Emerging Infectious Diseases 10 (1): 4047. doi:10.3201/eid1001.030125. PMC 3322747. PMID 15078595. [43] Guinea Ebola outbreak: Bat-eating banned to curb virus. BBC News. Retrieved 2014-08-17. [44] Pringle, C. R. (2005). Order Mononegavirales. In Fau- quet, C. M.; Mayo, M. A.; Manilo, J.; Desselberger, U.; Ball, L. A. Virus Taxonomy Eighth Report of the Inter- national Committee on Taxonomy of Viruses. San Diego, US: Elsevier/Academic Press. pp. 609614. ISBN 0-12- 370200-3 [45] Kiley MP, Bowen ET, Eddy GA, Isacson M, Johnson KM, McCormick JB, Murphy FA, Pattyn SR, Peters D, Prozesky OW, Regnery RL, Simpson DI, Slenczka W, Sureau P, van der Groen G, Webb PA, Wul H (1982). Filoviridae: A taxonomic home for Marburg and Ebola viruses? extquotedbl. Intervirology 18 (12): 2432. doi:10.1159/000149300. PMID 7118520. [46] Geisbert TW, Jahrling PB (1995). Dierentiation of loviruses by electron microscopy. Virus research 39 (23): 129150. doi:10.1016/0168-1702(95)00080-1. PMID 8837880. [47] Feldmann, H.; Geisbert, T. W.; Jahrling, P. B.; Klenk, H.- D.; Netesov, S. V.; Peters, C. J.; Sanchez, A.; Swanepoel, R.; Volchkov, V. E. (2005). Family Filoviridae. In Fau- quet, C. M.; Mayo, M. A.; Manilo, J.; Desselberger, U.; Ball, L. A. Virus Taxonomy Eighth Report of the Inter- national Committee on Taxonomy of Viruses. San Diego, US: Elsevier/Academic Press. pp. 645653. ISBN 0-12- 370200-3 [48] Smith, Tara (2005). Ebola (Deadly Diseases and Epi- demics). Chelsea House Publications. ISBN 0-7910- 8505-8. [49] Sullivan N, Yang ZY, Nabel GJ (2003). Ebola Virus Pathogenesis: Implications for Vaccines and Therapies (Free full text). Journal of Virology 77 (18): 97339737. doi:10.1128/JVI.77.18.9733-9737.2003. PMC 224575. PMID 12941881. [50] Ebola Hemorrhagic Fever Diagnosis. CDC. January 28, 2014. Retrieved 2014-08-03. [51] Grolla A, Lucht A, Dick D, Strong JE, Feldmann H (2005). Laboratory diagnosis of Ebola and Marburg hemorrhagic fever. Bull Soc Pathol Exot 98 (3): 2059. PMID 16267962. [52] Bchen-Osmond, Cornelia (2006-04-25). ICTVdB Virus Description 01.025.0.02. Ebolavirus. Interna- tional Committee on Taxonomy of Viruses. Retrieved 2009-06-02. [53] Suzuki Y, Gojobori T (1997). The origin and evolution of Ebola and Marburg viruses. Molecular Biology and Evolution 14 (8): 8006. doi:10.1093/oxfordjournals.molbev.a025820. PMID 9254917. [54] Taylor DJ, Leach RW, Bruenn J (2010). Filoviruses are ancient and integrated into mammalian genomes. BMC Evolutionary Biology 10: 193. doi:10.1186/1471-2148- 10-193. PMC 2906475. PMID 20569424. [55] Taylor DJ, Dittmar K, Ballinger MJ, Bruenn JA (2011). Evolutionary maintenance of lovirus-like genes in bat genomes. BMC Evolutionary Biology 11: 336. doi:10.1186/1471-2148-11-336. PMC 3229293. PMID 22093762. [56] Longo, DL; Kasper, DL; Jameson, JL, eds. (2012). Chapter 197. Harrisons Principles of Internal Medicine (18th ed.). McGraw-Hill. ISBN 0-07-174889-X. [57] Viral Hemorrhagic Fever. San Francisco Department of Public Health. Communicable Disease Control and Pre- vention. Retrieved 2014-08-17. [58] Gear JH(1989). Clinical aspects of African viral hemor- rhagic fevers. Reviews of infectious diseases. 11 Suppl 4: S777S782. doi:10.1093/clinids/11.supplement_4.s777. PMID 2665013. [59] Gear JH, Ryan J, Rossouw E (1978). A consideration of the diagnosis of dangerous infectious fevers in South Africa. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 53 (7): 235237. PMID565951. [60] Grolla A, Lucht A, Dick D, Strong JE, Feldmann H (2005). Laboratory diagnosis of Ebola and Marburg hemorrhagic fever. Bulletin de la Societe de pathologie exotique (1990) 98 (3): 205209. PMID 16267962. [61] Bogomolov BP (1998). Dierential diagnosis of infec- tious diseases with hemorrhagic syndrome. Terapevtich- eskii arkhiv 70 (4): 6368. PMID 9612907. [62] Ebola virus disease Fact sheet N103. WHO. Retrieved 2014-09-06. [63] Ebola 5 tips to avoid the deadly disease. Plan Interna- tional. 2014-09-06. [64] Centers for Disease Control and Prevention and World Health Organization (1998). Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting (PDF). Atlanta, Georgia, US: Centers for Disease Con- trol and Prevention. Retrieved 2013-02-08. 14 14 REFERENCES [65] Section 7: Use Safe Burial Practices. Information re- sources on Ebola virus disease. World Health Organiza- tion. 2014-06-01. [66] How anthropologists help medics ght Ebola in Guinea. Science and Development. Sept. 2014, accessdate 3rd October 2014. http: //www.scidev.net/global/cooperation/feature/ anthropologists-medics-ebola-guinea.html [67] West Africa - Ebola virus disease Update: Travel and transport. International travel and health. World Health Organization. [68] Infection Prevention and Control Guidance for Care of Patients with Suspected or Conrmed Filovirus Haemor- rhagic Fever in Health-care Settings with Focus on Ebola. Infection Prevention and Control Guidance for Care of Pa- tients with Suspected or Conrmed Filovirus Haemorrhagic Fever in Health-care Settings with Focus on Ebola. WHO. August 2014. Retrieved 21 August 2014. [69] Ebolavirus - Pathogen Safety Data Sheets. Laboratory Biosafety and Biosecurity > Biosafety Programs and Re- sources > Pathogen Safety Data Sheets and Risk Assess- ment. Public Health Agency of Canada. [70] Sompayrac, Lauren (2002). How pathogenic viruses work (3. print. ed.). Boston: Jones and Bartlett Publishers. p. 87. ISBN 9780763720827. [71] Alazard-Dany N, Ottmann Terrangle M, Volchkov V (2006). extquotedbl[Ebola and Marburg viruses: the hu- mans strike back] extquotedbl. Med Sci (Paris) (in French) 22 (4): 40510. doi:10.1051/medsci/2006224405. PMID 16597410. [72] Special Pathogens Branch CDC (2008-01-14). Known Cases and Outbreaks of Ebola Hemorrhagic Fever. Cen- ter for Disease Control and Prevention. Retrieved 2008- 08-02. [73] Schultz, edited by Kristi Koenig, Carl (2009). Koenig and Schultzs disaster medicine : comprehensive principles and practices. Cambridge: Cambridge University Press. p. 209. ISBN 9780521873673. [74] Lewis1, David (Jul 30, 2014). Liberia shuts schools, considers quarantine to curb Ebola. Reuters. Retrieved 2014-08-03. [75] Ebola 2014 New Challenges, New Global Response and Responsibility. NEJM. New England Journal of Medecine. Retrieved 15 September 2014. [76] What is Contact Tracing? extquotedbl. CDC. Centers for Disease Control. Retrieved 15 September 2014. [77] Choi JH, Croyle MA (2013). Emerging targets and novel approaches to Ebola virus prophylaxis and treat- ment. BioDrugs 27 (6): 56583. doi:10.1007/s40259- 013-0046-1. PMID 23813435. [78] Clark DV, Jahrling PB, Lawler JV (2012). Clinical management of lovirus-infected patients. Viruses 4 (9): 166886. doi:10.3390/v4091668. PMC 3499825. PMID 23170178. [79] FDA warns consumers about fraudulent Ebola treatment products. Retrieved 20 August 2014. [80] Inspections, Compliance, Enforcement, and Criminal In- vestigations. FDA. Retrieved 9 October 2014. [81] C.M. Fauquet (2005). Virus taxonomy classication and nomenclature of viruses; 8th report of the International Committee on Taxonomy of Viruses. Oxford: Else- vier/Academic Press. p. 648. ISBN 9780080575483. [82] More or Less behind the stats Ebola. www.bbc.co.uk. BBC World Service. Retrieved 8 October 2014. [83] Who, What, Why: Howmany people infected with ebola die? extquotedbl. BBC News. 2014-08-09. [84] Ebola haemorrhagic fever in Sudan, 1976 (pdf). [85] Hewlett, Barry; Hewlett, Bonnie (2007). Ebola, Culture and Politics: The Anthropology of an Emerging Disease. Cengage Learning. p. 103. Retrieved 2014-07-31. [86] Ebola haemorrhagic fever in Zaire, 1976. Bull. World Health Organ. 56 (2): 27193. 1978. PMC 2395567. PMID 307456. [87] King JW (2008-04-02). Ebola Virus. eMedicine. WebMd. Retrieved 2008-10-06. [88] Mystery DR Congo fever kills 100. BBC News. 2007- 08-31. Retrieved 2008-02-25. [89] Formenty P, Libama F, Epelboin A, Allarangar Y, Leroy E, Moudzeo H, Tarangonia P, Molamou A, Lenzi M, Ait- Ikhlef K, Hewlett B, Roth C, Grein T (2003). extquot- edbl[Outbreak of Ebola hemorrhagic fever in the Repub- lic of the Congo, 2003: a new strategy?] extquotedbl. Med Trop (Mars) (in French) 63 (3): 2915. PMID 14579469. [90] Russian Scientist Dies in Ebola Accident at Former Weapons Lab [91] Ebola Outbreak Conrmed in Congo. NewScien- tist.com. 2007-09-11. Retrieved 2008-02-25. [92] Ebola outbreak in Congo. CDC news. 2007-09-12. Re- trieved 2009-05-31. [93] Uganda: Deadly Ebola Outbreak Conrmed UN. UN News Service. 2007-11-30. Retrieved 2008-02-25. [94] DRC Conrms Ebola Outbreak. Voanews.com. Re- trieved 2013-04-15. [95] WHO | Ebola outbreak in Democratic Republic of Congo. Who.int. 2012-08-17. Retrieved 2013-04-15. [96] WHO| Ebola outbreak in Democratic Republic of Congo update. Who.int. 2012-08-21. Retrieved 2013-04-15. [97] Castillo M (2012). Ebola virus claims 31 lives in Demo- cratic Republic of the Congo. United States: CBS News. Retrieved 14 September 2012. [98] Guidelines for Evaluation of US Patients Suspected of Having Ebola Virus Disease. CDC. 2014-08-01. Re- trieved 2014-08-05. 15 [99] Grady, Denise; Sheri Fink (2014-08-09). Tracing Ebolas Breakout to an African 2-Year-Old. The New York Times. ISSN 0362-4331. Retrieved 2014-08-10. [100] The rst cases of this Ebola outbreak traced by WHO (png). who.int. WHO. 2014. [101] WHO raises global alarm over Ebola outbreak. CBS. Retrieved 2014-08-02. [102] In Liberias Ebola-Stricken Villages, Residents Face 'Stark' Choices. n Liberias Ebola-Stricken Villages, Res- idents Face 'Stark' Choices. Common Dreams. 18 August 2014. Retrieved 20 August 2014. [103] Disease outbreak news Ebola virus disease, West Africa update 28 August 2014. Epidemic & Pandemic Alert and Response (EPR) Outbreak News (WHO). Re- trieved 28 August 2014. [104] Ebola virus disease update, West Africa update 28 Au- gust 2014. Epidemic & Pandemic Alert and Response (EPR) Outbreak News (WHO). Retrieved 28 August 2014. [105] Senegalese minister of health conrms 1st case of Ebola virus in the West African country. Washington Post. 29 August 2014. Retrieved 29 August 2014. [106] First case of Ebola virus is conrmed in Senegal. ITV. 29 August 2014. Retrieved 29 August 2014. [107] Sta (30 September 2014). CDC and Texas Health Department Conrm First Ebola Case Diagnosed in the U.S.. CDC. Retrieved 30 September 2014. [108] Bustillo, Miguel; Campoy, Ann; Hinshaw, Drew. Dallas Ebola Patient Dies. The Wall Street Journal Online. Re- trieved 8 October 2014. [109] statement (26 September 2014). extquotedblhttp://www. who.int/mediacentre/news/ebola/26-september-2014/ en/ extquotedbl. WHO. Retrieved 28 September 2014. [110] WHO: EBOLA RESPONSE ROADMAP UPDATE-8 September 2014, WHO [111] Unprecedented number of medical sta infected with Ebola. WHO. 25 August 2014. Retrieved 29 August 2014. [112] WHO: Ebola Response Roadmap Situation Report - 1 Oc- tober 2014 [113] Feldmann H, Jones S, Klenk HD, Schnittler HJ (Au- gust 2003). Ebola virus: from discovery to vac- cine. Nature Reviews. Immunology 3 (8): 67785. doi:10.1038/nri1154. PMID 12974482. [114] Feldmann H, Geisbert TW (March 2011). Ebola haemorrhagic fever. Lancet 377 (9768): 84962. doi:10.1016/S0140-6736(10)60667-8. PMC 3406178. PMID 21084112. [115] Preston, Richard (July 20, 1995). The Hot Zone. Anchor Books (Random House). p. 117. Karl Johnson named it Ebola [116] Bredow, Rafaela von; Hackenbroch, Veronika (4 October 2014). extquotedbl'In 1976 I Discovered Ebola Now I Fear an Unimaginable Tragedy' extquotedbl. The Ob- server. Guardian Media Group. [117] Preston, Richard (1994). The Hot Zone. New York: Ran- dom House. p. 300. ISBN 978-0679437840. [118] McCormick & Fisher-Hoch 1999, pp. 277279 [119] Waterman, Tara (1999). Ebola Reston Outbreaks. Stan- ford University. Retrieved 2008-08-02. [120] McCormick & Fisher-Hoch 1999, pp. 298299 [121] Borio L, Inglesby T, Peters CJ, Schmaljohn AL, Hughes JM, Jahrling PB, Ksiazek T, Johnson KM, Meyerho A, O'Toole T, Ascher MS, Bartlett J, Breman JG, Eitzen EM, Hamburg M, Hauer J, Henderson DA, Johnson RT, Kwik G, Layton M, Lillibridge S, Nabel GJ, Oster- holm MT, Perl TM, Russell P, Tonat K (2002). Hem- orrhagic fever viruses as biological weapons: medi- cal and public health management. Journal of the American Medical Association 287 (18): 2391405. doi:10.1001/jama.287.18.2391. PMID 11988060. [122] Salvaggio MR, Baddley JW (2004). Other vi- ral bioweapons: Ebola and Marburg hemorrhagic fever. Dermatologic clinics 22 (3): 291302, vi. doi:10.1016/j.det.2004.03.003. PMID 15207310. [123] Zubray, Georey (2013). Agents of Bioterrorism: Pathogens and Their Weaponization. New York, NY, USA: Columbia University Press. pp. 7374. ISBN 9780231518130. [124] (1) Preston, Richard (1995). The Hot Zone, A Terrifying True Story. Anchor Books. ISBN0-385-47956-5. OCLC 32052009. At Google Books. (2) Best Sellers: June 4, 1995. The New York Times Book Review (New York: The New York Times). 1995- 06-04. Retrieved 2014-09-10. (3) About The Hot Zone. Random House. Retrieved 2014-09-10. [125] (1) Close, William T. (1995). Ebola: A Documentary Novel of Its First Explosion. New York: Ivy Books. ISBN 0804114323. OCLC 32753758. At Google Books. (2) Grove, Ryan (2006-06-02). More about the people than the virus. Review of Close, William T., Ebola: A Documentary Novel of Its First Explosion. Amazon.com. Retrieved 2014-09-17. (3) Close, William T. (2002). Ebola: Through the Eyes of the People. Marbleton, Wyoming: Meadowlark Springs Productions. ISBN 0970337116. OCLC 49193962. At Google Books. (4) Pink, Brenda (2008-06-24). A fascinating perspec- tive. Review of Close, William T., Ebola: Through the Eyes of the People. Amazon.com. Retrieved 2014-09- 17. [126] (1) Clancy, Tom (1996). Executive Orders. New York: Putnam. ISBN 0399142185. OCLC 34878804. At Google Books. (2) Line, Matt; Jeremy; Dan. extquotedblExecutive Or- ders book reviews. AllReaders.com. Archived from the 16 14 REFERENCES original on 20014-08-01. Retrieved 2014-09-10. (3) Stone, Oliver (1996-09-02). Whos That in the Oval Oce? extquotedbl. Books News & Reviews. The New York Times Company. Archived from the original on 2009-04-10. Retrieved 2014-09-10. [127] Rouquet P, Froment JM, Bermejo M, Kilbourn A, Karesh W, Reed P, Kumulungui B, Yaba P, Dlicat A, Rollin PE, Leroy EM (Feb 2005). Wild animal mortality monitor- ing and human Ebola outbreaks, Gabon and Republic of Congo, 20012003 (Free full text). Emerging Infectious Diseases 11 (2): 283290. doi:10.3201/eid1102.040533. ISSN 1080-6040. PMC 3320460. PMID 15752448. [128] Leroy EM, Rouquet P, Formenty P, Souquire S, Kilbourne A, Froment JM, Bermejo M, Smit S, Karesh W, Swanepoel R, Zaki SR, Rollin PE (2004). Multiple Ebola virus transmission events and rapid decline of central African wildlife. Science 303 (5656): 387390. Bibcode:2004Sci...303..387L. doi:10.1126/science.1092528. PMID 14726594. [129] Choi JH, Croyle MA (2013). Emerging targets and novel approaches to Ebola virus prophylaxis and treat- ment. BioDrugs 27 (6): 56583. doi:10.1007/s40259- 013-0046-1. PMID 23813435. [130] Ebola 'kills over 5,000 gorillas . BBC. 2006-12-08. Re- trieved 2009-05-31. [131] Formenty P, Boesch C, Wyers M, Steiner C, Donati F, Dind F, Walker F, Le Guenno B (1999). Ebola virus outbreak among wild chimpanzees living in a rain forest of Cte d'Ivoire. The Journal of infectious diseases. 179. Suppl 1 (s1): S120S126. doi:10.1086/514296. PMID 9988175. [132] Weingartl HM, Nfon C, Kobinger G (2013). Review of Ebola virus infections in domestic animals. Dev Biol (Basel) 135: 2118. doi:10.1159/000178495. PMID 23689899. [133] McNeil Jr, Donald G. (2009-01-24). Pig-to-Human Ebola Case Suspected in Philippines. New York Times. Retrieved 2009-01-26. [134] McCormick & Fisher-Hoch 1999, p. 300 [135] Ebola virus disease. Media centre. WHO. April 2014. Retrieved 18 August 2014. [136] Allela L, Boury O, Pouillot R, Dlicat A, Yaba P, Kumulungui B, Rouquet P, Gonzalez JP, Leroy EM (2005). Ebola virus antibody prevalence in dogs and human risk. Emerging Infect. Dis. 11 (3): 38590. doi:10.3201/eid1103.040981. PMC 3298261. PMID 15757552. [137] Briggs H. BBC News - Ebola: Experimental drugs and vaccines. BBC News. Retrieved 2014-08-08. [138] Ganey A (2014-08-07). Regulatory Explainer: What You Need to Know About the Regulation of Ebola Treat- ments. Regulatory Aairs Professionals Society (RAPS). [139] Ethical considerations for use of unregistered interven- tions for Ebola virus disease (EVD) extquotedbl. WHO. Retrieved 20 August 2014. [140] Oestereich L, Ldtke A, Wurr S, Rieger T, Muoz- Fontela C, Gnther S (2014). Successful treatment of advanced Ebola virus infection with T-705 (favipiravir) in a small animal model. Antiviral Res. 105: 1721. doi:10.1016/j.antiviral.2014.02.014. PMID 24583123. [141] French nurse cured of Ebola contracted in Liberia. MSN. Retrieved 7 October 2014. [142] BioCryst to Launch NHP Ebola Drug Safety, Ecacy Studies 'Within Weeks. David Kroll, Forbes Magazine. 29 August 2014. Forbes. 29 August 2014. Retrieved 5 October 2014. [143] DURHAM: BioCryst receives additional funding for Ebola drug - WNCN: News, Weather. WNCN. 18 September 2014. Retrieved 5 October 2014. [144] WNCNSta(3 September 2014). Chimerix experimen- tal drug shows promise in ghting Ebola virus. WNCN News, 4 September 2014. Retrieved 7 October 2014. [145] Chimerix Announces Emergency Investigational New Drug Applications for Brincidofovir Authorized by FDA for Patients With Ebola Virus Disease. Retrieved 7 Oc- tober 2014. [146] Perrone, Matthew (10/6/14). Experimental Drug Pro- vided to Dallas Ebola Patient. ABC. AP. Retrieved 10/6/14. [147] Doctor treats Ebola with HIV drug in Liberia -- seem- ingly successfully. Elizabeth Cohen, CNN news. 29 September 2014. CNN. 27 September 2014. Retrieved 7 October 2014. [148] A Liberian doctor is using HIV drugs to treat Ebola vic- tims. The NIHis intrigued. Elahe Izadi, Washington Post. 2 October 2014. Washington Post. Retrieved 7 October 2014. [149] Garrison, A. R.; Giomarelli, B. G.; Lear-Rooney, C. M.; Saucedo, C. J.; Yellayi, S; Krumpe, L. R.; Rose, M; Para- gas, J; Bray, M; Olinger Jr, G. G.; McMahon, J. B.; Huggins, J; O'Keefe, B. R. (2014). The cyanobacte- rial lectin scytovirin displays potent in vitro and in vivo activity against Zaire Ebola virus. Antiviral Research. doi:10.1016/j.antiviral.2014.09.012. PMID 25265598. [150] Barton, C; Kouokam, J. C.; Lasnik, A. B.; Foreman, O; Cambon, A; Brock, G; Monteori, D. C.; Vojdani, F; McCormick, A. A.; O'Keefe, B. R.; Palmer, K. E. (2014). Activity of and eect of subcutaneous treat- ment with the broad-spectrum antiviral lectin grithsin in two laboratory rodent models. Antimicrobial Agents and Chemotherapy 58 (1): 1207. doi:10.1128/AAC.01407- 13. PMC 3910741. PMID 24145548. [151] De Clercq, E (2013). A Cutting-Edge View on the Cur- rent State of Antiviral Drug Development. Medicinal Research Reviews: n/a. doi:10.1002/med.21281. PMID 23495004. [152] Elshabrawy, H. A.; Fan, J; Haddad, C. S.; Ra- tia, K; Broder, C. C.; Carey, M; Prabhakar, B. S. (2014). Identication of a broad-spectrum antiviral small molecule against severe acute respiratory syndrome 17 coronavirus and Ebola, Hendra, and Nipah viruses by us- ing a novel high-throughput screening assay. Journal of Virology 88 (8): 435365. doi:10.1128/JVI.03050-13. PMC 3993759. PMID 24501399. [153] Mudhasani, R; Kota, K. P.; Retterer, C; Tran, J. P.; Whitehouse, C. A.; Bavari, S (2014). High con- tent image-based screening of a protease inhibitor li- brary reveals compounds broadly active against Rift Valley fever virus and other highly pathogenic RNA viruses. PLoS Neglected Tropical Diseases 8 (8): e3095. doi:10.1371/journal.pntd.0003095. PMC 4140764. PMID 25144302. [154] Johnson, J. C.; Martinez, O; Honko, A. N.; Hensley, L. E.; Olinger, G. G.; Basler, C. F. (2014). Pyridinyl im- idazole inhibitors of p38 MAP kinase impair viral en- try and reduce cytokine induction by Zaire ebolavirus in human dendritic cells. Antiviral Research 107: 102 9. doi:10.1016/j.antiviral.2014.04.014. PMC 4103912. PMID 24815087. [155] Geisbert TW, Lee AC, Robbins M, Geisbert JB, Honko AN, Sood V, Johnson JC, de Jong S, Tavakoli I, Judge A, Hensley LE, Maclachlan I (29 May 2010). Postex- posure protection of non-human primates against a lethal Ebola virus challenge with RNA interference: A proof- of-concept study. The Lancet 375 (9729): 18961905. doi:10.1016/S0140-6736(10)60357-1. PMID20511019. [156] Warren TK, Wareld KL, Wells J, Swenson DL, Donner KS, Van Tongeren SA, Garza NL, Dong L, Mourich DV, Crumley S, Nichols DK, Iversen PL, Bavari S (Septem- ber 2010). Advanced antisense therapies for postexpo- sure protection against lethal lovirus infections. Nature Medicine 16 (9): 991994. doi:10.1038/nm.2202. PMID 20729866. [157] Pollack, Andrew (07 August 2014). Second drug is al- lowed for treatment of Ebola. The NewYork Times. Re- trieved 8 August 2014. [158] Helen Branswell (3 August 2014). Nancy Writebol, U.S. missionary, didn't get TKM-Ebola drug, Tekmira says. CBC News. Canadian Press. [159] Heald AE, Iversen PL, Saoud JB, Sazani P, Charleston JS, Axtelle T, Wong M, Smith WB, Vutikullird A, Kaye E (25 August 2014). Safety and pharmacokinetic pro- les of phosphorodiamidate morpholino oligomers with activity against Ebola virus and Marburg virus: results of two single ascending dose studies. Antimicrobial Agents and Chemotherapy. doi:10.1128/AAC.03442-14. PMID 25155593. [160] Johansen LM, Brannan JM, Delos SE, Shoemaker CJ, Stossel A, Lear C, HostromBG, Dewald LE, Schornberg KL, Scully C, Lehr J, Hensley LE, White JM, Olinger GG (2013). FDA-approved selective estrogen receptor modulators inhibit Ebola virus infection. Sci Transl Med 5 (190): 190ra79. doi:10.1126/scitranslmed.3005471. PMC 3955358. PMID 23785035. Lay summary Healthline Networks, Inc. [161] Gehring G, Rohrmann K, Atenchong N, Mittler E, Becker S, Dahlmann F, Phlmann S, Vondran FW, David S, Manns MP, Ciesek S, von Hahn T (2014). The clinically approved drugs amiodarone, dronedarone and verapamil inhibit lovirus cell entry. J. Antimicrob. Chemother. 69 (8): 212331. doi:10.1093/jac/dku091. PMID 24710028. [162] Tan, DX; Reiter, RJ; Manchester, LC (2014 Sep 27). Ebola virus disease: Potential use of melatonin as a treat- ment.. Journal of pineal research. PMID 25262626. [163] Kroll, David (26 August 2014). How will we know if the Ebola drugs worked? extquotedbl. Forbes. Retrieved 1 October 2014. [164] Nathan Seppa (29 August 2014). ZMapp drug fully pro- tects monkeys against Ebola virus. Science News (Society for Science & the Public). Retrieved 1 October 2014. [165] Blood transfusion named as priority treatment for Ebola. Nature. Retrieved 11 September 2014. [166] Use of convalescent whole blood or plasma collected from patients recovered from Ebola virus disease Empir- ical treatment during outbreaks. WHO. Retrieved 4 Oc- tober 2014. [167] Statement on the WHO Consultation on potential Ebola therapies and vaccines. WHO. 5 September 2014. Re- trieved 1 October 2014. [168] Mupapa K, Massamba M, Kibadi K, Kuvula K, Bwaka A, Kipasa M, Colebunders R, Muyembe-Tamfum JJ (1999). Treatment of Ebola hemorrhagic fever with blood trans- fusions from convalescent patients. International Scien- tic and Technical Committee. J. Infect. Dis. 179 Suppl 1: S1823. doi:10.1086/514298. PMID 9988160. [169] Saphire EO (2013). An update on the use of antibodies against the loviruses. Immunotherapy 5 (11): 122133. doi:10.2217/imt.13.124. PMID 24188676. [170] Gulland, A. (8 September 2014). First Ebola treatment is approved by WHO. BMJ 349 (sep08 7): g5539g5539. doi:10.1136/bmj.g5539. PMID 25200068. [171] FDA warns consumers about fraudulent Ebola treatment products. Retrieved 20 August 2014. [172] Xu L, Sanchez A, Yang Z, Zaki SR, Nabel EG, Nichol ST, Nabel GJ (January 1998). Immunization for Ebola virus infection. Nature Medicine 4 (1): 3742. doi:10.1038/nm0198-037. PMID 9427604. [173] Sullivan NJ, Geisbert TW, Geisbert JB, Xu L, Yang ZY, Roederer M, Koup RA, Jahrling PB, Nabel GJ (7 August 2003). Accelerated vaccination for Ebola virus haemor- rhagic fever in non-human primates. Nature 424 (6949): 681684. doi:10.1038/nature01876. PMID 12904795. [174] Geisbert TW, Daddario-Dicaprio KM, Geisbert JB, Reed DS, Feldmann F, Grolla A, Strher U, Fritz EA, Hens- ley LE, Jones SM, Feldmann H (9 December 2008). Vesicular stomatitis virus-based vaccines protect non- human primates against aerosol challenge with Ebola and Marburg viruses. Vaccine 26 (52): 68946900. doi:10.1016/j.vaccine.2008.09.082. PMC 3398796. PMID 18930776. 18 14 REFERENCES [175] Geisbert TW, Daddario-Dicaprio KM, Lewis MG, Geis- bert JB, Grolla A, Leung A, Paragas J, Matthias L, Smith MA, Jones SM, Hensley LE, Feldmann H, Jahrling PB (November 2008). Vesicular stomati- tis virus-based Ebola vaccine is well-tolerated and pro- tects immunocompromised nonhuman primates. In Kawaoka, Yoshihiro. PLoS Pathogens 4 (11): e1000225. doi:10.1371/journal.ppat.1000225. PMC 2582959. PMID 19043556. [176] Geisbert TW, Geisbert JB, Leung A, Daddario-DiCaprio KM, Hensley LE, Grolla A, Feldmann H (2009). Single- injection vaccine protects nonhuman primates against in- fection with Marburg virus and three species of Ebola virus. Journal of Virology 83 (14): 72967304. doi:10.1128/JVI.00561-09. PMC 2704787. PMID 19386702. [177] Wareld KL, Swenson DL, Olinger GG, Kalina WV, Aman MJ, Bavari S (2007). Ebola viruslike particle based vaccine protects nonhuman primates against lethal ebola virus challenge. The Journal of Infectious Dis- eases 196: S430S437. doi:10.1086/520583. PMID 17940980. [178] Oplinger, Anne A. (2003-11-18). NIAID Ebola vaccine enters human trial. Bio-Medicine. [179] Ebola/Marburg vaccine development (Press release). National Institute of Allergy and Infectious Diseases. 15 September 2008. [180] Martin JE, Sullivan NJ, Enama ME, Gordon IJ, Roed- erer M, Koup RA, Bailer RT, Chakrabarti BK, Bailey MA, Gomez PL, Andrews CA, Moodie Z, Gu L, Stein JA, Nabel GJ, Graham BS (November 2006). A DNA vaccine for Ebola virus is safe and immunogenic in a phase I clinical trial. Clinical and Vaccine Immunology 13 (11): 12671277. doi:10.1128/CVI.00162-06. PMC 1656552. PMID 16988008. [181] Bush, L (21 April 2005). Crucell and NIH sign Ebola vaccine manufacturing contract. Pharmaceutical Tech- nology 29. p. 28. [182] Jones SM, Feldmann H, Strher U, Geisbert JB, Fer- nando L, Grolla A, Klenk HD, Sullivan NJ, Volchkov VE, Fritz EA, Daddario KM, Hensley LE, Jahrling PB, Geisbert TW (July 2005). Live attenuated recombinant vaccine protects nonhuman primates against Ebola and Marburg viruses. Nature Medicine 11 (7): 786790. doi:10.1038/nm1258. PMID 15937495. [183] Viral Hemorrhagic Fever. Infectious Disease Emergen- cies. San Francisco Department of Public Health. Rib- avirin Therapy. Retrieved 24 October 2014. [184] Phoolcharoen W, Dye JM, Kilbourne J, Piensook K, Pratt WD, Arntzen CJ, Chen Q, Mason HS, Herbst- Kralovetz MM (2011). A nonreplicating subunit vac- cine protects mice against lethal Ebola virus chal- lenge. Proc. Natl. Acad. Sci. U.S.A. 108 (51): 20695700. Bibcode:2011PNAS..10820695P. doi:10.1073/pnas.1117715108. PMC 3251076. PMID 22143779. Lay summary BBC News. [185] Canadian-made Ebola vaccine used after German lab ac- cident. CBCNews (Canadian Broadcasting Corporation). Canadian Press. 20 March 2009. Retrieved 2 August 2014. [186] Tus A (March 2009). Experimental vaccine may have saved Hamburg scientist from Ebola fever. BMJ 338: b1223. doi:10.1136/bmj.b1223. PMID 19307268. [187] Feldmann H, Jones SM, Daddario-DiCaprio KM, Geis- bert JB, Strher U, Grolla A, Bray M, Fritz EA, Fernando L, Feldmann F, Hensley LE, Geisbert TW (January 2007). Eective post-exposure treatment of Ebola infection. PLoS Pathogens 3 (1): e2. doi:10.1371/journal.ppat.0030002. PMC 1779298. PMID 17238284. [188] Geisbert TW, Daddario-DiCaprio KM, Williams KJ, Geisbert JB, Leung A, Feldmann F, Hensley LE, Feld- mann H, Jones SM (June 2008). Recombinant vesic- ular stomatitis virus vector mediates postexposure pro- tection against Sudan Ebola hemorrhagic fever in nonhu- man primates. Journal of Virology 82 (11): 56645668. doi:10.1128/JVI.00456-08. PMC 2395203. PMID 18385248. [189] Experimental Ebola Vaccine Processed in Maryland. Drug Discov. Dev. Associated Press. 2 October 2014. [190] First British volunteer injected with trial Ebola vaccine in Oxford. Guardian. 17 September 2014. Retrieved 17 September 2014. [191] An Ebola vaccine was given to 10 volunteers, and there are no red ags yet. Washington Post. 16 September 2014. Retrieved 17 September 2014. Bibliography Klenk, Hans-Dieter (January 1999). Marburg and Ebola Viruses (Current Topics in Microbiology and Immunology). Berlin: Springer-Verlag Telos. ISBN 978-3-540-64729-4. Klenk, Hans-Dieter; Feldmann, Heinz (2004). Ebola and Marburg viruses: molecular and cellular biology (Limited preview). Wymondham, Norfolk, UK: Horizon Bioscience. ISBN 978-0-9545232-3- 7. Kuhn, Jens H. (2008). Filoviruses: A Compendium of 40 Years of Epidemiological, Clinical, and Lab- oratory Studies. Archives of Virology Supplement, vol. 20 (Limited preview). Vienna: SpringerWi- enNewYork. ISBN 978-3-211-20670-6. McCormick, Joseph; Fisher-Hoch, Susan (June 1999) [1996]. Level 4: Virus Hunters of the CDC (Limited preview). Horvitz, Leslie Alan (Updated [3rd] ed.). Barnes & Noble. ISBN 978-0-7607- 1208-5. 19 Pattyn, S. R. (1978). Ebola Virus Haemorrhagic Fever (Full free text) (1st ed.). Amsterdam: Elsevier/North-Holland Biomedical Press. ISBN 0- 444-80060-3. Ryabchikova, Elena I.; Price, Barbara B. (2004). Ebola and Marburg Viruses: A View of Infection Us- ing Electron Microscopy. Columbus, Ohio: Battelle Press. ISBN 978-1-57477-131-2. 15 External links Ebola virus disease at DMOZ CDC: Ebola hemorrhagic fever Centers for Dis- ease Control and Prevention, Special Pathogens Branch WHO: Ebola haemorrhagic fever World Health Organization, Global Alert and Response Google Map of Ebola Outbreaks WHO recommended infection control measures 20 16 TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES 16 Text and image sources, contributors, and licenses 16.1 Text Ebola virus disease Source: http://en.wikipedia.org/wiki/Ebola_virus_disease?oldid=629076102 Contributors: AxelBoldt, Magnus Manske, LC, Mav, Higbvuyb, Andre Engels, Eclecticology, Josh Grosse, Danny, William Avery, SimonP, Azhyd, Rsabbatini, Mintguy, Olivier, Edward, Kwertii, Liftarn, Ixfd64, Delirium, Minesweeper, Ams80, Ahoerstemeier, WilliamM. Connolley, Marumari, Jebba, Mark Foskey, Julesd, Shoecream, Poor Yorick, Jiang, Sunbeam60, Samuel, Adam Conover, Hashar, Stephenw32768, SaveThePoint, Charles Matthews, Ed Cormany, Piolinfax, Zoicon5, Timc, Itai, Thue, Jeeves, Nippp, Wilke, Pakaran, Jusjih, Camerong, Finlay McWalter, Rhys, Catskul, Robbot, Dale Arnett, Mustang dvs, Noldoaran, Astronautics, Korath, Chris 73, Jredmond, Donreed, Kowey, Nurg, Modulatum, Netpilot43556, Securiger, Sverdrup, PedroPVZ, Dukeofomnium, PxT, Ojigiri, Jondel, Radical edward, UtherSRG, Wikibot, Vfrickey, Webhat, Ruakh, Quadalpha, Seth Ilys, Hcheney, Oobopshark, Dina, Alan Liefting, Centrx, Giftlite, DocWatson42, Christopher Parham, Wolfkeeper, Lethe, Tom harrison, Timpo, Obli, Peruvianllama, Iridium77, Everyking, Bkonrad, P.T. Aufrette, Raph, Curps, Gamaliel, Varlaam, Ashraf2004, DO'Neil, JimD, Guanaco, Siroxo, Munkee, Hob, Joseph Dwayne, Geospear, Utcursch, Pgan002, Farside, Fys, Mike R, CryptoDerk, Yath, ConradPino, Proberts2003, Antandrus, Beland, Scottperry, Khaosworks, Flow, Kiteinthewind, Zantolak, Xtreambar, OwenBlacker, DragonySixtyseven, One Salient Oversight, PFHLai, GeoGreg, Karl-Henner, Lumidek, Cryptend64, TonyW, Aramgutang, Joyous!, MakeRocketGoNow, Kevin Rector, Mike Rosoft, Wikiti, Eyrian, Ocon, DanielCD, KNewman, MysteryDog, Dis- cospinster, Rich Farmbrough, Avriette, Guanabot, FT2, InnerSpacePilot, YUL89YYZ, LeeHunter, Paul August, Night Gyr, Bender235, ESkog, Neurophyre, Richard Taylor, Tooto, Brian0918, Pt, Ascorbic, Bletch, Claviola, Shanes, AreJay, Art LaPella, Mairi, Xed, SS451, Guettarda, Bobo192, Grue, Timdiggerm, TomStar81, Billymac00, Smalljim, Davidruben, Viriditas, Arcadian, Sludge, Larry V, Apostro- phe, Sam Korn, Krellis, CKlunck, Nsaa, Jakew, Orangemarlin, Freako, Alansohn, Free Bear, Tek022, Mc6809e, Yamla, Axl, Psychofox, Fritzpoll, Mac Davis, Wdfarmer, Eukesh, Katefan0, Stillnotelf, Bart133, Snowolf, Laundry, BanyanTree, Trigxine, ClockworkSoul, Pro- hibitOnions, Grenavitar, Geraldshields11, Bsadowski1, John5008, BDD, Tobyc75, Netkinetic, Ceyockey, Falcorian, TShilo12, Sylvain Mielot, OwenX, Woohookitty, LostAccount, Mindmatrix, Gccwang, TigerShark, DoctorWho42, Thorpe, Jbrown456, Barrylb, BillC, WadeSimMiser, Miss Madeline, Apokrif, Tabletop, Puersh101, GregorB, Macaddct1984, Eras-mus, Plrk, Wayward, Joe Beaudoin Jr., Prashanthns, Dysepsion, Graham87, Magister Mathematicae, Drbogdan, Sjakkalle, Rjwilmsi, Koavf, Matt.whitby, Jweiss11, Seraphim- blade, JonMoulton, Camdic, Justin Hirsh, Sohmc, SeanMack, Tomtheman5, The wub, Bhadani, Wareq, Reinis, Sampson, GregAsche, Sango123, Cassowary, Yamamoto Ichiro, Titoxd, Cjpun, Themalau, Mirror Vax, RobertG, Old Moonraker, Nihiltres, Who, Avalyn, AI, Moroboshi, RexNL, Wctaiwan, Gurch, Tijuana Brass, Kolbasz, TheDJ, Ralphael, Riki, OrbitOne, Intgr, TeaDrinker, Stevenfruitsmaak, Sderose, Alphachimp, Thecurran, Chobot, Cdmarcus, DVdm, Digitalme, Theblueower, FrankTobia, YurikBot, Wavelength, Sceptre, Kollision, RussBot, FrenchIsAwesome, Me and, GSchjetne, Lance Bryant, Hydrargyrum, Greenbe, Stephenb, Bill52270, Gaius Cornelius, CambridgeBayWeather, Kyorosuke, Chiaroscuros, Rsrikanth05, Pseudomonas, Alexbrennen, Wimt, Shanel, NawlinWiki, Wiki alf, Mi- padi, Liastnir, GenestealerUK, Dlpipper, Johann Wolfgang, Trovatore, Joel7687, Eric Sellars, Howcheng, Saoirse, Irishguy, Ragesoss, Toutey, Ellwyz, Moe Epsilon, Mlouns, Ezeu, Scs, Alex43223, Syrthiss, Dbrs, Zephalis, Rcinda1, Elkman, Haemo, Ochiwar, Maunus, Wknight94, Raistlin8r, FF2010, Simon80, Georgewilliamherbert, Donbert, Rmburt, Mike Serfas, Zzuuzz, Huangcjz, Mike Selinker, Josh3580, Toddgee, Dspradau, Peter, Eeee, Wbrameld, ArielGold, RunOrDie, ASchmoo, Junglecat, Ameinias, Demdem, Elliskev, DVD R W, Bibliomaniac15, That Guy, From That Show!, SmackBot, ILBobby, Unschool, Espresso Addict, Rtc, Tom Lougheed, Deuxsonic, KnowledgeOfSelf, Olorin28, Pgk, Jacek Kendysz, Solaris smoke, IainP, Finavon, Delldot, Jab843, Motorneuron, Canthusus, TheDoctor10, Kintetsubualo, Hbackman, Nil Einne, Edgar181, Aksi great, Gilliam, Ohnoitsjamie, Hmains, Skizzik, Kevinalewis, Icemuon, Squiddy, KD5TVI, Teemu Ruskeep, Chris the speller, Master Jay, Quinsareth, RDBrown, Thumperward, MalafayaBot, SchftyThree, Cathryn, Moshe Constantine Hassan Al-Silverburg, Deli nk, Bazonka, NeoNerd, The Moose, Darth Panda, Rlevse, Modest Genius, Royboycrash- fan, Amitwats, Tsca.bot, NYKevin, Can't sleep, clown will eat me, Bdevoe, Frap, Gameboy4192, Markkasan, Zone46, Sephiroth BCR, Synapse001, Npho, Nunocordeiro, Butterz, Anthony Leppert, New World Man, Addshore, PsychoCola, Jumping cheese, JR98664, Dan Sarandon, AdamWeeden, Savidan, Generalqueef, A.R., G716, Lcarscad, Sokolesq, Drphilharmonic, Pg2114, Baystatethrasher, Kotjze, Sigma 7, Ligulembot, Rodeosmurf, Pilotguy, Rory096, Ser Amantio di Nicolao, Chazchaz101, Giovanni33, Kuru, Ourai, iga, Pvera, Jan.Smolik, BurnDownBabylon, Bydand, JohnI, Khono, Soumyasch, Quarkey, Bucksburg, Mgiganteus1, IronGargoyle, Cielomobile, JWa- ters, Chrisd87, Ben Moore, Rocio Nadat, Cacetudo, Oublier, Booksworm, Muad, StanBrinkerho, Serephine, InedibleHulk, Waggers, Redeagle688, TastyPoutine, Magere Hein, Ryulong, Beck162, Phuzion, Cadaeib, Politepunk, Norm mit, Bctrainers, Fredil Yupigo, Iri- descent, StuHarris, Novandilism, Kgreen20, The7thmagus, Newone, Le2006, Kevinlipe, Twas Now, Peanutvampire, KsprayDad, Cap- italR, Ceilidthbear, Courcelles, Donners, Anger22, Jyoung, JayHenry, Tawkerbot2, MightyWarrior, Petr Matas, Beforemath, JForget, Tfccheng, CRGreathouse, Liam Skoda, CmdrObot, Ale jrb, FunPika, Dycedarg, Lavateraguy, Sninoy, T0fuMan, Forrest.brown, Erik Kennedy, Runningonbrains, Iandefor, Ruslik0, ToucanJoe, GHe, CuriousEric, Raz1el, Daveenna, Love To Learn, TheTito, Neelix, Meodipt, Aaaaaaaaaaaaaa, Tim1988, Singerboi22, Karenjc, TJDay, Phatom87, Cunningpal, RelentlessRecusant, Carl Turner, Travel- bird, Red Director, Anthonyhcole, JFreeman, Xxanthippe, Chasingsol, Pascal.Tesson, Mycroft.Holmes, Diabolos, DumbBOT, Optimist on the run, Viridae, Ward3001, Voldemortuet, Filthy trash can, FrancoGG, Thijs!bot, Epbr123, Nakomis, Pajz, Monosynthluv, Danthe- man13, Kayag, Ante Aikio, Dparry, Quaoarian, Magpie menace, Marek69, West Brom 4ever, Tapir Terric, Excalibur2211, Electron9, Tellyaddict, Stoneystig, Natalie Erin, ThomasPusch, BlueLightning, Danarmstrong, Hmrox, Gossamers, AntiVandalBot, Yonatan, Luna Santin, Seaphoto, Jraytram, Fru1tbat, Quintote, CPMartin, Quixote9, Vanjagenije, Farosdaughter, Malcolm, Spencer, Yellowdesk, Nancy Vandal, Fireice, Elaragirl, Res2216restar, Sluzzelin, JAnDbot, Dogru144, Husond, MER-C, Sperber, Wizardboy777, Andonic, Kirrages, Rothorpe, Alastair Haines, LittleOldMe, ThePrznKonection, Acroterion, DIETER, Wildhartlivie, FaerieInGrey, Magioladitis, WolfmanSF, Secret Squrrel, ParadiseMissouri, Freedomlinux, ZPM, Bongwarrior, VoABot II, Hb2019, Dekimasu, Nyq, Wikidudeman, JNW, Zatham, Trentono, Ed!, Nyttend, Kevinmon, Prestonmcconkie, Brusegadi, Day and Nite, Sub40Hz, Catgut, Cgingold, BatteryIncluded, Torchiest, Adrian J. Hunter, 28421u2232nfenfcenc, Mkdw, Allstarecho, Tins128, Cpl Syx, Sabedon, Glen, DerHexer, Valerius Tygart, Sanjay12, Djsquintz, Oren0, Read-write-services, Hdt83, MartinBot, STBot, Gandydancer, Scheuerm, Juansidious, Milov, Glrx, Kingofrock, Fast- man99, Mschel, R'n'B, AlexiusHoratius, Nono64, Lilac Soul, RockMFR, AlphaEta, Cold534, J.delanoy, Captain panda, Pharaoh of the Wizards, Lithui, CFCF, AAA!, Bogey97, Boghog, Uncle Dick, Xris0, Colincbn, Ginsengbomb, Dr.Ballsack Phd, WarthogDemon, Milo03, Acalamari, Mathglot, Katalaveno, Cannonmc, Buhadram, Ghidorah221, McSly, Xizes, Chicken666, Trumpet marietta 45750, Mikael Hggstrm, AntiSpamBot, Munman100010, (jarbarf), Floateruss, M-le-mot-dit, Veganaxos, Bobianite, EconomistBR, 83d40m, Heero Kirashami, Kingcampo, Wa3pxx, Thioxane, KylieTastic, Cometstyles, STBotD, Bioform 1234, EarthRise33, Tototo7, Jaimeastorga2000, Inter16, Mikeeeman, Ja 62, Martial75, MikeLeeds, Spellcast, Azuriteking, PetsTheCatsh, My Core Competency is Competency, Jrugor- don, Deor, Pumush, Cireshoe, CWii, DrMicro, Je G., Jennavecia, Moman5, Orthologist, Rubyuser, Naysie, Soliloquial, Prelate Zeratul, Sodapopkid, CART fan, Barneca, QuackGuru, Philip Trueman, HiraV, Oshwah, Crevox, Mxtbcca, Dwaynebailey, Nikolaivich, Z.E.R.O., Anonymous Dissident, Aymatth2, Qxz, Imasleepviking, Clarince63, Leafyplant, Millebe, LeaveSleaves, ^demonBot2, Raymondwinn, 16.2 Images 21 PDFbot, Optigan13, Sovietpride, Luuva, Maxim, Saturn star, Quindraco, Kaiketsu, Bogus987654321, Dmickan, Petero9, Lebron15594, Hedington, Itsmeiam, Rituido, Insanity Incarnate, Otterthay, Mr. Sandy, Jmh649, Billytrousers, Steven Weston, SylviaStanley, Karthik Sarma, Unused000702, Pvanheus, Gaelen S., BP-baller, BPP-baller, Lionfan1991, SieBot, Sonicology, Milnivri, Favouritesky, Jturner3, Graham Beards, Hertz1888, VVVBot, Da Joe, Dawn Bard, Ybidiotic, RJaguar3, Wienandwienand, M.thoriyan, LeadSongDog, GlassCo- bra, Francish7, Keilana, Flyer22, Tiptoety, Captain Yankee, Oda Mari, Grimey109, Taejin, Hiddenfromview, Stylesjx, Madam Sillyface, Mimihitam, Lanzarotemaps, Oxymoron83, Antonio Lopez, Faradayplank, Nuttycoconut, Bagatelle, Thirdeyeopen33, Lightmouse, Tech- man224, Johndheathcote, PbBot, Adragon111, Cheesefondue, Crazycasta, Dabomb87, Nn123645, Hordaland, Denisarona, Pgokey, Vanyo, Jamesdreherjr, TheCatalyst31, Zurppies, ClueBot, CiudadanoGlobal, Foxj, Colorado Dave, The Thing That Should Not Be, Sematimba, Jan1nad, Nnemo, Ohcrapitsdevvii, R000t, Chessy999, Arakunem, O Goncho88, Mild Bill Hiccup, WDM27, DigitalNinja, CounterVan- dalismBot, Robertpedley, Waterpolo379, Blanchardb, Dylan620, Fattman123, Auntof6, Lyonspen, Boneyard90, LeoFrank, Tomtomlily, Mkativerata, Excirial, HetmanSydor, Jusdafax, Nathan Laing, Eeekster, Leonard^Bloom, Lartoven, Ykhwong, Sun Creator, NuclearWar- fare, Aurora2698, Gralgrathor, Psinu, Bcrossiter, Falco11 2011, Iohannes Animosus, Bidimensional, Indians99, CowboySpartan, Morel, Razorame, Gciriani, Dekisugi, MedicRoo, Ottawa4ever, Kakofonous, Thingg, Aitias, Tuberculosishivaids, Jdiplacidi, Versus22, Rabid bee, IJA, SoxBot III, Vanished User 1004, DumZiBoT, XLinkBot, ViperNerd, Spitre, Jytdog, Licourtrix, ChyranandChloe, Stickee, Marco369, Rror, Corker1, Ericloewe, Revancher, WikiDao, Jinxed4ever, Ikihi123, Jpboia, Dsulkar, Jinnatun, Yameogo, Addbot, Proof- reader77, Jianrong95, Some jerk on the Internet, Imeriki al-Shimoni, Causecausecause, DOI bot, Blechnic, AliasMe, Ocdnctx, Elishabet, Ronhjones, Hockeyspeed, Hondamx267, MartinezMD, Dela01241, Szico VII, CanadianLinuxUser, Fluernutter, Mentisock, Chamal N, CarsracBot, Awanta, Glane23, Lihaas, Stuttermullet1, AnnaFrance, Keepcalmandcarryon, Danman999, Pantherfreak12, 5 albert square, Megamike345, Ehend661, 84user, JennieMacGuire, Matthias of redwall, Tide rolls, Lightbot, OlEnglish, Pietrow, 55, Ettrig, Maya- mussa, LuK3, Ben Ben, Legobot, Luckas-bot, Vedran12, Yobot, GRLant1, 2D, Kartano, Mcdennis13, Tohd8BohaithuGh1, Tmwerty, Legobot II, Welshdragon0586, II MusLiM HyBRiD II, Jason Recliner, Esq., Yngvadottir, Andreiwest, ArchonMagnus, THEN WHO WAS PHONE?, Coachuponnow, RotogenRay, Telekineticturtle, R500Mom, Tempodivalse, Anonymous from the 21th century, Bbar- ney, DiverDave, AnomieBOT, LordShonus, Popezilla, Archon 2488, SwiftlyTilt, Williamsu95, IsabelleHubert, Jim1138, IRP, Dwayne, Neptune5000, Blokeice, Biosafety 4 Exert, Kingpin13, Tommoxyz, Materialscientist, The High Fin Sperm Whale, Citation bot, Rick- james20000, GB fan, Quebec99, LilHelpa, Najarro, Sluchy523, Bryantwilson91, Obersachsebot, Zad68, , Character.assassin, The sock that should not be, Capricorn42, Gigemag76, Renaissancee, Ktwalker01, Locos epraix, Kalieroxs567, RadManCF, NOrbeck, Dr- Shane, Laurel.jensen, Gatorgirl7563, Anonymous from the 21st century, A dullard, INick3, Frankie0607, Queen Rhana, Doulos Christos, Taylornate, Moxy, GNRY09, Shortelz, Miyagawa, Nciszdabest, SchnitzelMannGreek, SD5, Snurg, Spongefrog, FrescoBot, Surv1v4l1st, Tobby72, Charlie1volley, StaticVision, Alxeedo, Saxifrage853, Bullgarbage, Goldentolken, BenzolBot, CanadianNine, Raikirisenpai, Can- nolis, Citation bot 1, Citation bot 4, Pizik, Amplitude101, DrilBot, DKMell, RubiksMaster110, Cubs197, JKDw, Pinethicket, Abductive, Ericbourland, Jonesey95, Lolaxoxo, Geogene, Dhomya, Jschnur, VenomousConcept, Salvidrim!, SW3 5DL, Ce-boHemFe, Salsaman22, Kgrad, Andrewmwolfe, Ryckpage, Nickpost05, Evert:Meulie, Dinamik-bot, Sangjinhwa, Vrenator, Zvn, Mannaro85, Clarkcj12, MrX, Mtmulch, Raidon Kane, Ink Falls, Reaper Eternal, Kitfoxxe, Weedwhacker128, Colton.eastman, Reach Out to the Truth, RobertMfromLI, DARTH SIDIOUS 2, Sojoho09, Lozion, RjwilmsiBot, 7mike5000, Protenpinner, Thedues, Agent Smith (The Matrix), Power t, Shak- tal, DASHBot, Karin127, Mukogodo, EmausBot, Bobjoejrthethird, Francophile124, Insorak, Echokilocharlie, Heracles31, Katherine, Racerx11, Tinss, RA0808, Borovi4ok, NotAnonymous0, Willjones98, Slightsmile, Wikipelli, K6ka, Lucas Thoms, CrimsonBlue (Roll- back), Mz7, Ronk01, John Cline, Bongoramsey, Ncboy2010, Jonpatterns, , Redav, Medeis, Iseecowboys, Marcofontes, Man- whatsup, Ewa5050, G-FINN22, Wingman4l7, Sbmeirow, Scotware, Brandmeister, Lorem Ip, Danmuz, Donner60, DeCausa, Fanyav- izuri, Waugh Bacon, Olivia Francois, Guitarguy949, Bpickett, Llightex, Sven Manguard, DASHBotAV, Spicemix, Sp4cetiger, Mixer98, ClueBot NG, Gareth Grith-Jones, Jack Greenmaven, TorstenMandal, This lousy T-shirt, 4Jmaster, Pizza1016, Clarkdn, Viveleroux, Wimpus, Armouredduck, Snotbot, Delusion23, O.Koslowski, Widr, Warm Worm, FiesTyPanDA, Pbmaise, GuyHimGuy, Pragmatic- statistic, Helpful Pixie Bot, WEWEE, Tholme, Tarikupu, Wbm1058, Bibcode Bot, BG19bot, Rodakarth, GruntUltra567, EvilResident, Kimchi1333, Mrjohncummings, Wzrd1, Patrug, CatPath, Huhshyeh, Kendall-K1, Badon, Mark Arsten, Moocow119, Bigdogbigdog52, Floating Boat, Jeancey, Swampdonkeyxx, Sodaant, Smbrizendine, MrBill3, AnselaJonla, Sdesalas, Joshua4157, Zorecchi, Duxwing, Kalkeeli, Barrett at central college, Daviscentralcollege, BattyBot, Factsearch, Metsfreak2121, Tutelary, Pete.clat, W.D., The Illusive Man, Ravikantc, Vincent Le Ho, Sermadison, Foxtrot620, Tietomanni, Khazar2, TylerDurden8823, Thecudder15, Thundermoose18, Dexbot, , Cheeseface101, Wolfblade0, Webclient101, Mogism, OscarK878, Inayity, Ptrw08, Cornelius90, Lugia2453, Vanished user jerij2o2, Electronsaregreen, Tianyshi, Jmoney90, Wywin, ZX95, Coachlover1000, Epicgenius, Rwhite2366, Pdecalculus, Lok- mac, Biomedicinal, Jmisasi, Jodosma, VoiceOfTheCommons, Jinkinson, Jake stranzl, Randomer679, EvergreenFir, Nodove, Kintamani- matt, Adiecoly, Prokaryotes, 3AlarmLampscooter, Wolfscopez, Tshuva, Glenburne, Anrnusna, Vigo1100, Jonnywidefoot, Lexanglopaddy, AH999, Drkvncnt, Biggem001, Craigrottman, Slenderdan, Monkbot, LeoLi1234, Kingrain1, Ddluv09, Vieque, AntiqueReader, NewEng- landDr, Coeedrinker115, TheQ Editor, BernieGordon, Dwade64, Amw2017, Lgkkitkat, Nowzer, Georsche, Badnaam, Elchap, Writin- gEnthusiast14, 59Ballons, Plantduets, Itztony, Anguskhan01, Trololololololol321, Amortias, Wontsilence, NQ, Signedzzz, ClaudioUEC, Wikicology, Malerisch, Joneys Joes, Lemos the Mad scientist, MissKatie89, Homomnius, Ryubyss, Emily1015, Davidjconnolly, ExoSuho, Bhavinderrao9, Omodeletobi, 93notes, Eftonia, Harrismark, Doc Ayomide, Ebola guy, Wrsa, Chizzy92, Inemudom, Chibike94, RealPyro, Fakecolepoland, Crlaozwyn, Dylang010, 2manyJimmiesRustled, BrianGroen, EoRdE6, Starstr, Xqxf and Anonymous: 1943 16.2 Images File:Biosafety_level_4_hazmat_suit.jpg Source: http://upload.wikimedia.org/wikipedia/commons/9/97/Biosafety_level_4_hazmat_ suit.jpg License: Public domain Contributors: http://www.sciencenewsline.com/medicine/2010052012000036.html Original artist: United States Army Medical Research Institute of Infectious Diseases File:Bushmeat_-_Buschfleisch_Ghana.JPG Source: http://upload.wikimedia.org/wikipedia/commons/e/e4/Bushmeat_-_ Buschfleisch_Ghana.JPG License: CC-BY-SA-3.0 Contributors: Own work Original artist: Wikiseal File:CDC_worker_incinerates_med-waste_from_Ebola_patients_in_Zaire.jpg Source: http://upload.wikimedia.org/wikipedia/ commons/a/a9/CDC_worker_incinerates_med-waste_from_Ebola_patients_in_Zaire.jpg License: Public domain Contributors: This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identication number #7197. Original artist: CDC/ Dr. Lyle Conrad File:Commons-logo.svg Source: http://upload.wikimedia.org/wikipedia/en/4/4a/Commons-logo.svg License: ? Contributors: ? Original artist: ? File:Diseased_Ebola_2014.png Source: http://upload.wikimedia.org/wikipedia/commons/8/86/Diseased_Ebola_2014.png License: CC- BY-SA-3.0 Contributors: Own work Original artist: Leopoldo Martin R 22 16 TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES File:EbolaCycle.png Source: http://upload.wikimedia.org/wikipedia/commons/f/fc/EbolaCycle.png License: Public domain Contributors: http://www.cdc.gov/vhf/ebola/resources/virus-ecology.html Original artist: CDC File:EbolaSubmit2.png Source: http://upload.wikimedia.org/wikipedia/commons/8/87/EbolaSubmit2.png License: CC-BY-SA-3.0 Contributors: Own work Original artist: Zorecchi File:Ebola_Pathenogensis_path.svg Source: http://upload.wikimedia.org/wikipedia/commons/1/12/Ebola_Pathenogensis_path.svg Li- cense: Public domain Contributors: Ebola__Pathenogensis.svg Original artist: Ebola__Pathenogensis.svg: ChyranandChloe File:Ebola_outbreak_in_Gulu_Municipal_Hospital.jpg Source: http://upload.wikimedia.org/wikipedia/commons/6/6e/Ebola_ outbreak_in_Gulu_Municipal_Hospital.jpg License: Public domain Contributors: http://www.cdc.gov/globalidplan/7-priority_1.htm Original artist: Daniel Bausch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC File:Ebola_virus_virion.jpg Source: http://upload.wikimedia.org/wikipedia/commons/e/e6/Ebola_virus_virion.jpg License: Public do- main Contributors: This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identication number #10816. Original artist: CDC/Cynthia Goldsmith File:Filovirus_phylogenetic_tree.svg Source: http://upload.wikimedia.org/wikipedia/commons/a/a5/Filovirus_phylogenetic_tree.svg License: Public domain Contributors: Towner JS, et al. http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1000212 Orig- inal artist: ChyranandChloe & Rewrite: Fred the Oyster File:Monoclonal_antibodies3.jpg Source: http://upload.wikimedia.org/wikipedia/commons/c/c5/Monoclonal_antibodies3.jpg License: Public domain Contributors: Originally from en.wikipedia; description page is/was here. Original artist: Original uploader was Quintote at en.wikipedia File:Padlock-silver.svg Source: http://upload.wikimedia.org/wikipedia/commons/f/fc/Padlock-silver.svg License: ? Contributors: http: //openclipart.org/people/Anonymous/padlock_aj_ashton_01.svg Original artist: This image le was created by AJ Ashton. Uploaded from English WP by User:Eleassar. Converted by User:AzaToth to a silver color. File:Rod_of_Asclepius2.svg Source: http://upload.wikimedia.org/wikipedia/commons/e/e3/Rod_of_Asclepius2.svg License: CC-BY- SA-3.0 Contributors: Rod of asclepius.png Original artist: Original: CatherinMunro File:Sida-aids.png Source: http://upload.wikimedia.org/wikipedia/commons/2/2f/Sida-aids.png License: CC-BY-SA-3.0 Contributors: User:FoeNyx 2004 (artistic illustration) Original artist: User:FoeNyx 2004 (artistic illustration) File:Symptoms_of_ebola.png Source: http://upload.wikimedia.org/wikipedia/commons/4/4a/Symptoms_of_ebola.png License: CC0 Contributors: Ebola Hemorrhagic Fever from Centers for Disease Control and Prevention.P age last updated: January 28, 2014. Original artist: Mikael Hggstrm File:Text_document_with_red_question_mark.svg Source: http://upload.wikimedia.org/wikipedia/commons/a/a4/Text_document_ with_red_question_mark.svg License: Public domain Contributors: Created by bdesham with Inkscape; based upon Text-x-generic.svg from the Tango project. Original artist: Benjamin D. Esham (bdesham) File:Wikidata-logo.svg Source: http://upload.wikimedia.org/wikipedia/commons/f/ff/Wikidata-logo.svg License: Public domain Con- tributors: Own work Original artist: User:Planemad File:Wikinews-logo.svg Source: http://upload.wikimedia.org/wikipedia/commons/2/24/Wikinews-logo.svg License: ? Contributors: This is a cropped version of Image:Wikinews-logo-en.png. Original artist: Vectorized by Simon 01:05, 2 August 2006 (UTC) Updated by Time3000 17 April 2007 to use ocial Wikinews colours and appear correctly on dark backgrounds. Originally uploaded by Simon. File:Wiktionary-logo-en.svg Source: http://upload.wikimedia.org/wikipedia/commons/f/f8/Wiktionary-logo-en.svg License: Public do- main Contributors: Vector version of Image:Wiktionary-logo-en.png. Original artist: Vectorized by Fvasconcellos (talk contribs), based on original logo tossed together by Brion Vibber 16.3 Content license Creative Commons Attribution-Share Alike 3.0