Several strains of the virus found in Africa cause hemorrhagic fever; one found in the W Pacific does not. Once a person is infected with the virus, the disease has an incubation period of 2-21 days; however, some infected persons are asymptomatic. Initial symptoms are sudden malaise, headache, and muscle pain, progressing to high fever, vomiting, severe hemorrhaging (internally and out of the eyes and mouth) and in 50%-90% of patients, death, usually within days. The likelihood of death is governed by the virulence of the particular Ebola strain involved. Ebola virus is transmitted in body fluids and secretions; there is no evidence of transmission by casual contact. There is no vaccine and no cure.
Outbreaks of Ebola virus in humans occurred in both Congo-Kinshasa (then Zaïre) and Sudan in 1976 and 1979; other outbreaks have occurred since in Gabon, Uganda, and both Congos. Outbreaks have been exacerbated by underequipped hospitals that reused syringes and lacked proper protective clothing for personnel. In 1989 a similar virus was found in monkeys imported to the United States.