The Ervebo vaccine has been shown to be effective in protecting people from the species Zaire ebolavirus and is recommended by the Strategic Advisory Group of Experts on Immunization as part of a broader set of Ebola outbreak response tools.
For almost 50 years, ebolaviruses and related filoviruses have been repeatedly reemerging across the vast equatorial belt of the African continent to cause epidemics of highly fatal hemorrhagic fever. The 2013-2015 West African epidemic, by far the most geographically extensive, most fatal, and longest lasting epidemic in Ebola's history, presented an enormous international public health challenge, but it also provided insights into Ebola's pathogenesis and natural history, clinical expression, treatment, prevention, and control. Growing understanding of ebolavirus pathogenetic mechanisms and important new clinical observations of the disease course provide fresh clues about prevention and treatment approaches. Although viral cytopathology and immune-mediated cell damage in ebolavirus disease often result in severe compromise of multiple organs, tissue repair and organ function recovery can be expected if patients receive supportive care with fluids and electrolytes; maintenance of oxygenation and tissue perfusion; and respiratory, renal, and cardiovascular support. Major challenges for managing future Ebola epidemics include establishment of early and aggressive epidemic control and earlier and better patient care and treatment in remote, resource-poor areas where Ebola typically reemerges. In addition, it will be important to further develop Ebola vaccines and to adopt policies for their use in epidemic and pre-epidemic situations.
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Clinical illness starts as a flu-like syndrome, often rapidly evolving to severe disease with haemorrhagic symptoms. Two vaccines against Ebola disease due to Zaire ebolavirus have been granted market authorisations by the EU. There are no licensed vaccines against Ebola disease due to the other ebolavirus species.
It includes four distinct species that are pathogenic to humans: Zaire ebolavirus, Bundibugyo ebolavirus, Ta Forest ebolavirus and Sudan ebolavirus. All four species are found in Africa and cause serious illness in humans. In addition, Reston ebolavirus can cause epizootics, but only causes asymptomatic infection in humans. So far, Reston ebolavirus outbreaks have only been reported in Asia.
Several fruit bats of the Pteropodidae family in central and western Africa, particularly the hammer-headed bat species (Hypsignathus monstrosus), Franquet's epauletted fruit bat (Epomops franqueti) and the little collared fruit bat (Myonycteris torquata) are considered natural reservoirs for ebolaviruses [14].
In 1976, epidemics of severe haemorrhagic fever occurred simultaneously in southern Sudan and the northern part of the Democratic Republic of the Congo, where a new virus was identified and named after a small river called Ebola, in the Mongala province. Later studies showed some differences between the virus isolated in the Democratic Republic of the Congo (Zaire ebolavirus) and the virus isolated in Sudan (Sudan ebolavirus). Multiple outbreaks of Ebola disease have been identified since its initial discovery [15].
Ebola disease due to Zaire ebolavirus is referred as Ebola virus disease. Large autochthonous outbreaks of Ebola virus disease have so far been reported in the Democratic Republic of the Congo, Gabon, Guinea, Liberia, the Republic of the Congo and Sierra Leone.
Laboratory tests on blood specimens detect viral material (viral genome or antigen) or specific antibodies. Ebola disease is diagnosed by the detection of ebolavirus ribonucleic acid (RNA) in whole blood, plasma or serum during the acute phase of illness, using reverse transcription polymerase chain reaction (RT-PCR) tests. Viral RNA can usually be detected up to a few days after the disappearance of symptoms.
Only a few diagnostic tests are commercially available for Ebola disease and these are specific to Ebola virus disease. According to Directive 2000/54/EC of the European Parliament and of the Council, the ebolaviruses are group 4 biological agents [1]. Therefore, samples from infected patients should be handled under strict biological containment conditions in biosafety level 3 (e.g. RT-PCR and enzyme-linked immunosorbent assay on non-inactivated samples) or level 4 laboratories (virus isolation). Any attempt at viral replication should be handled in biosafety level 4 laboratories [19] [20]. For inactivated samples, RT-PCR and ELISA testing can be performed at a laboratory with BSL-2 facilities.
It is advisable to avoid habitats that may be populated by bats, such as caves or mines in areas/countries where ebolaviruses might be present. The handling or consumption of any type of bushmeat should be avoided, as should close contact with wild animals (such as monkeys, forest antelopes, rodents and bats - alive or dead).
The appropriate use of infection control precautions and the application of strict barrier nursing procedures are critical to preventing nosocomial transmission. Implementation of appropriate infection control measures in healthcare settings, including use of personal protective equipment, will minimise the risk of transmission of ebolaviruses.
For Zaire ebolavirus transmission by sexual contact has been documented and the World Health Organization (WHO) recommends that male survivors practise safe sex for at least 12 months after clinical recovery, unless their semen has tested negative on two separate occasions [6,25,26]. Sexual transmission events have also been reported in male survivors with documented Zaire ebolavirus RNA persistence in semen after 12 months [3,9], indicating the need to document the absence of the virus in semen through repeated testing after clinical recovery.
The first of these vaccines is the Ervebo vaccine, which is a recombinant rVSVG-ZEBOV-GP live vaccine manufactured by Merck. It is a vector vaccine, expressing the surface glycoprotein of Zaire ebolavirus in a recombinant vesicular stomatitis virus construct [28]. It is administered as a single-dose vaccine by intramuscular injection, and was prequalified by WHO on 12 November 2019. This means that the vaccine meets the standards required by WHO in terms of quality, safety and efficacy, facilitating its procurement for at-risk countries.
21. World Health Organisation. Update on Ebola drug trial: two strong performers identified, 12 Aug 2019. Geneva: WHO. Available at: -08-2019-update-on-ebola-drug-trial-two-strong-performers-identified
25. World Health Organization. Interim advice on the sexual transmission of the Ebola virus disease, 21 Jan 2016. Geneva: WHO. Available at: -advice-on-the-sexual-transmission-of-the-ebola-virus-disease
30. US Food and Drug Administration. First FDA-approved vaccine for the prevention of Ebola virus disease, marking a critical milestone in public health preparedness and response, 19 Dec 2019. Maryland: FDA. Available at: -events/press-announcements/first-fda-approved-vaccine-prevention-ebola-virus-disease-marking-critical-milestone-public-health
32. World Health Organization - Regional Office for Africa. 11th Ebola outbreak in the Democratic Republic of the Congo declared over, 18 Nov 2020. Brazzaville: WHO; 2020. Available at: -republic-of-congo/news/1th-ebola-outbreak-democratic-republic-congo-declared-over
Background
Marburg virus disease is a rare but highly fatal viral hemorrhagic fever caused by two zoonotic viruses, Marburg virus and Ravn virus, that are closely related to ebolaviruses within family Filoviridae. In February and March 2023, two distinct outbreaks of Marburg virus were reported in Equatorial Guinea and Tanzania. These outbreaks mark the first time that Marburg virus has been identified in either Equatorial Guinea or Tanzania, though the virus has been identified previously in neighboring countries and the reservoir, the Egyptian fruit bat, is known to be present in both countries. Available information suggests that these outbreaks may have originated separately in each country. To date, there is no evidence that these two outbreaks are epidemiologically linked. Viral genetic sequencing from Tanzania is in process; these results, along with sequence data available from Equatorial Guinea, will further inform whether the outbreaks emerged separately through distinct animal-to-human spillover events.
Testing for Marburg virus and other causes of viral hemorrhagic fevers is available at CDC (Atlanta, Georgia) and within the Laboratory Response Network (LRN). To date, 32 geographically diverse LRN laboratories and 8 Regional Emerging Special Pathogen Treatment Centers can test using the Biofire FilmArray NGDS Warrior Panel, with several more LRN laboratories working toward building testing capability. The Warrior Panel can detect marburgviruses (Marburg and Ravn viruses) and ebolaviruses (Ebola, Sudan, Tai Forest, Bundibugyo, and Reston viruses) in addition to other high-consequence pathogens.
The U.S. Food and Drug Administration announced today the approval of Ervebo, the first FDA-approved vaccine for the prevention of Ebola virus disease (EVD), caused by Zaire ebolavirus in individuals 18 years of age and older. Cases of EVD are very rare in the U.S., and those that have occurred have been the result of infections acquired by individuals in other countries who then traveled to the U.S., or health care workers who became ill after treating patients with EVD.
Confirmed outbreaks of EVD have been documented since the 1970s, primarily in areas of sub-Saharan Africa, where scientists believe the virus is always present at low levels in certain infected wild animals. On rare occasions, people become sick with EVD after coming into direct contact with infected animals, which can then lead to EVD outbreaks when the virus spreads between people.
An outbreak in three West African countries (Guinea, Liberia and Sierra Leone) from 2014 to 2016 resulted in more than 28,000 cases of EVD and more than 11,000 deaths that were caused by Zaire ebolavirus. 2351a5e196
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