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Ebola disease (EBOD), a devastating hemorrhagic disease that is often fatal, has been plaguing Africa since its initial discovery in 1976. with no significant changes in case fatality rates. However, as the global response to EBOD evolves, we continue to learn about better ways to diagnose, treat and prevent this disease. In May 2026, a in the Democratic Republic of the Congo (DRC) and Uganda. This serves as a harsh reminder that EBOD is presently impactful and that sustaining the health and wellness of communities depends strongly on collaborative public health infrastructure that includes local expertise and input.

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Join the next Journal of Virology Seminar on Aug. 12 at 1 p.m. ET for a discussion on the 2026 Ebola outbreak, including its epidemiology, the accelerated push for vaccines, therapeutics and diagnostics and the barriers shaping the response on the ground.

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The Mystery Disease of Yambuku

It was a hot day at the end of August in Zaire, Africa (presently known as the DRC), and Mabalo Lokela was not feeling well. The 42-year-old headmaster of the Yambuku Mission School and was now plagued with fever and chills. Suspecting malaria, clinicians at the outpatient clinic of the Yambuku Hospital treated Lokela with an injection of chloroquine, the immunosuppressive drug used to treat the parasitic infection.

Initially, as Lokela’s fever resolved and his symptoms lessened, the treatment seemed to be working, and he appeared to be recovering. However, 1 week after presenting at the clinic, Lokela returned with a severe headache, muscle and abdominal pain and intestinal bleeding. A few days later, he died. Lokela’s infection would later be identified as EBOD, the first recorded case. Since this index case in 1976, , claiming the lives of thousands of people, with a fatality rate of over 90%, depending on strain.

Virology, Transmission Dynamics, Detection, Treatment

Basic Virology of Ebola 

Viruses that cause EBOD belong to the Orthoebolavirus genus of the family filoviridae, whose members also include  virus and the lesser-known Cuevavirus. have been identified, with 3 known to cause outbreaks in humans: Ebola virus (Orthoebolavirus zairense), Sudan virus (Orthoebolavirus sudanense) and Bundibugyo virus (Orthoebolavirus bundibugyoense). Ebola virus the highest mortality rate. of all global Ebola outbreaks between 1976-2022, the overall case fatality rates for each virus are 66.6% for Ebola, 48.5% for Sudan and 32.8% for Bundibugyo, although these rates vary depending on setting and study.

Ebola Transmission

EBOD does not naturally occur in the human population; it is introduced after exposure to close contact with the secretions, meat or bodily fluids of animals, such as fruit bats, monkeys or other rainforest animals. Once human-infecting orthoebolaviruses enter the population, they spread via direct contact with an infected person's blood or other bodily fluids, or through contact with items contaminated with fluids (blood, feces or vomit) from the body of a person who died from EBOD.

Healthcare workers have frequently been infected during EBOD outbreaks through close contact with their patients, when strict infection control practices have not been followed, or if access to proper protective equipment was limited. Practices important for processing grief and honoring loved ones who died from EBOD can also perpetuate disease. For example, traditional that involved direct contact with the body of a victim of EBOD (i.e., washing, dressing, lying over the corpse)  with the 2014-2016 outbreak across multiple countries in Africa.

It is important to note that orthoebolaviruses are not spread through droplet or aerosol routes, as is the case for respiratory viruses, and infected individuals are generally not considered to be contagious until they are symptomatic. Although EBOD is serious and often fatal, the transmission requirements (i.e., direct contact with blood, vomit and other bodily fluids) and high mortality contribute to a low disease incidence.

Ebola Diagnosis

. Labs performing testing on individuals suspected of having EBOD must have adequate stocks of appropriate personal protective equipment, an acceptable biosafety level (BSL) laboratory infrastructure and adequate training for donning and doffing of personal protective equipment. Isolation of the virus should only be performed in a maximum containment BSL-4 laboratory. Other forms of testing may be performed in lower BSL level laboratories, depending on specimen conditions and the type of testing performed.

Nucleic acid amplification testing (NAAT), which involves detecting viral RNA via RT-PCR or other validated molecular techniques, is the for orthoebolaviruses.The World Health Organization (WHO) notes that while testing should identify a specific orthoebolavirus species at the beginning of an outbreak, once the causative species has been confirmed, later testing can be scaled up to only differentiate between Orthoebolavirus and Orthomarburgvirus genera (both of which belong to the filoviridae family), without specifying species. Two negative NAAT results, at least 48 hours apart, are required for a clinically asymptomatic patient to be discharged from the hospital.

There are also available that received WHO Emergency Use and Assessment Listing status during the 2014-2016 Ebola outbreak. The tests range from pan-orthoebolavirus tests to those that are specific to Ebola virus (Orthoebolavirus zairense). In the light of the ongoing 2026 outbreak caused by Bundibugyo virus, the WHO Emergency Use Listing for in vitro diagnostics for Bundibugyo virus disease (BVD).

Ebola Treatment

During the 2014 outbreak of EBOD, Both therapeutics, , are monoclonal antibodies that prevent the virus from entering a patient’s cells. WHO has released formal recommendations for the use of these drugs during EBOD outbreaks. In late 2020, both drugs were for the treatment of Ebola virus in adults and children. In light of strong, randomized controlled trial data, demonstrating benefit and FDA clearance of both drugs, WHO has called upon the global community to improve access to these medications, which will inevitably save lives. Regardless of available therapies, supportive care, including IV rehydration, continue to be a staple in the care of EBOD patients.

Recent Outbreaks

Since the first EBOD outbreak in 1976, there have been multiple outbreaks of EBOD across Africa.  between 2014-2016 in multiple countries in West Africa. It resulted in approximately 28,652 cases and over 11,000 deaths. There were 20 EBOD outbreaks before 2014, and although much had been learned about the virus and how to prevent its spread, the 2014 outbreak presented multiple unique challenges.

The outbreak began in Guinea, where public health infrastructure was inadequately resourced, resulting in failed surveillance methods and undetected spread of the disease to urban centers across Guinea, Liberia and Sierra Leone. Furthermore, containment efforts were hindered by limited laboratory testing and patient treatment capacity, which further overwhelmed the healthcare system. According to the U.S. Centers for Disease Control and Prevention (CDC), nearly 4,000 staff members aided in the outbreak response, alongside others from local and international organizations. In describing the multidisciplinary effort, the CDC states that the individuals deployed to the impacted areas included “specialists in epidemiology, infection control, laboratory analysis, medical care, emergency management, information technology, health communication, behavioral science, anthropology, logistics, planning and other disciplines."

Outbreak Opportunity: Development and Study of an Ebola Vaccine

The unprecedented nature of the 2014-2016 outbreak provided an opportunity to initiate a . Data from the phase II trial demonstrate no significant safety concerns for . Furthermore, both vaccines initiate an immune response within a month of receiving the vaccine that offers protection for at least a year.

Another clinical trial called began in 2017 across Africa and aimed to assess the vaccine strategy that most effectively protects people, including children as young as 1 year. demonstrated no serious adverse events and an antibody response at 1 month in patients who received the vaccine, although it is important to note that only 32% of eligible individuals consented to receive the vaccine.

Currently, there is 1 licensed vaccine that protects against Ebola virus.  was studied in the PREVAIL trial and was also used under “compassionate use” during outbreaks in 2015 and 2018-2020, .

Current Outbreak

, an outbreak caused by Bundibugyo virus in the DRC and Uganda was declared a public health emergency of international concern by the WHO. There have been thousands of confirmed cases, with the number of cases and deaths continuing to grow, particularly in the DRC. The outbreak  than any on record, reaching 2,500 confirmed cases and 1,000 deaths nearly 3 times quicker than the 2014-2016 Ebola outbreak.  

It is important to note that no vaccine is available to protect against BVD, though efforts are underway to  to combat the disease. Scientists on the ground have worked diligently to identify the cause of, and track, the outbreak. For example, scientists in the DRC  within 16 hours of receiving them at the laboratory, highlighting the importance of local laboratory capacity. 

At the national level, the risk of disease spread is considered very high in the DRC and high in Uganda based on the following factors: 

• The severity of BVD and lack of vaccine for the BVD strain.
•  in outbreak regions, where populations are highly mobile and often displaced, limits access to healthcare and hinders contact tracing and infection prevention.  
•  have forced response teams to leave some areas and disrupted surveillance efforts.  have led to infections among healthcare workers treating patients.  
• Multiple chains of transmission have likely not been tracked. It is estimated that  in the outbreak have emerged outside known chains of transmission. 
• Use of traditional burial practices with large ceremonies for those who died from BVD.
• The health system can be easily overwhelmed if the outbreak spreads to other districts and regions.  initiatives, including the dismantling of the U.S. Agency for International Development, have limited funding and reduced laboratory capacity to test for Ebola.  

Overall, the risk of spread of disease at regional and global levels is currently considered to be low. However, since there is a lot of population movement across borders, the possibility of international spread cannot be ignored. National agencies like the CDC have prepared in the case of an outbreak outside of endemic areas (). These planning resources include tools that help assess healthcare system preparedness, risk communication messaging, information sharing, public health interventions, laboratory testing, epidemiologic investigation and responder health.

Conclusion

Ebola has caused significant morbidity and mortality since its discovery in 1976. While prevention and management of the disease remains a challenge, the 2014 outbreak led to new discoveries in therapeutics and vaccines, which offer a glimmer of hope for better future management of the disease.

However, public health response and equity remain core elements in preventing and treating EBOD. In his book Fevers, Feuds, and Diamonds, Paul Farmer said “.” This, combined with the of patients from high income countries like the U.S. serve as a strong reminder that public health infrastructure is the key to global health, and that until disease prevention and control is optimized in parts of the world with the most need, we are all at risk.

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Timely research remains essential to improving preparedness for and response to Ebola. The ¶¶ÒõÈÈÃÅ Journals Ebola Virus Collection brings together the latest research on virus biology, pathogenesis, transmission, diagnostics, therapeutic strategies and vaccine development.