receive training on the proper suit-up and removal of personal protective equipment (ppe); in addition, a designated person, appropriately trained in biosafety, should be watching each step of these procedures to ensure they are done correctly. in sierra leone, the typical training period for the use of such safety equipment lasts approximately 12 days. in 2022 in uganda, lighter personal protection equipment has become available as well as possibilities to monitor and communicate with patients from windows in the treatment tents until it is necessary to enter if e.g. a patient's oxygen levels drop. patients and household members the infected person should be in barrier-isolation from other people. all equipment, medical waste, patient waste and surfaces that may have come into contact with body fluids need to be disinfected. during the 2014 outbreak, kits were put together to help families treat ebola disease in their homes, which included protective clothing as well as chlorine powder and other cleaning supplies. education of caregivers in these techniques, and providing such barrier-separation supplies has been a priority of doctors without borders. disinfection ebolaviruses can be eliminated with heat (heating for 30 to 60 minutes at 60 °c or boiling for five minutes). to disinfect surfaces, some lipid solvents such as some alcohol-based products, detergents, sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder), and other suitable disinfectants may be used at appropriate concentrations. general population education of the general public about the risk factors for ebola infection and of the protective measures individuals may take to prevent infection is recommended by the world health organization. these measures include avoiding direct contact with infected people and regular hand washing using soap and water. bushmeat bushmeat, an important source of protein in the diet of some africans, should be handled and prepared with appropriate protective clothing and thoroughly cooked before consumption. some research suggests that an outbreak of ebola disease in the wild animals used for consumption may result in a corresponding human outbreak. since 2003, such animal outbreaks have been monitored to predict and prevent ebola outbreaks in humans. corpses, burial if a person with ebola disease dies, direct contact with the body should be avoided. certain burial rituals, which may have included making various direct contacts with a dead body, require reformulation so that they consistently maintain a proper protective barrier between the dead body and the living. social anthropologists may help find alternatives to traditional rules for burials. transport, travel, contact transportation crews are instructed to follow a certain isolation procedure, should anyone exhibit symptoms resembling evd. as of august 2014, the who does not consider travel bans to be useful in decreasing spread of the disease. in october 2014, the cdc defined four risk levels used to determine the level of 21-day monitoring for symptoms and restrictions on public activities. in the united states, the cdc recommends that restrictions on public activity, including travel restrictions, are not required for the following defined risk levels: having been in a country with widespread ebola disease transmission and having no known exposure (low risk); or having been in that country more than 21 days ago (no risk) encounter with a person showing symptoms; but not within three feet of the person with ebola without wearing ppe; and no direct contact with body fluids having had brief skin contact with a person showing symptoms of ebola disease when the person was believed to be not very contagious (low risk) in countries without widespread ebola disease transmission: direct contact with a person showing symptoms of the disease while wearing ppe (low risk) contact with a person with ebola disease before the person was showing symptoms (no risk). the cdc recommends monitoring for the symptoms of ebola disease for those both at "low risk" and at higher risk. laboratory in laboratories where diagnostic testing is carried out, biosafety level 4-equivalent containment is required. laboratory researchers must be properly trained in bsl-4 practices and wear proper ppe. isolation isolation refers to separating those who are sick from those who are not. quarantine refers to separating those who may have been exposed to a disease until they either show signs of the disease or are no longer at risk. quarantine, also known as enforced isolation, is usually effective in decreasing spread. governments often quarantine areas where the disease is occurring or individuals who may transmit the disease outside of an initial area. in the united states, the law allows quarantine of those infected with ebolaviruses. contact tracing contact tracing is considered important to contain an outbreak. it involves finding everyone who had close contact with infected individuals and monitoring them for signs of illness for 21 days. if any of these contacts comes down with the disease, they should be isolated, tested and treated. then the process is repeated, tracing the contacts' contacts. management as of 2019 two treatments (atoltivimab/maftivimab/odesivimab and ansuvimab) are associated with improved outcomes. the u.s. food and drug administration (fda) advises people to be careful of advertisements making unverified or fraudulent claims of benefits supposedly gained from various anti-ebola products. in october 2020, the u.s. food and drug administration (fda) approved atoltivimab/maftivimab/odesivimab with an indication for the treatment of infection caused by zaire ebolavirus. standard support a hospital isolation ward in gulu, uganda, during the october 2000 outbreak treatment is primarily supportive in nature. early supportive care with rehydration and symptomatic treatment improves survival. rehydration may be via the oral or intravenous route. these measures may include pain management, and treatment for nausea, fever, and anxiety. the world health organization (who) recommends avoiding aspirin or ibuprofen for pain management, due to the risk of bleeding associated with these medications. blood products such as packed red blood cells, platelets, or fresh frozen plasma may also be used. other regulators of coagulation have also been tried including heparin in an effort to prevent disseminated intravascular coagulation and clotting factors to decrease bleeding. antimalarial medications and antibiotics are often used before the diagnosis is confirmed, though there is no evidence to suggest such treatment helps. several experimental treatments are being studied. where hospital care is not possible, the who's guidelines for home care have been relatively successful. recommendations include using towels soaked in a bleach solution when moving infected people or bodies and also applying bleach on stains. it is also recommended that the caregivers wash hands with bleach solutions and cover their mouth and nose with a cloth. intensive care intensive care is often used in the developed world. this may include maintaining blood volume and electrolytes (salts) balance as well as treating any bacterial infections that may develop. dialysis may be needed for kidney failure, and extracorporeal membrane oxygenation may be used for lung dysfunction. prognosis evd has a risk of death in those infected of between 25% and 90%. as of september 2014, the average risk of death among those infected is 50%. the highest risk of death was 90% in the 2002–2003 republic of the congo outbreak. early admission significantly increases survival rates death, if it occurs, follows typically six to sixteen days after symptoms appear and is often due to low blood pressure from fluid loss. early supportive care to prevent dehydration may reduce the risk of death. if an infected person survives, recovery may be quick and complete. prolonged cases are often complicated by the occurrence of long-term problems, such as inflammation of the testicles, joint pains, fatigue, hearing loss, mood and sleep disturbances, muscular pain, abdominal pain, menstrual abnormalities, miscarriages, skin peeling, or hair loss. inflammation and swelling of the uveal layer of the eye is the most common eye complication in survivors of ebola virus disease. eye symptoms, such as light sensitivity, excess tearing, and vision loss have been described. ebola can stay in some body parts like the eyes, breasts, and testicles after infection. sexual transmission after recovery has been suspected. if sexual transmission occurs following recovery it is believed to be a rare event. one case of a condition similar to meningitis has been reported many months after recovery, as of october 2015. a study of 44 survivors of the ebola virus in sierra leone reported musculoskeletal pain in 70%, headache in 48%, and eye problems in 14%. epidemiology for more about specific outbreaks, see list of ebola outbreaks. the disease typically occurs in outbreaks in tropical regions of sub-saharan africa. from 1976 (when it was first identified) through 2013, the who reported 2,387 confirmed cases with 1,590 overall fatalities. the largest outbreak to date was the ebola virus epidemic in west africa, which caused a large number of deaths in guinea, sierra leone, and liberia. sudan cotton factory in nzara, south sudan, where the first outbreak occurred the first known outbreak of evd was identified only after the fact. it occurred between june and november 1976, in nzara, south sudan (then part of sudan), and was caused by sudan virus (sudv). the sudan outbreak infected 284 people and killed 151. the first identifiable case in sudan occurred on 27 june in a storekeeper in a cotton factory in nzara, who was hospitalised on 30 june and died on 6 july. although the who medical staff involved in the sudan outbreak knew that they were dealing with a heretofore unknown disease, the actual "positive identification" process and the naming of the virus did not occur until some months later in zaire. zaire main article: 1976 zaire ebola virus outbreak a cdc worker incinerates medical waste from ebola patients in zaire in 1976. on 26 august 1976, the second outbreak of evd began in yambuku, a small rural village in mongala district in northern zaire (now known as the democratic republic of the congo). this outbreak was caused by ebov, formerly designated zaire ebolavirus, a different member of the genus ebolavirus than in the first sudan outbreak. the first person infected with the disease was the village school's headmaster mabalo lokela, who began displaying symptoms on 26 august 1976. lokela had returned from a trip to northern zaire near the border of the central african republic, after visiting the ebola river between 12 and 22 august. he was originally believed to have malaria and was given quinine. however, his symptoms continued to worsen, and he was admitted to yambuku mission hospital on 5 september. lokela died on 8 september 14 days after he began displaying symptoms. soon after lokela's death, others who had been in contact with him also died, and people in yambuku began to panic. the country's minister of health and zaire president mobutu sese seko declared the entire region, including yambuku and the country's capital, kinshasa, a quarantine zone. no-one was permitted to enter or leave the area, and roads, waterways, and airfields were placed under martial law. schools, businesses and social organisations were closed. the initial response was led by congolese doctors, including jean-jacques muyembe-tamfum, one of the discoverers of ebola. muyembe took a blood sample from a belgian nun; this sample would eventually be used by peter piot to identify the previously unknown ebola virus. muyembe was also the first scientist to come into direct contact with the disease and survive. researchers from the centers for disease control and prevention (cdc), including piot, co-discoverer of ebola, later arrived to assess the effects of the outbreak, observing that "the whole region was in panic." piot concluded that belgian nuns had inadvertently started the epidemic by giving unnecessary vitamin injections to pregnant women without sterilizing the syringes and needles. the outbreak lasted 26 days and the quarantine lasted two weeks. researchers speculated that the disease disappeared due to the precautions taken by locals, the quarantine of the area, and discontinuing of the injections. during this outbreak, ngoy mushola recorded the first clinical description of evd in yambuku, where he wrote the following in his daily log: "the illness is characterised with a high temperature of about 39 °c (102 °f), haematemesis, diarrhoea with blood, retrosternal abdominal pain, prostration with 'heavy' articulations, and rapid evolution death after a mean of three days." the virus responsible for the initial outbreak, first thought to be the marburg virus, was later identified as a new type of virus related to the genus marburgvirus. virus strain samples isolated from both outbreaks were named "ebola virus" after the ebola river, near