Viewed through an electron microscope, ebolaviruses appear as long filaments, sometimes branched or intertwined. The virion (virus particle) contains one molecule of noninfectious single-stranded RNA (ribonucleic acid). It is not known how the viruses attack cells; it has been postulated that they produce proteins that suppress the immune system, allowing reproduction of virus to continue unhindered. Viral hemorrhagic fevers similar to Ebola typically are carried by arthropods and rodents, but the natural reservoirs for ebolaviruses are yet to be discovered. Among the suspected reservoirs for Ebola are bats, primates, rodents, and insects that inhabit tropical forests in Africa and Asia. Ebola can be transmitted through contact with infected blood and bodily fluids as well as through contact with surfaces or objects contaminated by those fluids. The virus has also been detected in the organs of patients after recovery from the fever. In men, the virus may remain infectious in semen for as long as two months following return to health. Unsanitary conditions and lack of adequate medical supplies may be factors in the spread of the disease. Burial rituals that involve close contact with the body of a person who has died from the disease also can result in the spread of Ebola. The surfaces of bodies of deceased victims remain infectious for more than a week. In addition, a small percentage of Ebola-infected individuals may remain asymptomatic; such persons may unknowingly carry and spread the virus.

Ebolaviruses have an incubation period of 2 to 21 days. The onset of illness is sudden and harsh. Infected persons may develop fever, severe headaches and muscle aches, and loss of appetite. Within a few days the virus causes a condition known as disseminated intravascular coagulation, which is marked by both blood clots and hemorrhaging. In the case of Ebola, clots are concentrated in the liver, spleen, brain, and other internal organs, forcing capillaries to bleed into surrounding tissue. Nausea, vomiting and diarrhea with blood and mucus, conjunctivitis, and sore throat soon follow. A maculopapular rash (discolored elevations of the skin) appears on the trunk and quickly spreads to the limbs and head. The patient is then beset by spontaneous bleeding from body orifices and any breaks in the skin, such as injection sites, and within the gastrointestinal tract, skin, and internal organs. Death is usually brought on by hemorrhaging, shock, or renal failure and occurs within 8 to 17 days. Persons who survive Ebola infection may experience post-Ebola syndrome, symptoms of which include vision problems (potentially blindness), headaches, severe joint and muscle pain, and extreme fatigue.

Treatment

Treatment for Ebola is primarily with supportive care, including fluids, electrolytes, and medications to stabilize blood pressure and manage complications. Early treatment greatly improves survival. For infections caused by the Zaire strain of Ebola virus, targeted antibody therapies such as REGN-EB3 (Inmazeb) and mAb114 (Ebanga) can help reduce mortality.

Other treatments that had been investigated for Ebola included the antiviral drug remdesivir (RDV) and ZMapp, a mixture of three antibodies that bind to proteins on ebolaviruses. ZMapp was administered to infected individuals during the 2014–16 outbreak, though its effectiveness was unclear. In trials during the 2018–20 Ebola outbreak, both REGN-EB3 and mAb114 were found to be more effective at reducing Ebola-related mortality compared with RDV and ZMapp. REGN-EB3 and mAb114 were approved by the U.S. Food and Drug Administration (FDA) in 2020.

The spread of ebolaviruses can be contained by barrier nursing, handling of infected blood and tissue in isolated laboratory units, and proper decontamination of reusable equipment. Experimental vaccines are under development for Ebola, including a vaccine known as VSV-EBOV, which was found to be highly effective in preventing the spread of ebolavirus among persons in close contact with infected individuals. VSV-EBOV was a recombinant vesicular stomatitis virus (VSV)-based vaccine that expressed an EBOV glycoprotein. When VSV-EBOV was injected, the vaccinated individuals generated antibodies against the EBOV protein, thereby gaining immunity.

Survivors of Ebola infection may be affected by a constellation of long-term health complications known as post-Ebola syndrome. In follow-up studies of persons who recovered from acute Ebola infection, many were found to suffer from uveitis (eye redness and pain), vision loss, tinnitus, hearing loss, stroke, headaches, muscle and joint pain, and other abnormalities in musculoskeletal and neurological function. Some affected individuals also suffered renal failure and were at increased risk of premature death. Post-Ebola syndrome is treated primarily by symptom management with drugs such as analgesics (pain relievers) and anti-inflammatory agents.