About EBOLA...

Editor's note: This story was updated on Jan. 20, 2015, with new case numbers.
Perhaps no virus strikes as much fear in people as Ebola, the cause of a deadly outbreak in
West Africa.
The World Health Organization (WHO) reports more than 21,600 confirmed or suspected
cases of Ebola, mostly in the countries of Guinea, Liberia, and Sierra Leone, as of Jan. 18.
More than 8,600 people have died in the largest Ebola outbreak ever recorded.
A surgeon from Sierra Leone who lives in the United States died after being flown to the
Nebraska Medical Center for treatment, the hospital said Nov. 17.
Martin Salia, who was reportedly working at a hospital in the Sierra eone capital of
Freetown, arrived in the U.S. Nov. 15 and was taken to the medical center.
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He was in extremely critical condition, suffering from kidney and respiratory failure, when he
arrived, the hospital said. We used every possible treatment available to give Dr. Salia every
possible opportunity for survival, said Phil Smith, MD, medical director of the hospitals
biocontainment unit. That included giving him the experimental treatment ZMapp, also given
to other Ebola patients, according to the hospital.
But Salias disease was extremely advanced, Smith said in a statement.
Salia was reportedly a permanent U.S. resident who lived in Maryland with his family.
Two other Americans -- Rick Sacra, MD, and Ashoka Mukpo -- recovered from Ebola after
being treated at the Nebraska isolation unit.
A Doctors Without Borders physician who returned to the U.S. after treating Ebola patients
in Guinea was the latest person in the U.S. to be diagnosed with Ebola. Craig Spencer, MD,
recovered after getting treatment at New Yorks Bellevue Hospital. He was released on Nov.
11.
Spencer, who returned to New York on Oct. 17, was taken to the hospital 6 days later after
reporting a fever and vomiting.

Two nurses at a Dallas hospital also caught Ebola after treating Thomas Eric Duncan, a
Liberian man who later died. The nurses, Nina Pham, 26, and Amber Vinson, 29, both work at
Texas Health Presbyterian Hospital. Duncan arrived in the U.S. on Sept. 20 to visit relatives
and 10 days later became the first person to be diagnosed with Ebola in the U.S. He died Oct.
8.

Ebola Virus Infection FAQ

Both Pham and Vinson recovered from the virus and have been released from hospitals. No
one who had contact with them, including people on flights Vinson took from Cleveland to
Dallas and back before being admitted to a hospital, caught Ebola.
In total, five Americans infected with the virus in Africa have been brought back to the U.S.
for treatment. All have recovered. The five include aid workers Sacra, Kent Brantly, MD, and
Nancy Writebol.
The fourth person was flown back to the U.S. on Sept. 9 for treatment at Atlantas Emory
University Hospital, where Brantly and Writebol were also treated. This person's arrival
came after the WHO said one of its doctors was being evacuated from Sierra Leone after
getting Ebola. The man was released from the hospital Oct. 19. He wants to remain
anonymous, the hospital said.
Mukpo, a freelance cameraman for NBC News, was flown to Omaha on Oct. 6. He was part of
a crew covering the outbreak in West Africa. He was released Oct. 22.

Ebola Outbreak Unfolds in Africa

On Aug. 8, the WHO declared the Ebola outbreak in West Africa to be a public health
emergency of international concern. It said a coordinated international response is deemed
essential to stop and reverse the international spread of the virus.
On Sept. 16, President Barack Obama announced a plan to scale up the nations response to
the Ebola crisis in West Africa. Responding to a plea for help from the Liberian government,
Obama said the Department of Defense will send personnel there to boost the international
response to the outbreak. The U.S. will also build 17 100-bed units to treat Ebola patients.
Ebola was first identified in 1976, when it appeared in outbreaks in Sudan and the
Democratic Republic of the Congo. It is named for the Ebola River, which runs near the
Congolese village where one of the first outbreaks happened.
WebMD asked Amesh Adalja, MD, about the virus and efforts to contain it. Adalja is an
infectious disease doctor at the University of Pittsburgh.
Q. How deadly is Ebola?

A. The Ebola strain in the current outbreak is the most lethal of the five known strains of the
virus. It is called Ebola Zaire and usually kills up to 9 out of 10 infected people. But the high
death rate might be due to a lack of modern medical care, Adalja says. Its hard to say exactly
what the [death] rate would be in a modern hospital with all of its intensive care units.
The CDC said in July the Ebola death rate in the West African outbreak is about 6 in 10,
rather than 9 in 10. That shows that early treatment efforts have been effective, says
Stephan Monroe, deputy director of the National Center for Emerging and Zoonotic
Infectious Diseases at the CDC.
On July 31, the CDC issued a travel advisory recommending against non-essential travel to
Guinea, Liberia, and Sierra Leone.
Q. What are the symptoms?
A. At first, the symptoms are like a bad case of the flu: high fever, muscle aches,
headache, sore throat, and weakness. They are followed quickly by vomiting, diarrhea, and
internal and external bleeding, which can spread the virus. The kidneys and liver begin to fail.
Ebola Zaire kills people quickly, typically 7 to 14 days after symptoms appear, Adalja says.
A person can have the virus but not show any symptoms for as long as 3 weeks, he says.
People who survive can still have the virus in their system for weeks afterward.
The virus has been detected in semen up to 7 weeks after recovery, according to the WHO.
But this is very rare, says Thomas Geisbert, PhD, a professor of microbiology and
immunology at the University of Texas Medical Branch. Geisbert has been studying the Ebola
virus since 1988.
Q. How does the virus spread?
A. Ebola isnt as contagious as more common viruses, such as colds, influenza, or measles,
Adalja says. It spreads to people by close contact with skin and bodily fluids from infected
animals, such as fruit bats and monkeys. Then it spreads from person to person the same way.
The key message is to minimize bodily fluid exposures, Adalja says.
Q. What precautions should people take if theyre concerned they might come in contact
with someone infected with Ebola?
A. Ebola is very hard to catch, Adalja emphasizes. Infected people are contagious only after
symptoms appear, by which time close contacts, such as health care workers and family
members, would use universal precautions. That's an infection control approach in which
all blood and certain body fluids are treated as if they are infectious for diseases that can be
borne in them, Adalja says.

Even though the virus can be transmitted by kissing or sex, people with Ebola symptoms are
so sick that theyre not typically taking part in those behaviors, he says.
Q. Is there a cure or a vaccine to protect against it?
A. No, but scientists are working on both. The National Institutes of Health is taking part in
human testing of an experimental Ebola vaccine, which began in early September. Testing for
that vaccine is also taking place in the U.K. and Mali.
The agency expects to have results of that trial by the end of 2014. The NIH is also testing
several other potential vaccines.
There is no specific treatment for Ebola. The only treatments available are supportive kinds,
such as IV fluids and medications to level out blood pressure, a breathing machine, and
transfusions, Adalja says.
ZMapp was given to Brantly and Writebol, among others. But health officials don't know if it
aided in their recovery. A trial of ZMapp in 18 Ebola-infected rhesus monkeys prompted
recovery in all 18, researchers reported.
Sacra received a different treatment, called TKM-Ebola. He also received a blood transfusion
from Brantly, a friend. Health officials don't know if any of these treatments helped with his
recovery.
Duncan and Mukpo both received an experimental drug named brincidofovir. The drug is
being tested for effectiveness against cytomegalovirus and adenovirus, but test-tube
experiments done at the CDC and National Institutes of Health reveal it showed
effectiveness against Ebola, according to its manufacturer, Chimerix Inc.
Mukpo and Pham also received blood transfusions from Brantly.
Spencer was reportedly given a range of treatments, including an experimental drug and a
blood transfusion from Writebol. The experimental drug was not identified.
Q. Why do some people survive the virus?
A. Thats hard to say. Adalja thinks several things might play a role, such as a person's age and
genetic makeup, and whether they have other medical conditions. Those aren't proven
reasons, though.
Q. How can the outbreak be stopped?
A. Simple steps to control infection, such as gowns, gloves, and eye protection, can help halt
the spread of Ebola, Adalja says. Public health officials will have to wait 6 weeks after the last
case is reported before declaring the outbreak over, he says.

Keys to stopping Ebola include identifying patients; providing treatment, preventing the
spread, and protecting health care workers, including following patients contacts and
monitoring them for symptoms; and preventing future cases through education and urging
people to avoid close contact with sick people or bodies, Frieden has said.
But, he said, turning the tide in Western Africa is not going to be quick or easy. Even in a
best-case scenario, it would take 3 to 6 months or more.
Q. Could an Ebola outbreak happen in the United States?
Although concerns have grown since Sept. 30, when the first case was diagnosed in the U.S.,
health officials have continued to say they are well-prepared to deal with Ebola, and that the
risk of an outbreak remains low.
I have no doubt that we will control this importation or this case of Ebola so that it doesnt
spread widely in this country, Frieden told reporters on Sept. 30.
The first case diagnosed in the U.S. was not unexpected, says William Schaffner, MD, an
infectious disease specialist at Nashvilles Vanderbilt University Hospital. Theres a lot of
travel between West Africa and the United States, and we all anticipated that sooner or later
there would be a traveler exposed.
Measures are being taken to isolate members of the mans family and track others he was in
contact with.
Because the virus isn't airborne, it would take very close contact with someone who is at an
advanced stage of illness to become infected, Thomas Geisbert tells HealthDay.
One of the five Ebola virus strains caused an outbreak in laboratory monkeys in Reston, VA,
outside Washington, DC, in 1989. People who were exposed to that strain of Ebola virus did
not get sick. but they developed antibodies to it.