Ebola disease is a viral hemorrhagic fever and is caused by a group of viruses called orthoebolaviruses. Only four of the six identified species can infect humans (Zaire, Sudan, Taï Forest, and Bundibugyo). Reston and Bombali have not affected humans to date. The mortality rate of orthoebolaviruses ranges from 25-90%. Orthoebolaviruses are primarily found in sub-Saharan Africa. The likely reservoir is bats.

Symptoms may appear anywhere from 2 to 21 days (with an average of 8 to 10 days) after exposure.

Symptomatic disease can range from mild to severe. Ebola disease can begin as nonspecific symptoms known as “dry” symptoms that progress to “wet” symptoms after 4-5 days of illness.

“Dry” Symptoms: 

• Fever 
• Aches and pains in the muscles and joints 
• Headache
• Weakness and fatigue 
• Sore throat 
• Loss of appetite

“Wet” symptoms:

• Unexplained bleeding
• Gastrointestinal symptoms
  • Nausea
  • Vomiting 
  • Diarrhea 
  • Abdominal pain 

Other symptoms can include chest pain, shortness of breath, confusion, red eyes, skin rash, hiccups, and seizures.

No sign or symptom is pathognomonic for Ebola disease. Fever and unexplained bleeding/bruising are not universally present in a patient with Ebola disease.

If mortality occurs, it is typically 7-10 days after symptom onset.

Many more common illnesses can have these same symptoms, particularly during the “dry” phase, including malaria, influenza (flu), typhoid fever, meningococcal disease, and other bacterial infections. It is important to test and treat for alternate diagnoses when clinical presentation fits the disease.

People can become infected with Ebola disease if their nonintact skin or mucous membranes (eyes, nose or mouth) come in contact with: 

• Body fluids (including blood, urine, feces, saliva, sweat, vomit, breast milk, amniotic fluid, semen, or vaginal fluids) of a person who is infected with or has died of Ebola disease.
• Objects contaminated with body fluids from a person who is infected with or has died of Ebola disease (e.g., surfaces, bedding, needles, clothing, medical equipment). 
• Semen from a man who has recovered from Ebola disease.
• Contact with an infected animal, such as bats, non-human primates (e.g., chimpanzees, gorillas), forest antelope, or porcupines when hunting, handling or eating infected animals.

People can spread Ebola disease to others when they start having symptoms, but they cannot spread it before symptom onset. People with Ebola disease in the later stages of the illness are at highest risk of spreading it due to the higher viral load of the virus. They are often vomiting, experiencing diarrhea, and possibly bleeding, which can expose others to their body fluids. Ebola does NOT spread through respiratory routes like respiratory diseases, such as COVID-19 or influenza (flu), and you cannot get Ebola disease from being near someone infected.

Other Risk Factors

• Preparing a body for a funeral or burial without proper personal protective equipment, touching a body during funeral or burial practices, or other unprotected contact with the body of someone who has dies from the disease.
• Experiencing a breach in infection prevention and control precautions that results in possible contact with body fluids of a patient with suspected or confirmed Ebola disease.
• Working in a healthcare facility or laboratory that cared for suspected or confirmed cases of Ebola disease.
• Visiting a healthcare facility that cared for suspected or confirmed cases of Ebola disease or visiting a traditional healer.
• Working or spending time in a mine or cave in areas where the virus is endemic.

Clinicians should consider Ebola disease in a patient that has compatible signs and symptoms and has an epidemiological risk factor in the 21 days prior to onset of symptoms. If evaluation indicates possible Ebola disease, isolate the patient in a private room with its own bathroom and contact your local health department and infection prevention and control program. The local health department and DSHS will coordinate with your facility’s infection prevention and control program to ensure appropriate precautions are taken. If indicated based on both epidemiological and clinical factors, DSHS will coordinate with the CDC and your facility to arrange for testing.

Additional guidance and resources are available to help with evaluation of an ill person for Ebola disease.

• DSHS Identify, Isolate, Inform 
• Screening and Evaluating an Ill Person for Viral Hemorrhagic Fevers | Viral Hemorrhagic Fevers (VHFs) | CDC
• Clinical Features of Ebola Disease | Ebola | CDC
• Travel Health Notices | Travelers' Health | CDC
• Considerations for Discharging People under Evaluation for Selected VHFs | Viral Hemorrhagic Fevers (VHFs) | CDC

Patients with Ebola disease have a much higher chance of surviving if they receive early supportive care, including fluid and electrolyte repletion, hemodynamic support, blood products, and management of symptoms with oxygen supplementation, nutritional support, antiemetics, and analgesics. Antimalarial and antimicrobial medications may be required if there are suspected or confirmed coinfections.

• Clinical Guidance for Ebola Disease | Ebola | CDC
• Hemorrhagic Fevers Caused by Filoviruses: Ebola and Marburg | Red Book: 2024–2027 Report of the Committee on Infectious Diseases | Red Book Online | American Academy of Pediatrics
• Caring for Ebola Disease Survivors in the U.S. | Ebola | CDC

Healthcare settings present a higher risk of exposure to orthoebolaviruses. Infection prevention and control measures can effectively prevent the transmission of orthoebolaviruses in healthcare settings. Recommendations are available for infection prevention and control measures for patients in U.S. hospitals who are suspected or confirmed to have Ebola disease, as well as recommendations for personal protective equipment, disinfectants, and other measures.

• Infection Prevention and Control Recommendations for Patients in U.S. Hospitals who are Suspected or Confirmed to have Selected Viral Hemorrhagic Fevers (VHF) | Viral Hemorrhagic Fevers (VHFs) | CDC
• Guidance for Personal Protective Equipment (PPE) | Viral Hemorrhagic Fevers (VHFs) | CDC
  • PPE: Clinically Stable Patients Suspected to have VHF | Viral Hemorrhagic Fevers (VHFs) | CDC
  • PPE: Confirmed Patients and Clinically Unstable Patients Suspected to have VHF | Viral Hemorrhagic Fevers (VHFs) | CDC
  • PPE FAQs | Viral Hemorrhagic Fevers (VHFs) | CDC
• Interim Guidance for Environmental Infection Control in Hospitals | Viral Hemorrhagic Fevers (VHFs) | CDC
• EPA’s Registered Antimicrobial Products Effective Against Ebola Virus [List L] | US EPA
• Disinfectants for Emerging Viral Pathogens (EVPs): List Q | US EPA
• Handling VHF-Associated Waste | Viral Hemorrhagic Fevers (VHFs) | CDC
• Safe Handling of Human Remains of VHF Patients in U.S. Hospitals and Mortuaries | Viral Hemorrhagic Fevers (VHFs) | CDC

Testing for Ebola disease is available at select Texas laboratories within the Laboratory Response Network or CDC. Testing decisions will be made in consultation with the local health department and DSHS in coordination with CDC. 

• DSHS Approval and Testing Process for Ebola algorithm
• Laboratory Testing for Patients with a Suspected VHF or High-Consequence Disease | Viral Hemorrhagic Fevers (VHFs) | CDC

Other testing may need to be performed while patients are under evaluation or patients may present with coinfections. Healthcare providers and laboratory professionals can safely and effectively perform other diagnostic testing on clinical specimens from these patients by following Standard Precautions for All Patient Care and the Bloodborne Pathogen Standard (29 CFR 1910.1030). Additional guidance is available on performing routine diagnostic testing for patients with suspected Ebola disease.

• Guidance on Performing Routine Diagnostic Testing for Patients with Suspected VHFs or Other High-Consequence Disease | Viral Hemorrhagic Fevers (VHFs) | CDC

All specimens collected from patients with suspected Ebola disease must be shipped Category A as a non-select agent following the Department of Transportation’s Hazardous Materials Regulations (HMR) Title 49 Code of Federal Regulations (CFR) 173.196.

There currently are no FDA-approved vaccines for Ebola disease caused by Bundibugyo virus (species Orthoebolavirus bundibugyoense).

One vaccine is approved by the U.S. Food and Drug Administration (FDA) to prevent Ebola virus disease caused by Ebola virus (species Orthoebolavirus zairense): ERVEBO^®.

ERVEBO is a replication-competent, live, attenuated recombinant vesicular stomatitis virus (VSV) vaccine. ERVEBO is not currently commercially marketed in the United States, but it is in the U.S. Strategic National Stockpile and is made available through CDC. ERVEBO is approved for prevention of infection in individuals 12 months of age and older and can be given as a pre-exposure vaccination for adults ≥18 years old who fall into specific occupational categories.

ERVEBO does not protect against the other 3 orthoebolaviruses that cause human disease (Orthoebolavirus sudanense, Orthoebolavirus taiense, and Orthoebolavirus bundibugyoense) or orthomarburgviruses.

• Ebola Vaccine Product Information | Ebola | CDC
• Ebola Vaccine Administration | Ebola | CDC

For the current outbreak of Ebola disease beginning in spring 2026 in the Democratic Republic of the Congo (DRC) and Uganda caused by Bundibugyo virus, several candidate vaccines are in development including a single-dose rVSV Bundibugyo vaccine, ChAdOx1 Bundibugyo vaccine, and an mRNA Bundibugyo virus vaccine.

• CEPI fast-tracks three Bundibugyo ebolavirus vaccine candidates

There are no FDA-licensed vaccines for the other 2 orthoebolaviruses that cause human disease (Orthoebolavirus sudanense and Orthoebolavirus taiense).

There currently are no FDA-approved treatments for Ebola disease caused by Bundibugyo virus (species Orthoebolavirus bundibugyoense).

Two treatments are approved by the U.S. Food and Drug Administration (FDA) to treat Ebola virus disease caused by Ebola virus (species Orthoebolavirus zairense): Inmazeb^® and Ebanga^®.

Inmazeb^® is a combination of 3 monoclonal antibodies, and Ebanga^® is a single monoclonal antibody.

There are no FDA-licensed or authorized therapeutics for the other 2 orthoebolaviruses that cause human disease (Orthoebolavirus sudanense and Orthoebolavirus taiense).

• Clinical Guidance for Ebola Disease | Ebola | CDC

For the current outbreak of Ebola disease beginning in spring 2026 in the Democratic Republic of the Congo (DRC) and Uganda caused by Bundibugyo virus, several treatments have been recommended for evaluation in research (i.e. clinical trials) including MBP134 and remdesivir.

• Interim Guidance for Emergency Services | Viral Hemorrhagic Fevers (VHFs) | CDC

Immediately report suspected cases of Ebola disease or any other viral hemorrhagic fever (VHF) to the local health department or public health region by using the contact information provided at the link or by calling 800-705-8868.

Several Texas laws (Tex. Health & Safety Code, Chapters 81, 84, and 87) require specific information regarding notifiable conditions to be provided to DSHS. Health care providers, hospitals, laboratories, schools, and others are required to report patients who are suspected or confirmed of having a notifiable condition (25 Tex. Admin. Code §97.2).

• Notifiable Conditions | Texas DSHS