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Deadliest ever outbreak of Ebola virus: What you need to know

By CNN.com staff
updated 6:33 AM EDT, Thu July 3, 2014
STORY HIGHLIGHTS
  • 467 people have been killed by Ebola virus in Guinea, Sierra Leone and Liberia
  • The outbreak, which began in March, is the deadliest on record, according to the WHO
  • Ebola is a viral hemorrhagic fever, affecting multiple organs and accompanied by bleeding
  • The virus was discovered in 1976, in Zaire (now Democratic Republic of Congo) and Sudan

(CNN) -- It began with a just a handful of cases in Guinea in March. But it spread quickly to two other countries and is now the deadliest outbreak of Ebola virus on record.

At least 759 people in Guinea, Sierra Leone and Liberia have been infected by Ebola since its symptoms were first observed four months ago, according to the World Health Organization. 467 of them have died. That's a 61.5 percent mortality rate.

The WHO says "drastic action is needed" to contain the virus, which has spread from rural areas to cities in West Africa. It has dispatched teams of experts to the region and is holding talks this week with the health ministers from 11 countries about what to do next.

Why does Ebola generate such fear?

Medecins Sans Frontieres (MSF) describes Ebola as "one of the world's most deadly diseases."

"It is a highly infectious virus that can kill up to 90% of the people who catch it, causing terror among infected communities," it says.

There is also no vaccination against it.

Of Ebola's five sub-types, the Zaire strain -- the first to be identified -- is considered the most deadly.

The WHO said preliminary tests on the Ebola virus in Guinea in March suggested that the outbreak there was this strain, although that has not been confirmed.


What is Ebola?

The Ebola virus causes viral hemorrhagic fever (VHF), which according to the U.S. Centers for Disease Control and Prevention (CDC), refers to a group of viruses that affect multiple organ systems in the body and are often accompanied by bleeding.

The virus is named after the Ebola River in the Democratic Republic of Congo (formerly Zaire), where one of the first outbreaks occurred in 1976. The same year there was another outbreak in Sudan.

The WHO says there are five different strains of the virus -- named after the areas they originated in. Three of these have been associated with large outbreaks of hemorrhagic fever in Africa.

These are the Bundibugyo -- an area of Uganda where the virus was discovered in 2007 -- Sudan and Zaire sub-types.

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There has been a solitary case of Ivory Coast Ebola. This subtype was discovered when a researcher studying wild chimpanzees became ill in 1994 after an autopsy on one of the animals. The researcher recovered.

Finally, Reston Ebola is named after Reston in the U.S. state of Virginia, where this fifth strain of the Ebola virus was identified in monkeys imported from the Philippines.

The CDC says while humans have been infected with Ebola Reston, there have been no cases of human illness or death from this sub-type.

What are Ebola's symptoms?

Early symptoms of the Ebola virus include sudden onset of fever, weakness, muscle pain, headaches and a sore throat. These symptoms can appear two to 21 days after infection.

The WHO says these non-specific early symptoms can be mistaken for signs of diseases such as malaria, typhoid fever, meningitis or even the plague.

MSF says some patients may also develop a rash, red eyes, hiccups, chest pains and difficulty breathing and swallowing.

The early symptoms progress to vomiting, diarrhea, impaired kidney and liver function and sometimes internal and external bleeding.

Ebola can only be definitively confirmed by five different laboratory tests.

How is it treated?

There are no specific treatments for Ebola. MSF says patients are isolated and then supported by health care workers.

"This consists of hydrating the patient, maintaining their oxygen status and blood pressure and treating them for any complicating infections," it says.

There have been cases of healthcare workers contracting the virus from patients and the World Health Organization has issued guidance for dealing with confirmed or suspected cases of the virus.

Carers are advised to wear impermeable gowns and gloves and to wear facial protection such as goggles or a medical mask to prevent splashes to the nose, mouth and eyes.

MSF says it contained a 2012 outbreak in Uganda by placing a control area around its treatment center. An outbreak is considered over once 42 days -- double the incubation period of the disease -- have passed without any new cases.

How does it spread?

The WHO says it is believed that fruit bats may be the natural host of the Ebola virus in Africa, passing on the virus to other animals.

Humans contract Ebola through contact with the bodily fluids of infected animals.

The WHO says in Africa there have been documented cases of humans falling ill after contact with dead or ill chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines.

It says Ebola later spreads from human-to-human via contact with bodily fluids containing the virus. The virus can be spread through contact with an object contaminated with infected secretions.

Direct contact with the corpses of Ebola victims can also result in infection and the virus can be transmitted via infected semen up to seven weeks after clinical recovery.

MSF says while the virus is believed to be able to survive for some days in liquid outside an infected organism, it is fragile and chlorine disinfection, heat, direct sunlight, soaps and detergents can kill it.

MSF epidemiologist Kamiliny Kalahne says outbreaks usually spread in areas where hospitals have poor infection control and limited access to resources such as running water.

"People who become sick with it almost always know how they got sick: because they looked after someone in their family who was very sick -- who had diarrhea, vomiting and bleeding -- or because they were health staff who had a lot of contact with a sick patient," she says.

How many cases have there been?

The CDC estimates there have been more than 1,800 cases of Ebola and more than 1,300 deaths.

The last recorded outbreaks before the current one in Guinea were in 2012 -- in Uganda and Democratic Republic of Congo.

The Uganda outbreak involved a total of 24 probable and confirmed cases, and 17 deaths, according to the WHO, which declared it had ended in October 2012.

MSF said the Uganda outbreak had been the Sudan strain, while the virus found in DRC was the Bundibugyo sub-type.

According to the CDC, the most deadly outbreak was the 1976 outbreak in then Zaire, when 280 of 318 infected people died. In 2000, there were 425 cases of Ebola Sudan in Uganda, which resulted in 224 fatalities.

If Ebola is so infectious, why hasn't it spread further?

MSF epidemiologist Kamiliny Kalahne says there have not yet been any cases of Ebola being spread to a developed country.

"This is because people generally transmit the infection when they are very sick, have a high fever and a lot of symptoms -- and in these situations, they don't travel.

"And even if they do get sick once they travel to a developed country, they will be in a good hospital with good infection control, so they are very unlikely to infect others," she says.

CNN's Nick Thompson contributed to this report.

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