‘Out of control’ Ebola challenges West Africa and the world
07/10/2014 // Feature // Text: Richard Johnson // Photos: CDC/Frederick Murphy, WHO/Jess Hoffman, Harvard University/ Broad Institute

Rapid, accurate diagnosis is a needed step to gain control of outbreak

The epidemic of Ebola hemorrhagic fever that has infected thousands of people in West Africa epitomizes the difficulty of fighting disease in under-resourced areas – and the threat of contagion in an age of globalization. The world is mobilizing to combat the 2014 outbreak, urgently sending people and technologies while also learning from genomic insights.

Ebola had not yet arrived in Sierra Leone when scientists Kristian Andersen and Stephen Gire visited the country’s third-largest city this spring – but they knew it was coming.

A few months later, the Ebola virus had spread to five countries in West Africa and killed more people than all previous outbreaks combined. Global authorities said the hemorrhagic fever was “spiraling out of control,” overwhelming medical resources and growing exponentially.

By the time the Harvard University and Broad Institute research team including Gire and Andersen published a genomic analysis of the 2014 Ebola outbreak, five of the study’s 58 contributors – caregivers in Sierra Leone – had died from Ebola. Of more than 7,100 patients diagnosed with Ebola so far in West Africa, more than 3,300 had died by end of September. Global health authorities are forecasting that total cases could range from 20,000 to as many as 1.4 million by early next year.

Ebola crosses all bounds between science and nightmares, life and death.


Diagnosis plays an essential role

Containment and infection control are bywords in the effort to stop Ebola. Gaining an accurate diagnosis, as early as possible, is essential to isolating and caring for people with the virus.

“The problem in Africa is that you have lots of patients coming in with many different diseases. Many of these people look like they could have Ebola,” Andersen says. “It’s important to be able to do a differential diagnosis between things that are very common – like malaria, typhoid and cholera – and other things that are somewhat common – like Lassa fever – and things that are rare – like Ebola. You need to be able to distinguish between all of those.”

To effectively diagnose Ebola in the midst of the crisis, even a relatively advanced institution like the Kenema lab needs quick, easy-to-perform methods. The lab’s preferred approach is genetic identification using a polymerase chain reaction (PCR) cycler – in line with diagnostic practice in developed countries’ labs, although the infrastructure in Sierra Leone demands extra flexibility.

“The setup we wanted to develop with the local team had to be very easy,” Andersen says. “You have to be able to run it fast, without a complicated protocol – and it must be pretty robust for factors like the temperature, or the electricity cutting out.”

As patients arrive with suspected Ebola, Kenema’s caregivers take samples of the patient’s blood or other fluids, use sample preparation technologies to isolate the genetic material of the virus, and conduct PCR analysis to identify which of the many infectious diseases is at work.

“In order to do the diagnostic tests they are performing in Kenema, they need to get RNA [ribonucleic acid, a molecule that plays an active role in biological processes]. So among the things we brought over were a bunch of these QIAGEN RNA extraction kits that they could use for diagnostic purposes. It has to work well, and it has to be easy,” Andersen says.

In collaboration with the Tulane/Harvard/Broad team and partners in Sierra Leone, QIAGEN has donated a supply of QIAamp Viral RNA Mini Kits for extraction of genetic material – in addition to support with a variety of reagents for use in the testing. The company is actively engaging with regional healthcare authorities in other countries affected by the epidemic.

“QIAGEN has a long history of helping public health agencies and providers confront outbreaks of disease, such as the avian flu and swine flu pandemics of recent years,” says Line Martinsen, Global Business Director Infectious Disease at QIAGEN. “In addition to our donations, we continue to explore new ways to help fight Ebola, directly or through our commercial partners.”

For instance, QIAGEN’s technologies are an integral part of the Ebola test protocol developed by the U.S. Department of Defense, which has received an emergency use authorization from the FDA to facilitate detection of the deadly virus. In addition, QIAGEN also distributes a dedicated real-time PCR test for the detection of the Ebola virus in blood samples developed by Altona Diagnostics in Hamburg, Germany. In collaboration with QIAGEN's commercial partners in Africa, it provides healthcare authorities in the region with an automated sample-to-result system to help fight the outbreak.

Scientists answer the urgent call

Part of the Ebola story is unfolding in the Kenema Government Hospital, a cluster of one-story buildings in a city of 188,000 in eastern Sierra Leone. The Kenema hospital and its laboratory have long-standing relationships with global healthcare groups and U.S. universities to study and treat Lassa fever, a virus that is similar to but less easily transmitted than Ebola.

“When it was confirmed in March that Ebola was in Guinea, bordering this region, we knew the lab in Kenema had to get ready because of the very close connection between Guinea, Liberia and Sierra Leone,” says Dr. Andersen, an immunologist with Harvard University and the Broad Institute, two institutions that, together with Tulane University, are partners in the U.S.-based Viral Hemorrhagic Fever Consortium.

“We knew we had to get over there and help them set up diagnostic assays, so they could get accurate diagnosis when or if the patients started to arrive. Ebola also requires better personal protective equipment, containment equipment and so on. So we gathered supplies they would need, jumped on a plane and brought over a bunch of suitcases and crates full of equipment.”

The Kenema hospital became the focal point for fighting the disease in Sierra Leone. On May 25, 2014, a few weeks after the team from Harvard/Broad visited, the lab confirmed Sierra Leone’s first Ebola case and the hospital began dealing with an influx of patients. Doctors and nurses started isolating and treating patients, saving some severely ill ones while losing others.

Since then the outbreak has spread through Sierra Leone, Liberia and Guinea, with a smaller outbreak in Nigeria and Senegal. The epidemic threatens to infect tens of thousands more as infected people move among multiple countries. “This is not just an outbreak. This is not just a public health crisis. This is a social crisis, a humanitarian crisis, an economic crisis, and a threat to national security well beyond the outbreak zones,” Dr. Margaret Chan,
 Director-General of the World Health Organization (WHO), told an emergency session of the UN Security Council.

Ebola exemplifies the challenges a virulent disease poses for doctors, nurses and hospitals in regions with limited resources. West Africa is now getting help from governments, agencies like the World Health Organization and U.S. Centers for Disease Control, nonprofit groups like Doctors Without Borders, top medical research institutions, and healthcare-related companies.

News report are full of dramatic stories of caregivers in West Africa, laboring long hours in head-to-toe protective suits, caring for the Ebola patients fortunate enough to make it to a hospital. For patients and healthcare professionals alike, the battle is heroic.


Emerging threats demand collaboration

Global leaders are urgently trying to contain the 2014 Ebola emergency – while working to improve longer-term prospects for under-resourced countries like those in West Africa. The Tulane/Harvard/Broad team has supplied quick infusions of equipment and expertise but also has focused on educating scientists, developing technologies and encouraging sound policies.

“Collaboration is absolutely key to everything, including outbreak response, diagnostics, clinical care, and research. Our role in Sierra Leone ultimately is capacity-building, making science sustainable, working with the partners there to provide infrastructure, reagents, support and training,” Andersen says. “We want to empower them to deal with these kinds of pathogens. It has to continue past the current outbreak, so new outbreaks can be prevented. ”

Agencies like the WHO and Doctors Without Borders are addressing immediate clinical needs for resources and international healthcare teams to supplement overloaded in-country staffs. Tulane/Harvard/Broad is training additional personnel within each country for the longer term.

“Right now we have about 20 scientists from across West Africa here in Boston, receiving training at Harvard and the Broad Institute. Unfortunately, their colleagues from Sierra Leone are not able to be here because of the outbreak, but future training is already planned,” Andersen says.

Amid the frantic response in West African centers like Kenema, new habits of working together are taking hold among global health organizations, local institutions and caregivers, academic researchers and companies – with the common goal of defeating Ebola.

“There is an extraordinary battle still ahead, and we have lost many friends and colleagues already,” Dr. Pardis Sabeti, who heads the lab doing Ebola sequencing research at Harvard and the Broad Institute, said in announcing the paper in Science. “We are all in this fight together.”

 

###

Download our fact sheet QIAGEN and global Ebola surivellance (PDF)

Diagnosis plays an essential role

Containment and infection control are bywords in the effort to stop Ebola. Gaining an accurate diagnosis, as early as possible, is essential to isolating and caring for people with the virus.

“The problem in Africa is that you have lots of patients coming in with many different diseases. Many of these people look like they could have Ebola,” Andersen says. “It’s important to be able to do a differential diagnosis between things that are very common – like malaria, typhoid and cholera – and other things that are somewhat common – like Lassa fever – and things that are rare – like Ebola. You need to be able to distinguish between all of those.”

To effectively diagnose Ebola in the midst of the crisis, even a relatively advanced institution like the Kenema lab needs quick, easy-to-perform methods. The lab’s preferred approach is genetic identification using a polymerase chain reaction (PCR) cycler – in line with diagnostic practice in developed countries’ labs, although the infrastructure in Sierra Leone demands extra flexibility.

“The setup we wanted to develop with the local team had to be very easy,” Andersen says. “You have to be able to run it fast, without a complicated protocol – and it must be pretty robust for factors like the temperature, or the electricity cutting out.”

As patients arrive with suspected Ebola, Kenema’s caregivers take samples of the patient’s blood or other fluids, use sample preparation technologies to isolate the genetic material of the virus, and conduct PCR analysis to identify which of the many infectious diseases is at work.

“In order to do the diagnostic tests they are performing in Kenema, they need to get RNA [ribonucleic acid, a molecule that plays an active role in biological processes]. So among the things we brought over were a bunch of these QIAGEN RNA extraction kits that they could use for diagnostic purposes. It has to work well, and it has to be easy,” Andersen says.

In collaboration with the Tulane/Harvard/Broad team and partners in Sierra Leone, QIAGEN has donated a supply of QIAamp Viral RNA Mini Kits for extraction of genetic material – in addition to support with a variety of reagents for use in the testing. The company is actively engaging with regional healthcare authorities in other countries affected by the epidemic.

“QIAGEN has a long history of helping public health agencies and providers confront outbreaks of disease, such as the avian flu and swine flu pandemics of recent years,” says Line Martinsen, Global Business Director Infectious Disease at QIAGEN. “In addition to our donations, we continue to explore new ways to help fight Ebola, directly or through our commercial partners.”

For instance, QIAGEN’s technologies are an integral part of the Ebola test protocol developed by the U.S. Department of Defense, which has received an emergency use authorization from the FDA to facilitate detection of the deadly virus. In addition, QIAGEN also distributes a dedicated real-time PCR test for the detection of the Ebola virus in blood samples developed by Altona Diagnostics in Hamburg, Germany. In collaboration with QIAGEN's commercial partners in Africa, it provides healthcare authorities in the region with an automated sample-to-result system to help fight the outbreak.


“The setup we wanted to develop with the local team had to be very easy. You have to be able to run it fast, without a complicated protocol – and it must be pretty robust for factors like the temperature, or the electricity cutting out.”
Dr. Kristian Andersen, Harvard University

Research in Kenema yields valuable insights

Much remains to be learned about Ebola, how it spreads and how to conquer it. But the multinational research team led by Tulane/Harvard/Broad, in addition to helping with infrastructure, already has gained valuable insights rooted in that trip to Kenema in the spring.

As Ebola patients began arriving in Sierra Leone in late May, doctors took samples for diagnosis and began saving the excess sample material from Ebola patients for further study. Nearly 100 of those extra samples from the outbreak’s early days were preserved and frozen, the virus itself deactivated, and shipped to Boston for the Harvard/Broad researchers.

When 99 genomes from Kenema patients were sequenced, the researchers catalogued 395 genetic changes that differentiate the current Ebola virus, both from outbreaks dating back to 1976 and from one patient to the next in the current epidemic. The full genomes were released online, enabling scientists to study potential targets for future diagnostics, vaccines or drugs.

The research team also published a study summarizing the genomic analysis, describing the origin and evolution of the West Africa outbreak, and offering valuable insights into how the disease is spreading (Science online, Aug. 28, 2014; print edition, Sept. 12, 2014).

This research, for example, provides timely guidance regarding a sensitive policy issue: eating meat from wild animals. Ebola virus originates in animals and is introduced to humans initially through contact with blood, organs or other bodily fluids from infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope or porcupines.

But sequencing shows that the Ebola virus of 2014 – since the initial introduction from its animal reservoir into the human population in Guinea around December 2013 – has spread by human-to-human contacts rather than a series of new introductions from animals.

“That’s important, because there’s been talk about banning ‘bush meat,’ which is the main food source for people in many rural areas affected by Ebola,” Andersen says. “This finding puts the emphasis back on diagnosing the disease, tracing contacts, and containing the infection.”


“Collaboration is absolutely key to everything, including outbreak response, diagnostics, clinical care, and research."
Dr. Kristian Andersen, Harvard University

Emerging threats demand collaboration

Global leaders are urgently trying to contain the 2014 Ebola emergency – while working to improve longer-term prospects for under-resourced countries like those in West Africa. The Tulane/Harvard/Broad team has supplied quick infusions of equipment and expertise but also has focused on educating scientists, developing technologies and encouraging sound policies.

“Collaboration is absolutely key to everything, including outbreak response, diagnostics, clinical care, and research. Our role in Sierra Leone ultimately is capacity-building, making science sustainable, working with the partners there to provide infrastructure, reagents, support and training,” Andersen says. “We want to empower them to deal with these kinds of pathogens. It has to continue past the current outbreak, so new outbreaks can be prevented. ”

Agencies like the WHO and Doctors Without Borders are addressing immediate clinical needs for resources and international healthcare teams to supplement overloaded in-country staffs. Tulane/Harvard/Broad is training additional personnel within each country for the longer term.

“Right now we have about 20 scientists from across West Africa here in Boston, receiving training at Harvard and the Broad Institute. Unfortunately, their colleagues from Sierra Leone are not able to be here because of the outbreak, but future training is already planned,” Andersen says.

Amid the frantic response in West African centers like Kenema, new habits of working together are taking hold among global health organizations, local institutions and caregivers, academic researchers and companies – with the common goal of defeating Ebola.

“There is an extraordinary battle still ahead, and we have lost many friends and colleagues already,” Dr. Pardis Sabeti, who heads the lab doing Ebola sequencing research at Harvard and the Broad Institute, said in announcing the paper in Science. “We are all in this fight together.”

 

###

Download our fact sheet QIAGEN and global Ebola surivellance (PDF)


Ebola epidemic at a glance

  • West African countries affected: Liberia, Sierra Leone, Guinea, Nigeria and Senegal
  • Total suspected Ebola deaths: 3,431 as of October 3, 2014
  • Suspected & confirmed cases: 7,470 as of October 3, 2014
  • 25 Ebola outbreaks since 1976: So far in 2014 the virus has infected more than twice the total of all prior outbreaks.
  • Mortality is a grim reality: Ebola outbreaks vary in size but generally produce mortality rates of 60% to 90%.
  • Virus overwhelms the body: Ebola shows itself in 2-21 days with sudden high fever, weakness, muscle pain, headache and sore throat. Vomiting, diarrhea and rash may follow. The virus spreads quickly, overwhelming the immune system. Tissue damage to the liver and other organs ensues. As a hemorrhagic fever, Ebola can produce internal and external bleeding, such as from the eyes.
  • Medical care does help: Many people survive Ebola, on their own or with supportive care such as hydration and oxygen. While there is no approved drug or vaccine, testing of experimental products has accelerated.


Ebola had not yet arrived in Sierra Leone when scientists Kristian Andersen and Stephen Gire visited the country’s third-largest city this spring – but they knew it was coming.

A few months later, the Ebola virus had spread to five countries in West Africa and killed more people than all previous outbreaks combined. Global authorities said the hemorrhagic fever was “spiraling out of control,” overwhelming medical resources and growing exponentially.

By the time the Harvard University and Broad Institute research team including Gire and Andersen published a genomic analysis of the 2014 Ebola outbreak, five of the study’s 58 contributors – caregivers in Sierra Leone – had died from Ebola. Of more than 7,100 patients diagnosed with Ebola so far in West Africa, more than 3,300 had died by end of September. Global health authorities are forecasting that total cases could range from 20,000 to as many as 1.4 million by early next year.

Ebola crosses all bounds between science and nightmares, life and death.


Scientists answer the urgent call

Part of the Ebola story is unfolding in the Kenema Government Hospital, a cluster of one-story buildings in a city of 188,000 in eastern Sierra Leone. The Kenema hospital and its laboratory have long-standing relationships with global healthcare groups and U.S. universities to study and treat Lassa fever, a virus that is similar to but less easily transmitted than Ebola.

“When it was confirmed in March that Ebola was in Guinea, bordering this region, we knew the lab in Kenema had to get ready because of the very close connection between Guinea, Liberia and Sierra Leone,” says Dr. Andersen, an immunologist with Harvard University and the Broad Institute, two institutions that, together with Tulane University, are partners in the U.S.-based Viral Hemorrhagic Fever Consortium.

“We knew we had to get over there and help them set up diagnostic assays, so they could get accurate diagnosis when or if the patients started to arrive. Ebola also requires better personal protective equipment, containment equipment and so on. So we gathered supplies they would need, jumped on a plane and brought over a bunch of suitcases and crates full of equipment.”

The Kenema hospital became the focal point for fighting the disease in Sierra Leone. On May 25, 2014, a few weeks after the team from Harvard/Broad visited, the lab confirmed Sierra Leone’s first Ebola case and the hospital began dealing with an influx of patients. Doctors and nurses started isolating and treating patients, saving some severely ill ones while losing others.

Since then the outbreak has spread through Sierra Leone, Liberia and Guinea, with a smaller outbreak in Nigeria and Senegal. The epidemic threatens to infect tens of thousands more as infected people move among multiple countries. “This is not just an outbreak. This is not just a public health crisis. This is a social crisis, a humanitarian crisis, an economic crisis, and a threat to national security well beyond the outbreak zones,” Dr. Margaret Chan,
 Director-General of the World Health Organization (WHO), told an emergency session of the UN Security Council.

Ebola exemplifies the challenges a virulent disease poses for doctors, nurses and hospitals in regions with limited resources. West Africa is now getting help from governments, agencies like the World Health Organization and U.S. Centers for Disease Control, nonprofit groups like Doctors Without Borders, top medical research institutions, and healthcare-related companies.

News report are full of dramatic stories of caregivers in West Africa, laboring long hours in head-to-toe protective suits, caring for the Ebola patients fortunate enough to make it to a hospital. For patients and healthcare professionals alike, the battle is heroic.


Diagnosis plays an essential role

Containment and infection control are bywords in the effort to stop Ebola. Gaining an accurate diagnosis, as early as possible, is essential to isolating and caring for people with the virus.

“The problem in Africa is that you have lots of patients coming in with many different diseases. Many of these people look like they could have Ebola,” Andersen says. “It’s important to be able to do a differential diagnosis between things that are very common – like malaria, typhoid and cholera – and other things that are somewhat common – like Lassa fever – and things that are rare – like Ebola. You need to be able to distinguish between all of those.”

To effectively diagnose Ebola in the midst of the crisis, even a relatively advanced institution like the Kenema lab needs quick, easy-to-perform methods. The lab’s preferred approach is genetic identification using a polymerase chain reaction (PCR) cycler – in line with diagnostic practice in developed countries’ labs, although the infrastructure in Sierra Leone demands extra flexibility.

“The setup we wanted to develop with the local team had to be very easy,” Andersen says. “You have to be able to run it fast, without a complicated protocol – and it must be pretty robust for factors like the temperature, or the electricity cutting out.”

As patients arrive with suspected Ebola, Kenema’s caregivers take samples of the patient’s blood or other fluids, use sample preparation technologies to isolate the genetic material of the virus, and conduct PCR analysis to identify which of the many infectious diseases is at work.

“In order to do the diagnostic tests they are performing in Kenema, they need to get RNA [ribonucleic acid, a molecule that plays an active role in biological processes]. So among the things we brought over were a bunch of these QIAGEN RNA extraction kits that they could use for diagnostic purposes. It has to work well, and it has to be easy,” Andersen says.

In collaboration with the Tulane/Harvard/Broad team and partners in Sierra Leone, QIAGEN has donated a supply of QIAamp Viral RNA Mini Kits for extraction of genetic material – in addition to support with a variety of reagents for use in the testing. The company is actively engaging with regional healthcare authorities in other countries affected by the epidemic.

“QIAGEN has a long history of helping public health agencies and providers confront outbreaks of disease, such as the avian flu and swine flu pandemics of recent years,” says Line Martinsen, Global Business Director Infectious Disease at QIAGEN. “In addition to our donations, we continue to explore new ways to help fight Ebola, directly or through our commercial partners.”

For instance, QIAGEN’s technologies are an integral part of the Ebola test protocol developed by the U.S. Department of Defense, which has received an emergency use authorization from the FDA to facilitate detection of the deadly virus. In addition, QIAGEN also distributes a dedicated real-time PCR test for the detection of the Ebola virus in blood samples developed by Altona Diagnostics in Hamburg, Germany. In collaboration with QIAGEN's commercial partners in Africa, it provides healthcare authorities in the region with an automated sample-to-result system to help fight the outbreak.


Research in Kenema yields valuable insights

Much remains to be learned about Ebola, how it spreads and how to conquer it. But the multinational research team led by Tulane/Harvard/Broad, in addition to helping with infrastructure, already has gained valuable insights rooted in that trip to Kenema in the spring.

As Ebola patients began arriving in Sierra Leone in late May, doctors took samples for diagnosis and began saving the excess sample material from Ebola patients for further study. Nearly 100 of those extra samples from the outbreak’s early days were preserved and frozen, the virus itself deactivated, and shipped to Boston for the Harvard/Broad researchers.

When 99 genomes from Kenema patients were sequenced, the researchers catalogued 395 genetic changes that differentiate the current Ebola virus, both from outbreaks dating back to 1976 and from one patient to the next in the current epidemic. The full genomes were released online, enabling scientists to study potential targets for future diagnostics, vaccines or drugs.

The research team also published a study summarizing the genomic analysis, describing the origin and evolution of the West Africa outbreak, and offering valuable insights into how the disease is spreading (Science online, Aug. 28, 2014; print edition, Sept. 12, 2014).

This research, for example, provides timely guidance regarding a sensitive policy issue: eating meat from wild animals. Ebola virus originates in animals and is introduced to humans initially through contact with blood, organs or other bodily fluids from infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope or porcupines.

But sequencing shows that the Ebola virus of 2014 – since the initial introduction from its animal reservoir into the human population in Guinea around December 2013 – has spread by human-to-human contacts rather than a series of new introductions from animals.

“That’s important, because there’s been talk about banning ‘bush meat,’ which is the main food source for people in many rural areas affected by Ebola,” Andersen says. “This finding puts the emphasis back on diagnosing the disease, tracing contacts, and containing the infection.”


Emerging threats demand collaboration

Global leaders are urgently trying to contain the 2014 Ebola emergency – while working to improve longer-term prospects for under-resourced countries like those in West Africa. The Tulane/Harvard/Broad team has supplied quick infusions of equipment and expertise but also has focused on educating scientists, developing technologies and encouraging sound policies.

“Collaboration is absolutely key to everything, including outbreak response, diagnostics, clinical care, and research. Our role in Sierra Leone ultimately is capacity-building, making science sustainable, working with the partners there to provide infrastructure, reagents, support and training,” Andersen says. “We want to empower them to deal with these kinds of pathogens. It has to continue past the current outbreak, so new outbreaks can be prevented. ”

Agencies like the WHO and Doctors Without Borders are addressing immediate clinical needs for resources and international healthcare teams to supplement overloaded in-country staffs. Tulane/Harvard/Broad is training additional personnel within each country for the longer term.

“Right now we have about 20 scientists from across West Africa here in Boston, receiving training at Harvard and the Broad Institute. Unfortunately, their colleagues from Sierra Leone are not able to be here because of the outbreak, but future training is already planned,” Andersen says.

Amid the frantic response in West African centers like Kenema, new habits of working together are taking hold among global health organizations, local institutions and caregivers, academic researchers and companies – with the common goal of defeating Ebola.

“There is an extraordinary battle still ahead, and we have lost many friends and colleagues already,” Dr. Pardis Sabeti, who heads the lab doing Ebola sequencing research at Harvard and the Broad Institute, said in announcing the paper in Science. “We are all in this fight together.”

 

###

Download our fact sheet QIAGEN and global Ebola surivellance (PDF)


Ebola epidemic at a glance

  • West African countries affected: Liberia, Sierra Leone, Guinea, Nigeria and Senegal
  • Total suspected Ebola deaths: 3,431 as of October 3, 2014
  • Suspected & confirmed cases: 7,470 as of October 3, 2014
  • 25 Ebola outbreaks since 1976: So far in 2014 the virus has infected more than twice the total of all prior outbreaks.
  • Mortality is a grim reality: Ebola outbreaks vary in size but generally produce mortality rates of 60% to 90%.
  • Virus overwhelms the body: Ebola shows itself in 2-21 days with sudden high fever, weakness, muscle pain, headache and sore throat. Vomiting, diarrhea and rash may follow. The virus spreads quickly, overwhelming the immune system. Tissue damage to the liver and other organs ensues. As a hemorrhagic fever, Ebola can produce internal and external bleeding, such as from the eyes.
  • Medical care does help: Many people survive Ebola, on their own or with supportive care such as hydration and oxygen. While there is no approved drug or vaccine, testing of experimental products has accelerated.