Ebola Virus Disease in Africa: Recurrent Outbreaks, Continuing Public Health Threat, Medical Countermeasures, and One Health Perspectives

Mahendra Pal^1, , Mahek Desai², Dhwani Upadhyay² and Sônia de Avila Botton³

¹Narayan Consultancy on Veterinary Public Health and Microbiology, Bharuch, Gujarat, India

²Department of Life Sciences, Faculty of Applied Sciences, Parul University, Vadodara, Gujarat, India

³Laboratório de Pesquisas Micológicas (LAPEMI), Prédio 20, Sala 4139, CEP 97105-900, Santa Maria- RS- Brasil

Cite this paper:
Mahendra Pal, Mahek Desai, Dhwani Upadhyay and Sônia de Avila Botton. Ebola Virus Disease in Africa: Recurrent Outbreaks, Continuing Public Health Threat, Medical Countermeasures, and One Health Perspectives. American Journal of Epidemiology and Infectious Disease. 2026; 14(1):14-21. doi: 10.12691/ajeid-14-1-3

Abstract

Ebola virus disease (EVD) is a zoonotic disease of great public health importance. It is characterized by a high case fatality rate, causes outbreaks, and can lead to major social and economic disruption. First recognised in 1976 in Sudan and the Democratic Republic of the Congo, the disease has since emerged in different parts of Africa. The most significant outbreak occurred between 2014 and 2016 in West Africa. EVD is caused by species of the genus Orthoebolavirus, including Ebola virus, Sudan virus, and Bundibugyo virus. These viruses differ in fatality rates and in the availability of medical countermeasures. Fruit bats are believed to be the natural reservoir. Transmission to humans occurs through contact with infected animals, body fluids of infected persons, and contaminated environments, including during unsafe burial practices. The early stages present with non-specific symptoms, followed by gastrointestinal and hemorrhagic symptoms. Laboratory confirmation involves molecular, antigen-based, serological, and virological methods. Treatment options include supportive care, monoclonal antibodies for cases caused by Orthoebolavirus zaire, and vaccination. However, major gaps remain in the treatment and prevention of Sudan and Bundibugyo virus infections. Despite progress in EVD management, further research is needed to improve preparedness, diagnosis, treatment, and control. Therefore, this review discusses the etiology, epidemiology, transmission, pathogenesis, clinical spectrum, diagnosis, treatment, control, and One Health implications of Ebola virus disease, while highlighting existing knowledge gaps and future research needs.

Keywords:
Ebola virus Orthoebolavirus One Health Zoonotic disease Africa

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Broadhurst M.J., Kelly J.D., Miller A., Semper A., Bailey D., Groppelli E., et al., “ReEBOV antigen rapid test kit for point-of-care and laboratory-based testing for Ebola virus disease: a field validation study.”, The Lancet, 386(9996), 867-874, 2015.
[2]	Weyer J., Grobbelaar A. and Blumberg L., “Ebola virus disease: history, epidemiology and outbreaks.”, Current Infectious Disease Reports, 17(5), 480, 2015.
[3]	Bowen E.T., Platt G.S., Lloyd G., Baskerville A., Harris W.J. and Vella E.E., “Viral haemorrhagic fever in southern Sudan and northern Zaire. Preliminary studies on the aetiological agent.”, The Lancet, 1(8011), 571-573, 1977.
[4]	Pal M., Tariku F., Upadhyay D. and Zende R., “Current innovations in the diagnosis and immunization of emerging and re-emerging zoonoses.”, American Journal of Epidemiology and Infectious Disease, 12(2), 23-28, 2024.
[5]	Feldmann H. and Geisbert T.W., “Ebola haemorrhagic fever.”, The Lancet, 377(9768), 849-862, 2011.
[6]	Baize S., Pannetier D., Oestereich L., Rieger T., Koivogui L., Magassouba N.F., et al., “Emergence of Zaire Ebola virus disease in Guinea.”, New England Journal of Medicine, 371(15), 1418-1425, 2014.
[7]	Hayman D.T.S., Yu M., Crameri G., Wang L.F., Suu-Ire R., Wood J.L.N., et al., “Ebola virus antibodies in fruit bats, Ghana, West Africa.”, Emerging Infectious Diseases, 18(7), 1207-1209, 2012.
[8]	Kuhn J.H., Adachi T., Adhikari N.K., Arribas J.R., Bah I.E., Bausch D.G., et al., “New filovirus disease classification and nomenclature.”, Nature Reviews Microbiology, 17(5), 261-263, 2019.
[9]	Leroy E.M., Kumulungui B., Pourrut X., Rouquet P., Hassanin A., Yaba P., et al., “Fruit bats as reservoirs of Ebola virus.”, Nature, 438(7068), 575-576, 2005.
[10]	Olival K.J. and Hayman D.T.S., “Filoviruses in bats: current knowledge and future directions.”, Viruses, 6(4), 1759-1788, 2014.
[11]	Deen G.F., Broutet N., Xu W., Knust B., Sesay F.R., McDonald S.L., et al., “Ebola RNA persistence in semen of Ebola virus disease survivors.”, New England Journal of Medicine, 377(15), 1428-1437, 2017.
[12]	Singh R.K., Dhama K., Malik Y.S., Ramakrishnan M.A., Karthik K., Khandia R., et al., “Ebola virus - epidemiology, diagnosis, and control: threat to humans, lessons learnt, and preparedness plans - an update on its 40 year’s journey.”, Veterinary Quarterly, 37(1), 98-135, 2017.
[13]	Gonzalez V., Hurtado-Monzón A.M., O'Krafka S., Mühlberger E., Letko M., Frank H.K., et al., “Studying bats using a One Health lens: bridging the gap between bat virology and disease ecology.”, Journal of Virology, 98(12), e01453-24, 2024.
[14]	Pal M., Zende R., Rebuma T., Nair A. and de Avila Botton S., “The role of veterinarians in One Health implementation: bridging animal, human and environmental health.”, American Journal of Public Health Research, 14(2), 18-24, 2026.
[15]	Pourrut X., Délicat A., Rollin P.E., Ksiazek T.G., Gonzalez J.P. and Leroy E.M., “Spatial and temporal patterns of Zaire ebolavirus antibody prevalence in the possible reservoir bat species.”, The Journal of Infectious Diseases, 196(Supplement 2), S176-S183, 2007.
[16]	Vetter P., Kaiser L., Schibler M., Ciglenecki I. and Bausch D.G., “Sequelae of Ebola virus disease: the emergency within the emergency.”, The Lancet Infectious Diseases, 16(6), e82-e91, 2016.
[17]	World Health Organization, “Epidemic of Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda determined a public health emergency of international concern.”, World Health Organization, 17 May 2026. Available at: https://www.who.int/news/item/17-05-2026-epidemic-of-ebola-disease-in-the-democratic-republic-of-the-congo-and-uganda-determined-a-public-health-emergency-of-international-concern. Accessed July 13, 2026.
[18]	Smout E., “Communicating in a crisis like Ebola: facts and figures.”, SciDev.Net, 22 April 2015. Available at: https://www.scidev.net/global/features/communicating-crisis-ebola-facts-figures/. Accessed July 13, 2026.
[19]	Kabami Z., Ario A.R., Harris J.R., Ninsiima M., Ahirirwe S.R., Ocero J.R., et al., “Ebola disease outbreak caused by the Sudan virus in Uganda, 2022: a descriptive epidemiological study.”, The Lancet Global Health, 12(10), e1684-e1692, 2024.
[20]	Boum II Y., Dereje N., Mercy K., Fallah M., Aragaw M., Tsague L., et al., “Ebola disease outbreak caused by Bundibugyo virus in Africa: a defining moment for Africa’s health security and sovereignty.”, Journal of Public Health in Africa, 17(1), a2069, 2026.
[21]	Basler C.F. and Amarasinghe G.K., “Evasion of interferon responses by Ebola and Marburg viruses.”, Journal of Interferon and Cytokine Research, 29(9), 511-520, 2009.
[22]	Kuhn J.H., Amarasinghe G.K., Basler C.F., Bavari S., Bukreyev A., Chandran K., et al., “ICTV virus taxonomy profile: Filoviridae.”, Journal of General Virology, 100(6), 911-912, 2019.
[23]	Ahmad S.I. (Ed.), Human Viruses: Diseases, Treatments and Vaccines: The New Insights, Springer, Cham, Switzerland, 2021.
[24]	Milambo M.J.P., “Drivers of Ebola virus disease resurgence in DRC: a root cause analysis of the 16th outbreak in Mweka, Kasai Province (2025).”, Zoonotic Diseases, 6(2), 25, 2026.
[25]	Nicastri E., Kobinger G., Vairo F., Montaldo C., Mboera L.E.G., Ansunama R., et al., “Ebola virus disease: epidemiology, clinical features, management, and prevention.”, Infectious Disease Clinics of North America, 33(4), 953-976, 2019.
[26]	Cheng N., Ye R.Z., Li Y.Y., Kargbo K.B., Ren L.L. and Cao W.C., “Global distribution and genetic diversity of orthoebolaviruses: mapping and evolutionary analysis.”, One Health, 21, 101236, 2025.
[27]	Jain S., Martynova E., Rizvanov A., Khaiboullina S. and Baranwal M., “Structural and functional aspects of Ebola virus proteins.”, Pathogens, 10(10), 1330, 2021.
[28]	Omoleke S.A., Mohammed I. and Saidu Y., “Ebola viral disease in West Africa: a threat to global health, economy and political stability.”, Journal of Public Health in Africa, 7(1), 534, 2016.
[29]	Leroy E.M., Rouquet P., Formenty P., Souquière S., Kilbourne A., Froment J.M., et al., “Multiple Ebola virus transmission events and rapid decline of central African wildlife.”, Science, 303(5656), 387-390, 2004.
[30]	Olivero J., Fa J.E., Real R., Márquez A.L., Farfán M.A., Vargas J.M., et al., “Recent loss of closed forests is associated with Ebola virus disease outbreaks.”, Scientific Reports, 7(1), 14291, 2017.
[31]	Judson S.D. and Munster V.J., “The multiple origins of Ebola disease outbreaks.”, The Journal of Infectious Diseases, 228(Supplement 7), S465-S473, 2023.
[32]	Centers for Disease Control and Prevention, “Ebola outbreak: current situation.”, CDC, 2026. Available at: https:// ebola/ situation-summary/index.html. Accessed July 13, 2026.
[33]	Chowell G. and Nishiura H., “Transmission dynamics and control of Ebola virus disease (EVD): a review.”, BMC Medicine, 12(1), 196, 2014.
[34]	Kaner J. and Schaack S., “Understanding Ebola: the 2014 epidemic.”, Globalization and Health, 12(1), 53, 2016.
[35]	Mate S.E., Kugelman J.R., Nyenswah T.G., Ladner J.T., Wiley M.R., Cordier-Lassalle T., et al., “Molecular evidence of sexual transmission of Ebola virus.”, New England Journal of Medicine, 373(25), 2448-2454, 2015.
[36]	Bray M. and Geisbert T.W., “Ebola virus: the role of macrophages and dendritic cells in the pathogenesis of Ebola hemorrhagic fever.”, The International Journal of Biochemistry & Cell Biology, 37(8), 1560-1566, 2005.
[37]	Martines R.B., Ng D.L., Greer P.W., Rollin P.E. and Zaki S.R., “Tissue and cellular tropism, pathology and pathogenesis of Ebola and Marburg viruses.”, The Journal of Pathology, 235(2), 153-174, 2015.
[38]	Messaoudi I., Amarasinghe G.K. and Basler C.F., “Filovirus pathogenesis and immune evasion: insights from Ebola virus and Marburg virus.”, Nature Reviews Microbiology, 13(11), 663-676, 2015.
[39]	McElroy A.K., Erickson B.R., Flietstra T.D., Rollin P.E., Nichol S.T., Towner J.S., et al., “Ebola hemorrhagic fever: novel biomarker correlates of clinical outcome.”, The Journal of Infectious Diseases, 210(4), 558-566, 2014.
[40]	Warsame A., Eamer G., Kai A., Robles Dios L., Rohan H., Keating P., et al., “Performance of a safe and dignified burial intervention during an Ebola epidemic in the eastern Democratic Republic of the Congo, 2018-2019.”, BMC Medicine, 21(1), 484, 2023.
[41]	Adepoju P., “Uganda launches vaccine trial for Sudan virus disease.”, The Lancet Microbe, 6(4), 101110, 2025.
[42]	Mulangu S., Dodd L.E., Davey R.T. Jr., Tshiani Mbaya O., Proschan M., Mukadi D., et al., “A randomized, controlled trial of Ebola virus disease therapeutics.”, New England Journal of Medicine, 381(24), 2293-2303, 2019.
[43]	Henao-Restrepo A.M., Camacho A., Longini I.M., Watson C.H., Edmunds W.J., Egger M., et al., “Efficacy and effectiveness of an rVSV-vectored vaccine in preventing Ebola virus disease: final results from the Guinea ring vaccination, open-label, cluster-randomised trial (Ebola Ça Suffit!).”, The Lancet, 389(10068), 505-518, 2017.
[44]	Gupta N., Mora-Rillo M., Gkrania-Klotsas E., Drexler J.F., Jokelainen P., Pellejero-Sagastizabal G., et al., “Bundibugyo ebolavirus outbreak in the Democratic Republic of the Congo and Uganda: rapid assessment from the ESCMID Emerging Infections Subcommittee.”, Clinical Microbiology and Infection, published online May 30, 2026.
[45]	Ilunga Kalenga O., Moeti M., Sparrow A., Nguyen V.K., Lucey D. and Ghebreyesus T.A., “The ongoing Ebola epidemic in the Democratic Republic of Congo, 2018-2019.”, New England Journal of Medicine, 381(4), 373-383, 2019.
[46]	West T.E. and von Saint André-von Arnim A., “Clinical presentation and management of severe Ebola virus disease.”, Annals of the American Thoracic Society, 11(9), 1341-1350, 2014.
[47]	Balinandi S., Mulei S., Whitmer S., Nyakarahuka L., Cossaboom C.M., Shedroff E., et al., “Crimean-Congo hemorrhagic fever cases diagnosed during an outbreak of Sudan virus disease in Uganda, 2022–23.”, PLoS Neglected Tropical Diseases, 18(10), e0012595, 2024.