title: Transmission of Ebola viruses: what we know and what we do not know.
abstract: Available evidence demonstrates that direct patient contact and contact with infectious body fluids are the primary modes for Ebola virus transmission, but this is based on a limited number of studies. Key areas requiring further study include (i) the role of aerosol transmission (either via large droplets or small particles in the vicinity of source patients), (ii) the role of environmental contamination and fomite transmission, (iii) the degree to which minimally or mildly ill persons transmit infection, (iv) how long clinically relevant infectiousness persists, (v) the role that "superspreading events" may play in driving transmission dynamics, (vi) whether strain differences or repeated serial passage in outbreak settings can impact virus transmission, and (vii) what role sylvatic or domestic animals could play in outbreak propagation, particularly during major epidemics such as the 2013-2015 West Africa situation. In this review, we address what we know and what we do not know about Ebola virus transmission. We also hypothesize that Ebola viruses have the potential to be respiratory pathogens with primary respiratory spread.
authors.affiliation: Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, Minnesota, USA mto@umn.edu.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Osterholm
authors.affiliation: Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Moore
authors.affiliation: Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Kelley
authors.affiliation: Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Brosseau
authors.affiliation: National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Wong
authors.affiliation: The Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Murphy
authors.affiliation: The Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA.
authors.forename: Clarence J
authors.initials: CJ
authors.lastname: Peters
authors.affiliation: The Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: LeDuc
authors.affiliation: Sabin Vaccine Institute, Washington, DC, USA.
authors.forename: Phillip K
authors.initials: PK
authors.lastname: Russell
authors.affiliation: Medical Department Unit, Médecins sans Frontières, Brussels, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Van Herp
authors.affiliation: Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Kapetshi
authors.affiliation: Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.
authors.forename: Jean-Jacques T
authors.initials: JJ
authors.lastname: Muyembe
authors.affiliation: Ministry of Health, Kinshasa, Democratic Republic of the Congo.
authors.forename: Benoit Kebela
authors.initials: BK
authors.lastname: Ilunga
authors.affiliation: National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada.
authors.forename: James E
authors.initials: JE
authors.lastname: Strong
authors.affiliation: National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada.
authors.forename: Allen
authors.initials: A
authors.lastname: Grolla
authors.affiliation: Medical Department Unit, Médecins sans Frontières, Brussels, Belgium.
authors.forename: Anja
authors.initials: A
authors.lastname: Wolz
authors.affiliation: Ministry of Health and Sanitation, Freetown, Sierra Leone.
authors.forename: Brima
authors.initials: B
authors.lastname: Kargbo
authors.affiliation: Ministry of Health and Sanitation, Freetown, Sierra Leone.
authors.forename: David K
authors.initials: DK
authors.lastname: Kargbo
authors.affiliation: Department of Biological Sciences, Purdue University, Lafayette, Indiana, USA.
authors.forename: David Avram
authors.initials: DA
authors.lastname: Sanders
authors.affiliation: National Laboratory for Zoonotic Diseases and Special Pathogens, Public Health Agency of Canada, Winnipeg, Canada.
authors.forename: Gary P
authors.initials: GP
authors.lastname: Kobinger
mesh_terms: D000354:Africa, Western / Q000453:epidemiology; D000818:Animals; D018562:Disease Transmission, Infectious; D029043:Ebolavirus / Q000302:isolation & purification; D019142:Hemorrhagic Fever, Ebola / Q000635:transmission* / Q000821:virology; D006801:Humans; D015047:Zoonoses / Q000635:transmission / Q000821:virology