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Ebola/VHF
Topic Collection
March 27, 2026

Topic Collection: Ebola/VHF

Though Ebola and other viral hemorrhagic fevers have been recognized for their virulence and biosecurity implications for decades, the 2014-2016 Ebola outbreak in West Africa for the first time spread into metropolitan areas, far exceeding the scope of previous outbreaks, killing thousands, overwhelming health systems, and highlighting international gaps in infectious disease preparedness and response. For the first time, patients with Ebola were treated in American facilities, and we also saw the first secondary cases of Ebola in the U.S. Smaller outbreaks since that time continue to highlight the risk posed by these viruses though advances in vaccination and antiviral therapies hold promise for limiting the impact of future outbreaks. The following resources highlight recent case studies, lessons learned, tools, and promising practices for planning for and responding to Ebola and viral hemorrhagic fever outbreaks.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:42 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:37 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
Centers for Disease Control and Prevention. (2024). Clinical Guidance for Ebola Disease. U.S. Department of Health and Human Services.
This webpage provides comprehensive information for clinicians on Ebola virus disease, including clinical presentation, pathogenesis, treatment, and updated vaccine information with additional references toward the end.
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Centers for Disease Control and Prevention. (2025). Post-Travel Evaluation of the Ill Traveler. U.S. Department of Health and Human Services.
This chapter of the Yellow Book provides detailed information for health care professionals to evaluate ill travelers returning from international locations.
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Smith, C., Hughes, S., Karwowski, M., et al. (2015). Addressing Needs of Contacts of Ebola Patients During an Investigation of an Ebola Cluster in the United States - Dallas, Texas, 2014. MMWR Morbidity and Mortality Weekly Report. 64(5):121-123.
In this report, the authors discuss the importance of anticipating the nonclinical needs of those under public health surveillance (e.g., concerns about housing, transportation, education, employment, food, and other household needs). The report also stresses the importance of ensuring these types of support are addressed so that residents will be more likely to comply with quarantine orders, and the utility of community collaboration (with partners such as businesses, schools, community and faith-based organizations, and social services).
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Assessing and Testing

Association of Public Health Laboratories. (2014). Template for Public Health Laboratory Risk Assessment for Ebola Virus Disease (EVD) Testing.
Laboratory staff can download and tailor this template to meet their requirements. It includes comprehensive information on using enhanced precautions and personal protective equipment when handling high-risk Ebola specimens.
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Brainard, J., Pond, K., Hopper, L., et al. (2016). Presence and Persistence of Ebola or Marburg Virus in Patients and Survivors: A Rapid Systematic Review. PLoS Neglected Tropical Diseases. 10(2):e0004475.
In this study, the authors review and summarize 33 studies that examined evidence of presence and persistence of infectious virus in various body fluids compared to onset of Ebola or Marburg illness. Research consistently showed high viral loads in blood during illness, but rarely later than 16 days after illness onset. Filovirus was also found in non-blood body fluids of actively ill patients, but rarely found in survivors, with the exception of semen, which tested positive as late as 203 days after onset of illness.
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* Centers for Disease Control and Prevention. (2024). Guide for Clinicians Evaluating an Ill Person for VHF or Other High-Consequence Disease. U.S. Department of Health and Human Services.
This guide provides information for healthcare providers on evaluating a patient potentially exposed to a high consequence disease, including viral hemorrhagic fevers. It includes information on exposure risk factors and symptoms, consultation with local, tribal, state, or territorial health departments after a patient is safely isolated, and a testing algorithm for determining when to test an individual with a suspected infection.
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* Nebraska Medicine. (2022). Viral Hemorrhagic Fever or Orthopox Virus ED Screening.
This flowchart is intended to help screen for potential Ebola, Lassa, Marburg, or Orthopox virus cases in the Emergency Department. It includes color coded procedural steps for processing incoming patients, specific questions to ask, screening notes, and infection control guidance.
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Oza, S., Sesay, A., Russell, N., et al. (2017). Symptom- and Laboratory-Based Ebola Risk Scores to Differentiate Likely Ebola Infections. Emerging Infectious Diseases. 23(11):1792-99.
The authors reviewed retrospective data from both positive and negative Ebola patients in Sierra Leone to develop two risk scores on the likelihood of Ebola infection among patients with suspected or confirmed Ebola virus disease. The Ebola symptom-based risk (ESR) score was based on headache, diarrhea, difficulty breathing, nausea/vomiting, loss of appetite, and conjunctivitis. If available, laboratory test results for alanine transaminase, creatine kinase, creatinine, and total bilirubin were added to the ESR score to calculate the Ebola symptom- and laboratory-based (ESLR) score. Among suspected patients who tested positive for Ebola virus disease, the ESR score categorized more than 70% and the ESLR score categorized more than 90% as high risk. The risk scores may be useful in separating patients who meet the case definition by their likeliness of infection and implementing greater protections and directing more resources to those with higher risk scores while awaiting laboratory confirmation of disease.
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Clinical Care

ASPR TRACIE. (2017). Lessons Learned on Crisis Standards of Care in Kenema.
In this video, Dr. Lewis Rubinson shares his personal experiences treating Ebola patients in Sierra Leone.
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ASPR TRACIE. (2017). Step Care for Ebola/Viral Hemorrhagic Fever Patients: Guidance for International Field Hospitals. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This document is intended to help organizations who want to provide care for Ebola virus disease (EVD)/viral hemorrhagic fever (VHF) patients determine an appropriate level of medical care that they can provide and anticipate the supplies that may be needed. This guidance may be applicable to other diseases where dehydration and electrolyte imbalance are key contributors to mortality.
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Diallo, M., Toure, A., Sow, M., et al. (2021). Understanding the Long-Term Evolution and Predictors of Sequelae of Ebola Virus Disease Survivors in Guinea: A 48-Month Prospective, Longitudinal Cohort Study (PostEboGui). Clinical Infectious Diseases.
This study aims to understand long-term Ebola virus disease sequelae prevalence, incidence, and duration over a 48-month period following 803 survivors. Results indicate that while prevalence and incidence of symptoms decreased over time, sequelae were present 48 months post discharge.
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* Feldmann, H., Sprecher, A., and Geisbert, T. (2020). Ebola. The New England Journal of Medicine. 382:1832-1842.
This article provides a comprehensive overview of Ebola, its virologic, epidemiologic, and ecologic features, and information on disease pathogenesis. For clinicians, it includes guidance for diagnosis, patient care, investigational treatment, vaccines, and outbreak management information.
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Kiiza, P., Mullin, S., Teo, K., et al. (2021). Treatment of Ebola-Related Critical Illness. Intensive Care Medicine. 46:285-297.
This article reviews updated care guidelines for treating Ebola-related illness. Information summarizes advancements in point-of-care diagnostics, patient standards of care, drug therapies, and supportive care.
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Kortepeter, M., Dierberg, K., Shenoy, E., et al. (2020). Marburg Virus Disease: A Summary for Clinicians. International Journal of Infectious Diseases. 99(2020):233-242.
This article offers a summary of clinical features, diagnostic testing options, potential medical countermeasures, infection prevention and control recommendations, and additional recommendations related to caring for patients with Marburg virus disease.
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* Lamontagne, F., Fowler, R., Adhikari, N., et al. (2017). Evidence-Based Guidelines for Supportive Care of Patients with Ebola Virus Disease. The Lancet. 391(10121):700-708.
These evidence-based guidelines developed by a 34 member expert panel provide recommendations on the delivery of supportive care for patients in treatment units during a future Ebola outbreak. The panel used the Grading of Recommendations Assessment, Development, and Evaluation methodology to develop 8 clinical recommendations on oral rehydration, parenteral administration of fluids, systematic monitoring and charting of vital signs and volume status, serum biochemistry, staffing ratio, communication with family and friends, analgesic therapy, and antibiotics.
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Lyon, G., Mehta, A., Varkey, J., et al. (2014). Clinical Care of Two Patients with Ebola Virus Disease in the United States. The New England Journal of Medicine. 371:2402-2409.
The authors (from Emory University) present two case reports on two U.S. citizens who contracted the Ebola virus while working in Liberia. Line graphs detail laboratory values in both patients as they received ZMapp, an experimental treatment.
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Mbala-Kingebani, P., Pratt, C., Mutafali-Ruffin, M., et al. (2021). Ebola Virus Transmission Initiated by Relapse of Systemic Ebola Virus Disease. The New England Journal of Medicine. 384:1240-1247.
The authors provide a case report of acute Ebola virus disease relapse resulting in death in a previously recovered and vaccinated patient.
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Vetter, P., Kaiser, L., Schibler, M., et al. (2016). Sequelae of Ebola Virus Disease: The Emergency Within the Emergency. The Lancet Infectious Diseases. 16(6):e82-e91.
The authors discuss current knowledge of Ebola virus disease sequelae, challenges to provision of care to survivors, and areas for future research.
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Decontamination and Waste Management

Fischer, R., Judson, S. Miazgowicz, K., et al. (2015). Ebola Virus Stability on Surfaces and in Fluids in Simulated Outbreak Environments. Emerging Infectious Diseases. 21(7):1243-1246.
The authors simulated environmental conditions and found that the Ebola virus remains active for a longer time on hospital surfaces than it does in African conditions. The virus also lives longer in liquid than it does in dried blood.
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U.S. Department of Labor, Occupational Safety and Health Administration, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, and Environmental Protection Agency. (2016). Safe Handling, Treatment, Transport and Disposal of Ebola-Contaminated Waste.
This fact sheet provides a step-by-step summary of actions workers should take from the point Ebola-contaminated waste is generated through final disposal.
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U.S. Environmental Protection Agency. (2018). List L: Disinfectants for Use Against the Ebola Virus.
The Environmental Protection Agency lists products that meet the Centers for Disease Control and Prevention’s criteria for use against the Ebola virus on hard, non-porous surfaces. Products are listed by name and indicate whether they are approved for use in hospital/healthcare facilities, institutions such as schools and offices, and residences.
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Various Federal Agencies. (2024). Managing Solid Waste Contaminated with a Category A Infectious Substance.
This guidance document is based on extensive federal interagency coordination and stakeholder input and designed to help those who work in healthcare facilities, medical transportation operations, and laboratories better understand infectious waste and how to manage it.
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Education and Training

ASPR TRACIE. (2020). Highly Pathogenic Infectious Disease Training and Exercise Resources Webinar.
The National Ebola Training and Education Center (NETEC) and ASPR’s Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) are partnering on a series of joint webinars featuring NETEC’s suite of free, fully customizable, Homeland Security Exercise and Evaluation Program (HSEEP)-compliant exercise materials, trainings, and other resources. This webinar highlights a new course, exercise templates, and other ASPR TRACIE and NETEC resources.
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ASPR TRACIE and NETEC. (2017). Highly Pathogenic Infectious Disease Exercise Planning for Health Care Coalitions.
The speakers in this webinar discussed exercise templates designed to help manage patients with highly pathogenic infectious diseases; explained how exercises support ASPR's regional, tiered approach; and shared their experiences planning and executing exercises for Ebola and other special pathogens.
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ASPR TRACIE and NETEC. (2017). Highly Pathogenic Infectious Disease Exercise Planning Tools.
Speakers share information on HSEEP-compliant exercise templates that test readiness for highly pathogenic infectious disease patients, and highlight how these exercises support ASPR’s regional, tiered approach and address unique challenges and situations.
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ASPR TRACIE and NETEC. (2018). Healthcare System Readiness for Highly Pathogenic Infectious Diseases.
In this joint NETEC-ASPR TRACIE webinar, speakers provided an overview of the current situation in the DRC; described the regional, tiered system established to manage patients suspected and known to be infected with EVD or other special pathogens; provided updates on current Ebola readiness and trends; reinforced the “Identify, Isolate, and Inform” response framework; and shared best practices and lessons learned from previous experience.
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Centers for Disease Control and Prevention. (2021). Marburg Virus Disease. U.S. Department of Health and Human Services.
This webpage provides an overview of MVD with links to information on transmission, signs and symptoms, risk of exposure, diagnosis, treatment, and prevention guidance, as well as historical outbreak data and additional resources.
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Centers for Disease Control and Prevention. (2025). Post-Travel Evaluation of the Ill Traveler. U.S. Department of Health and Human Services.
This chapter of the Yellow Book provides detailed information for health care professionals to evaluate ill travelers returning from international locations.
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Department of Emergency Health Services. (2018). Emerging Infectious Diseases Videos for Prehospital Providers. University of Maryland Baltimore County.
This instructional series, comprised of nine modules (listed at the top of the page), includes an introduction to infectious diseases, basic infection control concepts, considerations for personal protective equipment (including donning and doffing), personnel decontamination, patient transport, and transfer of patient care for patients with Ebola and other highly infectious diseases.
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National Emerging Special Pathogens Training & Education Center. (n.d.). NETEC Resources for Marburg Virus Disease. (Accessed 10/31/2024.)
This resource page provides an overview of Marburg virus disease, a brief history of outbreaks, and links to additional resources and publications, including clinical guidance, infection prevention information, and laboratory and EMS resources.
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National Emerging Special Pathogens Training & Education Center. (2024). NETEC Resources for Lassa Fever.
This resource page provides an overview and brief history of Lassa Fever, and links to additional resources on topics such as clinical guidance, infection prevention information, waste management, relevant training, and laboratory practices.
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West Virginia Hospital Association. (2016). Be Smart, Take Part – Emerging Infectious Disease Preparedness and Response for Frontline Healthcare Facilities.
This training program includes a video for people or groups who may come in contact with an individual with a possible infectious disease. It also includes a free, downloadable, Homeland Security Exercise and Evaluation Program-compliant, no-notice drill template for frontline healthcare facilities. Upon registration, West Virginia providers may also access eight brief online courses to reinforce and test the concepts introduced in the training guide video.
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Emergency Medical Services

ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
Favorite:
2
You must Login to add a comment
  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:42 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:37 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
Centers for Disease Control and Prevention. (2024). Viral Hemorrhagic Fevers: Interim Guidance for Emergency Services. U.S. Department of Health and Human Services.
This webpage provides comprehensive emergency services information for emergency department (ED) and emergency medical services (EMS) staff treating suspected or confirmed Ebola patients. Information includes guidance on ED preparedness training, 911 answering points, air medical transport, and interfacility transport.
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* National Emerging Special Pathogens Training and Education Center. (2024). EMS Procedural Guidelines for Special Pathogens.
These model procedural guidelines, created by NETEC's EMS/Patient Transport Work Group, are designed to help EMS agencies develop standard operating procedures for the transport and management of patients suspected or confirmed to have a high-consequence infectious disease. The guidelines address personal protective equipment (PPE) donning and doffing, EMS provider down, PPE breaches, biohazard spills, waste management, ambulance modification, and ambulance cleaning and disinfection. They complement ASPR TRACIE's EMS Infectious Disease Playbook (https://files.asprtracie.hhs.gov/documents/aspr-tracie-transport-playbook-508.pdf).
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Wu, H., Fairley, J., Steinberg, J., and Kozarsky, P. (2014). The Potential Ebola-Infected Patient in the Ambulatory Care Setting: Preparing for the Worst Without Compromising Care. Annals of Internal Medicine. 162(1):66-67.
The authors discuss implications of people with undiagnosed Ebola reporting to healthcare facilities. They worked with key stakeholders to develop a list of considerations for patient management, which is displayed in Table 1.
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Fatality Management

Centers for Disease Control and Prevention. (2024). Safe Handling of Human Remains of VHF Patients in U.S. Hospitals and Mortuaries.
The Centers for Disease Control and Prevention provides step-by-step guidance for individuals responsible for performing postmortem care on viral hemorrhagic fever patients in U.S. hospitals and mortuaries.
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National Emerging Special Pathogens Training and Education Center. (2024). Decedent Management Considerations for Confirmed or Suspected Viral Hemorrhagic Fever (VHF).
This guide is a planning tool for facilities managing deceased patients with confirmed or suspected viral hemorrhagic fever. It includes information on communication, safety measures, postmortem care, and in-room postportem preparation.
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Hospital/Clinic Policies

Centers for Disease Control and Prevention. (2024). Clinical Guidance for Ebola Disease. U.S. Department of Health and Human Services.
This webpage provides comprehensive information for clinicians on Ebola virus disease, including clinical presentation, pathogenesis, treatment, and updated vaccine information with additional references toward the end.
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* Centers for Disease Control and Prevention. (2024). Infection Prevention and Control Recommendations for Patients in U.S. Hospitals who are Suspected or Confirmed to have Selected Viral Hemorrhagic Fevers (VHF).
This webpage provides guidance for healthcare professionals regarding standard, contact, and droplet precautions when caring for an individual with suspected or confirmed viral hemorrhagic fever.
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* Lamontagne, F., Fowler, R., Adhikari, N., et al. (2017). Evidence-Based Guidelines for Supportive Care of Patients with Ebola Virus Disease. The Lancet. 391(10121):700-708.
These evidence-based guidelines developed by a 34 member expert panel provide recommendations on the delivery of supportive care for patients in treatment units during a future Ebola outbreak. The panel used the Grading of Recommendations Assessment, Development, and Evaluation methodology to develop 8 clinical recommendations on oral rehydration, parenteral administration of fluids, systematic monitoring and charting of vital signs and volume status, serum biochemistry, staffing ratio, communication with family and friends, analgesic therapy, and antibiotics.
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Infection Control

* Centers for Disease Control and Prevention. (2024). Infection Prevention and Control Recommendations for Patients in U.S. Hospitals who are Suspected or Confirmed to have Selected Viral Hemorrhagic Fevers (VHF).
This webpage provides guidance for healthcare professionals regarding standard, contact, and droplet precautions when caring for an individual with suspected or confirmed viral hemorrhagic fever.
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Chughtai, A., Barnes, M., and MacIntyre, C. (2016). Persistence of Ebola Virus in Various Body Fluids During Convalescence: Evidence and Implications for Disease Transmission and Control. Epidemiology and Infection. 144(8):1652-1660.
The authors review articles examining persistence of Ebola virus disease in body fluids during the convalescent phase. They note that the virus persists in body fluids following clinical recovery and clearance from the blood and recommend additional study to quantify virus persistence and infectivity after the acute illness phase to better inform infection control guidelines.
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Keita, A.K., Koundouno, F.R., Faye, M., et al. (2021). Resurgence of Ebola Virus in 2021 in Guinea Suggests a New Paradigm for Outbreaks. Nature. 597:539-543.
The authors used next-generation sequencing to determine that the 2021 outbreak of Ebola virus disease was not due to a novel zoonotic spillover event, but to a persistent or latent infection. The article emphasizes the importance of long-term healthcare and support for survivors of Ebola virus disease.
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Lessons Learned

ASPR TRACIE. (2016). Lessons Learned in Developing an Effective Regional Ebola CONOPS. United States Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
The speakers in this webinar share lessons learned to assist regions in the development of their Ebola concept of operations.
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Bell, B., Damon, I., Jernigan, D., et al. (2016). Overview, Control Strategies, and Lessons Learned in the CDC Response to the 2014-2016 Ebola Epidemic. MMWR Supplement. 65(3):4-11.
The authors provide a history of Ebola virus disease, discuss the response to the recent epidemic, and describe how to apply lessons learned to future outbreaks.
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Fielding, J., Allen, T., Chu, B., et al. (2016). Report of the Independent Panel on the U.S. Department of Health and Human Services (HHS) Ebola Response. Independent Panel on the U.S. Department of Health and Human Services (HHS) Ebola Response.
This report discusses the findings and recommendations of the independent panel established to examine the U.S. Department of Health and Human Services response to the 2014-2016 Ebola epidemic.
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* Kamali, A., Jamieson, D., Kpaduwa, J., et al. (2016). Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States. Emerging Infectious Diseases. 22(7):1156-1161.
The authors describe lessons learned through the treatment and delivery of a healthy infant to an Ebola survivor.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). U.S. Department of Health and Human Services Ebola Response Improvement Plan Based on Lessons Learned from the 2014-2016 Ebola Epidemic.
This improvement plan addresses the key findings and recommendations of the Report of the Independent Panel on the HHS Ebola Response.
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Monitoring/Quarantine

Smith, C., Hughes, S., Karwowski, M., et al. (2015). Addressing Needs of Contacts of Ebola Patients During an Investigation of an Ebola Cluster in the United States - Dallas, Texas, 2014. MMWR Morbidity and Mortality Weekly Report. 64(5):121-123.
In this report, the authors discuss the importance of anticipating the nonclinical needs of those under public health surveillance (e.g., concerns about housing, transportation, education, employment, food, and other household needs). The report also stresses the importance of ensuring these types of support are addressed so that residents will be more likely to comply with quarantine orders, and the utility of community collaboration (with partners such as businesses, schools, community and faith-based organizations, and social services).
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Pediatric Issues

Davies, H. and Byington, C. (2016). Parental Presence During Treatment of Ebola or Other Highly Consequential Infection. Pediatrics. 138(3):e20161891.
This clinical report from the American Academy of Pediatrics Committee on Infectious Diseases presents options for meeting the needs of patients and their families while posing the least risk to healthcare providers and facilities.
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Eriksson, C., Uyeki, T., Christian, M., et al. (2015). Care of the Child with Ebola Virus Disease. Pediatric Critical Care Medicine. 16(2):97-103.
The authors discuss considerations for the care of children with Ebola virus disease. They emphasize infection control practices to limit disease spread, and supportive care to treat patients.
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Kangbai, J., Heumann, C., Hoelscher, M., et al. (2019). Epidemiological Characteristics, Clinical Manifestations, and Treatment Outcome of 139 Paediatric Ebola Patients Treated at a Sierra Leone Ebola Treatment Center. BMC Infectious Diseases. 19:81.
This article describes a retrospective study to better understand effects of Ebola virus disease on pediatric patients. Medical data for patients under 15 years of age admitted to 34 military hospitals was assessed to determine clinical characteristics and related sociodemographic data.
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Olupot-Olupot, P. (2015). Ebola in Children: Epidemiology, Clinical Features, Diagnosis and Outcomes. Pediatric Infectious Disease Journal. 34(3):314-316.
The author looks at the current and past Ebola outbreaks and focuses on infection and how it presents, is diagnosed, and treated in children.
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Personal Protective Equipment and Responder Safety

Biondi, M., Garnett, L., Bello, A., et al. (2021). Characterization of Ebola Virus Risk to Bedside Providers in an Intensive Care Environment. Microorganisms. 9(3):498.
To better understand viral transmission, the authors completed an extensive environmental and animal sampling study during intensive care of non-human primates. The found significant unexpected contamination of monitor lines, equipment, and tubes as well as a high risk of exposure during blood draws throughout illness and urine and gastric contents handling in later stage disease.
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McLaws, M., Chughtai, A., Salmon, S., and MacIntyre, R. (2016). A Highly Precautionary Doffing Sequence for Health Care Workers after Caring for Wet Ebola Patients to Further Reduce Occupational Acquisition of Ebola. American Journal of Infection Control. 44(7):740-744.
The authors reviewed video guidelines to identify exemplary doffing, which they defined as no used personal protective equipment surface coming into contact with mucous membranes, face, or hair.
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* National Emerging Special Pathogens Training & Education Center and ASPR TRACIE. (2025). Estimating PPE Needs: Using the DASH Tool for Special Pathogen Readiness.
In this webinar, NETEC and and ASPR TRACIE demonstrate the Disaster Available Supplies in Hospitals (DASH) Tool and highlight the National Special Pathogen System framework, real-world use cases of DASH for Level 2 and Level 3 care, and how PPE needs change over 24-hour and multi-day scenarios.
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United States Department of Labor, Occupational Safety and Health Administration. (2014). PPE Selection Matrix for Occupational Exposure to Ebola Virus.
The U.S. Department of Labor shares information on the type of personal protective equipment to be worn in various situations (e.g., normal work activities, casual interaction, providing medical and supportive care, cleaning and disinfecting environments, and dealing with waste).
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Plans, Tools, and Templates

* Centers for Disease Control and Prevention. (2024). Guide for Clinicians Evaluating an Ill Person for VHF or Other High-Consequence Disease. U.S. Department of Health and Human Services.
This guide provides information for healthcare providers on evaluating a patient potentially exposed to a high consequence disease, including viral hemorrhagic fevers. It includes information on exposure risk factors and symptoms, consultation with local, tribal, state, or territorial health departments after a patient is safely isolated, and a testing algorithm for determining when to test an individual with a suspected infection.
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Minnesota Department of Health, Association for Professionals in Infection Control and Epidemiology - Minnesota, and Health Care Coalitions of Minnesota. (2019). High Consequence Infectious Disease (HCID) Toolbox for Frontline Health Care Facilities.
This toolbox includes a variety of resources to assist frontline facilities in their readiness activities related to patients with high consequence infectious diseases. Included are planning and training tools, exercise templates, and the components (e.g., screening guide, checklists, posters) to create a readiness binder.
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National Ebola Training and Education Center. (n.d.). NETEC Exercise Templates. (Accessed 9/9/2024.)
This web page includes links to various Homeland Security Exercise and Evaluation Program-compliant templates to assist healthcare coalitions, frontline facilities, assessment hospitals, state-designated Ebola treatment centers, regional Ebola and special pathogen treatment centers, and their respective response partners in the planning and conduct of exercises on the identification, assessment, treatment, management, transport, and transfer of high risk patients. The site includes templates for drills, tabletops, functional, and full-scale exercises. There is also a beginners guide to assist users new to exercise planning.
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* National Emerging Special Pathogens Training & Education Center and ASPR TRACIE. (2025). Estimating PPE Needs: Using the DASH Tool for Special Pathogen Readiness.
In this webinar, NETEC and and ASPR TRACIE demonstrate the Disaster Available Supplies in Hospitals (DASH) Tool and highlight the National Special Pathogen System framework, real-world use cases of DASH for Level 2 and Level 3 care, and how PPE needs change over 24-hour and multi-day scenarios.
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National Emerging Special Pathogens Training and Education Center. (2022). Health Care Facility Viral Hemorrhagic Fever Preparedness Checklist.
NETEC developed this checklist to help healthcare facilities assess their ability to identify, isolate, inform, and provide initial treatment to patients known or suspected to be infected with a special pathogen. Healthcare facilities can review their immediate care capabilities and follow links to additional resources that may assist them in filling readiness gaps.
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* National Emerging Special Pathogens Training and Education Center. (2024). EMS Procedural Guidelines for Special Pathogens.
These model procedural guidelines, created by NETEC's EMS/Patient Transport Work Group, are designed to help EMS agencies develop standard operating procedures for the transport and management of patients suspected or confirmed to have a high-consequence infectious disease. The guidelines address personal protective equipment (PPE) donning and doffing, EMS provider down, PPE breaches, biohazard spills, waste management, ambulance modification, and ambulance cleaning and disinfection. They complement ASPR TRACIE's EMS Infectious Disease Playbook (https://files.asprtracie.hhs.gov/documents/aspr-tracie-transport-playbook-508.pdf).
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* Nebraska Medicine. (2022). Viral Hemorrhagic Fever or Orthopox Virus ED Screening.
This flowchart is intended to help screen for potential Ebola, Lassa, Marburg, or Orthopox virus cases in the Emergency Department. It includes color coded procedural steps for processing incoming patients, specific questions to ask, screening notes, and infection control guidance.
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New York City Department of Health and Mental Hygiene. (n.d.). Mystery Patient Drill Toolkit. (Accessed 3/5/2025.)
This toolkit is intended for use by hospital emergency departments, and tests how long it takes for a potential patient with a highly infectious disease to be identified and for staff to begin exposure mitigation procedures; how long it takes for a patient to be transferred to an isolation room; and the capability of the facility to make notifications internally and to the health department. The Toolkit includes scenarios for Ebola Virus Disease, Middle East Respiratory Syndrome, and Measles, but may be modified to suit healthcare facilities of any nature and any type of disease outbreak.
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New York City Health + Hospitals. (2019). Frontline Hospital Planning Guide: Special Pathogens.
This planning guide from New York City Health + Hospitals provides high-level planning information for frontline hospital multidisciplinary teams to support planning and training for the initial care of suspected special pathogen patients while determining whether and when they will be transferred to another facility for further assessment and treatment.
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Vaccine/Targeted Treatment

Choi, M., Cossaboom, C., Whitesell, A., et al. (2021). Use of Ebola Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. Morbidity and Mortality Weekly Report 70(1):1-12.
This report summarizes recommendations by the Advisory Committee on Immunization Practices to vaccinate adults at high risk of occupational exposure to Zaire ebolavirus. Vaccination is recommended for: persons responding to an outbreak of Ebola virus disease; healthcare personnel working at federally designated Ebola treatment centers; and laboratorians and other biosafety level 4 facility staff.
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* Feldmann, H., Sprecher, A., and Geisbert, T. (2020). Ebola. The New England Journal of Medicine. 382:1832-1842.
This article provides a comprehensive overview of Ebola, its virologic, epidemiologic, and ecologic features, and information on disease pathogenesis. For clinicians, it includes guidance for diagnosis, patient care, investigational treatment, vaccines, and outbreak management information.
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Gsell, P., Camacho, A., Kucharski, A., et al. (2017). Ring Vaccination with rVSV-ZEBOV Under Expanded Access in Response to an Outbreak of Ebola Virus Disease in Guinea, 2016: An Operational and Vaccine Safety Report. The Lancet. 17(12):1276-84.
The authors describe the first use of an Ebola vaccine in an outbreak setting outside of a clinical trial. More than 1500 individuals, including 303 children age 6 and older, were vaccinated in 4 rings. No confirmed cases were reported among vaccinees or within the rings once vaccination was completed. Mild adverse events were reported in 17% of those age 6-17; 36% of adults also reported adverse events, with 98% being mild. There were no reports of severe vaccine-related adverse events.
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Iversen, P., Kane, C., Zeng, X., et al. (2020). Recent Successes in Therapeutics for Ebola Virus Disease: No Time for Complacency. The Lancet Infectious Diseases. 20(9):E231-E237.
This article discusses the recent success of the PALM trial in the DRC in treating acute Ebola virus disease; however, the author underscores the need for continued efforts to treat severe Ebola disease, utilize effective post-exposure prophylaxis, and understand the role of viral persistence as it relates to Ebola.
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Mulangu, S., Dodd, L., Davey, R., et al. (2019). A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics. The New England Journal of Medicine. 381:2293-2303.
This article outlines the trial of four investigational Ebola therapies during an outbreak in the DRC in 2018. Patients received monoclonal antibody ZMapp (the control group), the antiviral agent remdesivir, the single monoclonal antibody MAb114, or the triple monoclonal antibody REGN-EB3. Of the 681 patients enrolled, results showed both MAb114 and REGN-EB3 reduced Ebola-related mortality.
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Tomori, O. and Olatunji Kolawole, M. (2021). Ebola Virus Disease: Current Vaccine Solutions. (Abstract only.) Current Opinion in Immunology. 71:27-33.
This article explores how Ebola vaccines can address traditionally unpredictable outbreaks of Ebola virus which make it difficult to preemptively vaccinate. The authors also highlight the challenges associated with getting vaccines approved for use.
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Women's Health

Black, B., Caluwaerts, S., and Achar, J. (2015). Ebola Virus Disease and Pregnancy. Obstetric Medicine. 8(3):108-113.
The authors provide an overview of the interaction between Ebola and pregnancy, current practices in the field, gaps in knowledge, and potential management strategies.
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* Kamali, A., Jamieson, D., Kpaduwa, J., et al. (2016). Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States. Emerging Infectious Diseases. 22(7):1156-1161.
The authors describe lessons learned through the treatment and delivery of a healthy infant to an Ebola survivor.
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Medina-Rivera, M., Centeno-Tablante, E., Finkelstein, J., et al. (2020). Presence of Ebola Virus in Breast Milk and Risk of Mother-to-Child Transmission: Synthesis of Evidence. Annals of the New York Academy of Sciences.
This systematic review looked at evidence related to the presence of Ebola virus in breastmilk as a potential route for viral transmission during breastfeeding. 148 full text articles were evaluated with eight studies included where breastmilk samples were provided. Results showed that seven of the ten samples detected Ebola virus and four of five infants breastfed Ebola virus positive milk were found to be infected.
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Agencies and Organizations

Centers for Disease Control and Prevention. Clinical Guidance for Ebola Disease.
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Emory University. Ebola: What's Ahead.
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Institute for Diseases and Disaster Management. Tools and Resources. NYC Health + Hospitals.
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National Emerging Special Pathogens Training and Education Center.
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Occupational Safety and Health Administration. Ebola. U.S. Department of Labor.
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U.S. Food and Drug Administration. Ebola Preparedness and Response Updates from FDA. U.S. Department of Health and Human Services.
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World Health Organization. Ebola Virus Disease.
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This ASPR TRACIE Topic Collection was refreshed in 2024. It was comprehensively reviewed in April 2015 by John Hick, MD, HHS ASPR and Hennepin County Medical Center.

Additional assistance provided by Alicia Livinski, Biomedical Librarian, HHS National Institutes of Health, and the following subject matter experts (listed in alphabetical order): James A. Geiling, MD, MPH, FCCM, Consultant and Professor of Medicine, Geisel School of Medicine at Dartmouth; Dan Hanfling, MD (Panel Chair, Editor) Contributing Scholar, UPMC Center for Health Security, Member, InterAgency Board, Attending Physician, BestPractices, Inc. (a division of EmCare), and Clinical Professor of Emergency Medicine, George Washington University; Nathaniel Hupert, MD, IPA Consultant, HHS-ASPR-BARDA and HPP, Associate Professor of Healthcare Policy and Research and of Medicine, Weill Medical College, Cornell University HHS ASPR; Aaron Resnick, Planning and Preparedness Manager, Northwest Healthcare Response Network; and Connie Savor Price, MD, Chief, Infectious Diseases, Medical Director, Infection Prevention, Denver Health and Hospital, Professor of Medicine, University of Colorado-Denver.
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