Ebola virus disease

Ebola virus disease

Ebola virus disease: an overview

Ebola virus disease is a serious illness that originated in Africa, where there is currently an outbreak. But for people living in countries outside Africa, it continues to be a very low threat.

The current outbreak of the Ebola virus mainly affects three countries in West Africa: Guinea, Liberia and Sierra Leone. Around 27,000 cases and more than 11,000 deaths have been reported by the World Health Organization. This is the largest known outbreak of Ebola.

Experts studying the virus believe it is highly unlikely the disease would spread within the UK. To understand why, read Why is the risk low for people in the UK?

What are the symptoms, and what should I do if I think I’m infected?

A person infected with Ebola virus will typically develop a fever, headache, joint and muscle pain, a sore throat, and intense muscle weakness.

These symptoms start suddenly, between two and 21 days after becoming infected.

If you feel unwell with the above symptoms within 21 days of coming back from Guinea, Liberia or Sierra Leone, you should stay at home and immediately telephone 111 or 999 and explain that you have recently visited West Africa.

These services will provide advice and arrange for you to be seen in a hospital if necessary so the cause of your illness can be determined.

It’s really important that medical services are expecting your arrival and calling 111 or 999 will ensure this happens.

Read more about the symptoms of Ebola virus disease.

How does Ebola spread among people?

People can become infected with the Ebola virus if they come into contact with the blood, body fluids or organs of an infected person.

Most people are infected by giving care to other infected people, either by directly touching the victim’s body or by cleaning up body fluids (stools, urine or vomit) that carry infectious blood.

Read more information about how Ebola spreads, and how the outbreak started.

Who is at risk, and how can we prevent its spread?

Anyone who cares for an infected person or handles their blood or fluid samples is at risk of becoming infected. Hospital workers, laboratory workers and family members are at greatest risk. 

Strict infection control procedures and wearing protective clothing minimises this risk – see preventing the spread of Ebola virus for more information. Simply washing hands with soap and water can destroy the virus.

How is Ebola virus disease treated?

There’s currently no licensed treatment or vaccine for Ebola virus disease, although potential new vaccines and drug therapies are being developed and tested.

Patients diagnosed with Ebola virus disease are placed in isolation in intensive care, where their blood oxygen levels and blood pressure are maintained at the right level and their body organs supported. Read more information about how Ebola virus disease is treated.

Healthcare workers need to avoid contact with the bodily fluids of their infected patients by taking strict precautions.

ZMapp is an experimental treatment that can be tried, although it has not yet been tested in humans for safety or effectiveness. The product is a combination of three different antibodies that bind to the protein of the Ebola virus.

How is it diagnosed?

It’s difficult to know if a patient is infected with Ebola virus in the early stages as symptoms such as fever, headache and muscle pain are similar to those of many other diseases.

But specialist infection clinicians will make expert judgements on what the most likely diagnosis is, based on the patient’s history.

Read our page on diagnosing Ebola virus disease for more information.

Why is the risk low for people in the UK?

The likelihood of catching Ebola virus disease is considered very low unless you’ve travelled to a known infected area and had direct contact with a person with Ebola-like symptoms, or had contact with an infected animal or contaminated objects.

Not easily transmitted

While it is possible people infected with Ebola could arrive in the UK on a plane, the virus is not as easily transmitted as a respiratory virus such as influenza.

Only infectious when symptoms start

People infected with Ebola do not become infectious until they have developed symptoms, such as a fever. The disease then progresses very rapidly. This means infectious people do not walk around spreading the disease for a long period.

It typically takes five to seven days for symptoms to develop after infection, so there is time to identify people who may have been exposed, put them under surveillance and, if they show symptoms, quarantine them.

Effective infection control procedures

In past outbreaks, infection control measures have been very effective in containing Ebola within the immediate area. The UK has a robust public health system with the trained staff and facilities necessary to contain cases of Ebola.

Training and awareness 

Public Health England has advised frontline medical practitioners to be alert to Ebola in those returning from affected areas. 

Advice has been issued to the Border Force to identify possible cases of Ebola and there are procedures in place to provide care to the patient and to minimise public health risk to others.

Flight crew are trained to respond swiftly to any passengers who develop symptoms during a flight from Africa. They will take measures to reduce transmission on board the plane. But this event is very unlikely, and so far there have been no documented cases of people catching the disease simply by being in the same plane as an Ebola victim.

More information

Symptoms of Ebola virus disease

How Ebola virus disease spreads 

Diagnosing Ebola virus disease

Treating Ebola virus disease

Travel advice 

Preventing the spread of Ebola virus disease

FAQs

 

 

Symptoms of Ebola virus disease

A person infected with Ebola virus will typically develop a fever, a headache, joint and muscle pain, a sore throat, and intense muscle weakness.

These symptoms start suddenly between 2 and 21 days after becoming infected.

Diarrhoea, vomiting, a rash, stomach pain and impaired kidney and liver function follow.

The patient then bleeds internally, and may also bleed from the ears, eyes, nose or mouth.

Ebola virus disease is fatal in 50-90% of cases. The sooner a person is given care, the better the chances that they will survive.

What if I think I might have Ebola in the UK?

If you feel unwell with symptoms such as fever, chills, muscle aches, headache, nausea, vomiting, diarrhoea, a sore throat or a rash within 21 days of coming back from Guinea, Liberia or Sierra Leone, you should stay at home and immediately call 111 or 999 and explain that you have recently visited West Africa.

These services will provide advice and arrange for you to be seen in a hospital, if necessary, so the cause of your illness can be determined.

Other illnesses much more common than Ebola (such as flutyphoid fever and malaria) have similar symptoms in the early stages, so proper medical assessment is really important to ensure you get the right diagnosis and treatment.

It is also really important that medical services are expecting your arrival, and calling 111 or 999 will ensure this happens.

Read on to find out how Ebola virus disease spreads.

How Ebola virus disease spreads

People can become infected with the Ebola virus if they come into contact with the blood, body fluids or organs of an infected person.

Most people are infected by giving care to other infected people, either by directly touching the victim’s body or by cleaning up body fluids (stools, urine or vomit) that carry infectious blood.

Traditional African burial rituals have also played a part in its spread. The Ebola virus can survive for several days outside the body, including on the skin of an infected person, and it’s common practice for mourners to touch the body of the deceased. They only then need to touch their mouth to risk becoming infected.

Other ways people can catch Ebola are:

  • touching the soiled clothing of an infected person, then touching their mouth
  • having sex with an infected person without using a condom (the virus is present in semen for up to seven weeks after the infected person has recovered)
  • handling unsterilised needles or medical equipment that were used in the care of the infected person

A person is infectious as long as their blood, urine, stools or secretions contain the virus.

Who is at risk?

Anyone who cares for an infected person or handles their blood or fluid samples is at risk of becoming infected. Hospital workers, laboratory workers and family members are at greatest risk.

Strict infection control procedures and wearing protective clothing minimises this risk – see preventing the spread of Ebola virus for more information. Simply washing hands with soap and water can destroy the virus.

Can you catch Ebola by touching the skin of someone with symptoms of Ebola?

If the person has a fever but no other symptoms, then the level of virus in their body is very low and unlikely to be passed on to someone else.

In later stages, all body fluids such as blood, urine, faeces, vomit, saliva and semen are infectious, with blood, faeces and vomit being the most infectious. 

Ebola virus disease is not spread through ordinary social contact, such as shaking hands, travelling on public transport or sitting beside someone who is infected and does not have any symptoms – see below.

How is Ebola not spread?

You’d need to have close contact with the source of infection to be at risk. 

The virus is not, for example, as infectious as diseases such as the flu, as airborne transmission is much less likely.

Ebola virus disease is generally not spread through routine social contact (such as shaking hands) with patients who do not have symptoms. 

It’s unlikely you would catch Ebola just by travelling on a plane with someone who is infected. You would need to have had direct contact with the blood or body fluids from that person.

It’s also unlikely you would catch Ebola virus from the sweat left on gym equipment. A person who has symptoms of Ebola virus disease would not be well enough to go to the gym – and until they develop symptoms, they are not infectious. The World Health Organization (WHO) says whole live virus has never been isolated from sweat.

Why is the risk low for people in the UK?

The likelihood of catching Ebola virus disease is considered very low unless you’ve travelled to a known infected area and had direct contact with a person with Ebola-like symptoms, or had contact with an infected animal or contaminated objects. 

The time it takes for symptoms to appear after infection ranges from two to 21 days, so it is possible that a person infected in Africa could arrive in the UK. But this is extremely unlikely to result in a large outbreak of Ebola virus disease in the UK.

The overview page explains in more detail why the risk in the UK is considered low.

How did the outbreak start?

It’s thought the Ebola virus has been living harmlessly in fruit bats for many years, building up in this population and spreading to other forest animals including chimpanzees and gorillas.

It’s likely the virus makes its way into people after they butcher or handle dead animals contaminated with the virus.

Ebola was first identified in Africa in the mid-1970s.
The current outbreak, which began in March 2014, has been the most serious so far.

Diagnosing Ebola virus disease

It’s difficult to know if a patient is infected with Ebola virus in the early stages as symptoms such as fever, headache and muscle pain are similar to those of many other diseases.

But specialist infection clinicians will make expert judgements on what the most likely diagnosis is based on the patient’s history.

If Ebola is considered a possibility on this basis, then a person would be tested for the disease. 

Samples of blood or body fluid can be sent to a laboratory to be tested for the presence of Ebola virus, and a diagnosis can be made rapidly.

A person suspected of having Ebola would be isolated to minimise contact with other people while they are being tested. It is only if this test is positive that the case is considered to be ‘confirmed’.

If the test is positive, they will be transferred to a hospital high-level isolation unit.

If the result is negative, doctors will test for other diseases such as malaria, typhoid fever and cholera.

Read about the treatment of Ebola virus disease.

How Ebola virus disease is treated

There’s currently no licensed treatment or vaccine for Ebola virus disease, although potential new vaccines and drug therapies are being developed and tested.

Any area affected by an outbreak should be immediately quarantined, and patients confirmed to have Ebola virus disease should be treated in isolation in intensive care. 

Hospital care

Dehydration is common, so fluids may be given directly into a vein (intravenously). The patient’s blood oxygen levels and blood pressure need to be maintained at the right level and body organs supported, while the patient’s body fights the disease and any other infections are treated.

Healthcare workers need to avoid contact with the bodily fluids of their infected patients by taking strict precautions. 

Read about the prevention of Ebola virus disease.

ZMapp

ZMapp is an experimental treatment that can be tried, although it has not yet been tested on humans for safety or effectiveness. The product is a combination of three different antibodies that bind to the protein of the Ebola virus.

Preventing the spread of Ebola virus disease

Any area affected by an outbreak should be immediately quarantined and patients treated in isolation. 

Healthcare workers need to avoid contact with the bodily fluids of their infected patients by:

  • wearing face masks, goggles, gowns and gloves
  • taking extra care when handling blood, secretions and catheters, and when connecting patients to a drip
  • disinfecting non-disposable medical equipment before reusing 
  • sterilising and disposing of used needles and disposable equipment carefully
  • properly disposing of any secretions or bodily waste from the patient
  • carefully and frequently washing hands with soap and water (or alcohol hand rub, if soap isn’t available)
  • washing disposable gloves with soap and water after use, disposing of them carefully, then washing hands

Public Health England (PHE) has developed a leaflet recommending the precautions humanitarian workers should take and providing advice on what they should do if they suspect an infection. 

Read the leaflet here (links to external site).

Screening in the UK

In 2014, the UK introduced a screening procedure at key UK airports, starting at Heathrow. The aim was to ensure that as many people as possible arriving from infected countries knew the symptoms and how to get access to healthcare services as quickly as possible. 

The government is now adjusting its Ebola screening arrangements, as the likelihood of further Ebola cases being imported into the UK is now very low. Read more about how the UK government is responding to Ebola.

Travel advice for people concerned about Ebola virus disease

The risk of Ebola to the general public in the UK remains very low and there is no increased risk of catching Ebola virus disease from taking public transport.

It’s unlikely Ebola can be passed on by someone coughing or sneezing nearby because Ebola is not a respiratory illness transmitted by virus particles that remain suspended in the air.

What’s the advice for travellers in at-risk areas?

Visit the GOV.UK foreign travel advice section, where you can find the latest advice for the country you are travelling to.

Travellers in at-risk areas should follow these simple precautions to minimise their risk of catching Ebola virus disease:

  • Wash hands frequently using soap and water (or alcohol hand rubs, when soap is not available), as this destroys the virus.
  • Make sure fruit and veg is properly washed and peeled before you eat it.
  • Avoid physical contact with anyone who has symptoms.
  • Avoid dense and crowded places where people may be infected.  
  • Don’t handle dead animals or their raw meat.
  • Don’t eat “bushmeat”. 

If you think that you or a family member has symptoms of Ebola infection:

  • visit a healthcare provider immediately and inform them that you may have had contact with the Ebola virus (the nearest Embassy or Consular Office can help you find a provider in the area)
  • limit contact with others and avoid all other travel

It’s more likely that the cause is another disease, such as malaria, but you may need to be tested for Ebola as a precaution. 

I may have been on a flight with someone with Ebola. Am I at risk?

You cannot catch Ebola through social contact or by travelling on a plane with someone who is infected, unless you come into direct contact with the blood or bodily fluids of an infected person.

Cabin crew who suspect that a passenger on board could have an infectious disease, as well as ground staff receiving the passenger at the destination, would follow the International Air Transport Association guidelines for suspected communicable diseases (PDF, 37kb).

If there is someone on board a flight who is unwell, the pilot of the aircraft is legally required to inform air traffic control. Arrangements will be made for medical assessments for the person on arrival. The exact arrangements will depend on the airport involved. The local Public Health Team would be alerted if there was a possibility that the individual was suffering from an infectious disease, so that appropriate public health action could be initiated.

Why have they introduced screening at UK airports?

The UK recently introduced screening procedures to the highest-risk UK ports  Heathrow, Gatwick and Eurostar terminals.  

The purpose of screening is to identify and give advice to passengers coming from high-risk areas who will be spending time in the UK.

Read specific FAQs on screening for Ebola at UK airports.

Frequently asked questions

Background information

General advice

The UK situation

How do Ebola outbreaks start?

It’s thought the Ebola virus has been living harmlessly in fruit bats for many years, building up in this population and spreading to other forest animals, including chimpanzees and gorillas.

It’s likely the virus makes its way into people after they butcher or handle dead animals contaminated with the virus.

How does it spread among people?

People can become infected with the Ebola virus if they come into contact with the blood, body fluids or organs of an infected person.

Most people are infected by giving care to other infected people, either by directly touching the victim’s body or by cleaning up body fluids (stools, urine or vomit) that carry infectious blood.

Traditional African burial rituals have also played a part in its spread. The Ebola virus can survive for several days outside the body, including on the skin of an infected person, and it’s common practice for mourners to touch the body of the deceased. They only then need to touch their mouth to become infected.

Other ways people can catch Ebola are:

  • touching the soiled clothing of an infected person, then touching their mouth
  • having sex with an infected person without using a condom (the virus is present in semen for up to seven weeks after the infected person has recovered)
  • handling unsterilised needles or medical equipment that were used in the care of the infected person

A person is infectious as long as their blood, urine, stools or secretions contain the virus.

Ebola virus disease is generally not spread through routine social contact (such as shaking hands) with patients who do not have symptoms. 

The virus is not, for example, as infectious as diseases such as the flu, as airborne transmission is much less likely. You’d need to have close contact with the source of infection to be at risk. 

Who is at risk?

Anyone who cares for an infected person or handles their blood or fluid samples is at risk of becoming infected. Hospital workers, laboratory workers and family members are at greatest risk.

Strict infection control procedures and wearing protective clothing minimises this risk – see What’s the advice for healthcare and aid workers? Simply washing hands with soap and water can destroy the virus.

What are the symptoms?

An infected person will typically develop a fever, a headache, joint and muscle pain, a sore throat, and intense muscle weakness. These symptoms start suddenly between 2 and 21 days after becoming infected.

Diarrhoea, vomiting, a rash, stomach pain, and impaired kidney and liver function follow. The patient then bleeds internally, and may also bleed from the ears, eyes, nose or mouth.

Ebola virus disease is fatal in 50-90% of cases. The sooner a person is given care, the better their chances of survival.

How is it treated?

There’s currently no licensed treatment or vaccine for Ebola virus disease, although potential new vaccines and drug therapies are being developed and tested.

Patients need to be placed in isolation in intensive care. Dehydration is common, so fluids may be given directly into a vein (intravenously).

Blood oxygen levels and blood pressure need to be maintained at the right level and body organs supported while the patient’s body fights the disease and any other infections are treated.

ZMapp is an experimental treatment that can be tried, although it has not yet been tested in humans for safety or effectiveness. The product is a combination of three different antibodies that bind to the protein of the Ebola virus.

What is the UK government doing to respond to the Ebola crisis?

The UK is co-ordinating and leading the response to Ebola in Sierra Leone, and has committed to provide 700 Ebola treatment beds in at least four treatment centres in areas where the need is greatest.

To provide staff for these facilities, the UK will scale up the national Ebola Training Facility (which already trains 90 health workers a week) to train Sierra Leonean and international staff.

Public Health England staff have also been on the frontline as part of the international effort to tackle Ebola in West Africa. They have been supporting the Sierra Leone Ministry of Health by providing expert guidance on managing the outbreak and preventing the spread of the virus.

What is being done to try to find new treatments or cures?

The UK government, alongside the Wellcome Trust and the Medical Research Council, has co-funded clinical trials of a potential vaccine for Ebola virus disease.

What’s the advice for healthcare and aid workers?

Any area affected by an outbreak should be immediately quarantined and patients treated in isolation. 

Healthcare workers need to avoid contact with the bodily fluids of infected patients by taking the following precautions:

  • wear face masks, goggles, gowns and gloves
  • take extra care when handling blood, secretions and catheters, and when connecting patients to a drip
  • disinfect non-disposable medical equipment before reuse
  • sterilise and dispose of used needles and disposable equipment carefully
  • properly dispose of any secretions or body waste from the patient
  • carefully and frequently wash hands with soap and water (use alcohol hand rub if soap isn’t available)
  • wash disposable gloves with soap and water after use, dispose of them carefully, then wash hands

Public Health England has developed a leaflet recommending the precautions humanitarian workers should take, as well as providing advice about what they should do if they suspect an infection. Read the leaflet for humanitarian aid workers on the GOV.UK website.

What’s the advice for travellers in at-risk areas?

Following these simple precautions will minimise your risk of catching Ebola virus disease:

  • don’t handle dead animals or their raw meat
  • don’t eat bushmeat
  • avoid contact with patients who have symptoms 
  • avoid having sex with people in risk areas (use a condom if you do)
  • make sure fruit and veg is washed and peeled before you eat it
  • wash hands frequently using soap and water (or alcohol hand rubs when soap is not available) as this destroys the virus

If you think you or a family member has symptoms of Ebola infection:

  • visit a healthcare provider immediately and inform them that you may have had contact with the Ebola virus (the nearest Embassy or Consular Office can help you find a provider in the area)
  • limit contact with others and avoid all other travel

It’s more likely the cause of your symptoms is another disease, such as malaria, but you may need to be tested for Ebola as a precaution. 

What if I think I might have Ebola in the UK?

If you feel unwell with symptoms such as fever, chills, muscle aches, a headache, nausea, vomiting, diarrhoea, a sore throat or a rash within 21 days of coming back from Guinea, Liberia or Sierra Leone, you should stay at home and immediately telephone 111 or 999 and explain that you have recently visited West Africa.

These services will provide advice and arrange for you to be seen in a hospital if necessary so the cause of your illness can be determined.

There are other illnesses that are much more common than Ebola (such as flu, typhoid fever and malaria) that have similar symptoms in the early stages, so proper medical assessment is really important to ensure you get the right diagnosis and treatment.

It is also really important that medical services are expecting your arrival – calling 111 or 999 will ensure this happens.

What guidance has the UK government given schools and universities? 

Guidance has been developed to assist universities and other further educational establishments that may have students returning or visiting from affected countries. Read the official guidance for educational establishments on the GOV.UK website.

How is it diagnosed?

It’s difficult to know if a patient is infected with Ebola virus in the early stages as symptoms such as fever, headache and muscle pain are similar to those of many other diseases.

But specialist infection clinicians will make expert judgements on what the most likely diagnosis is based on the patient’s history. If Ebola is considered a possibility on this basis, then a person would be tested for the disease. 

Samples of blood or body fluid can be sent to a laboratory to be tested for the presence of Ebola virus, and a diagnosis can be made rapidly.

A suspect case would be isolated in a side room to minimise contact with other people while they are being tested. It is only if this test is positive that the case is considered to be “confirmed”.

If the test is positive, the person will be transferred to a hospital-based high-level isolation unit.

If the result is negative, doctors will test for other diseases, such as malaria, typhoid fever and cholera.

Why is the risk low for people in the UK?

The likelihood of catching Ebola virus disease is considered very low unless you’ve travelled to a known infected area and had direct contact with a person with Ebola-like symptoms, or had contact with an infected animal or contaminated objects.

While it is possible that people infected with Ebola can arrive in the UK on a plane, the virus is not as easily transmitted as a respiratory virus such as influenza.

In past outbreaks, infection control measures have been very effective at containing Ebola within the immediate area. The UK has a robust public health system with the trained staff and facilities necessary to contain cases of Ebola.

Advice has been issued to the Border Force to identify possible cases of Ebola, and there are procedures in place to provide care to the patient and minimise the public health risk to others.

Also, people infected with Ebola do not become infectious until shortly before they develop symptoms. The disease then progresses very rapidly. This means infectious people do not walk around spreading the disease for a long period.

It typically takes 5-7 days for symptoms to develop after infection, so there is time to identify people who may have been exposed, put them under surveillance and, if they show symptoms, quarantine them.

Flight crew are trained to respond swiftly to any passengers who develop symptoms during a flight from Africa. They will take measures to reduce transmission onboard the plane. But this event is very unlikely, and so far there have been no documented cases of people catching the disease simply by being on the same plane as an Ebola victim.

I may have been on a flight with someone with Ebola. Am I at risk?

You cannot catch Ebola through social contact or by travelling on a plane with someone who is infected without coming into direct contact with the blood or body fluids of an infected person.

Cabin crew who identify a sick passenger with a suspected infectious disease onboard, and ground staff who receive the passenger at the destination, follow the International Air Transport Association guidelines for suspected communicable diseases (PDF, 37kb).

If there is someone unwell onboard a flight, the pilot of the aircraft is legally required to inform air traffic control. Arrangements will be made for medical assessments for the person on arrival. The exact arrangements will depend on the airport involved.

The local public health team would be alerted if there was a possibility that the individual was suffering from an infectious disease so appropriate public health action could be initiated.

Now a case of Ebola has been confirmed in the UK, will we see an outbreak similar to West Africa?

A case of imported Ebola is extremely unlikely to result in a large outbreak in the UK. England has a world-class healthcare system with robust infection control systems and processes, and disease control systems that have a proven record of dealing with imported infectious diseases. 

Is there a risk of Ebola transmission from illegal bushmeat?

The risk to the UK population of acquiring Ebola virus from bushmeat is very low.

It is illegal to import bushmeat into the UK. Cooking will kill the virus, but there is some risk in handling raw bushmeat. The official Food Standards Agency advice has always been that people should avoid illegal bushmeat, as you can never be certain of its safety. 

Is there a risk of catching Ebola virus from sweat left on gym equipment?

It’s unlikely a person who has symptoms of Ebola virus disease would be well enough to go to the gym – and, until they have symptoms, they are not infectious. The World Health Organization (WHO) says whole live virus has never been isolated from sweat.

What actions are being taken to halt the virus from coming to the UK?

In 2014, the UK introduced a screening procedure at key UK airports, starting at Heathrow. The aim was to ensure that as many people as possible arriving from infected countries knew the symptoms and how to get access to healthcare services as quickly as possible. 

The government is now adjusting its Ebola screening arrangements, as the likelihood of further Ebola cases being imported into the UK is now very low. Read more about how the UK government is responding to Ebola.