title: Ebola Virus Shedding and Transmission: Review of Current Evidence.
abstract: The magnitude of the 2013-2016 Ebola virus disease outbreak in West Africa was unprecedented, with >28 500 reported cases and >11 000 deaths. Understanding the key elements of Ebola virus transmission is necessary to implement adequate infection prevention and control measures to protect healthcare workers and halt transmission in the community.
  
  
  
  We performed an extensive PubMed literature review encompassing the period from discovery of Ebola virus, in 1976, until 1 June 2016 to evaluate the evidence on modes of Ebola virus shedding and transmission.
  
  
  
  Ebola virus has been isolated by cell culture from blood, saliva, urine, aqueous humor, semen, and breast milk from infected or convalescent patients. Ebola virus RNA has been noted in the following body fluids days or months after onset of illness: saliva (22 days), conjunctiva/tears (28 days), stool (29 days), vaginal fluid (33 days), sweat (44 days), urine (64 days), amniotic fluid (38 days), aqueous humor (101 days), cerebrospinal fluid (9 months), breast milk (16 months [preliminary data]), and semen (18 months). Nevertheless, the only documented cases of secondary transmission from recovered patients have been through sexual transmission. We did not find strong evidence supporting respiratory or fomite-associated transmission.
authors.affiliation: Division of Infectious Diseases, Geneva University Hospitals Laboratory of Virology and Swiss Reference Center for Emerging Viral Diseases.
authors.forename: Pauline
authors.initials: P
authors.lastname: Vetter
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of North Carolina-Chapel Hill School of Medicine.
authors.forename: William A
authors.initials: WA
authors.lastname: Fischer
authors.affiliation: Division of Infectious Diseases, Geneva University Hospitals Laboratory of Virology and Swiss Reference Center for Emerging Viral Diseases University of Geneva Medical School, Switzerland.
authors.forename: Manuel
authors.initials: M
authors.lastname: Schibler
authors.affiliation: Department of Infectious Diseases, Royal Free London NHS Foundation Trust, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Jacobs
authors.affiliation: Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Bausch
authors.affiliation: Division of Infectious Diseases, Geneva University Hospitals Laboratory of Virology and Swiss Reference Center for Emerging Viral Diseases University of Geneva Medical School, Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Kaiser
mesh_terms: D000354:Africa, Western / Q000453:epidemiology; D012634:Bodily Secretions / Q000821:virology*; D001826:Body Fluids / Q000821:virology*; D004196:Disease Outbreaks; D029043:Ebolavirus / Q000235:genetics / Q000502:physiology*; D005243:Feces / Q000821:virology; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D006801:Humans; D008297:Male; D017201:Virus Shedding
keywords: Ebola virus; shedding; transmission