In the Journals

Ebola survivors face high burden of ongoing health issues

Anthony S. Fauci, MD
Anthony S. Fauci

Ebola virus survivors in Liberia experience a higher prevalence of certain health issues, including neurological sequelae and uveitis, compared with uninfected contacts who share similar environmental exposures, according to research published in The New England Journal of Medicine.

The PREVAIL III cohort study was initiated in June 2015 to determine long-term consequences of Ebola virus disease (EVD). Researchers compared the prevalence of symptoms and abnormal findings among survivors and controls at study entry and during follow-up examinations after 6 and 12 months.

They enrolled 966 Ebola virus survivors as study participants and 2,350 antibody-negative close contacts as controls. Most — 90% — of the survivors were followed for 1 year.

At enrollment, the following six symptoms were reported significantly more by survivors compared with controls, according to the researchers: urinary frequency (14.7% vs. 3.4%), headache (47.6% vs. 35.6%), fatigue (18.4% s. 6.3%), muscle pain (23.1% vs. 10.1%), memory loss (29.2% vs. 4.8%) and joint pain (47.5% vs. 17.5%). The researchers reported that survivors also were more likely to have abnormal abdominal, chest, neurologic and musculoskeletal findings and uveitis when compared with controls.

Ebola survivors 
Survivors of the West African Ebola epidemic face a higher burden of ongoing health issues than people who were not infected but shared similar environmental exposures.
Source: CDC/Rebecca Hall, MPH

The prevalence every condition except uveitis declined during follow-up for both cohorts, the researchers reported. Uveitis increased from rates of 26.4% vs. 12.1% at baseline to 33.3% vs. 15.4% at 1 year for the survivors and controls, respectively, they found. Among survivors, there was a greater incidence of most symptoms, neurologic findings and uveitis compared with controls.

“The collection of symptoms and findings were similar to those reported among those experiencing post-traumatic stress disorder, which is not unexpected, give the traumatic nature of being involved with this epidemic,” Cavan S. Reilly, PhD, a professor of biostatistics at the University of Minnesota School of Public Health and cochair of the PREVAIL III study group writing committee, told Infectious Disease News.

Previous research showed that Ebola virus RNA can persist in semen for up to 2 years. In the current study, Ebola virus RNA was detected in the semen of 30% of a subset of 267 male survivors who provided samples. The maximum time from EVD to detection of Ebola virus RNA was 40 months.

Reilly explained that the length of time of EBOV RNA persisted in semen “varies across individuals for reasons we do not completely understand,” but age seems to be a factor.

“Given this variability, and the intermittent nature of shedding, we cannot say for sure the maximal length of time that Ebola virus RNA may persist in a given male’s genitourinary tract,” he said.

Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said in a news release that PREVAIL “has yielded novel insight regarding the health issues facing some survivors of Ebola virus disease in Liberia and their close contacts.” – by Bruce Thiel

Disclosures: Fauci and Reilly report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Anthony S. Fauci, MD
Anthony S. Fauci

Ebola virus survivors in Liberia experience a higher prevalence of certain health issues, including neurological sequelae and uveitis, compared with uninfected contacts who share similar environmental exposures, according to research published in The New England Journal of Medicine.

The PREVAIL III cohort study was initiated in June 2015 to determine long-term consequences of Ebola virus disease (EVD). Researchers compared the prevalence of symptoms and abnormal findings among survivors and controls at study entry and during follow-up examinations after 6 and 12 months.

They enrolled 966 Ebola virus survivors as study participants and 2,350 antibody-negative close contacts as controls. Most — 90% — of the survivors were followed for 1 year.

At enrollment, the following six symptoms were reported significantly more by survivors compared with controls, according to the researchers: urinary frequency (14.7% vs. 3.4%), headache (47.6% vs. 35.6%), fatigue (18.4% s. 6.3%), muscle pain (23.1% vs. 10.1%), memory loss (29.2% vs. 4.8%) and joint pain (47.5% vs. 17.5%). The researchers reported that survivors also were more likely to have abnormal abdominal, chest, neurologic and musculoskeletal findings and uveitis when compared with controls.

Ebola survivors 
Survivors of the West African Ebola epidemic face a higher burden of ongoing health issues than people who were not infected but shared similar environmental exposures.
Source: CDC/Rebecca Hall, MPH

The prevalence every condition except uveitis declined during follow-up for both cohorts, the researchers reported. Uveitis increased from rates of 26.4% vs. 12.1% at baseline to 33.3% vs. 15.4% at 1 year for the survivors and controls, respectively, they found. Among survivors, there was a greater incidence of most symptoms, neurologic findings and uveitis compared with controls.

“The collection of symptoms and findings were similar to those reported among those experiencing post-traumatic stress disorder, which is not unexpected, give the traumatic nature of being involved with this epidemic,” Cavan S. Reilly, PhD, a professor of biostatistics at the University of Minnesota School of Public Health and cochair of the PREVAIL III study group writing committee, told Infectious Disease News.

Previous research showed that Ebola virus RNA can persist in semen for up to 2 years. In the current study, Ebola virus RNA was detected in the semen of 30% of a subset of 267 male survivors who provided samples. The maximum time from EVD to detection of Ebola virus RNA was 40 months.

Reilly explained that the length of time of EBOV RNA persisted in semen “varies across individuals for reasons we do not completely understand,” but age seems to be a factor.

“Given this variability, and the intermittent nature of shedding, we cannot say for sure the maximal length of time that Ebola virus RNA may persist in a given male’s genitourinary tract,” he said.

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Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said in a news release that PREVAIL “has yielded novel insight regarding the health issues facing some survivors of Ebola virus disease in Liberia and their close contacts.” – by Bruce Thiel

Disclosures: Fauci and Reilly report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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