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Large assessment of Ebola survivors in Guinea paints post-disease picture
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Ebola survivors deal with a litany of post-disease symptoms that include pain, depression and ocular disorders, according to a multidisciplinary analysis of initial data from a large group of survivors in Guinea, the epicenter of the recent West African outbreak.
The ongoing Postebogui cohort study, conducted by an international group of researchers, includes more than 800 survivors of the largest Ebola outbreak in history, including 100 children.
According to the researchers, survivors who experienced a symptom during the acute phase of Ebola virus disease (EVD) were at an increased risk for presenting with the same symptom when they were enrolled in the study, suggesting the symptoms were either persistent or recurring.
“We found a clear association between neurological disorders and ocular symptoms, as well as with musculoskeletal symptoms, delineating the post-EVD sequelae,” they wrote. “Of note, ocular complications were more frequent at enrollment than at discharge, implying that ophthalmological screening should continue long after discharge. Reassuringly, biological assessments showed no inflammatory syndrome or liver cytolysis, and very rare renal injury, which is of interest for patients' long-term prognosis.”
Large number of survivors
The West African Ebola outbreak began in Guéckédou, Guinea, in December 2013 and killed more than 11,300 people, mostly in Guinea, Liberia and Sierra Leone. It left behind scores of survivors — more than 17,000 — leading to flare-ups largely related to the persistence of the virus in survivors, including in semen.
Researchers in the current study reported detecting Ebola in semen up to 548 days after disease onset, confirming its long-term persistence.
“The large number of survivors from this unprecedented outbreak has raised new fundamental questions and medical care issues including long-term clinical complications and their treatment, psychosocial consequences, risk of reactivation of the virus and disease, and the risk of viral reintroduction in the community due to sexual transmission,” the researchers wrote.
However, there also has been some good news recently.
Researchers showed that an experimental Ebola vaccine developed by the Public Health Agency of Canada was 100% effective at preventing the disease during a ring vaccination trial in Guinea, giving the world a way to defend against future outbreaks.
The drug — a recombinant, vesicular stomatitis virus-based vaccine candidate — gives the world a defense against future outbreaks of Ebola, Marie-Paule Kieny, PhD, WHO’s assistant director-general for health systems and innovation, said in a statement when the results were announced.
Study includes 74% of Guinean survivors
Between March 23, 2015, and July 11, 2016, the researchers recruited 74% of all Ebola survivors in Guinea for their study. The cohort included 802 patients aged older than 1 year from four hospitals in rural and urban sections of the country.
To be included in the study, patients must have been cleared of the virus by a blood test prior to being released from an Ebola treatment center (ETC). The median amount of time between ETC discharge and enrollment in the study was 350 days.
According to the researchers, the most frequent symptoms at enrollment were:
- general symptoms (40%);
- musculoskeletal pain (38%);
- headaches (35%);
- abdominal pain (22%);
- ocular disorders (18%); and
- depression (17% of 713 respondents).
Seventy-eight percent of adults had at least one clinical symptom compared with 64% of children. More adults also reported ocular complications (19% to 11%) and musculoskeletal symptoms (43% to 18%) than children, the researchers said.
The study included 158 children — approximately 20% of the cohort — with a median age of 11 years. According to the researchers, although children reported fewer overall clinical symptoms than adults, they commonly experienced psychological distress. Children aged older 8 years reported more fatigue, ocular disorders, joint pain, neurosensory disorders and headache than those aged 1 to 8 years.
While these initial data were collected at inclusion, the researchers said they plan to follow the patients for 24 months and report further findings at a later time.
In a related editorial, Janet T. Scott, PhD, clinical lecturer in pharmacology and infectious disease, and Malcolm G. Semple, PhD, senior lecturer in child health and consultant respiratory pediatrician, both of the University of Liverpool, wrote, “A picture is now emerging of post-EVD sequelae.”
Dominant symptoms such as pain, psychosocial issues and ocular problems appear to be related to the patients’ acute EVD — a connection that may be clarified in further studies, Scott and Semple said.
They suggest that inspiration for improved management strategies for Ebola survivors could come from programs designed for patients with chikungunya or chronic fatigue syndrome, who may suffer from similar conditions.
“After all that EVD survivors have been through,” Scott and Semple wrote, “the final insult appears to be that they might not be in the clear.” – by Gerard Gallagher
References:
Etard JF, et al. Lancet Infect Dis. 2016;doi:10.1016/S1473-3099(16)30516-3.
Scott JT, Semple MG. Lancet Infect Dis. 2016;doi:10.1016/S1473-3099(17)30027-0.
Disclosures: The researchers report no relevant financial disclosures. Scott and Semple report receiving grants from the Wellcome Trust outside of the submitted work.