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Ebola, Marburg, Lassa fever and Crimean-Congo haemorrhagic fever (CCHF) are not one disease. “Viral hemorrhagic fever” (VHF) is a clinical grouping for several infections caused by different viruses. They vary in animal reservoirs, vectors, routes of transmission, incubation patterns, geography, vaccines and treatments. Symptoms overlap so extensively that bleeding, rash or fever cannot identify the virus; diagnosis requires professional assessment, exposure history and pathogen-specific laboratory testing.
This comparison focuses first on Ebola and Marburg, which are related filovirus diseases, then contrasts Lassa fever and CCHF. Yellow fever is included as a mosquito-borne, vaccine-preventable VHF example. It is an educational guide, not a way to diagnose yourself.
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What “viral hemorrhagic fever” means
VHF describes a group of viral illnesses that can damage blood vessels, cause fever and, in severe cases, lead to bleeding, shock or organ failure. The label does not imply a shared transmission route or a single treatment. Ebola disease, Marburg virus disease, Lassa fever, CCHF, South American hemorrhagic fevers, Rift Valley fever and yellow fever are examples covered by international and US public-health guidance.
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Clinical appearance is an unreliable classifier. Early fever, severe headache, muscle aches, weakness, vomiting, diarrhea and abdominal pain can resemble malaria, typhoid, influenza or other infections. Bleeding is not universal, and when it occurs it may appear late. A person cannot determine the pathogen from one symptom or from the fact that a fever is high.
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Incubation periods overlap. The World Health Organization (WHO) gives 2–21 days for Ebola, Marburg and Lassa fever. CCHF varies according to whether infection followed a tick bite, contact with infected animal tissue or contact with an infected person. Therefore, counting days since an exposure is useful information for a clinician but not a self-diagnosis test.
Ebola and Marburg: related filoviruses, different diseases
Ebola disease
Ebola disease is caused by orthoebolaviruses. Ebola virus, Sudan virus and Bundibugyo virus have caused large outbreaks. A first human infection can follow contact with infected animal tissue. Once symptoms begin, person-to-person transmission occurs through direct contact with infected body fluids or objects contaminated with those fluids. The virus is not spread like a routine respiratory infection through simply sharing air or being near someone.
Illness can begin abruptly with fever, fatigue, muscle pain, headache and sore throat, followed by vomiting, diarrhea, rash, impaired kidney or liver function and, in severe cases, bleeding or shock. Bleeding is less frequent than popular images suggest and is not required for Ebola disease.
WHO reported an average case-fatality rate of about 50% across Ebola disease outbreaks, with past outbreaks ranging from 25% to 90%. Those figures describe groups of patients over different outbreaks and care conditions; they are not a prediction for an individual or a current outbreak.
Marburg virus disease
Marburg virus disease is caused by Marburg virus or Ravn virus. Initial human infections have been linked to prolonged exposure in mines or caves inhabited by fruit bats. Subsequent spread occurs through direct contact with infected body fluids and contaminated materials, including in healthcare or caregiving settings.
Marburg often has abrupt onset with high fever, severe headache, muscle pain, profound weakness, diarrhea, abdominal pain, nausea, vomiting and a rapidly worsening clinical course. Rash and bleeding can occur, but visible hemorrhage is not a reliable early sign. The incubation period is 2–21 days.
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WHO reports an average case-fatality rate of about 50%, with historical outbreaks ranging from 24% to 88%. The range reflects different outbreaks, pathogens, access to care and case definitions, so it should not be directly compared with Ebola as though both figures came from one standardized study.
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| Feature | Ebola disease | Marburg virus disease |
|---|---|---|
| Virus group | Orthoebolaviruses, including Ebola, Sudan and Bundibugyo viruses | Marburg virus or Ravn virus |
| Typical introduction to humans | Contact with infected animal tissue is a possible source | Prolonged exposure to mines or caves inhabited by fruit bats is a recognized source |
| Human transmission | Direct contact with body fluids or contaminated materials after illness begins | Direct contact with body fluids or contaminated materials after illness begins |
| Incubation | 2–21 days | 2–21 days |
| Approved disease-specific options | Approved vaccines and therapeutics for Ebola virus disease; these do not apply to Sudan or Bundibugyo disease | WHO reports no approved vaccine or antiviral treatment |
Both diseases require rapid specialist evaluation and rigorous infection prevention. They are clinically similar enough that even an experienced clinician cannot reliably distinguish them without laboratory testing.
How Lassa fever differs
Lassa fever is caused by Lassa virus and is mainly a rodent-associated infection. People can be exposed to urine, feces or other materials contaminated by infected rodents. Human-to-human transmission occurs less often and is primarily described in healthcare settings through body fluids or contaminated medical equipment.
Compared with the often abrupt presentation of Ebola and Marburg, Lassa fever commonly has a more gradual onset. Fever, weakness, headache, sore throat, chest or abdominal pain, vomiting and diarrhea may develop over days. Severe disease can involve facial swelling, bleeding, low blood pressure, breathing problems or neurologic complications. Hearing loss may persist after recovery.
WHO reports that approximately 15% of hospitalized Lassa fever patients die. This denominator is hospitalized patients, not everyone infected; many infections are mild or never diagnosed. Up to 25% of survivors have been reported to experience sudden hearing loss.
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How CCHF differs
Crimean-Congo haemorrhagic fever is caused by CCHF virus. Its main transmission pattern is linked to ticks and livestock rather than the fruit-bat exposure emphasized for Marburg or the rodent exposure associated with Lassa. People may become infected through a tick bite, crushing or handling infected ticks, contact with blood or tissues from infected livestock, or contact with blood and other body fluids from an infected person.
CDC describes CCHF as occurring across parts of Eastern and Southern Europe, the Mediterranean, northwestern China, Central Asia, Africa, the Middle East and the Indian subcontinent. WHO summarizes endemic areas more broadly as Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north. These are broad geographic patterns, not a diagnosis or proof that every location currently has an outbreak.
Symptoms can start suddenly with fever, severe headache, dizziness, neck and back pain, muscle aches, joint pain, abdominal pain, vomiting and diarrhea. Red eyes, facial flushing, a rash and mood changes may occur. In severe illness, liver, kidney and lung failure can develop quickly, with bleeding possible later.
WHO gives a case-fatality estimate of 10%–40% in its overview and up to 40% in its key facts. CDC separately says up to 50% of hospitalized patients die. These denominators and settings differ, so the figures should not be merged into one universal rate.
There is no approved specific treatment. Early supportive care is central, and WHO says the efficacy of ribavirin remains uncertain. For people in areas where CCHF occurs, CDC recommends preventing tick bites with DEET-containing repellent and using gloves and protective clothing when handling animals. Those measures are not general prevention for Ebola, Marburg, Lassa or yellow fever.
Yellow fever: a mosquito-borne VHF with a vaccine
Yellow fever is caused by yellow fever virus and spreads through the bites of infected mosquitoes. That vector-borne route is fundamentally different from the body-fluid transmission emphasized for Ebola and Marburg, the rodent route of Lassa, and the tick and livestock routes of CCHF.
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WHO says one dose of a safe, affordable yellow-fever vaccine provides lifelong protection for most people. Vaccination recommendations depend on country, travel itinerary, age, pregnancy, immune status and other medical factors, so travelers should consult an official travel-health service. Treatment remains primarily supportive; there is no routine antiviral cure.
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Transmission routes compared
| Disease | Main reservoir, vector or source highlighted by health agencies | Important human exposure |
|---|---|---|
| Ebola | Infected wild animals can introduce infection | Direct contact with infected body fluids or contaminated objects |
| Marburg | Fruit bats in mines and caves | Direct contact with infected body fluids or contaminated objects |
| Lassa fever | Infected rodents | Rodent-contaminated materials; less commonly body fluids or contaminated equipment in healthcare |
| CCHF | Ticks and infected livestock | Tick bites, animal blood or tissue, and infected human body fluids |
| Yellow fever | Infected mosquitoes | Mosquito bites |
For Ebola specifically, CDC states: “Ebola does NOT spread the same way as respiratory viruses like flu and COVID. You cannot get it from being near someone.” That statement addresses casual proximity; it does not remove the need for precautions around body fluids, contaminated materials or healthcare procedures.
Symptoms, severity and fatality figures
Fever, fatigue, aches, headache, vomiting and diarrhea occur across several VHFs. Rash, sore throat, abdominal pain, low blood pressure and organ dysfunction can also overlap. Bleeding may occur in severe disease but is neither universal nor necessarily early.
| Disease | Statistic reported by the named source | How to interpret it |
|---|---|---|
| Ebola | About 50% average case-fatality; historical range 25%–90% (WHO, 2025) | Across outbreaks, not an individual prognosis |
| Marburg | About 50% average case-fatality; historical range 24%–88% (WHO, 2025) | Across outbreaks with differing care and denominators |
| Lassa | About 15% mortality among hospitalized patients (WHO) | Not the fatality rate for all infections |
| CCHF | 10%–40% in WHO overview; up to 40% in WHO key facts; up to 50% of hospitalized patients in CDC overview | Estimates use different populations and should not be combined |
Fatality statistics are useful for public-health planning but do not tell a person which infection they have. Access to fluids, oxygen, monitoring, treatment of complications and timely referral can substantially affect outcomes.
Vaccines, medicines and supportive care
What is available
- Ebola virus disease has approved vaccines and therapeutics. Those approvals do not extend automatically to Sudan virus disease or Bundibugyo virus disease.
- Marburg virus disease has no vaccine or antiviral treatment approved according to WHO.
- Lassa fever has no licensed vaccine or approved antiviral; ribavirin use has uncertain efficacy and dosing.
- CCHF has no approved specific treatment; WHO also describes ribavirin efficacy as uncertain.
- Yellow fever has a vaccine that WHO says provides lifelong protection after one dose for most people.
Why supportive care matters
Supportive treatment can include carefully managed fluids and electrolytes, oxygen and blood-pressure support, treatment of secondary infections or complications, nutrition, kidney support and close monitoring. The exact plan must be set by trained clinicians because excessive or inadequate fluids, invasive procedures and unprotected contact with body fluids can all create danger.
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How diagnosis works
Clinicians begin with the illness pattern and a detailed exposure and travel history: contact with a sick person, animal blood or tissue, rodents, ticks, mines or caves, mosquitoes, healthcare equipment and the timing of each event. They also consider malaria, typhoid and other common causes of fever.
Confirmation requires appropriate laboratory testing, such as reverse-transcription polymerase chain reaction (RT-PCR) or other pathogen-specific assays. Non-inactivated specimens can pose an extreme biohazard risk and must be collected, packaged, transported and tested under specialized procedures.
In US healthcare settings, CDC guidance calls for VHF-specific infection-control measures, including appropriate personal protective equipment. A presumptive negative result alone may not release a patient from special-pathogen isolation; confirmatory reference testing may be needed. Those recommendations are for US clinical settings and should not be treated as a universal protocol for every country.
What to do after a possible exposure
- Seek urgent professional advice. Contact local emergency services or public-health authorities and tell them about symptoms, travel, animal or tick contact, healthcare exposure and the date of each event.
- Follow instructions before traveling to a clinic. A public-health team may coordinate transport and alert the receiving facility so staff can prepare safely.
- Do not attempt home testing or treatment. Do not start ribavirin or another antiviral without a specialist prescription, and do not improvise a PPE or decontamination procedure.
- Avoid contact with blood and other body fluids. Do not handle contaminated clothing, bedding, needles or medical waste unless trained responders instruct you.
- Do not infer safety from one negative test. Clinicians decide whether repeat or reference testing and continued precautions are necessary.
People without a credible exposure should not diagnose themselves from a fever or internet symptom list. If you are ill, contact a qualified clinician and describe your travel and exposure history accurately.
Quick decision framework
- Body-fluid exposure after a person became ill: Ebola or Marburg are among the conditions specialists may consider, but laboratory testing is required.
- Rodent-contaminated home or healthcare exposure: Lassa fever may be relevant in an endemic setting.
- Tick bite or livestock blood exposure: CCHF becomes a concern in an area where it occurs.
- Mosquito exposure in a yellow-fever risk area: Yellow fever and other mosquito-borne illnesses need evaluation; vaccination status matters.
- No compatible exposure: Common infections remain more likely, but persistent or severe illness still needs medical care.
This framework helps a clinician ask the right questions; it cannot identify a virus or determine whether someone is contagious.
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