Microbial Pathogenesis 181 (2023) 106213 Available online 23 June 2023 0882-4010/© 2023 Elsevier Ltd. All rights reserved. Ebola virus disease: A narrative review Arash Letafati a, * , Omid Salahi Ardekani b , Hassan Karami a , Mina Soleimani c a Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran b Department of Bacteriology & Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran c Department of Laboratory Medicine, Faculty of Paramedical Sciences, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran A R T I C L E INFO Keywords: Ebola Filoviridae Epidemic MicroRNA Coinfection Symptoms ABSTRACT Ebola virus disease (EVD), which is also referred to as Ebola hemorrhagic fever, is a highly contagious and frequently lethal sickness caused by the Ebola virus. In 1976, the disease emerged in two simultaneous outbreaks in Sudan and the Democratic Republic of Congo. Subsequently, it has caused intermittent outbreaks in several African nations. The virus is primarily spread via direct contact with the bodily fuids of an infected individual or animal. EVD is distinguished by symptoms such as fever, fatigue, muscle pain, headache, and hemorrhage. The outbreak of EVD in West Africa in 2014–2016 emphasized the need for effective control and prevention mea- sures. Despite advancements and the identifcation of new treatments for EVD, the primary approach to treat- ment continues to be centered around providing supportive care. Early detection and supportive care can enhance the likelihood of survival. This includes intravenous fuids, electrolyte replacement, and treatment of secondary infections. Experimental therapies, for instance, monoclonal antibodies and antiviral drugs, have shown promising results in animal studies and some clinical trials. Some African countries have implemented the use of vaccines developed for EVD, but their effectiveness and long-term safety are still being studied. This article provides an overview of the history, transmission, symptoms, diagnosis, treatment, epidemiology, and Ebola coinfection, as well as highlights the ongoing research efforts to develop effective treatments and vaccines to combat this deadly virus. 1. Introduction The Ebola virus (EBOV) belongs to the family Filoviridae, which is a group of single-stranded RNA viruses that can lead to severe hemor- rhagic fever in humans and other primates. This virus is an extremely infectious virus with a high rate of fatalities (up to 90%) which makes it one of the deadliest viral diseases (Ebola virus disease (EVD)) in the last two decades [1]. The virus is transmitted through direct interaction with virus- containing body fuids, such as blood, saliva, sweat, breast milk, and semen of infected individuals or animals during the acute phase of sickness. Ebola virus can also be transmitted through contact with ob- jects contaminated with the virus, such as needles or syringes [2]. The greatest Ebola outbreak occurred in West Africa between 2014 and 2016, resulting in over 28,000 cases and 11,000 deaths [3]. We have discussed several Ebola outbreaks that occurred between 1976 and 2022 in Table 1. The virus causes severe illness, with symptoms including fever, vomiting, diarrhea, and bleeding [4]. The severity of the disease is infuenced by various factors, including the strain of the virus, the viral load, and the individual’s immune response [5]. It is not only a physical illness but also a psychological one. The emotional toll of Ebola can have long-lasting effects on survivors, their families, and communities [6]. These experiences can lead to a sense of hopelessness, loss of identity, and feelings of isolation and loneliness. Efforts to address the emotional damage of Ebola require a compre- hensive approach. This includes providing psychological support to survivors, families, and communities affected by the disease. Health workers need to be trained to recognize and address the emotional needs of Ebola patients and their families [7]. It is also important to address the stigma and discrimination associated with the disease, which can worsen emotional problems. Signifcant progress is being made in the identifcation of new treatments for EVD, raising hopes for effective interventions. Never- theless, the primary focus of treatment still revolves around providing supportive care, focusing on managing symptoms such as fever, dehy- dration, and bleeding. Prevention measures include strict infection * Corresponding author. Medical Virology, Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran. E-mail addresses: arashletafati@yahoo.com (A. Letafati), omid.salahi23@gmail.com (O. Salahi Ardekani), hassan.karami2120@gmail.com (H. Karami), minasoleimani2000@gmail.com (M. Soleimani). Contents lists available at ScienceDirect Microbial Pathogenesis journal homepage: www.elsevier.com/locate/micpath https://doi.org/10.1016/j.micpath.2023.106213 Received 20 March 2023; Received in revised form 23 May 2023; Accepted 22 June 2023