Outsmarting Ebola: Breakthroughs, challenges, and the path forward

Ebola virus disease comes from viruses that look like long threads under a microscope. Scientists named them “filoviruses” from the Latin word “filium,” which means thread. A specific group called “orthoebolaviruses” causes Ebola disease.

These tiny threads cause terrible damage once they enter the human body. The virus attacks two important systems: our immune defenses and the processes that help our blood clot properly. When these systems fail, the body can suffer severe inflammation and bleeding both inside and outside—a scary sign of serious Ebola cases.

There are six known types of Ebola viruses. The Zaire ebolavirus has caused the biggest and deadliest Ebola outbreaks in human history.

Scientists think certain fruit bats carry Ebola naturally. Researchers are still working to understand where the virus lives between human outbreaks.

The case fatality rate for Ebola Virus Disease varies between outbreaks, ranging from 25% to 90%.

Notable outbreaks

Ebola has caused numerous outbreaks since its discovery and multiple outbreaks in Uganda and Democratic Republic of Congo.

• 1976 – Democratic Republic of the Congo (formerly Zaire): The first recognized outbreak occurred in Yambuku, near the Ebola River, with 318 cases and a fatality rate of 88%. The initial case received an injection for suspected malaria at the Yambuku Mission Hospital. The virus spread through the reuse of contaminated needles and syringes in healthcare settings, as well as close personal contact.
• 1976 – Sudan: 284 reported cases and a 53% fatality rate. The outbreak is believed to have started with workers in a cotton factory where 37% of workers in the cloth room were infected. The virus spread mainly through close personal contact within hospitals. Many healthcare personnel were infected.
• 1995 – Kikwit, Democratic Republic of Congo (DRC): This outbreak resulted in 315 cases and a fatality rate of 81%.
• 2000–2001 – Uganda: An outbreak in Gulu district led to 425 cases with a 53% fatality rate.​
• 2014–2016 – West Africa: The largest recorded outbreak affected Guinea, Liberia, and Sierra Leone, resulting in over 28,000 cases and more than 11,000 deaths. ​Infected travelers and healthcare workers spread the disease, with 10 countries reporting cases of Ebola Virus Disease.
• 2018–2020 – DRC: The North Kivu and Ituri provinces experienced an outbreak with 3,470 cases and 2,280 deaths.​
• 2022 – Uganda: An outbreak of the Sudan strain resulted in 164 infections and 55 deaths.

Who is at risk of getting Ebola?

The highest risk groups for Ebola infection include:

• Healthcare workers treating Ebola patients. During the 2014 outbreak in Sierra Leone, healthcare workers had an infection rate 100 times higher than the general population
• Family members and others in close contact with infected individuals
• Participation in traditional burial practices involving direct contact with the deceased
• Hunters or others who handle infected wildlife (particularly bats and primates)

How does Ebola spread?

Ebola is not airborne and doesn’t spread through casual contact.

Transmission occurs when the virus enters the body through mucous membranes (eyes, nose, mouth) or breaks in the skin.

Human-to-human transmission

Ebola can spread from person to person through:

• Direct contact with the blood, secretions, organs, or other bodily fluids of infected individuals
• Contact with surfaces and materials (e.g., bedding, clothing) contaminated with these fluids can also lead to infection.
• Body fluids (like semen) in some individuals who recovered from Ebola

Transmission from animals

Direct contact with wild animals such as fruit bats, their blood, secretions, organs, or other bodily fluids can lead to a person contracting Ebola.

Ebola symptoms typically appear 2-21 days after infection (most commonly 8-10 days) and progress in stages:

Early symptoms (also called “dry symptoms”) resemble many other illnesses:

• Sudden fever
• Extreme fatigue
• Headache
• Muscle and joint pain
• Sore throat

More severe symptoms develop after 4-5 days as the disease progresses.

• Nausea and vomiting
• Diarrhea (can be bloody)
• Rash
• Impaired kidney and liver function
• In some cases, internal bleeding (in stool, from gums) and external bleeding (from injection sites)

Many Ebola survivors suffer from long-term complications after recovery from the illness. These include symptoms across multiple organ systems

Systemic Symptoms

• Fatigue
• Weight gain

Neurological Symptoms

• Headaches
• Memory loss
• Nerve pain or tingling in hands and feet
• Difficulty falling or remaining asleep (insomnia)
• Depression, anxiety, post-traumatic stress disorder (PTSD)

Musculoskeletal Symptoms

• Muscle and joint pain
• Ocular (Eye) System
• Blurry vision
• Eye pain
• Redness
• Light sensitivity

Gastrointestinal Symptoms

• Stomach pain
• Loss of appetite

Endocrine & Reproductive Symptoms

• Changes in menstruation
• Impotence
• Decreased or lost interest in sex
• Inflammation of one or both testicles

Cardiovascular Symptoms

• Tightness in the chest
• Inflammation of heart tissues (pericarditis)

Dermatological (Skin & Hair) Symptoms

• Hair loss

Otolaryngology (Ear, Nose, and Throat) Symptoms

• Hearing problems
• Dry mouth
• Neck swelling

Since early symptoms mimic common illnesses like malaria or typhoid, definitive diagnosis requires laboratory testing:

• PCR (polymerase chain reaction) testing: Detects the virus’s genetic material
• Antigen testing: Identifies viral proteins
• Antibody testing: Detects immune response to the virus. Includes antibody-capture tests and serum neutralization tests

These tests require specialized equipment and trained personnel, making diagnosis challenging in resource-limited settings. Delays in diagnosis can lead to disease progression and increased transmission, underlining the need for effective treatments.

The Ebola virus was first found in 1976 near the Ebola River. For many years, doctors could only provide supportive care by giving fluids, helping patients breathe, and treating other viral infections that developed.

Major breakthroughs came during the large West African outbreak of 2014-2016, which sped up research significantly. Scientists developed and tested monoclonal antibody treatments (mABs). These are lab-made proteins that work like our immune system to fight the virus.

In December 2020, the FDA approved two treatments:

• Inmazeb: A mix of three monoclonal antibodies
• Ebanga: A single monoclonal antibody

These treatments greatly reduced deaths from Ebola in clinical trials.

Supportive care is still very important for helping patients survive, including:

• IV fluids to prevent dehydration
• Help with breathing
• Treatment for other infections
• Medicine for symptoms like pain, fever, and nausea

The current antibody treatments work well but need cold storage and must be given through an IV. This can be difficult during outbreaks. Researchers are working on easier treatments, like pills, for areas with limited resources.

In March 2025, scientists reported promising results for an oral medication against Ebola. They gave infected monkeys a pill called Obeldesivir. All treated monkeys survived, while untreated ones died. This same medication is also being tested against Marburg virus, a close cousin of the Ebola virus.

Prevention remains the best defense against Ebola.

• Vaccines: Ervebo (rVSV-ZEBOV) was approved by the FDA in December 2019, followed by a two-dose vaccine (Zabdeno and Mvabea) approved in Europe in 2020
• Infection control: Healthcare settings implement strict protocols, including isolation of patients, protective equipment for healthcare workers, and safe burial practices
• Contact tracing: Identifying and monitoring individuals who had contact with infected patients
• Community education: Teaching at-risk communities about transmission routes, early symptoms, and when to seek medical care
• Wildlife precautions: Avoiding contact with wildlife that may carry the virus, particularly bats and primates

The story of Ebola shows both the struggles and victories of modern medicine. While Ebola still causes outbreaks in Africa, better monitoring, vaccines, and treatments are helping us respond more effectively.

Scientists continue searching for improved treatments. Options like obeldesivir are promising and are the next step forward. As research advances, health experts around the world stay watchful. Managing Ebola requires being prepared, responding quickly, and continuing to develop new scientific solutions.

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