Viral Rash: Types, Symptoms, and Treatment in Adults and Babies

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Ebola Outbreak In Five Graphics

More than 1,800 people have died and more than 2,700 have been infected in the latest outbreak of Ebola in central Africa.

The World Health Organization (WHO) has declared the crisis a public health emergency of international concern.

The outbreak is the second-largest in the history of the virus. It follows the 2013-16 epidemic in West Africa that killed more than 11,300 people.

1. Ebola cases are on the rise

So far, more than 1,800 people have died in the Democratic Republic of Congo in the latest outbreak, which began in August last year.

The death of a priest from the disease in the eastern city of Goma, a major transport hub on the DR Congo-Rwanda border, could be a "game-changer" given the city has a large population, the WHO said.

He had travelled 200km (125 miles) by bus from Butembo - one of the towns hardest hit by Ebola - where he had mixed with worshippers sick with the disease.

The DR Congo health ministry said the driver of the bus he was travelling on and the other 18 passengers were being vaccinated.

However, the case has heightened concerns the outbreak could spread to Rwanda.

The country's authorities have ruled out closing the border saying the priest's death was not sufficient reason to shut the frontier.

2. North Kivu and Ituri provinces are affected

The current 12-month epidemic began in the eastern region of Kivu in the DR Congo and cases have since been reported in neighbouring Ituri.

The latest case in the border transport hub of Goma is of particular concern to health authorities, as it is far harder to isolate patients and trace contacts in major cities, where highly-mobile, large populations are living in close proximity.

Goma adjoins the city of Gisenyi on the Rwandan side, and people travel between the two places every day.

Rwanda has stepped up border monitoring and has urged its citizens to avoid "unnecessary" travel to DR Congo. Some 2,600 health workers had also been vaccinated.

Ugandan health officials are also screening travellers at the border to check their temperature and disinfect their hands.

Three Ebola cases that originated in DR Congo were confirmed in the country last month, but no new cases have been registered there.

The country's health minister, Jane Ruth Aceng, said the challenge was to stop people crossing at "unofficial entry points" between the two countries.

3. The virus can spread quickly

Ebola infects humans through close contact with infected animals, including chimpanzees, fruit bats and forest antelope.

It can then spread rapidly, through contact with even small amounts of bodily fluid of those infected - or indirectly through contact with contaminated environments.

Even funerals of Ebola victims can be a risk, if mourners have direct contact with the body of the deceased.

Subsequent stages can bring vomiting, diarrhoea and - in some cases - both internal and external bleeding.

Patients tend to die from dehydration and multiple organ failure.

There are normally fewer than 500 cases reported each year, and no cases were reported at all between 1979 and 1994.

The current outbreak is the worst on record after an epidemic that struck Liberia, Guinea and Sierra Leone between 2013-16, leaving more than 11,300 people dead.

It killed five times more than all other known Ebola outbreaks combined.

4. The virus can be fatal, but there are treatments

The fatality rate from Ebola is high - up to 90%, according to the WHO, and there is no proven cure as yet.

However, rehydration with oral or intravenous fluids and the treatment of specific symptoms can improve survival - especially if the virus is caught early.

Ebola patients are channelled into specialist treatment centres, where those of high-risk are separated from those of low-risk.

Entry point: Those displaying symptoms of Ebola are examined by staff in protective gear. Patients are then divided into two groups: those likely and those unlikely to have the virus. Samples are sent off to the laboratory for analysis.

Low probability ward: Patients who may not have the deadly virus are isolated from those suffering from Ebola, reducing their exposure to the infection.

High probability ward: Patients suspected of having Ebola based on initial medical examinations remain here until official confirmation.

Ebola ward: Once patients are diagnosed, medical workers provide supportive care and treatment for symptoms, such as dehydration.

Decontamination: When leaving the high-risk area, referred to as the red zone, medical workers decontaminate their clothing and equipment with a chlorine solution.

Dressing rooms: Medical workers work in pairs to put on and take off protective clothing, with the process taking around 15 minutes.

Entrance for sick patients: Patients known to have Ebola go directly to the Ebola ward without being subject to medical tests.

Visitors: Patients strong enough to walk can talk to relatives and friends across two fences. The double barrier makes touching impossible and eliminates the risk of infection.

Although medics currently treat Ebola's symptoms rather than offer a cure, a range of new drugs, blood products and immune therapies are currently being tested.

A multiple drug trial is currently under way in DR Congo to fully evaluate effectiveness, according to the WHO.

An experimental vaccine, which proved highly protective in a major trial in Guinea in 2015, has now been given to more than 130,000 people in DR Congo.

Thousands of health workers across the region have also been vaccinated.

5. With the right action, the spread can be stopped

The key to containing and controlling an outbreak is good communication with affected communities, the WHO says.

It is crucial to trace those who may have been in contact with infected people, ensuring they get tested and receive treatment, but people also need to know how to reduce the risk of passing on the virus.

The WHO and its partners are communicating advice to affected communities. Recommendations include:

Seeking medical help immediately if you think you or someone you know may have Ebola

Washing your hands with soap and water regularly, especially if you have been in contact with a sick person

Handling animals and animal products with gloves

Wearing protective clothing, especially gloves, when treating patients

Ensuring the safe burial of the dead, with bodies only handled by people wearing protective clothing

In Uganda, mass gatherings including market days and prayers have been cancelled.

By Dominic Bailey, Lucy Rodgers and Wesley Stephenson

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Editor's note: The views expressed in this commentary are solely those of the writer. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation.

The Conversation —

The Ebola virus devastated west Africa in 2014, claiming over 11,000 lives in Sierra Leone, Liberia and Guinea.

It was the largest Ebola outbreak since the virus had first been discovered in the Democratic Republic of Congo in 1976.

Ebola is a terrifying virus which, if left untreated, causes bleeding inside the body and through the eyes, nose, mouth and rectum.

Case fatality rates have varied from 25% to 90% in past outbreaks, depending on circumstances and the response.

The 2014 outbreak in west Africa exposed a critical gap in global preparedness for infectious diseases: the absence of effective vaccines.

There were no drugs or vaccines approved to treat or prevent Ebola or ready to enter into clinical trials at the outset of the epidemic. Therefore, many felt it was ethically necessary to conduct such research as quickly and safely as possible.

As a biologist and epidemiologist, I travelled to Guinea amid the chaos to coordinate the laboratory activities of the rVSV-ZEBOV Ebola vaccine trials.

Almost 10,000 participants were enrolled in trials to make sure the drug was safe and effective to use. The trials would last two years and involved more than 500 scientists and healthcare workers.

My five-year-old daughter, Ashanti, spoke words that strengthened my resolve: "People need you to support them. If you don't go, who will?"

READ MORE: Mpox vaccines: where they come from and what stands in the way of distributing them in Africa

Her encouragement fuelled me as I led the trial's laboratory operations, navigating immense logistical and emotional challenges.

We had to set up a full laboratory in a week, to process thousands of samples. Delivering the vaccine required ultra cold freezers (minus 80°C); none were available in the country.

We had to address vaccine hesitancy among the population of Guinea, including the medical and academic community.

Of course there was also fear of getting infected by a disease that was a virtual death sentence.

First line workers and individuals in close contact with confirmed Ebola cases were vaccinated with rVSV-ZEBOV. This created a protective "ring" around the infected.

As a field coordinator, I witnessed firsthand the challenges of conducting research into the safety of the vaccine in the middle of an outbreak.

Collaboration between the World Health Organization, Médecins Sans Frontières, the medical research centre Epicentre and local health authorities proved pivotal.

These efforts also underscored the importance of adaptable, rapid-response research during health crises.

READ MORE: 154 million lives saved in 50 years: 5 charts on the global success of vaccines

On 18 August 2015 the preliminary results of the trial were announced. They marked a turning point in the fight against Ebola. The vaccine's near-perfect efficacy offered a rare moment of hope.

Today Sierra Leone is embarking on a nationwide campaign with the rVSV-ZEBOV vaccine, trademarked as Ervebo.

The campaign will target 20,000 frontline workers in 16 districts. These include healthcare workers, traditional healers, community health and social workers, laboratory personnel, motorcycle taxi drivers and security forces. Anybody who will be involved in any response to future outbreaks.

The Ervebo vaccine, developed by Merck, is a single-dose vaccine. It works by using a modified virus to produce antibodies against Ebola, equipping the immune system to recognise and neutralise the virus upon exposure.

Clinical trials have shown its efficacy exceeds 95% in preventing infection from the Zaire Ebola virus strain, the deadliest variant.

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The vaccine was deployed during the 2018-2020 Ebola epidemic in the Democratic Republic of Congo under emergency use authorisation.

This allows a medical product to be used without being authorised by the relevant drug agencies, such the Food and Drug Administration in the United States, the European Medicines Agency and the African Medicines Agency.

It was also used in Burundi, Uganda, South Sudan and Rwanda in preventive vaccination campaigns to protect healthcare and frontline workers.

Ervebo is now a cornerstone in the fight against Ebola, particularly in controlling outbreaks caused by the Zaire strain.

However, its success depends on ensuring equitable access and strengthening healthcare systems.

Challenges do persist, including limited vaccine supply, logistical hurdles in remote regions, and vaccine hesitancy fuelled by misinformation.

READ MORE: Vaccine misinformation distorts science – a biochemist explains how RFK Jr. And his lawyer's claims threaten public health

Addressing these obstacles requires coordinated efforts between governments, health organisations and communities.

Additionally, establishing local vaccine manufacturing in Africa should be a long-term goal, giving affected countries greater control over supply and distribution.

While Ervebo is a monumental achievement, it cannot end Ebola on its own.

The virus's ability to persist in animal reservoirs such as bats and to then be transmitted to humans means that vaccination must be part of a broader strategy.

Integrating vaccination, surveillance, outbreak response and community engagement is essential for achieving long-term control.

Ervebo's success provides a model for addressing other infectious disease outbreaks, like mpox. Clinical trials during the mpox outbreak could potentially lead to new and effective vaccines.

Ebola Virus: Number Of New Cases On The Decline In Africa

New cases of the Ebola virus have fallen to their lowest levels in months in Liberia, Sierra Leone and Guinea, the three worst affected countries in West Africa, according to the World Health Organization's (WHO) latest situation report.

A total of 21,296 people have been infected with Ebola since the deadly outbreak began in February last year and 8,429 are known to have died from the disease, although the real figure is likely to be much higher.

UN Secretary General Ban Ki-Moon last year predicted the epidemic could be over by as early as mid-2015, but the WHO is unwilling to set a target having already been proven wrong several times, Al Jazeera reports. A country will not be declared Ebola-free until it reports no new cases of the virus for 42 consecutive days, according to WHO standards.

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The decrease in the number of cases has been attributed to an increase in international support, including more beds and treatment centres and health care workers as well an improvement in burial practices.

The current situation in:

The UK

Cases: 1

Deaths: 0

British nurse Pauline Cafferkey was diagnosed with the disease upon returning to Glasgow last month from working at a treatment centre in Sierra Leone. She is no longer in a critical condition and is showing signs of improvement, but continues to undergo treatment at a specialist London hospital.

A second British national, William Pooley, was officially diagnosed in Sierra Leone and later brought back to the UK for treatment. He made a full recovery after receiving the experimental drug zMapp. A woman admitted to hospital in Northamptonshire yesterday is "unlikely" to have the disease, say doctors.

Sierra Leone

Cases: 10,124

Deaths: 3,062

Sierra Leone remains the country worst affected by the disease, with transmission in the west of the country most intense. Although the number of new cases is declining, and is at its lowest since August, the country's health services still reported 184 new cases of the disease since last week.

Liberia

Cases: 8,331

Deaths: 3,538

Liberia is faring the best out of the three worst affected countries. At the outbreak's peak last year, Liberia reported 300 new cases of the virus a week, but in the last week only eight new cases were confirmed, the lowest number since June. Some parts of the country, including the Lofa region in the north, have been declared Ebola-free. Researchers in the US are predicting that the Ebola epidemic could be contained in Liberia by June if current hospitalisation trends continue Time reports. "Continuing on the path to elimination will require sustained watchfulness and individual willingness to be treated," researchers said.

Guinea

Cases: 2,806

Deaths: 1,814

Cases on Ebola continue to decline steadily in Guinea, and have now fallen to their lowest level since August last year. However fear surrounding the disease remains high and violent mob reactions to Ebola are frequent in the country, according to AFP. This week, two policemen were killed and their bodies set alight by an angry mob, when locals accused them of spreading the disease.

Ebola Virus Disease