Introduction
The Ebola virus has existed for centuries. Like all life forms and viruses, it has been changing and adapting since the beginning of time to survive. Despite this the disease did not make itself known until the twentieth century. However, once the virus revealed itself only three major outbreaks have occurred. There were two in 1976 and one which took started in 2014 (CDC, 2015). The latest outbreak has been the longest and worst, effecting numerous countries such as, Mali, Nigeria, Liberia and Senegal in West Africa (CDC, 2015). This paper will look at the scientific aspects of the Ebola Virus from its description to treatments.
Description of the Ebola Virus
The Ebola virus originally occurred along the Ebola River in 1976 in the area currently recognized as the Democratic Republic of the Congo. This region is where most of the outbreaks happen, with seven occurring since 1976. There have only been two outbreaks besides the original. These outbreaks happened in 1976 and 2014. The outbreak in 2014 is the largest to date and has been ongoing. Science still have no concrete idea of where the virus came from, but evidence has led many to believe that the most likely source are bats. Bats in the area of the Ebola River reservoir were found to have symptomless infections. Therefore, the bats showed through testing that they had either an immune response to the disease or their DNA sequencing showed evidence of the disease, even though they did not manifest any symptoms or signs of illness. It is believed that the virus was passed to humans when people ate non-human primates that had been bitten by an infected bat. (ASM, 2015)
Ebola is a rare and, deadly disease that is caused by a virus in the family Filoviridae a thread virus, genus Ebolavirus. It is made up of an enveloped, unsegmented, single strand, negative RNA virus. The virus is 80 nm in diameter and the length, which can vary is as long as 14,000 nm. (Harper, 2005). Most viruses are only 920 nm and it has been found that viruses that are longer than 970 are more infectious. (Harper, 2005). The virus is undistinguishable from the Marburg virus in terms of structure and form, but it is genetically different from Marburg (Harper, 2005). The Ebola virus is often shaped like a 6 or a U, sometimes it is branched or coiled up like a snake. It often has extended regions at both ends that are noncoded. (Harper, 2005). The non-coded areas indicate the possibility that the virus has been evolving in response to several areas in the wild. This is further confirmed by the small changes that have occurred in the glycoproteins because of a relative lack of genetic drift, which has caused the viral messaging to be relatively stable (Harper, 2005). The virus is also made up of seven structural proteins, one of which is made of two forms.
Currently there are only five Ebola virus species, which have been identified. Four of these virus species can cause illness in humans. Each species is named for the region in which it was discovered. The genus is called Ebola because the first case was found along the Ebola River in the Sudan and other cases were also found to be connected to the river. These are Ebola virus (Zaire ebolavirus); Sudan virus (Sudan ebolavirus); Taï Forest virus (Taï Forest ebolavirus, which was formerly the Côte d’Ivoire ebolavirus); and Bundibugyo virus (Bundibugyo ebolavirus). The fifth, Reston virus (Reston ebolavirus), causes disease only in nonhuman primates. (CDC, 2015). In fact, there has been testing done on pigs to determine if the virus can be spread to them. This testing has found that the pigs in study 1, which had the pigs anesthetized every other day after being exposed to the virus suffer from no signs of the disease and the Ebola genome or virus was not found when the pig was euthanized at day 28 of the experiment. On the other hand, study 2 used the timelines that were determined by the results of study 1. The pigs were injected with the virus and two pigs from each group were killed on days 6 and 8 after a subcutaneous or orinasal challenge. Testing found that the pigs in study 2 were infected with the virus (Marsh et al., 2011). This means that it is possible for domestic animals to become infected from eating tainted meat. These animals may not display symptoms, but they are still able to infect humans.
Virulence Factors of the Ebola Virus
The virus has three important proteins that determine virulence, the most important which is Virion Structural Protein 40. VSP 40 is part of the third gene of a person’s genome (Minnaert, 2004). This protein acts as a matrix protein. Another important protein in VSP 24 which is felt to interact between VSP 40 and the RNP complex, linking the two together (Minnaert, 2004).
The virulence factor for the Zaire ebolavirus occurs when VP35 attaches to the double strand RNA (dsRNA). The VP35 protein has an end-cap, which are hydrophobic molecules that are connected to the end of the tail. The end-cap aids the VP35 protein in connecting to the dsRNA (Leung, Prins, Basler, & Amarasinghe, 2010). The end-cap is also able to impersonate the expression of RlG-l- receptors (RLR). This ability to impersonate is why the virus is able to destroy the immune system of the host (cite). The VP35 protein is usually the target when the disease is being treated (Leung, Prins, Basler, & Amarasinghe, 2010). Currently, there have been two different methods tested to combat the virulence factor. These are using siRNA molecules and nucleic acids. The reason that the Zaire ebolavirus is so important is that when the host is first exposed to the virus, their body creates a large amount of, cytokines, growth factors and chemokines (Leung, Prins, Basler, & Amarasinghe, 2010). The loss of CD4 and CD8 causes lymphocyte apoptosis (Leung, Prins, Basler, & Amarasinghe, 2010). The resulting low production of lymphocytes enables the virus to overcome the cells (Leung, Prins, Basler, & Amarasinghe, 2010).
Finally, the fifth gene found on the genome of the Ebola virus creates the Glycoprotein (Minnaert, 2004). This is done by the protein being edited by the viral polymerase. Then once the mature protein is created, it will integrate itself into the membrane of the host where it will bud. Once the protein has budded, it becomes the only antigen in the membrane. The host cell will continue to secrete viral transcripts which will secrete the glycoprotein to other membranes and cell (Minnaert, 2004).
It has been found that in the areas of regions with high numbers of Ebola infections that VSP 35 contributed to virulence by “viral RNA synthesis” and “host immune invasion” (Leung, Prins, Basler, & Amarasinghe, 2010). The virus encodes factors that work to target the type I IFN system. The virus’s ability to destabilize both adaptive trigger and innate responses makes the Ebola virus a pathogen that is highly virulent. This virulence is deadly because the body becomes overwhelmed with the inflammatory responses that occur as the virus imposes tissue damage on the body. This damage is often the result of hemorrhagic fever syndrome (Zampieri, Sullivan, & Nabel, 2007). The result is often vascular and liver damage from the hosts immune system being overcome by the cell damage and the inflammatory factors. This results in many people dying because of septic shock (Zampieri, Sullivan, & Nabel, 2007).
Immunity to the Ebola Virus
There are many people living in West Africa who are immune to the Ebola virus according to virologists. If this is the case scientists would be able to harvest the antibodies that are needed from their blood to treat the disease. People who are immune could also handle the dead, which would cut down on new infections. Nonetheless, it is currently unclear as to who has the immunity and how strong the immunity is. According to Robert F. Garry Jr, an expert in hemorrhagic fevers from Tulane University who is working in Sierra Leone, “It’s fair to say that some people are immune, but we don’t know if it’s 1 percent or 2 percent or 20 percent.” (McNeil, 2015).
However, there are currently about 1800 people who have gained immunity to the virus because they survived the disease. Scientist believe that this immunity is possible if a person was in contact with a small amount of the virus and the immune system is able to fight it off. Some believe that this contact has happened because of people eating fruit that bats have gnawed on. To determine the number of people who are immune would take thousands of blood tests, which the recent epidemic has made impossible, since doing so puts the lives of the health workers in the region at greater risk. However, in 2010 Dr. Leroy did such as study in Gabon. He and his team to samples from over 4, 000 people in 220 random villages. In their analysis, they discovered that a median 15 percent of those tested had antibodies, with 34 percent occurring near the jungles of Congo’s borders and only 3 percent living near the coast having the resistance (McNeil, 2015). Randal Schoepp, who is the head of diagnostics at the United States Army Medical Research Institute of Infectious Diseases located in Fort Detrick, Md., conducted a study of patients at the Sierra Leone Hospital who were thought to have Lassa fever, but did not. Nine percent of those tested had Ebola antibodies in samples that dated back to 2006, eight years before the current outbreak (McNeil, 2015). Many people suffer from silent infections, which is where the person is able to fight off the infection before symptoms even occur (McNeil, 2015).
The biggest problem with immunity is that there is no guaranteed way to know whether or not a person is immune to the disease. A person could be a carrier and asymptomatic themselves. A person who has beat the virus could have a weaker immunity then they thought, leaving them susceptible earlier then they planned. So far it has been determined that individuals that development an immunity to the Ebola virus after being exposed to the disease were only able to maintain their immunity for about ten years. There have been no studies on the effects of a person being effected after losing their immunity.
Infectious Disease Information Ebola
The Ebola Virus is transferred by skin to skin contact and bodily fluids. While the disease is not deadly itself, the bodies attempts to combat the virus are. As the body tries to fight back against the disease the blood vessels weaken resulting in system failure (Brodwin. 2014). Many people who are infected display indicators within 21 days of being in contact with an effected person. Signs include, abdominal pain, cramping, diarrhea, fever, nausea, vomiting and weakness that begins a few days to a week after exposure. A person whose symptoms are caught early enough have a better chance for survival, but if they develop hemorrhagic fever, their odds for survival lessen exponentially. (Moghadam, et.al, 2015).
Health care workers have a high probability of becoming infected unless they take several precautions. Since the recent outbreak started in 2014, 876 healthcare workers have become infected with the virus. Five hundred and nine of them have died, since July 2015. There have been several healthcare workers from the United States that were infected while employed as nurses in West Africa. They have returned to the US for treatment (CDC, 2015). Recently the United States, has had only been two cases brought in from people who had travelled to Africa and two domestic cases, which were the nurses that worked on the aforementioned patients. These four cases have only resulted in one death. (CDC, 2015)
The CDC website states that scientist cannot find a definitive source of the virus and how it came to infect humans. Their strongest theory is that humans became infected by ingesting something that was contaminated by an infected animal by eating it. After the first person is infected the disease is spread is rapidly with several people being infected by the time the first begins to show symptoms (CDC, 2015).
It is important for people in areas were Ebola is prevalent to be very cautious as the Ebola virus can be spread through several means, such as:
The body fluids or blood of a person who is infected with or that has died from the virus. The bodily fluids to be avoided are breast milk, feces, saliva, semen, sweat, urine, vomit. This is because the virus pass into the body through broken mucous membranes and/or skin.
Items that have been handled by or near a person who has the virus or has died of the infection. These include, clothing, needles and syringes
Having sexual intercourse or contact with men who have recovered from the Ebola virus, This, is because their sperm may still contain the virus.
Avoid insects and non-human primates that have the virus
Remember that the loved ones of a person who is infected are more likely to become infected as they are most likely to encounter the person’s bodily fluids. (CDC, 2015).
The indicators of Ebola, which manifest between 2-21 days after coming into contact with the virus are:
Abdominal pain
Diarrhea
Exhaustion
Fever
Hemorrhaging either causing severe bruising or bleeding from the orifices
Migraines
Nausea and vomiting
Muscle Ache
Weakness
A person’s likelihood of recovery is dependent on their immune system and how quickly they get treatment. Once a patient is cured they will be immune from the virus for about ten years because it has allowed antibodies to build up in the blood. (CDC, 2015)
The disease attacks the cells involved with lymphatic function and the fibroblastic reticular cells (FRC) that are part of the connective tissue located under the skin and in the FRC conduit (FRCC), which is in the lymph nodes. Access to the lymph nodes enables the virus to quickly enter the bloodstream, which causes the lymphocyte homing at high endothelial venules (HEV) to become disrupted. The virus will proceed to attack every tissue and organ in the body until only the skeleton remains (Ross, 2014). It accomplishes this task by turning the collagen within the tissues of the organs into liquid and liquefying the layers under a person’s skin. The “upper layer of skin ends up floating on a layer of liquefied tissue, resulting in tiny white blisters and red spots on the surface that can tear off with just a small amount of pressure” (Ross, 2014). Blood clots called macrophages trigger coagulation cause the person’s bloodstream to thicken and blood vessels begin to leak causing hemorrhaging from various orifices. This reduces oxygen to the person’s body and the organs are deprived of oxygen. This results in the organs shutting down. However, there are some people who die of blood loss (Ross, 2014).
This is not a quick process, as it first weakens the person’s immune system eradicating the body’s T-lymphocyte cells. These are the same cells that are effected by the AIDS virus. The Ebola virus continues to destroy the body’s immune system, while also creating several proteins that work to block the white blood cells from telling the antibodies to attack the virus. After the virus has control of the immune system the virus will begin replicating (Ross, 2014).
Epidemiology of the Ebola Virus
The first documented Ebola outbreak took pace in 1976 in South Sudan. The virus was then identified as the Sudan virus. The outbreak killed 151 people and infected 284 more. The initial case that was identified was that of a shopkeeper who was hospitalized on the 30th of June and died on the 6th of July. The identification and naming of the virus did not happen until months later (Ebola Virus Net, 2017) . The second outbreak started in August of 1976 in Zaire in what is now known as the Democratic Republic of Congo. This version of the virus was a different genus than the one that was responsible for the outbreak in Sudan. The first person to be infected in Zaire was Mabalo Lokelo a headmaster of a school. He started to show symptoms on August 25 after returning from a trip to the northern border of Zaire. close to the Central African Republic and visiting the Ebola River a few days beforehand. At first, he was giving quinine as he was thought to have malaria, but his condition quickly became worse. He died on September 9th two weeks after he started showing signs of being sick (Ebola Virus Net, 2017)
After Lokelo’s death there was a high number of people in the village who also died because they came in contact with him, while he was ill. This caused panic in the village and the President of Zaire Mobutu Sese Seko along with the Minister of Health declared the region to be under quarantine (Ebola Virus Net, 2017) . People were prevented from coining or going from the country and the exists in and out of the region were closed under martial law. Businesses, schools and organizations were also closed. The outbreak lasted only 26 days(Ebola Virus Net, 2017). Even though the CDC researchers that arrived during this time did not know what caused the disease to eradicate so quickly, it was believed that the quarantine and precautions of the people living within the region was greatly responsible. Most importantly nurses stopped reusing dirty needles and began sterilizing equipment, wearing protective gear. (Ebola Virus Net, 2017)
After subsequent testing on the virus that affected Sudan it was discovered that the virus was related to the Marburg virus and both strands were given the name of Ebola virus. There were 318 cases reported during this time. Most of the victims in the Sudan were involved Yambuku Mission Hospital or a person who had contact with someone suffering from the disease. Out of the 318 cases, 280 people died, and through analysis of both viruses Scientists discovered that both areas have been effected by different strains (Ebola Virus Net, 2017).
The second outbreak happened in the Democratic Republic of Congo in 1995. This outbreak resulted in 254 deaths and 315 people being infected. The third took place in Uganda in 2000. This outbreak had 224 die and 425 infected. Then in 2003 there was another outbreak on the Republic of Congo that killed 128 of the 143-people infected. There was another outbreak in the Congo in 2007 resulting in 187 out of 264 people being killed after the people of four villages became ill, possible due to attending the funerals of two Chiefs. Uganda also had another outbreak in 2007, which was found to be a new strain of the virus, there were 149 people infected by this strain of which 37 died. There was another two outbreak in Uganda in 2012. Both resulting in a total of 31 people being effected with 21 dying. The Sudanvirus strain was responsible for both the outbreaks in Uganda. Then in August of 2012 another outbreak caused by the newest Ebola-Bundibugyo strain occurred in Congo. The virus effected 57 people and caused 29 deaths. This was the last time that this strain was identified as the cause of an outbreak (Ebola Virus Net, 2017)
The most recent and current outbreak started in the Congo in 2014. There was also another outbreak in West Africa between 2014-15, which was found not to be related to the one in Congo. However, they were both of the Zaire species. The West Africa outbreak had a total of 66 people infected, 49 of whom died. Also in 2014 there was an outbreak in Guinea. This was found to have been caused by an infant who had died in December 2013. The disease spread to Sierra Leone and Liberia, becoming the largest outbreak ever documented as well as the first outbreak in the region. The magnitude of the outbreak caused the WHO to declare a global health emergency to get support for the countries effected. Isolation and tracing the people that the infected were in contact with helped to stop the virus from spreading further, and by December 2015 there had been 28, 638 cases with 11, 315 deaths. The WHO has said that there is a possibility that these numbers were underestimated. Guinea was declared free of the virus in December 2015. There have been 17 cases of Ebola outside of Africa, resulting in 4 deaths (Ebola Virus Net, 2017).
There were four confirmed cases in the United State starting December 2014. Of the four patients, two were men who had either came to visit or had returned to the states with the infection. The first man was 45-year-old Thomas Duncan from Liberia, who was diagnosed on September 30th in Texas. Duncan died on October 8th. The next person to become sick from the virus was Craig Spencer, a doctor who had returned to the states after working alongside Doctors Without Borders in Guinea. Spencer was released from the hospital on November 11th. However, even though the nurses who treated Duncan contracted the virus during their treatment. They were able to get diagnosed early and survive. These events caused a nationwide panic as many people sought to get tested for the virus, and worried that every sick person that they encountered was carrying the Ebola virus. Many people also wanted the Obama administration to institute a travel ban, forbidding people from traveling to areas that are known hotspots of the disease. Obama refused arguing that it would make the situation worse. There have been no new cases of Ebola since October 2014 (Ebola Virus Net, 2017).
reservoir
The Reservoir transfers the disease by:
Direct Contact Talking
food
agent and vector
hosts-portals of entry are the mouth, cuts sexual organs
Infected Agents.
(Images Microsoft icons and google clip art)
Ebola Presentation
Jon arrived in the Emergency Room today. He was showing signs of being infected with the Ebola virus. Jon is a thirty-two-year-old Hispanic/ Asian male, who had been doing some aid work in the Democratic Republic of Congo. He had returned home the week prior. Jon being aware of the virus had been extremely careful during his stay. He avoided touching dead bodies, bodily fluids, and continued his long-held practice of washing his hands. The only time that he had been at risk was when he helped bandage the child of one of the villagers. He was off work and it was a simple wound, so he had felt that gloves and caution. were enough. However, he did end up getting a small amount of blood on himself. Jon then convinced himself that everything was fine as he was not showing any signs when he left for the airport a week later. When he arrived home, he felt very worn-out and weak, but convinced himself that he was just suffering from jet lag and would be fine in a day or so. Instead of feeling better he started to have flu-like symptoms, weakness, malaise, nausea, vomiting, diarrhea and constant headaches. It was when these started that Jon decided to go to the ER.
The doctors quickly isolated Jon and ran the needed tests. The tests came back positive for the virus and the flu. The hospital put him on a strict regime of antibodies. The doctors and nurses were hoping that his body would be strong enough to combat both infections since he was young, healthy and had only been in contact with a small amount of the virus. However, combatting both the Ebola virus and the flu became too much for his body. A couple days after arriving at the hospital Jon began to bleed from his eyes. Within a day, Jon was dead.
Prevention of the Ebola virus
As there is presently no cure for the virus it is important to be vigilant against the disease. Health care staff and medical officials can prevent the virus from spreading by constructive perimeters, wearing protective gear and using sterilized equipment. Healthcare workers should also isolate Ebola patients from others in the hospital, avoid having direct contact with the bodies of people who have succumbed to the disease, and alert the proper officials if you come into contact with the bodily fluids of a person with the virus (CDC 2015).
People who are traveling to regions that are affected by the virus should (1) avoid contact with bodily fluids (2) wash their hands (3) refrain from touching anything that may have been in contact with bodily fluids (4) not attend funerals where it is required to touch the body of the deceased (5) avoid bats (6) refrain from eating the raw meat of non-human primates. (7) do not go to places where Ebola victims are being treated. (8) refrain from having sexual relations with men who have had Ebola until it is certain that the virus is no longer in his semen, and finally, watch your health for 21 days after returning and get medical assistance if any symptoms occur (CDC, 2015).
The article, Genetic Changes in Ebola Virus in West African Outbreak Could Hinder Potential Treatments (ASM, 2015) says researchers have been tracing the alterations that have been happening in the Ebola virus since its discovery in 1976. Researchers have concluded that the continual changes have affected the efficiency of the medications used to battle Ebola. This contradicts the article “Gene study finds no worrisome changes in Ebola virus” by The Center for infectious Disease Research and Policy (CIDRAP) article (Schnirring, 2015), which says that there has been only a minute change in the virus since 2014. This conclusion was reached by a researcher from the National Institutes of Health (NIH) Rocky Mountain Laboratories in Hamilton, Montana. The researcher analyzed numerous samples that had been taken from patients residing in three diverse regions at three different times of the year.
Ebola Virus Treatment
Since Ebola is a virus, it is continuously adapting and growing more virulent against the drugs that are being used to treat it. This increases the chances that it will spread as well as the severity of the disease (Brodwin, 2014). A situation like this could trigger a pandemic that could result in the level of death not seen since the Bubonic Plague, which was responsible for the loss of about sixty percent of the population of Asia and Europe (Cohen, 2013). Due to the constant adaptation of the virus it has become difficult to develop an antivirus. Fortunately, no troublesome variations have occurred in the virus. This has some researchers saying that the virus is no longer changing and that it is possible to create an antivirus (ASM, 2015). The problem with those who contend that the virus is not changing, is that they only examined a small sample from a shorter period. While the other group has been analyzing data and samples for 40 years (ASM, 2015). Still the findings support the idea that the virus has only changed minutely in the past forty years. The problem that is preventing the antivirus medication from being effective is that the medicine that is being used to fight the infection are binding themselves to the DNA of the virus (ASM, 2015). This means that if there is a change on the genetic sequence of the virus then the drugs would no longer work. It was discovered by researchers who were comparing the genome of the current strain with the previous two variants, that changes referred to as single nucleotide polymorphisms, or SNPs had occurred in over 3 percent of the genome (ASM, 2015). This knowledge can allow scientists to create an antivirus that is based on the genome of the virus.
Clinical Relevance of the Ebola Virus.
Currently there are no antivirus medication approved by the FDA in the United States. However, it was found in December 2016, that a new vaccine rVSV-ZEBOV is up to 70 percent effective when it comes to treating the disease (Geisbert, 2016). Despite this there may be a wait for the drug to become available for commercial use. The antivirus that currently exist for the Ebola virus is important because it is the only thing preventing more people from succumbing to the disease. However, the antivirus is proving to be not as effective on some strains. This will only worsen, if the strains begin to mutate, which they have been slow to do over the last forty years. Nonetheless, it remains a fear within the medical and scientific communities when it comes to the Ebola virus. The main reason that the Ebola virus is a continual worry to medical and scientific professionals is because the virus attaches itself to the genome sequence of the infected person’s DNA. This means that the Ebola virus has essentially made itself a part of the person’s genome and it becomes harder to remove the virus. There is also the fear of mutations, if a mutation were to suddenly occur it would change the structure of Ebola’s genome. This new version of the virus would be more virulent and resistant than any previous strands. The antivirus that the CDC and WHO have in stock would be useless against this new threat. The virus may even change the way that it attacks the body or is transmitted. For, example viruses normally do not change the way that they are transmitted, and the Ebola virus is not transmitted through the air. Nevertheless, it is possible that a mutation on the virus’s genome could enable aerosol transmission. Should this occur millions would succumb from the disease.
References
ASM. (2015) Genetic Changes in Ebola Virus in West African Outbreak Could Hinder Potential Treatments. ASM Society. Retrieved from http://www.asm.org/index.php/asm-newsroom2/press-releases/93374-genetic-changes-in-ebola-virus-in-west-african-outbreak-could-hinder-potential-treatments
Brodwin, E. (2014). Why Ebola Is Such A Uniquely Terrible Virus. Retrieved November 24, 2015, from http://www.businessinsider.com/what-makes-ebola-virus-so-deadly-2014-10
CDC (2015). 2014 Ebola Outbreak in West Africa, Centers for disease control and prevention. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/
Cohen, R. (2013). Skin and Bones. Retrieved November 24, 2015, from https://books.google.com/books?id=gMVKAgAAQBAJ&pg=PA8&lpg=PA8&dq=bubonic plague killed 30-60%of population&source=bl&ots=kEhHnGn4Q8&sig=avUbAokFu-zmd1faNKUp1VhKq_s&hl=en&sa=X&ved=0ahUKEwiHoI7s-6nJAhUKdD4KHUnJBhoQ6AEITjAH#v=onepage&q=bubonic plague k
Ebola Virus Net. (2017). Ebola Epidemiology. Retrieved from http://www.ebolavirusnet.com/epidemiology.html
Geisbert, T. W. (2016). First Ebola virus vaccine to protect human beings? The Lancet. doi:10.1016/s0140-6736(16)32618-6
Harper, T. (2005). Ebola: Description, Vector, Mechanisms, Symptoms, etc. Retrieved from http://www.tarakharper.com/v_ebola.htm
Leung, D. W., Prins, K. C., Basler, C. F., & Amarasinghe, G. K. (2010). EbolavirusVP35 is a multifunctional virulence factor. Virulence, 1(6), 526-531. doi:10.4161/viru.1.6.12984
Marsh, G. A., Haining, J., Robinson, R., Foord, A., Yamada, M., Barr, J. A., Middleton, D. (2011). Ebola Reston Virus Infection of Pigs: Clinical Significance and Transmission Potential. Journal of Infectious Diseases, 204(suppl 3), S804-S809. doi:10.1093/infdis/jir300
McNeil, D. (2015, September 5). Many in West Africa May Be Immune to Ebola Virus. New York Times [New York City].
Minnaert, J. (2004). Ebola Virus. Retrieved from http://web.uconn.edu/mcbstaff/graf/Student%20presentations/Ebola/Ebola.html
Moghadam, S. R., Omidi, N., Bayrami, S., Moghadam, S., & Alinaghi, S. (2015). Ebola viral disease: a review literature, Asian Pacific Journal of Tropical Biomedicine (4), 260-267. doi: doi:10.1016/S2221-1691(15)30341-5
Ross, P. (2014, October 17). How Ebola Kills: What The Deadly Virus Does To The Human Body. Retrieved from http://www.ibtimes.com/how-ebola-kills-what-deadly-virus-does-human-body-1706965
Schnirring, L. (2015). Gene study finds no worrisome changes in Ebola virus. CIDRAP. Retrieved from http://www.cidrap.umn.edu/news-perspective/2015/03/gene-study-finds-no-worrisome-changes-ebola-virus
Zampieri, C. A., Sullivan, N. J., & Nabel, G. J. (2007). Immunopathology of highly virulent pathogens: insights from Ebola virus. Nature Immunology, 8(11), 1159-1164. doi:10.1038/ni1519
