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Content current as of October 12, 2026. AI-assisted draft; not yet reviewed by a licensed pharmacist. Current CDC schedules: immunization schedules.
- The disease and why it matters
- Video and figures
- Get CE credit
- Products available
- Who should get it
- Dosing and schedule, including catch-up
- Administration
- Storage and handling
- Contraindications and precautions
- Safety and adverse events
- Special populations
- Counseling pearls for the pharmacy counter
- Common patient questions
- References
The disease and why it matters
Ebola virus disease is a rare disease that most commonly affects people and nonhuman primates; outbreaks occur mostly on the African continent, the virus spreads through direct contact with the blood, body fluids and tissues of infected or deceased people or animals, and health care workers and family and friends in close contact with sick people are at highest risk, with little risk for travelers or the general public who have not cared for or been in close contact with an infected person. [1]
A person can spread Ebola virus to others only after developing symptoms, which may appear 2 to 21 days after contact with the virus; early symptoms include fever, aches, pain, sore throat and fatigue and progress to diarrhea, vomiting and unexplained hemorrhaging and bleeding; Ebola virus disease is often deadly, and survivors may have lasting health problems. [1]
Video and figures
Video
Get CE credit
No free accredited CE activities for this topic have been confirmed yet.
RxEvidence is not an accredited continuing education provider and does not award CE credit. These are links to activities offered by others.
Products available
ERVEBO (Merck) is approved by FDA for the prevention of disease caused by Ebola virus (Zaire ebolavirus) in individuals 12 months of age and older as a single dose; it is a replication-competent, live, attenuated recombinant vesicular stomatitis virus (VSV) vaccine containing a gene from the Ebola virus, so it cannot cause Ebola disease. [2]
| Item | Statement |
|---|---|
| Manufacturer (FDA page) | Merck Sharp & Dohme LLC [3] |
| Indication | Prevention of disease caused by Zaire ebolavirus in individuals 12 months of age and older [4] |
| Limitations of use | Duration of protection unknown; does not protect against other species of Ebolavirus or Marburgvirus; effectiveness when given concurrently with antiviral medication, immune globulin and/or blood or plasma transfusions is unknown [4] |
| Dose and route | A single 1 mL dose intramuscularly; supplied as a single-dose vial [4] |
The FDA ERVEBO page is marked content current as of 04/21/2026 and the label is revised 4/2026; its highlights list a recent major change to section 5.3 (immunocompromised individuals). [3] [4]
Who should get it
CDC (Ebola vaccine VIS, January 31, 2025)
As of January 31, 2025
CDC recommends Ebola vaccine for adults 18 years and older at high risk for potential exposure to Ebola virus because they are responding or planning to respond to an outbreak of Ebola virus disease; laboratorians or other staff working at biosafety-level 4 or Laboratory Response Network facilities in the United States that might handle specimens that might contain live Ebola virus; or health care personnel working at federally or state designated special pathogen treatment centers in the United States involved or expected to be involved in the care and transport of patients with suspected or confirmed Ebola virus disease. [1]
FDA label (ERVEBO, 4/2026)
As of April 21, 2026
The label is indicated for individuals 12 months of age and older (broader than CDC's recommendation for adults 18 years and older at occupational risk), and its safety and effectiveness have been established in individuals 12 months through 17 years of age. [4]
CDC says ERVEBO is only effective against one of the viruses that causes Ebola disease; vaccinated laboratory staff and healthcare workers at occupational risk must continue to follow biosafety and infection prevention and control procedures, and vaccinated outbreak responders must wear recommended personal protective equipment. [2]
Clinical efficacy was supported by a randomized cluster vaccination study during the 2014 to 2016 outbreak in Guinea in which 3,775 people in close contact with someone diagnosed with Ebola disease and their close contacts received immediate vaccination; no one vaccinated immediately developed Ebola disease 10 or more days after vaccination. [2]
Dosing and schedule, including catch-up
ERVEBO is given as a single 1 mL intramuscular dose; the duration of protection conferred is unknown. [4]
Administration
- Thaw the vial at room temperature until no visible ice is present (do not thaw in a refrigerator), gently invert it several times, and inspect: the vaccine is a colorless to slightly brownish-yellow liquid with no visible particulates; if particulates or discoloration are present, discard the vial. [4]
- Use the vaccine immediately after thawing; if not used immediately it may be stored for 4 hours at room temperature (up to 25 °C) protected from light and must not be refrozen; withdraw the 1 mL dose with a sterile needle and syringe, administer intramuscularly and discard the unused portion. [4]
- Monitor vaccinated individuals for signs and symptoms of hypersensitivity reactions; appropriate medical treatment and supervision must be available in case of an anaphylactic event; healthcare providers administering the vaccine should exercise appropriate infection control practices because vaccine virus RNA has been detected after vaccination. [4] [2]
Storage and handling
- Store frozen at −80 to −60 °C (−112 to −76 °F) in the original carton to protect from light; thawed vials not used immediately may be stored refrigerated at 2 to 8 °C for a total time of no more than 2 weeks and at room temperature (up to 25 °C) for no more than 4 hours; do not re-freeze thawed vaccine. [4]
- The vaccine is supplied in cartons of ten 1 mL single-dose vials. [4]
Contraindications and precautions
| Source | Statement |
|---|---|
| ERVEBO label | Do not administer to individuals with a history of a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine, including rice protein. [4] |
| CDC (contraindications) | Known severe allergy (for example anaphylaxis) to any component, including rice protein; clinical evidence of a systemic infection or other acute intercurrent illness at the scheduled time of vaccination (for example oral temperature above 38 °C), in which case vaccination may be rescheduled. [2] |
| Immunocompromised | The effectiveness may be diminished and the risk of vaccinating immunocompromised individuals with a live virus vaccine should be weighed against the risk of disease; safety and effectiveness have not been assessed in immunocompromised people other than 201 people living with HIV on antiretroviral therapy with viral load below 40 copies/mL and CD4 count of 200 cells/mm3 or more. [4] |
ERVEBO is produced with rice-derived recombinant human serum albumin, so precautions should be taken with people allergic to rice; the label also says vaccinated individuals should continue to adhere to infection control practices because vaccination may not protect all individuals. [2] [4]
Safety and adverse events
Label adverse reactions in adults 18 years and older: injection-site pain (70%), headache (55%), feverishness (39%), muscle pain (33%), somnolence/reduced activity/fatigue (26%), joint pain (19%), chills (17%), injection-site swelling (17%), decreased appetite (15%), abdominal pain (13%), injection-site redness (12%), nausea (10%), arthritis (5%), vomiting (4%), rash (4%), abnormal sweating (3%) and mouth ulceration (2%). [4]
In children 12 months through 2 years the most frequently reported were feverishness (83%), crying (31%), decreased appetite (27%) and injection-site pain (26%); in 3 through 11 years feverishness (65%), headache (50%) and injection-site pain (40%); in 12 through 17 years headache (59%), injection-site pain (52%) and feverishness (48%). [4]
Across 12 studies, of 15,399 people who received the vaccine, three serious adverse events were judged related or possibly related (one febrile reaction, one anaphylactic reaction and one influenza-like illness); among 18,817 participants vaccinated with at least one dose in trials, there were two reports of anaphylaxis. [2] [4]
The VIS says joint pain or swelling can occur after Ebola vaccination (rarely severe and long lasting), arthritis or worsening arthritis can occur most frequently in women and people with a history of arthritis, and certain white blood cell counts can become lower than normal without illness; the vaccine contains a live virus that might be transmitted to others, so vaccinated people should not donate blood for at least 6 weeks, should avoid sharing needles, razors, toothbrushes, utensils and open-mouth kissing for 2 weeks, use effective barrier methods to prevent pregnancy for 2 months, and consider avoiding close contact with high-risk people for up to 6 weeks. [1]
Attenuated VSV vaccine virus RNA has been detected by RT-PCR in urine up to 7 days post-vaccination, in blood and saliva up to 14 days, and in fluid from skin vesicles up to 20 days; transmission through personal contact is theoretically possible. [2]
Laboratory testing: the label has a section on interference with laboratory tests (section 7.1), and CDC says to avoid contact with immunocompromised individuals, pregnant or breastfeeding women, and children younger than 1 year for up to 6 weeks following vaccination. [4] [2]
Special populations
Pregnancy and lactation: pregnancy and lactation are not absolute exclusion criteria, but live attenuated vaccines are generally contraindicated in pregnancy and women of reproductive age should be counseled about potential fetal risks, with the decision individualized based on the benefit and risk of vaccination against the risk of exposure to Ebola virus; the label says no adequate studies in pregnant women exist, and that fetal and neonatal outcomes are universally poor among pregnant women infected with Zaire ebolavirus. [2] [4]
CDC notes that the World Health Organization recommends ERVEBO in pregnant and breastfeeding women in areas experiencing an active outbreak, in the context of rigorous research or through a compassionate use protocol; human data are not available on effects on breast milk, the breastfed child or milk production. [2]
Older adults: a total of 542 older adults received the vaccine in clinical trials, inadequate to determine whether the immune response differs from younger participants, but FDA approval in adults is inclusive of older adults without an upper age limit; the label says 559 participants 65 years or older received at least one dose. [2] [4]
Counseling pearls for the pharmacy counter
- Ebola vaccine is a live virus vaccine given as a single injection into a muscle; it contains a weakened vesicular stomatitis virus altered to carry a gene from the Ebola virus, so it cannot cause Ebola disease. [1]
- Tell the provider about previous allergic reactions including to rice protein, pregnancy or planned pregnancy, breastfeeding, and a weakened immune system or close contact with someone who has one. [1]
- If a rash develops after vaccination, cover it with a bandage until healed, dispose of used bandages in a sealed plastic bag and wash hands with soap and water; try to avoid exposing livestock to blood or body fluids for at least 6 weeks. [1]
- Vaccination does not replace infection control: ERVEBO may not protect all vaccinated individuals and does not protect against other species. [4]
Common patient questions
Does Ervebo protect a worker against Sudan virus or Marburg virus?
No. The label says ERVEBO does not protect against other species of Ebolavirus or Marburgvirus. [4]
A nurse at a special pathogen treatment center is pregnant. Is vaccination an option?
Pregnancy is not an absolute exclusion criterion but live attenuated vaccines are generally contraindicated in pregnancy; the decision should be individualized based on the benefit and risk of vaccination against the risk of exposure, with counseling on potential fetal risks. [2]
How long can a thawed vial be used?
Use immediately after thawing; if not used immediately a thawed vial can be stored refrigerated for a total of no more than 2 weeks and at room temperature for no more than 4 hours (and never refrozen). [4]
A patient has a rice allergy. What does the label say?
The label contraindicates the vaccine in individuals with a history of a severe allergic reaction (for example anaphylaxis) to any component of the vaccine, including rice protein. [4]
Can a vaccinated person donate blood?
The VIS says not to donate blood for at least 6 weeks after vaccination. [1]
References
- Centers for Disease Control and Prevention. Ebola vaccine: what you need to know. Vaccine Information Statement, January 31, 2025. Accessed October 12, 2026. https://www.cdc.gov/vaccines/hcp/current-vis/ebola.html. Accessed October 12, 2026.
- Centers for Disease Control and Prevention. Ebola vaccine product information (health care providers). Page dated January 30, 2025. Accessed October 12, 2026. https://www.cdc.gov/ebola/hcp/vaccines/index.html. Accessed October 12, 2026.
- U.S. Food and Drug Administration. ERVEBO product page (content current as of 04/21/2026). Accessed October 12, 2026. https://www.fda.gov/vaccines-blood-biologics/ervebo. Accessed October 12, 2026.
- ERVEBO (Ebola Zaire vaccine, live), injectable suspension for intramuscular use: prescribing information, revised 4/2026. Merck Sharp & Dohme LLC. U.S. Food and Drug Administration. Accessed October 12, 2026. https://www.fda.gov/media/133748/download?attachment. Accessed October 12, 2026.
For professional education. Check current labeling and guidance before acting. Not medical advice.
