Question 1

What is Ebola?

Accepted Answer

Ebola virus disease (EVD) is a severe, often fatal illness caused by Ebola virus — a filovirus transmitted through direct contact with blood, secretions, organs or other body fluids of infected people or animals. It causes fever, weakness, muscle pain, headache and sore throat, followed by vomiting, diarrhoea, rash, haemorrhage and impaired organ function. Case fatality rates range from 25-90% depending on the virus species and healthcare quality.

Question 2

How does Ebola spread?

Accepted Answer

Ebola spreads through direct contact with the blood or body fluids of infected people — including secretions, urine, vomit, semen and breast milk. It can also spread from dead bodies (which remain infectious for days to weeks). Healthcare workers who don't use full PPE are at high risk. The virus does not spread through the air (aerosol route). Traditional burial practices involving touching the body are a major transmission route in West African communities.

Question 3

What was the 2014-2016 West Africa Ebola epidemic?

Accepted Answer

The West Africa epidemic — primarily in Guinea, Liberia and Sierra Leone — was the largest and most complex Ebola outbreak in history: 28,616 cases and 11,310 deaths over 2 years. It overwhelmed health systems, caused economic collapse and displaced large populations. WHO's initial response was widely criticised as inadequate. The outbreak catalysed major investments in Ebola vaccine development (culminating in rVSV-ZEBOV approval), WHO's Health Emergencies Programme reform, and global health security architecture.

Question 4

What is rVSV-ZEBOV (Ervebo)?

Accepted Answer

rVSV-ZEBOV (brand name Ervebo) is the first licensed Ebola vaccine — developed by Merck. It uses a recombinant vesicular stomatitis virus (a mild livestock virus) as a vector expressing the Ebola Zaire glycoprotein. WHO prequalified it in 2019; it received FDA approval in 2019. A single dose provides protection within 10 days and appears to be highly effective in ring vaccination. It also provides passive protection for healthcare workers and clinical trial volunteers during outbreaks.

Question 5

What is ring vaccination?

Accepted Answer

Ring vaccination for Ebola immunises all identified contacts and contacts-of-contacts of a confirmed case within the protective "ring" — stopping the chain of transmission. It was used with remarkable effectiveness in the 2018-2020 DRC outbreak, vaccinating over 300,000 people. It differs from mass vaccination in that it only targets at-risk individuals, requiring high-quality contact tracing. Ring vaccination with rVSV-ZEBOV was evaluated in the Guinea STRIVE trial.

Question 6

What is Marburg virus?

Accepted Answer

Marburg virus — in the same family (Filoviridae) as Ebola — causes severe haemorrhagic fever with a case fatality rate of 24-88%. Its natural reservoir is the Egyptian fruit bat (Rousettus aegyptiacus). Outbreaks have occurred in Uganda, Kenya, Angola, South Africa and, in 2023, Equatorial Guinea and Tanzania. Investigational vaccines — including a recombinant vesicular stomatitis virus vaccine (rVSV-MARV) and mRNA vaccines — are in Phase 1-2 trials. WHO nearly declared a PHEIC for Marburg in 2023.

Question 7

Why do Ebola outbreaks keep occurring in DRC?

Accepted Answer

The DRC has experienced the most Ebola outbreaks of any country — including the two largest (2018-2020 in North Kivu/Ituri). Factors include: active Ebola virus reservoir in DRC's fruit bat populations; dense equatorial forest where bat-to-human spillover occurs; deep distrust of health authorities from decades of conflict; armed groups disrupting outbreak response; and chronic underfunding of health infrastructure. The conflict zone context of the 2018-2020 outbreak added extraordinary complexity to response.

Question 8

What is the role of safe and dignified burial?

Accepted Answer

The bodies of Ebola patients remain highly infectious — blood and secretions contain high viral loads. Traditional burial practices in West African and Central African communities often involve touching, washing and sometimes kissing the body — contributing significantly to outbreak amplification. Safe and Dignified Burial (SDB) teams, trained in protective burial while respecting cultural practices, were a critical intervention in the 2014-2016 outbreak, preventing transmission while maintaining community trust.

Question 9

How does Ebola affect healthcare workers?

Accepted Answer

Healthcare workers face a dramatically elevated risk of Ebola infection — they account for approximately 5% of cases in most outbreaks. In the 2014-2016 outbreak, over 500 healthcare workers died. Inadequate PPE, insufficient training, and PPE shortage were major factors. WHO guidelines now specify full body coverage with no skin exposed. Vaccine access for healthcare workers is prioritised in ring vaccination strategies.

Question 10

What monitoring exists for Ebola between outbreaks?

Accepted Answer

WHO coordinates Ebola zoonotic surveillance through: Event Management System alerts; human case detection and investigation networks; animal surveillance monitoring bat and wildlife reservoir populations; cross-border alert systems; and laboratory diagnostic capacity in endemic regions. GOARN (Global Outbreak Alert and Response Network) pre-positions response capacity for rapid deployment when outbreaks are detected.

Question 11

How does GMJ News cover Ebola and Marburg?

Accepted Answer

GMJ News tracks WHO outbreak situation reports, PHEIC declarations, vaccine development milestones and international response. Ebola and Marburg are critical global health security concerns — the principles of outbreak detection, containment and community engagement are directly relevant to PHIG's public health preparedness work and the Georgian Medical Journal's global health coverage.

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