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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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| | {{Ebola}}{{About1|Ebola virus}} |
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| {{Taxobox
| | '''For patient information, click [[{{PAGENAME}} (patient information)|here]].''' |
| | name = Ebola virus
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| | image = Ebola_virus.jpg
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| | image_width = 200px
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| | caption = An [[electron microscope|electron micrograph]] of an Ebola virus
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| | virus_group = V
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| | ordo = ''[[Mononegavirales]]''
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| | familia = ''[[Filovirus]]''
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| | genus = ''Ebolavirus''
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| | type_species = ''Zaïre Ebolavirus'' | |
| | subdivision_ranks = Species
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| | subdivision = ''[[Ebola Reston|Reston Ebolavirus]]''<br />''Sudan Ebolavirus''<br />''Ivory Coast Ebolavirus''<br />''Bundibugyo Ebolavirus''
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| }}
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| {{Infobox_Disease
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| | Name = Ebola
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| | Image =
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| | Caption =
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| | DiseasesDB = 18043
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| | ICD10 = {{ICD10|A|98|4|a|90}}
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| | ICD9 = {{ICD9|065.8}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus = 001339
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| | MeshName = Ebola
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| | MeshNumber = C02.782.417.415
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| }}
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| {{CMG}} | | {{CMG}}; {{AE}} {{MJM}}, {{GRN}}, {{Marjan}} {{HK}} |
| {{Ebola}} | |
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| ==Overview==
| | {{SK}} Ebola hemorrhagic fever, Ebola haemorrhagic fever, Ebola HF, EHF, Zaire virus, Zaire Ebolavirus, ZEBOV, Sudan Ebolavirus, SEBOV, Reston Ebolavirus, REBOV, Cote d'Ivoire Ebolavirus, CIEBOV, Bundibugyo ebolavirus, Tai Forest ebolavirus |
| '''Ebola''' is the common term for a group of [[virus]]es belonging to genus ''[[Ebola]]'', family ''[[Filoviridae]]'', and for the disease which they cause, ''Ebola [[viral haemorrhagic fever|hemorrhagic fever]]''. The viruses are characterised by a long, filamentous morphology surrounded by a protein/lipid [[viral envelope]]. Ebola viruses are morphologically similar to the [[Marburg virus]], also in the family ''Filoviridae'', and share similar disease symptoms. Ebola has caused a number of serious and highly publicized outbreaks since its discovery.<ref name="CDCEbola">{{cite web | url = http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebotabl.htm | title = Ebola Cases and Outbreaks - CDC Special Pathogens Branch | accessdate = 2007-12-08 | author = | authorlink = | coauthors = | date = | format = | work = | publisher = Centers for Disease Control and Prevention}}</ref>
| | ==[[Ebola overview|Overview]]== |
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| ==Introduction== | | ==[[Ebola historical perspective|Historical Perspective]]== |
| The Ebola virus first came to notice in 1976 in outbreaks of Ebola [[hemorrhagic fever]] in [[Zaire]] and [[Sudan]].<ref>{{cite web |url=http://www.bmj.com/archive/6991e-2.htm |title=BMJ website |accessdate=2008-02-25 |format= |work= }}</ref> The strain of Ebola which broke out in Zaire has one of the highest [[case fatality rate]]s of any human pathogenic virus, roughly 90%. The strain which broke out later in Sudan has a mortality of approximately 50%. The virus is believed to be initially transmitted to a human via contact with an infected animal host. From the first human infected, the virus is then transmitted by human contact with infected blood and bodily fluids of a diseased person, and by human contact with contaminated medical equipment, such as needles. Both of these infectious mechanisms will occur in clinical ([[nosocomial]]) and non-clinical situations. Due to the high fatality rate, the rapidity of demise, and the often remote areas where infections occur, the potential for widespread epidemic outbreaks is considered low.
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| Ebola is believed to be a [[zoonosis|zoonotic]] virus as it is currently devastating the populations of lowland [[gorillas]] in Central Africa. As of late 2005, three species of fruit bat were identified as carrying the virus, and did not exhibit symptoms, and are now believed to be the natural host species, or reservoir, of the virus.
| | ==[[Ebola classification|Classification]]== |
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| Ebola hemorrhagic fever is potentially lethal and encompasses a range of symptoms including [[fever]], [[vomiting]], [[diarrhea]], generalized pain or malaise, and sometimes [[internal bleeding|internal]] and [[hemorrhage|external bleeding]]. [[Mortality rate]]s are extremely high, with the human case-fatality rate ranging from 50% - 89%, according to viral subtype.<ref>{{cite journal |last=Rouquet |first=P |authorlink= |coauthors=''et al.'' |year=2005 |month= |title=Wild animal mortality monitoring and human Ebola outbreaks, Gabon and Republic of Congo, 2001–2003 |journal=Emerging Infectious Diseases |volume=11 |issue= |pages=283-290 |id= |url=http://www.iucn-vsg.org/documents/D.C.%20docs/ebolaeid.pdf |accessdate= |quote= }}</ref> The cause of death is usually due to [[Hypovolemia|hypovolemic shock]] or [[multiple organ dysfunction syndrome|organ failure]].
| | ==[[Ebola pathophysiology|Pathophysiology]]== |
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| Because Ebola is potentially lethal and since no approved [[vaccine]] or treatment is available, Ebola is classified as a [[Biosafety level#The levels|biosafety level 4]] agent, as well as a [[Bioterrorism#Category A agents|Category A bioterrorism]] agent by the [[Centers for Disease Control and Prevention]]. It has the potential to be weaponized for use in [[biological warfare]] and was investigated for that use by both the [[Soviet Union]] and the [[United States]] during the [[Cold War]]{{Fact|date=October 2007}}. Its effectiveness as a biological-warfare agent is compromised by its extreme deadliness and its level of contagion: a typical outbreak spreads through a small village or hospital, affects the entire population, and then runs out of potential hosts, burning out before it reaches a larger community. Also important is that none of the strains of Ebola known to cause disease in humans have been found to be airborne; only the strain known as Ebola Reston (after the city of Reston, Virginia where it was first identified in Green Monkeys) is believed to be airborne.
| | ==[[Ebola causes|Causes]]== |
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| ==Etymology== | | ==[[Ebola differential diagnosis|Differentiating Ebola from other Diseases]]== |
| The virus is named after the [[Ebola River]] Valley in the [[Democratic Republic of the Congo]] (formerly [[Zaire|Zaïre]]), near the site of the first recognized outbreak in [[1976]], in a mission run by Flemish nuns.<ref>{{cite journal |last=Bardi |first=Jason Socrates |authorlink= |coauthors= |year=2002 |month= |title=Death Called a River |journal=Scribbs Research Institute |volume=2 |issue=1 |pages= |id= |url=http://www.scripps.edu/newsandviews/e_20020114/ebola1.html |accessdate=2006-12-08 |quote= }}</ref>
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| == Structure == | | ==[[Ebola epidemiology and demographics|Epidemiology and Demographics]]== |
| [[Image:ebola virus em.png|thumb|135px|[[electron microscope|Electron micrograph]] of the filamentous structure of Ebola]]
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| ===Size and shape===
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| [[Electron microscope|Electron micrographs]] of members of ''Ebola virus'' show them to have the characteristic thread-like structure of a [[Filoviridae|filovirus]].<ref name="Klenk2004">{{cite book |title=Ebola and Marburg Viruses, Molecular and Cellular Biology |last=Klenk |first=Hans-Dieter |authorlink= |coauthors=Feldmann, Heinz |year=2004 |publisher=Horizon Bioscience |location=Wymondham, Norfolk |isbn=0954523237 |pages= }}</ref> EBOV VP30 is around 288 amino acids long.<ref name="Klenk2004" /> The virions are tubular and variable in shape and may appear as a "U", "6", coiled, circular, or branched shape, however, laboratory purification techniques, such as [[centrifugation]], may contribute to the various shapes.<ref name="Klenk2004" /> Virions are generally 80 [[nanometer|nm]] in diameter.<ref name="Klenk2004" /> They are variable in length, and can be up to 1400 nm long. On average, however, the length of a typical [[virion|Ebola virus]] is closer to 1000 nm. In the center of the virion is a structure called nucleocapsid, which is formed by the helically wound viral genomic RNA complexed with the proteins ''NP, VP35, VP30'' and ''L''. It has a diameter of 40 – 50 nm and contains a central channel of 20–30 nm in diameter. Virally encoded [[glycoprotein]] (GP) spikes 10 nm long and 10 nm apart are present on the outer [[viral envelope]] of the virion, which is derived from the host cell membrane. Between envelope and nucleocapsid, in the so-called matrix space, the viral proteins VP40 and VP24 are located.
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| ===Genome=== | | ==[[Ebola risk factors|Risk Factors]]== |
| Each virion contains one minor molecule of linear, single-stranded, [[Sense (molecular biology)|negative-sense]] RNA, totaling 18959 to 18961 nucleotides in length. The 3′ terminus is not polyadenylated and the 5′ end is not capped. It was found that 472 nucleotides from the 3' end and 731 nucleotides from the 5' end were sufficient for replication.<ref name="Klenk2004" /> It codes for seven structural proteins and one non-structural protein. The gene order is 3′ - leader - NP - VP35 - VP40 - GP/sGP - VP30 - VP24 - L - trailer - 5′; with the leader and trailer being non-transcribed regions which carry important signals to control transcription, replication and packaging of the viral genomes into new virions. The genomic material by itself is not infectious, because viral proteins, among them the RNA-dependent RNA polymerase, are necessary to transcribe the viral genome into mRNAs, as well as for replication of the viral genome.
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| ==Subtypes== | | ==[[Ebola screening|Screening]]== |
| <!-- The correct term is "ebolavirus" without any spaces -->
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| <!-- Ebola has "subtypes", not "species" -->
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| Microbiologists have defined several subtypes of Ebola. The following list is not exclusive. A new strain of Ebola has been identified in Uganda during an outbreak. It does not match any of the four Ebola subtypes previously identified by scientists.<ref>{{cite news |first= |last= |authorlink= |coauthors= |title=New subtype of Ebola suspected in Uganda |url=http://www.usatoday.com/news/world/2007-11-30-uganda-ebola_N.htm |work=[[USA Today]] |publisher= |date=2007-11-30 |accessdate=2008-02-25 }}</ref>
| | ==[[Ebola natural history|Natural History, Complications and Prognosis]]== |
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| === ''Zaïre ebola virus'' === | | ==Diagnosis== |
| [[Image:Ebola-zaire chart.jpg|thumb|300px|right|Known human cases and deaths during outbreaks of ''Zaïre Ebolavirus'' between 1976 and 2003]]
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| The ''Zaïre Ebola virus'' has the highest mortality rate, up to 90% in some epidemics, with an average of approximately 83% mortality over 27 years. The case-fatality rates were 88% in 1976, 100% in 1977, 59% in 1994, 81% in 1995, 73% in 1996, 80% in 2001-2002 and 90% in 2003. There have been more outbreaks of ''Zaïre Ebola virus'' than any other strain.
| | [[Ebola algorithm for the evaluation of the returned traveler|Algorithm for the Evaluation of the Returned Traveler]] | [[Ebola emergency department evaluation|Emergency Department Evaluation]] | [[Ebola case definition|Case Definition]] | [[Ebola history and symptoms|History and Symptoms]] | [[Ebola physical examination|Physical Examination]] | [[Ebola laboratory tests|Laboratory Findings]] | [[Ebola other diagnostic studies|Other Diagnostic Studies]] |
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| The first outbreak took place on [[August 26]] [[1976]] in [[Yambuku]], a town in the north of [[Zaire|Zaïre]]. The first recorded case was Mabalo Lokela, a 44-year-old schoolteacher returning from a trip around the north of the state. His high fever was diagnosed as possible [[malaria]] and he was subsequently given a [[quinine]] shot. Lokela returned to the hospital every day. A week later, his symptoms included uncontrolled [[vomiting]], bloody diarrhea, [[headache]], [[dizziness]], and trouble breathing. Later, he began bleeding from his nose, mouth, and anus. Lokela died on [[September 8]] [[1976]], roughly 14 days after the onset of symptoms.
| | ==Treatment== |
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| Soon after, more patients arrived with varying but similar symptoms including fever, headache, muscle and joint aches, fatigue, nausea, and dizziness. These often progressed to bloody diarrhea, severe vomiting, and bleeding from the nose, mouth, and anus. The initial transmission was believed to be due to reuse of the needle for Lokela’s injection without sterilization. Subsequent transmission was also due to care of the sick patients without [[Universal precautions|barrier nursing]] and the traditional burial preparation method, which involved washing and [[gastrointestinal tract]] cleansing.
| | [[Ebola medical therapy|Medical Therapy]] | [[Ebola air medical transport|Air Medical Transport]] | [[Ebola monitoring and movement of persons following exposure|Monitoring and Movement Following Exposure]] | [[Ebola primary prevention|Primary Prevention]] | [[Ebola future or investigational therapies|Future or Investigational Therapies]] |
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| Two nuns working in Yambuku as nurses also died in the same outbreak.<ref>{{cite paper |last=Isaacson |first=Margaretha |author= |authorlink= |coauthors=''et al.'' |title=Two Belgian nurses died of Ebola |version= |publisher= |date= |url=http://www.itg.be/ebola/ebola-12.htm |format= |id= |accessdate= }}</ref>
| | ==Postmortem Care== |
| <!-- The correct term is "Ebola virus" with a space -->
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| === ''Sudan ebolavirus'' ===
| | [[Ebola postmortem care|Postmortem Care]] |
| [[Image:Ebola-sudan chart.jpg|thumb|300px|right|Known human cases and deaths during outbreaks of Sudan Ebolavirus between 1976 and 2003]] | |
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| Sudan Ebolavirus was the second strand of Ebola reported in 1976. It apparently originated amongst cotton factory workers in Nzara, Sudan. The first case reported was a worker exposed to a potential natural reservoir at the cotton factory. Scientists tested all animals and insects in response to this, however none tested positive for the virus. The carrier is still unknown.
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| A second case involved a nightclub owner in Nzara, [[Sudan]]. The local hospital, Maridi, tested and attempted to treat the patient; however, nothing was successful, and he died. The hospital did not advocate safe and practical procedures in sterilizing and disinfecting the medical tools used on the nightclub owner, likely facilitating the spread of the virus in the hospital.
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| The most recent outbreak of ''Sudan Ebolavirus'' occurred in [[May]] [[2004]]. As of [[May]] [[2004]], 20 cases of ''Sudan Ebolavirus'' were reported in [[Yambio|Yambio County]], [[Sudan]], with 5 deaths resulting. The [[Centers for Disease Control and Prevention]] confirmed the virus a few days later. The neighbouring countries of [[Uganda]] and the [[Democratic Republic of Congo]] have increased surveillance in bordering areas, and other similar measures have been taken to control the outbreak. The average fatality rates for ''Sudan Ebolavirus'' were 54% in 1976, 68% in 1979, and 53% in 2000/2001. The average case-fatality rate is 54%.
| | [[Category:Biological weapons]] |
| <!-- The correct term is "ebolavirus" without any spaces -->
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| ===''Reston ebolavirus''===
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| {{main|Ebola Reston}}
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| First discovered in [[November]] [[1989]] in a group of 100 [[Crab-eating Macaque|Crab-eating macaques]] (''{{lang|la|Macaca fascicularis}}'') imported from the [[Philippines]] to [[Reston, Virginia|Reston]], [[Virginia]]. A parallel infected shipment was also sent to [[Philadelphia]]. This strain was highly lethal in monkeys, but did not cause any fatalities in humans. Six of the Reston primate handlers tested positive for the virus, two due to previous exposure. The bio-thriller ''[[The Hot Zone]]'' was based on this incident.
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| Further ''Reston Ebolavirus'' infected monkeys were shipped again to Reston, and [[Alice, Texas|Alice]], [[Texas]], in February of 1990. More ''Reston Ebolavirus'' infected monkeys were discovered in 1992 in [[Siena]], [[Italy]] and in Texas again in March 1996. A high rate of co-infection with [[Simian hemorrhagic fever virus|Simian hemorragic fever]] (SHF) was present in all infected monkeys. No human illness has resulted from these two outbreaks.
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| ===''Tai (Ivory Coast) ebolavirus''===
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| This subtype of Ebola was first discovered amongst [[chimpanzee]]s of the Tai Forest in [[Côte d'Ivoire|Côte d’Ivoire]], [[Africa]]. On [[November 1]] [[1994]], the corpses of two chimpanzees were found in the forest. [[Necropsy|Necropsies]] showed blood within the heart to be liquid and brown, no obvious marks seen on the organs, and one presented lungs filled with liquid blood. Studies of tissues taken from the chimps showed results similar to human cases during the 1976 Ebola outbreaks in Zaïre and Sudan. Later in 1994, more dead chimpanzees were discovered, with many testing positive to Ebola using molecular techniques. The source of contamination was believed to be the meat of infected [[Western Red Colobus]] monkeys, upon which the chimpanzees preyed.<ref>[http://virus.stanford.edu/filo/eboci.html Ebola Cote d'Ivoire Outbreaks<!-- Bot generated title -->]</ref>
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| One of the scientists performing the necropsies on the infected chimpanzees contracted Ebola. She developed symptoms similar to [[dengue fever]] approximately a week after the necropsy and was transported to Switzerland for treatment. After two weeks she was discharged from hospital, and was fully recovered six weeks after the infection.
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| ===''Bundibugyo ebolavirus''===
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| On [[November 24]] [[2007]], the Uganda Ministry of Health confirmed an outbreak of Ebola in the [[Bundibugyo District]]. After confirmation of samples tested by the United States National Reference Laboratories and the [[Centers for Disease Control]], the World Health Organization has confirmed the presence of a new species of the Ebola virus. On [[February 20]] [[2008]], the Uganda Ministry officially announced the end of the epidemic in Bundibugyo with the last infected person discharged on [[January 8]] [[2008]].<ref>{{cite press release |title=End of Ebola outbreak in Uganda |publisher=[[World Health Organization]] |date=2008-02-20 |url=http://www.who.int/csr/don/2007_02_20b/en/index.html |format= |language= |accessdate= |quote= }}</ref> Ugandan officials confirmed a total of 149 cases of this new Ebola species, with 37 deaths attributed to the strain.<ref>{{cite news |first=Tim |last= Cocks|authorlink= |coauthors= |title=Uganda confirms 113 suspected Ebola cases |url=http://africa.reuters.com/top/news/usnBAN126612.html |work= |publisher=[[Reuters]] |date=2007-12-11 |accessdate=2008-02-25 }}</ref>
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| ==Ebola hemorrhagic fever ==
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| ===Symptoms===
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| [[Image:7042 lores-Ebola-Zaire-CDC Photo.jpg|thumb|right|200px|1976 photograph of two nurses standing in front of Kinshasa case #3 ([[Nurse Mayinga]]) who was treated and later died in Ngaliema Hospital, in [[Kinshasa]], [[Zaire|Zaïre]]]]
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| Symptoms are varied and often appear suddenly. Initial symptoms include high [[fever]] (at least 38.8°C; 101.8°F), [[headache|severe headache]], [[myalgia|muscle]], [[Arthralgia|joint]], or [[abdominal pain]], [[Muscle weakness|severe weakness]] and [[exhaustion]], [[Pharyngitis|sore throat]], [[nausea]], and [[dizziness]]<ref name="WHO">[http://www.who.int/csr/disease/ebola/en/ WHO Fact Sheet Ebola haemorrhagic fever]</ref>. Before an [[outbreak]] is suspected, these early symptoms are easily mistaken for [[malaria]], [[typhoid fever]], [[dysentery]], [[influenza]], or various [[bacteria|bacterial infections]], which are all far more common and reliably less fatal.
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| Ebola may progress to cause more serious symptoms, such as [[diarrhea]], dark or bloody [[feces]], [[Coffee ground vomiting|vomiting blood]], red eyes due to [[Distension]] and hemorrhage of [[Sclerosis|sclerotic arterioles]], [[petechia]], [[maculopapular rash]], and [[purpura]]. Other secondary symptoms include [[hypotension]] (less than 90 mm Hg systolic /60 mm Hg diastolic), [[hypovolemia]], [[tachycardia]], organ damage (especially the [[kidneys]], [[spleen]], and [[liver]]) as a result of disseminated systemic [[necrosis]], and [[proteinuria]]. The interior bleeding is caused by a chemical reaction between the virus and the platelets which creates a chemical that will cut cell sized holes into the capillary walls. After 5-7 days the person will die of "a million cuts."
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| Occasionally, [[internal bleeding|internal]] and external hemorrhage from [[orifice]]s, such as the nose and mouth may also occur, as well as from incompletely healed injuries such as needle-puncture sites. Ebola virus can affect the levels of [[white blood cells]] and [[platelets]], disrupting [[thrombosis|clotting]].{{Fact|date=May 2007}} Fewer than 50 percent of patients will not develop any hemorrhaging.
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| Methods of diagnosis of Ebola include testing saliva and urine samples. The span of time from onset of symptoms to death is usually between 7 and 14 days. By the second week of infection, patients will either [[defervescence|defervesce]] (the fever will lessen) or undergo systemic multi-organ failure. Mortality rates are generally high, ranging from 50% - 90%.<ref name="WHO" /> The cause of death is usually due to [[Hypovolemia|hypovolemic shock]] or [[multiple organ dysfunction syndrome|organ failure]].<ref>{{cite journal |last=Bray |first=Mike |authorlink= |coauthors=Geisbert, Thomas W |year=2005 |month= |title=Ebola virus: The role of macrophages and dendritic cells in the pathogenesis of Ebola hemorrhagic fever |journal=International Journal of Biochemistry & Cell Biology |volume=37 |issue=8 |pages=1560-1566 |doi=10.1016/j.biocel.2005.02.018 |url= |accessdate= |quote= }}</ref>
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| Filoviruses replicate well in a wide range of organs and cell types such as hepatocytes, epithelial cells, fibroblasts, fibroblastic reticular cells and adrenal cortical cells.<ref name="Klenk2004" /> Most notably, the susceptibility of human [[endothelial cells]] is likely the cause of the symptoms that appear in the late stages of the infection such as shock syndrome and hemorrhaging.<ref name="Klenk2004" />
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| ===Transmission===
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| Among humans, the virus is transmitted by direct contact with infected [[body fluid]]s, or to a lesser extent, skin or [[mucous membrane]] contact. The [[incubation period]] can be anywhere from 2 to 21 days, but is generally between 5 and 10 days.
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| Although [[airborne transmission]] between monkeys has been demonstrated by an accidental outbreak in a laboratory located in Virginia, USA, there is very limited evidence for human-to-human airborne transmission in any reported epidemics. [[Mayinga N'Seka|Nurse Mayinga]] might represent the only possible case. The means by which she contracted the virus remains uncertain.
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| The infection of human cases with Ebola virus has been documented through the handling of infected chimpanzees, gorillas, and forest antelopes--both dead and alive--as was documented in Côte d'Ivoire, the Republic of Congo and Gabon. The transmission of the Ebola Reston strain through the handling of cynomolgus monkeys has also been reported.<ref name="WHO" />
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| So far, all epidemics of Ebola have occurred in sub-optimal hospital conditions, where practices of basic hygiene and sanitation are often either luxuries or unknown to caretakers and where disposable needles and [[autoclave]]s are unavailable or too expensive. In modern hospitals with disposable needles and knowledge of basic hygiene and [[Universal precautions|barrier nursing]] techniques, Ebola has never spread on such a large scale.
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| In the early stages, Ebola may not be highly contagious. Contact with someone in early stages may not even transmit the disease. As the illness progresses, bodily fluids from diarrhea, vomiting, and bleeding represent an extreme [[biohazard]]. Due to lack of proper equipment and hygienic practices, large scale epidemics occur mostly in poor, isolated areas without modern hospitals or well-educated medical staff. Many areas where the infectious reservoir exists have just these characteristics. In such environments, all that can be done is to immediately cease all needle-sharing or use without adequate [[Sterilization (microbiology)|sterilization]] procedures, to isolate patients, and to observe strict [[Universal precautions|barrier nursing]] procedures with the use of a medical rated disposable face mask, gloves, goggles, and a gown at all times. This should be strictly enforced for all medical personnel and visitors.
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| Ebola is unlikely to develop(sometimes) into a [[Pandemic|pandemic]], or world-wide infection, due to its difficulty in spreading by [[airborne transmission]] and the period of time that the virus can use a living and contagious victim to spread compared to other infectious diseases. In isolated settings such as a quarantined hospital or a remote village, most victims are infected shortly after the first case of infection is present. In addition, the quick onset of symptoms from the time the disease becomes contagious in an individual makes it easy to identify sick individuals and limits an individual's ability to spread the disease by traveling. Because bodies of the deceased are still infectious, many doctors implemented measures to properly dispose of dead bodies in spite of some traditional local burial rituals.<ref name="nyt">{{cite news |first=Blaine |last=Harden |authorlink= |coauthors= |title=Dr. Matthew's Passion |url=http://www.nytimes.com/library/magazine/home/20010218mag%2debola.html |work=[[New York Times]] Magazine |publisher= |date=2001-02-18 |accessdate=2008-02-25 }}</ref>
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| ===Treatments===
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| [[Image:Ebola outbreak in Gulu Municipal Hospital.jpg|frame|right|A hospital isolation ward in [[Gulu]], [[Uganda]] during the October 2000 outbreak]]
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| Treatment is primarily supportive and includes minimizing invasive procedures, balancing electrolytes since patients are frequently dehydrated, replacing lost [[coagulation factor]]s to help stop bleeding, maintaining oxygen and blood levels, and treating any complicating infections. Convalescent Plasma (factors from those who have survived Ebola infection) shows promise as a treatment for the disease {{Fact|date=April 2008}}. Ribavirin is ineffective. [[Interferon]] is also thought to be ineffective. In monkeys, administration of an inhibitor of coagulation (rNAPc2) has shown some benefit, protecting 33% of infected animals from a usually 100% (for monkeys) lethal infection (unfortunately this inoculation does not work on humans). In early 2006, scientists at [[USAMRIID]] announced a 75% recovery rate after infecting four [[rhesus monkey]]s with Ebola virus and administering [[Antisense therapy|antisense drugs]].<ref>{{cite press release |title=USAMRIID press release |publisher= |date= |url=http://www.usamriid.army.mil/press%20releases/warfield_press_release.pdf |format= |language= |accessdate= |quote= }}</ref>
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| ===Vaccines ===
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| Vaccines have been produced for both Ebola <ref name="Jones2005">{{cite journal |last=Jones |first=Steven |authorlink= |coauthors=''et al.'' |year=2005 |month= |title=Live attenuated recombinant vaccine protects nonhuman primates against Ebola and Marburg viruses |journal=[[Nature Medicine]] |volume=11 |issue=7 |pages=786-790 |doi=10.1038/nm1258 |url= |accessdate= |quote= }}</ref> and Marburg<ref name="Hevey1998">{{cite journal |last=Hevey |first=M |authorlink= |coauthors=''et al.'' |year=1998 |month= |title=Marburg Virus Vaccines Based upon Alphavirus Replicons Protect Guinea Pigs and Nonhuman Primates |journal=Virology |volume=251 |issue=1 |pages=28-37 |doi=10.1006/viro.1998.9367 |url= |accessdate= |quote= }}</ref> that were 99% effective in protecting a group of monkeys from the disease. These vaccines are based on either a [[recombinant]] [[Vesicular stomatitis virus]] or a recombinant [[Adenoviridae|Adenovirus]]<ref name="Sullivan2003">{{cite journal |last=Sullivan |first=Nancy |authorlink= |coauthors=''et al.'' |year=2003 |month= |title=Accelerated vaccination for Ebola virus haemorrhagic fever in non-human primates |journal=[[Nature (journal)|Nature]] |volume=424 |issue=6949 |pages=681-684 |doi=10.1038/nature01876 |url= |accessdate= |quote= }}</ref> carrying the Ebola spikeprotein on its surface. Early human vaccine efforts, like the one at [[NIAID]] in 2003, have so far not reported any successes.<ref>{{cite press release |title=NIAID Ebola Vaccine Enters Human Trial |publisher=National Institute of Allergy and Infectious Diseases |date=2003-11-18 |url=http://www3.niaid.nih.gov/news/newsreleases/2003/ebolahumantrial.htm |format= |language= |accessdate= |quote= }}</ref> The biggest problem with the vaccine is that unless the patient is given it near the onset of the virus (1-4 days after the symptoms begin) then there will be too much damage to the human body to repair, ie: ruptured arteries and capillaries, vomiting, and other symptoms which may still cause enough harm to kill or seriously traumatize the patient.
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| ==Viral reservoirs==
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| Despite numerous studies, the wildlife reservoir of ''Ebolavirus'' has not been identified. Between 1976 and 1998, from 30,000 mammals, birds, reptiles, amphibians, and arthropods sampled from outbreak regions, no ''Ebolavirus'' was detected <ref name="Pourrut2005">{{cite journal |last=Pourrut |first=Xavier |authorlink= |coauthors=''et al.'' |year=2005 |month= |title=The natural history of Ebola virus in Africa |journal=Microbes and Infection |volume=7 |issue=7-8 |pages=1005-1014 |doi=10.1016/j.micinf.2005.04.006 |url= |accessdate= |quote= }}</ref> apart from some genetic material found in six rodents (''Mus setulosus'' and ''Praomys'' species) and a [[shrew]] (''Sylvisorex ollula'') collected from the [[Central African Republic]] in 1998.<ref name="Morvan1999">{{cite journal |last=Morvan |first=Jaques |authorlink= |coauthors=''et al.'' |year=1999 |month= |title=Identification of Ebola virus sequences present as RNA or DNA in organs of terrestrial small mammals of the Central African Republic |journal=Microbes and Infection |volume=1 |issue=14 |pages=1193-1201 |doi=10.1016/S1286-4579(99)00242-7 |url= |accessdate= |quote= }}</ref> ''Ebolavirus'' was detected in the carcasses of [[gorilla]]s, chimpanzees and [[duiker]]s during outbreaks in 2001 and 2003 (the carcasses were the source of the initial human infections) but the high mortality from infection in these species precludes them from acting as reservoirs.<ref name="Pourrut2005" />
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| [[Plant]]s, [[arthropods]], and birds have also been considered as reservoirs, however bats are considered the most likely candidate<ref>{{cite news |first= |last= |authorlink= |coauthors= |title=Fruit bats may carry Ebola virus |url=http://news.bbc.co.uk/2/hi/health/4484494.stm |work=BBC News |publisher= |date=2005-12-11 |accessdate=2008-02-25 }}</ref>. Bats were known to reside in the cotton factory in which the index cases for the 1976 and 1979 outbreaks were employed and have also been implicated in Marburg infections in 1975 and 1980.<ref name="Pourrut2005" /> Of 24 plant species and 19 vertebrate species experimentally inoculated with ''Ebolavirus'', only bats became infected.<ref>{{cite journal |last=Swanepoel |first=R |authorlink= |coauthors=''et al.'' |year=1996 |month= |title=Experimental inoculation of plants and animals with Ebola virus |journal=Emerging Infectious Diseases |volume=2 |issue= |pages=321-325 |doi= |url=http://www.cdc.gov/ncidod/eid/vol2no4/swanepo2.htm |accessdate= |quote= }}</ref> The absence of clinical signs in these bats is characteristic of a reservoir species. In 2002-03, a survey of 1,030 animals from [[Gabon]] and the [[Republic of the Congo]] including 679 bats found ''Ebolavirus'' RNA in 13 [[fruit bats]] (''Hyspignathus monstrosus, Epomops franquetti and Myonycteris torquata'').<ref>{{cite journal |last=Leroy |first=Eric |authorlink= |coauthors=''et al.'' |year=2005 |month= |title=Fruit bats as reservoirs of Ebola virus |journal=Nature |volume=438 |issue= |pages=575-576 |doi=10.1038/438575a |url= |accessdate= |quote= }}</ref> Bats are also known to be the reservoirs for a number of related viruses including [[Nipah virus]], [[Hendra virus]] and [[lyssavirus]]es.
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| ==Weaponization==
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| Because Ebola is lethal and since no approved [[vaccine]] or treatment is available, Ebola is classified as a [[Biosafety Level 4]] agent, as well as a Category A [[bioterrorism]] agent<ref>{{cite journal |last=Hoenen |first=Thomas |authorlink= |coauthors=''et al.'' |year=2006 |month= |title=Ebola virus: unravelling pathogenesis to combat a deadly disease |journal=Trends in Molecular Medicine |volume=12 |issue=5 |pages=206-215 |doi=10.1016/j.molmed.2006.03.006 |url= |accessdate= |quote= }}</ref> and a [[select agent]] by the [[Centers for Disease Control and Prevention|CDC]].
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| Ebola shows potential as a biological weapon because of its lethality but due to its relatively short incubation period it may be more difficult to spread since it may kill its victim before it has a chance to be transmitted, meaning that it would be hard to spread amongst small populations. However, if an outbreak occurred in a city the effects would likely be devastating.
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| As a terrorist weapon, Ebola has been considered by members of [[Japan]]'s [[Aum Shinrikyo]] [[cult]], whose leader, [[Shoko Asahara]] led about 40 members to Zaire in 1992 under the guise of offering medical aid to Ebola victims in what was presumably an attempt to acquire a sample of the virus.<ref>{{cite paper |last= |first= |author= |authorlink= |coauthors= |title=Chronology of Aum Shinrikyo's CBW Activities |version= |publisher=Monterey Institute for International Studies |date= |url=http://cns.miis.edu/pubs/reports/pdfs/aum_chrn.pdf |format= |id= |accessdate= }}</ref>
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| ==Recent outbreaks==
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| As of [[August 30]], [[2007]], 103 people (100 adults and three children) were infected by a suspected hemorrhagic fever outbreak in the village of [[Mweka, Democratic Republic of the Congo]] (DRC). The outbreak started after the funerals of two village chiefs, and 217 people in four villages fell ill. The [[World Health Organization]] sent a team to take blood samples for analysis and confirmed that many of the cases are the result of the Ebola virus <ref>{{cite news |first= |last= |authorlink= |coauthors= |title=Ebola Outbreak Confirmed in Congo |url=http://www.newscientist.com/article/dn12624-ebola-outbreak-confirmed-in-congo.html |work=NewScientist.com |publisher= |date=2007-09-11 |accessdate=2008-02-25 }}</ref>. The Congo's last major Ebola epidemic killed 245 people in 1995 in [[Kikwit]], about 200 [[mile]]s from the source of the Aug. 2007 outbreak.<ref>{{cite news |first= |last= |authorlink= |coauthors= |title=Mystery DR Congo fever kills 100 |url=http://news.bbc.co.uk/2/hi/africa/6973013.stm |work= BBC News |publisher= |date=2007-08-31 |accessdate=2008-02-25 }}</ref>
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| On [[November 30]], [[2007]], the [[Uganda]] Ministry of Health confirmed an outbreak of Ebola in the [[Bundibugyo District]]. After confirmation of samples tested by the United States National Reference Laboratories and the Centers for Disease Control, the World Health Organization confirmed the presence of a new species of the Ebola virus.<ref>{{cite news |first= |last= |authorlink= |coauthors= |title=Uganda: Deadly Ebola Outbreak Confirmed - UN |url=http://allafrica.com/stories/200711301070.html |work=UN News Service |publisher= |date=2007-11-30 |accessdate=2008-02-25 }}</ref> The epidemic came to an official end on February 20, 2008. 149 cases of this new strain were reported and 37 of those led to deaths.
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| ==Life Cycle==
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| * Virus attaches to host receptors through the GP (glycoprotein) surface [[peplomer]] and is endocytosed into vesicles in the host cell.
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| * Fusion of virus membrane with the vesicle membrane occurs; nucleocapsid is released into the cytoplasm.
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| * The encapsidated, negative-sense genomic ssRNA is used as a template for the synthesis ( 3' - 5') of polyadenylated, monocistronic mRNAs.
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| * Translation of the mRNA into viral proteins occurs using the host cell's machinery.
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| * Post-translational processing of viral proteins occurs. GP0 (glycoprotein precursor) is cleaved to GP1 and GP2, which are heavily glycosylated. These two molecules assemble, first into heterodimers, and then into trimers to give the surface peplomers. SGP (secreted glycoprotein) precursor is cleaved to SGP and delta peptide, both of which are released from the cell.
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| * As viral protein levels rise, a switch occurs from translation to replication. Using the negative-sense genomic RNA as a template, a complementary +ssRNA is synthesized; this is then used as a template for the synthesis of new genomic (-)ssRNA, which is rapidly encapsidated.
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| * The newly-formed nucleocapsides and envelope proteins associate at the host cell's plasma membrane; budding occurs, and the virions are released.
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| ==Cultural impact==
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| [[Image:Stuffed ebola.jpg|thumb|An Ebola virus cuddly toy]]
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| Ebola and Marburg have served as a rich source of ideas and plotlines for many forms of entertainment. The infatuation with the virus is likely due to the high mortality rate of its victims, its mysterious nature, and its tendency to cause gruesome bleeding from bodily orifices.
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| In the movie ''[[Outbreak (film)|Outbreak]]'', the virus looks the same as the Ebola virus.{{Or|date=March 2008}} In fact, the entire movie's made up virus "Motaba" is based very closely on Ebola.{{Or|date=March 2008}} The symptoms and area of infection had relevance.
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| The Rage Virus from the movies [[28 Days Later]] and [[28 Weeks Later]] is a modified version of the Ebola virus.
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| In the book ''[[Outbreak (novel)|Outbreak]]'', by [[Robin Cook (novelist)| Robin Cook]], the Ebola virus is used in name as a possible weapon, with criminal intent. This book is different from the movie ''[[Outbreak (film)|Outbreak]]'' of the same name
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| Biological warfare using airborne modifications of the Ebola virus was a main theme in [[Tom Clancy]]'s novels ''[[Executive Orders]]'' and ''[[Rainbow Six (novel)|Rainbow Six]]''. | |
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| In ''[[Resident Evil]]'', the T-Virus is a modified version of the Progenitor Virus, created by inserting it with Ebola genes.<ref>{{cite web |url=http://www3.capcom.co.jp/bio/weskars/index.html |title=Capcom.co.jp "Wesker's Report II" |accessdate=2008-04-12}}</ref>
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| [[Tomb Raider: The Cradle of Life]] features a biological weapon<ref>{{cite web |url=http://www.jesusfreakhideout.com/movies/TombRaider2.asp |title=Jesusfreakhideout.com "Lara Croft Tomb Raider: The Cradle of Life" Movie Review |accessdate=2008-03-11 |format= |work= }}</ref> consisting of a greatly accelerated form of Ebola, capable of causing death within minutes.
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| Much of the representation of the Ebola virus in fiction and the media is considered [[apocryphal|exaggerated or myth]].{{Fact|date=June 2007}} One pervasive myth follows that the virus kills so fast that it has little time to spread. Victims die very soon after contact with the virus. In reality, the incubation time is usually about a week. The average time from onset of early symptoms to death varies in the range 3-21 days, with a mean of 10.1. Although this would prevent the transmission of the virus to many people, it is still enough time for some people to catch the disease.
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| Another myth states that the virus causes patients to melt, liquefy, or bleed profusely. In depictions of this type, victims of Ebola suffer from squirting blood, liquefying flesh, [[zombie]]-like faces and dramatic projectile bloody vomiting, at times, from even recently deceased. In actual fact, only a fraction of Ebola victims have severe bleeding, and most accounts of the course of the disease describe patients as dull and lethargic. Approximately 10% of patients suffer some bleeding, but this is often internal or subtle, such as bleeding from the gums. Ebola symptoms are usually limited to extreme exhaustion, vomiting, diarrhea, abdominal pain, a high fever, headaches and other body pains.
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| The following is an excerpt from an interview with Philippe Calain, M.D. Chief Epidemiologist, CDC Special Pathogens Branch, Kikwit 1996:
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| {{cquote|''At the end of the disease the patient does not look, from the outside, as horrible as you can read in some books. They are not melting. They are not full of blood. They're in shock, muscular shock. They are not unconscious, but you would say 'obtunded', dull, quiet, very tired. Very few were hemorrhaging. Hemorrhage is not the main symptom. Less than half of the patients had some kind of hemorrhage. But the ones that had bled, died.''}}
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| ==See also==
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| <div style="-moz-column-count:3; column-count:3;">
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| *Dr. [[Ngoy Mushola]]
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| *[[Needle remover]]
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| *[[Sharps waste]]
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| *[[Bolivian haemorrhagic fever]]
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| *[[Crimean-Congo haemorrhagic fever|Crimean Congo hemorrhagic fever (CCHF)]]
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| *[[Marburg virus|Marburg haemorrhagic fever]], the first known disease caused by a [[filovirus]]
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| *Dr. [[Matthew Lukwiya]] (1957-[[Dec 5]], [[2000]]), A [[Uganda]]n doctor at the forefront of the 2000 outbreak.
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| *Dr. [[Jonah Kule]], (-[[Dec 4]], [[2007]])
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| *[[VHFs]]
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| *[[Epidemiology]]
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| *[[Bushmeat]]
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| </div>
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| ==References==
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| {{reflist|2}}
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| ==External links==
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| <div class="references-small">
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| '''Overviews'''
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| *[http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/01.025.0.02.htm Database entry on genus ''Ebolavirus''] - [[ICTVdB]]
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| *[http://www.itg.be/ebola/ Ebola Virus Haemorrhagic Fever] - Proceedings of an International Colloquium on Ebola Virus Infection and Other Haemorrhagic Fevers held in Antwerp, Belgium, 6-8 December, 1977
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| *[http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebola/qa.htm Questions and Answers about Ebola Hemorrhagic Fever] - Center for Disease Control (CDC), retrieved 10 July 2006
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| *[http://www.who.int/mediacentre/factsheets/fs103/en/index.html WHO Factsheet] - retrieved 10 July 2006
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| * [http://www.vrc.nih.gov/scientificupdates_ebola.htm Vaccine Research Center (VRC)] - Information concerning Ebola vaccine research studies
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| '''Outbreaks'''
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| *[http://www.cbc.ca/health/story/2007/09/12/ebola-outbreak.html Ebola outbreak in Congo] - CBC News, 12 September 2007. Retrieved [[2007-09-13]].
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| *[http://news.bbc.co.uk/2/hi/science/nature/6220122.stm Ebola 'kills over 5,000 gorillas'] - BBC News, 8 December 2006. Retrieved [[2006-12-08]].
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| * [http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebotabl.htm History of Ebola Outbreaks] - Centers for Disease Control Special Pathogens Branch, retrieved [[2006-07-10]].
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| *[http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual/entire.pdf Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting] - Center for Disease Control and Prevention, Atlanta, [[December]] [[1998]].
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| *[http://www.ird.fr/filomeeting2008/ Filovirus Global Symposium] - Filomeeting 2008
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| '''Life Cycle'''
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| *[http://biomarker.cdc.go.kr:8080/pathogen/pathogen_view_en.jsp?pclass=2&id=44 Biomarker Database] - information on Ebola
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|
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| '''Infectivity'''
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| *[http://www.usamriid.army.mil/press%20releases/warfield_press_release.pdf U.S. Army Medical Research Institute of Infectious Diseases: Gene-Specific Ebola Therapies Protect Nonhuman Primates from Lethal Disease]
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| * [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8712894&query_hl=12 Lethal experimental infection of rhesus monkeys with Ebola-Zaire (Mayinga) virus by the oral and conjunctival route of exposure] PubMed, February 1996, Jaax et al.
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| * [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7547435&query_hl=12 Lethal experimental infections of rhesus monkeys by aerosolized Ebola and marburg virus] PubMed, August 1995
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| * [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15588056&query_hl=12 Marburg and Ebola viruses as aerosol threats] PubMed, 2004, [[USAMRIID]]
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| * [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15207310&query_hl=12 Other viral bioweapons: Ebola and Marburg hemorrhag fever] PubMed, 2004
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| * [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8551825&query_hl=12 Transmission of Ebola virus (Zaire strain) to uninfected control monkeys in a biocontainment laboratory] PubMed, December 1993
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| * [http://www.brettrussell.com/personal/what_are_the_chances_.html What is the probability of a dangerous strain of Ebola mutating and becoming airborne?] Brett Russel, retrieved [[2006-07-10]].
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| </div>
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| {{Viral diseases}}
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| [[Category:Ebola| ]]
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| [[Category:Mononegavirales]] | | [[Category:Mononegavirales]] |
| [[Category:Viral diseases]] | | [[Category:Viral diseases]] |
| [[Category:Biological weapons]]
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| [[Category:Zoonoses]] | | [[Category:Zoonoses]] |
| [[Category:Hemorrhagic fevers]]
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| [[Category:Mature chapter]]
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| [[Category:Overview complete]]
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| [[es:Virus Ébola]]
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