Ebola virus disease in the modern era: pathogenesis, therapeutic advances, vaccine strategies, and global health preparedness.

Ebola virus disease (EVD) remains one of the most severe and complex viral hemorrhagic fevers confronting global public health systems. Since its first recognized emergence in 1976, recurrent outbreaks caused primarily by Zaire ebolavirus have demonstrated the extraordinary epidemic potential of filoviruses, particularly in regions with fragile healthcare infrastructure. The unprecedented West African epidemic of 2013-2016 fundamentally altered scientific understanding of Ebola virus transmission, pathogenesis, clinical progression, and outbreak management. Subsequent outbreaks in the Democratic Republic of Congo and Uganda have further emphasized the persistent risk posed by Ebola virus disease despite advances in diagnostics, therapeutics, and vaccination strategies. Ebola virus infection is characterized by extensive immune dysregulation, aberrant inflammatory responses, endothelial dysfunction, coagulopathy, and progressive multiorgan injury. Recent studies have significantly expanded understanding of viral persistence, post-Ebola syndrome, host immune responses, and mechanisms of viral immune evasion. Parallel developments in molecular diagnostics, genomic surveillance, monoclonal antibody therapy, and recombinant vaccine platforms have substantially improved survival outcomes and epidemic control measures. Although India has not experienced endemic Ebola outbreaks, globalization and increasing international mobility have heightened the possibility of imported infections, necessitating robust preparedness frameworks. Following the West African epidemic, India strengthened airport surveillance, laboratory biosafety capacity, integrated disease surveillance systems, and emergency outbreak-response protocols. However, substantial challenges remain regarding rapid diagnostics, healthcare infrastructure, biosafety training, and public awareness. This review critically examines current advances in Ebola virus epidemiology, molecular biology, pathogenesis, clinical manifestations, diagnostics, therapeutics, vaccine development, and public health preparedness, with particular emphasis on implications for India and future global health security.