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Ebola After Recovery

In the wake of the 2014 West African outbreak, the largest outbreak of Ebola Virus Disease (EVD) to date, there are now more EVD survivors than ever before. This large number of survivors provides a chance to better understand how Ebola virus affects people who have recovered, and to advise survivors on how to take care of themselves and their communities.

Recovery from EVD depends on good supportive care and the patient’s immune response. Antibodies to the virus have been detected in some survivors up to 10 years after recovery. Scientists do not know if people who recover from EVD are immune for life or if they may be susceptible to infection from a different species of Ebola virus.

Health Concerns for Survivors of Ebola

In most cases, people who have completely recovered from EVD do not go through a comeback of the illness. However, many survivors suffer from health issues after recovery from Ebola.

The most commonly reported complications are:

  • Tiredness
  • Headaches
  • Muscle and joint pain
  • Eye and vision problems (blurry vision, pain, redness, and light sensitivity)
  • Weight gain
  • Stomach pain or loss of appetite

Other health problems can include memory loss, neck swelling, dry mouth, tightness of the chest, hair loss, hearing problems (ringing in the ears and hearing loss), pain or tingling in the hands and feet, inflammation of the pericardium (tissue around the heart), inflammation of one or both testicles, changes in menstruation, impotence, decreased or lost interest in sex, difficulty falling or remaining asleep, depression, anxiety, and post-traumatic stress disorder (PTSD).

The timing of onset, severity, and duration of complications among EVD survivors are variable.

Care for people who recovered from EVD

A number of medical complications have been reported in people who recovered from Ebola, including mental health issues. Ebola virus may persist in some body fluids, including semen. Ebola survivors need comprehensive support for the medical and psychosocial challenges they face and also to minimize the risk of continued Ebola virus transmission. To address these needs, a dedicated programme can be set up for care for people who recovered from Ebola.

Ebola virus is known to persist in immune-privileged sites in some people who have recovered from Ebola virus disease. These sites include the testicles, the inside of the eye, and the central nervous system. In women who have been infected while pregnant, the virus persists in the placenta, amniotic fluid and fetus. In women who have been infected while breastfeeding, the virus may persist in breast milk.

Relapse-symptomatic illness in someone who has recovered from EVD due to increased replication of the virus in a specific site is a rare event, but has been documented. Reasons for this phenomenon are not yet fully understood.

Studies of viral persistence indicate that in a small percentage of survivors, some body fluids may test positive on reverse transcriptase polymerase chain reaction (RT-PCR) testing for Ebola virus for longer than 9 months.

More surveillance data and research are needed on the risks of sexual transmission, and particularly on the prevalence of viable and transmissible virus in semen over time. In the interim, and based on present evidence,

WHO recommends that:

  • All Ebola survivors and their sexual partners should receive counselling to ensure safer sexual practices until their semen has twice tested negative. Survivors should be provided with condoms.
  • Male Ebola survivors should be offered semen testing at 3 months after onset of disease, and then, for those who test positive, every month thereafter until their semen tests negative for virus twice by RT-PCR, with an interval of one week between tests.
  • Ebola survivors and their sexual partners should either:
    • abstain from all types of sex, or
    • observe safer sex through correct and consistent condom use until their semen has twice tested negative.
  • Having tested negative, survivors can safely resume normal sexual practices without fear of Ebola virus transmission.
  • Based on further analysis of ongoing research and consideration by the WHO Advisory Group on the Ebola Virus Disease Response, WHO recommends that male survivors of Ebola virus disease practice safe sex and hygiene for 12 months from onset of symptoms or until their semen tests negative twice for Ebola virus.
  • Until such time as their semen has twice tested negative for Ebola, survivors should practice good hand and personal hygiene by immediately and thoroughly washing with soap and water after any physical contact with semen, including after masturbation. During this period, used condoms should be handled safely, and safely disposed of, so as to prevent contact with seminal fluids.
  • All survivors, their partners and families should be shown respect, dignity and compassion.

Persistence of Ebola Virus

There is no known risk of getting EVD through casual contact with an Ebola survivor. However, the virus can remain in areas of the body that are immunologically privileged sites for several months after acute infection. These are sites where viruses and pathogens, like the Ebola virus, are shielded from the survivor’s immune system, even after being cleared elsewhere in the body. These areas include the testes, interior of the eyes, and central nervous system, particularly the cerebrospinal fluid. Whether the virus is present in these body parts and for how long varies by survivor.

Scientists continue to study the long-term effects of Ebola virus infection, including viral persistence, to better understand how to provide treatment and care to EVD survivors.

 

 

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References:

https://www.cdc.gov/vhf/ebola/treatment/survivors.html

https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease

 

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