Post-Ebola virus syndrome

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Post-Ebola virus syndrome
Other names: Post Ebola syndrome
Ebola virus particles (blue) attacking a cell (yellow)
SpecialtyInfectious disease
SymptomsChest pain, fatigue, hearing loss[1]
CausesEVD
Diagnostic methodNeurological observation[2]

Post-Ebola virus syndrome, also known as post-Ebola syndrome, is a post-viral syndrome that may affect those who have recovered Ebola.[3] Symptoms may include joint and muscle pain, eye problems, including blindness, and various neurological problems. Sometimes symptoms are so severe that the person is unable to work.[4] Although similar symptoms have been reported among those who have recovered following prior outbreaks, the term only came into use in 2014.[5]

Signs and symptoms

Researchers have been aware of a group of symptoms that frequently followed Ebola virus disease for 20 years, but it became more widely reported with the large number of survivors of the Ebola virus epidemic in West Africa in 2014.[3][6][7][8][2]

Post Ebola syndrome may manifest as joint pain, muscle pain, chest pain, tiredness, hearing loss, hair loss, cessation of menstruation, and poor long term health. Some survivors report neurological issues including memory problems and anxiety attacks. Vision loss is also frequent, along with eye pain, inflammation, and blurred vision.[9] Two papers in 2015 reported symptoms including lethargy, joint pains, hair loss, and vision loss, frequently to the point of near blindness, and uveitis.[10][11]

Cause

The cause is having been infected by the Ebola virus disease.[1]

Mechanism

Although, there is some progress, further research is required to provide more answers about post-Ebola syndrome.[12]

Studies from previous outbreaks reveal that the virus is able to survive for months after recovery in some parts of the body such as the eyes and testes, where the immune system cannot reach. It is not known if the neurologic symptoms seen in survivors are a direct result of the virus or, instead, triggered by the immune response to the infection. It is known that Ebola can trigger a cytokine storm that can cause bleeding, including in the brain, which may explain some neurological symptoms.[13]

Viral persistence

Spermatozoa

Ebola virus was identified in almost 3 out of 4 seminal fluid samples (18 survivors) almost 4 months after initial infection, with the last positive samples being more than 6 months (203 days) after infection had occurred.[14] Another aspect of survivors of the Ebola virus, is that it could become sexually transmitted, as the virus is present in semen nine months after the individuals are declared free of Ebola.[15] A 2017 study found the virus in the semen of some men after more than two years following the recovery from the acute infection[16] and in one case, Ebola viral RNA was identified up to 40 months after illness.[17]

At the start of 2021 an outbreak of EVD that caused 18 cases and 9 deaths in Guinea is thought to be due to a West Africa Ebola outbreak survivor. This individual apparently infected a woman more than 5 years after he himself had incurred the infection[18]

Diagnosis

In terms of diagnosis, the individual may show sensitivity to light or eye redness when ocular problems are suspected. Neurologically the individual's coordination, gait and frontal release signs should be observed.[2]

Management

Management depends on the symptoms, for example, if the individual has muscular-skeletal pain then paracetamol (acetaminophen) may be used. If there are eye problems, then prednisone and cyclopentolate may be given.[2]

History

The following list indicates those Ebola outbreaks or epidemics that have been major (the Ebola survivors for example in the West Africa Ebola virus outbreak were about 16,000 and the Kivu Ebola epidemic resulted in about 1,200 survivors), this is not to say other Ebola outbreaks have not occurred, they simply are not listed here and have been minor

Date Country Virus Human cases Human deaths Case fatality rate/Percent survived Description
Jun–Nov 1976  Sudan SUDV 284 151 53%/47% Occurred in Nzara (the source town), Maridi, Tumbura, and Juba (cities in present-day South Sudan). The index cases were workers in a cotton factory. The disease was spread by close contact with an acute case, usually from patients to their nurses. Many medical care personnel were infected.[19]
Aug 1976  Zaire EBOV 318 280 88%/12% Occurred in Yambuku and surrounding areas in what was then Zaire (present-day Democratic Republic of the Congo DRC). It spread through personal contact and by use of contaminated needles and syringes in hospitals and clinics.[20]
Aug–Sep 1979  Sudan SUDV 34 22 65%/35% Occurred in Nzara and Maridi. This was a recurrent outbreak at the same site as the 1976 Sudan epidemic.[21]
Dec 1994–Feb 1995  Gabon EBOV 52 31 60%/40% Occurred in Makokou and gold-mining camps deep in the rainforest along the Ivindo River. Until 1995, the outbreak was incorrectly classified as yellow fever.[22]
May–Jul 1995  Zaire EBOV 315 254 81%/19% Occurred in Kikwit and surrounding areas. The outbreak was traced to a patient who worked in a forest adjoining the city. The epidemic spread through families and hospital admissions.[23][24]
Jan–Apr 1996  Gabon EBOV 31 21 68%/32% Occurred in the village of Mayibout 2 and neighboring areas. A chimpanzee found dead in the forest was eaten by villagers hunting for food. Nineteen people involved in the butchery of the animal became ill, and other cases occurred in their family members.[22]
Jul 1996–Mar 1997  Gabon EBOV 60 45 75%/25% Occurred in the Booué area with transport of patients to Libreville. The index case-patient was a hunter who lived in a forest timber camp. The disease was spread by close contact with infected persons. A dead chimpanzee found in the forest at the time was determined to be infected.[22]
Oct 2000–Jan 2001  Uganda SUDV 425 224 53%/47% Occurred in the Gulu, Masindi, and Mbarara districts of Uganda. The three greatest risks associated with Sudan virus infection were attending funerals of case-patients, having contact with case-patients in one's family, and providing medical care to case-patients without using adequate personal protective measures.[25] Victims included Matthew Lukwiya.
Oct 2001–Jul 2002  Gabon EBOV 65 53 82%/18% Occurred on both sides of the border between Gabon and the Republic of the Congo.
Oct 2001–Jul 2002 ROC EBOV 59 44 75%/25% Occurred on both sides of the border between Gabon and the Republic of the Congo (RC). This outbreak included the first reported occurrence of Ebola virus disease in the RC.[26]
Dec 2002–Apr 2003 ROC EBOV 143 128 90%/10% Occurred in the districts of Mbomo and Kelle in the Cuvette-Ouest Department.[27]
Nov–Dec 2003 ROC EBOV 35 29 83%/17% Occurred in Mbomo and Mbandza villages, located in Mbomo District in the Cuvette-Ouest Department.[28]
Apr–Jun 2004  Sudan SUDV 17 7 41%/59% Occurred in Yambio county in Western Equatoria of southern Sudan (present-day South Sudan). This outbreak was concurrent with an outbreak of measles in the same area, and several suspected EVD cases were reclassified later as measles cases.[29]
Apr-May 2005 ROC EBOV 12 10 83%/17% Occurred in the Etoumbi district of Cuvette Ouest Department of the Republic of the Congo [30]
Aug–Nov 2007 DRC EBOV 264 187 71%/29%
Dec 2007–Jan 2008  Uganda BDBV 149 37 25%/75% Occurred in the Bundibugyo District in western Uganda. This was the first identification of the Bundibugyo virus (BDBV).[31]
Dec 2008–Feb 2009 DRC EBOV 32 14 45%/55% Occurred in the Mweka and Luebo health zones of the Kasaï-Occidental province.[32]
Jun–Aug 2012  Uganda SUDV 24 17 71%/29% Occurred in the Kibaale District.[33]
Jun–Nov 2012 DRC BDBV 57 29 51%/49% Occurred in the Orientale Province.[34]
Dec 2013–Jan 2016 Widespread:
Template:Country data Liberia 
Template:Country data Sierra Leone 
Template:Country data Guinea 
Limited and local:
 Nigeria
 Mali
 United States
 Senegal
 Spain
 United Kingdom
 Italy
EBOV 28,616 11,310 70–71% (general)[35][36][37]

However, the general estimated case fatality rate (70.8 percent) for this epidemic differs from the ratio of the number of deaths divided by that of cases due to the estimation method used. Current infections have not run their course, and the estimate may be poor if reporting is biased towards severe cases.
57–59% (among hospitalized patients)[38]

This was the most severe Ebola outbreak in recorded history in regards to both the number of human cases and fatalities. It began in Guéckédou, Guinea, in December 2013 and spread abroad.[39][40] Flare-ups of the disease continued into 2016,[41] and the outbreak was declared over on 9 June 2016.
Aug–Nov 2014 DRC EBOV 66[42] 49[42] 74%/26% Occurred in Équateur province. Outbreak detected 24 August and, as of 28 October 2014, the WHO said that twenty days had passed since the last reported case was discharged and no new contacts were being followed.[42][43] Declared over on 15 November 2014.[44]
May–Jul 2018 DRC EBOV 54 33 61%/39%

On 8 May 2018, the government of the Democratic Republic of the Congo reported two confirmed cases of Ebola infection in the northwestern town of Bikoro.[45] On 17 May, a case was confirmed in the city of Mbandaka.[46] Health authorities were planning to ring vaccinate with rVSV-ZEBOV, a recently developed experimental Ebola vaccine, to contain the outbreak.[46][47] The outbreak was ongoing as of 24 June 2018, in 2014 a different area of Equateur province was affected[48][49] On 24 July 2018 the outbreak was declared over.[50][51][52][53]

Aug 2018–Jun 2020 Widespread:
DRC
Limited and local:
 Uganda
EBOV 3,470[54][55] 2,280[54][55] 66%/34%

On 1 August 2018, the Democratic Republic of the Congo Ministry of Health declared an outbreak when 4 individuals tested positive for the Ebola virus.[56][57][58][59] On 11 June 2019, the WHO confirmed that a five-year-old boy in Uganda died after being diagnosed with Ebola.[60][61] On 25 June 2020, the second biggest EVD outbreak ever was declared over.[62]

May 2020–Nov 2020 DRC EBOV 130 55 42%/58% On 31 May 2020, the DRC Health Minister Eteni Longondo announced an additional Ebola outbreak, separate to the ongoing Kivu Ebola epidemic. The outbreak originated in Équateur province (which was also the location of the 2018 Équateur province Ebola outbreak).[63][64][65] By 17 October 2020, the case count was 128 with 53 fatalities.[66]

By 18 November 2020, the World Health Organization and the Congolese government had not received reports of any cases of Ebola in Équateur province or all of the DRC for 42 days.[67] When the outbreak was declared over, there were 130 reported cases and 55 reported fatalities due to the virus.[68]

Feb–May 2021 DRC EBOV 12 6 50%/50% On 6 February 2021, an outbreak was declared in Butembo in the North Kivu province by the Ministry of Public Health of the Democratic Republic of the Congo.[1] By 3 May 2021, the outbreak was declared over.[69]
Feb–Jun 2021 Template:Country data Guinea  EBOV 23 12 52%/48% First Ebola cases and deaths in the country since 2016.[70] The first cases were confirmed on 14 February 2021, and by 9 April 2021, there were 23 reported cases of the virus, with 12 fatalities and 9 recoveries.[71] Scientists concluded that the likely source of the outbreak was a man who had survived the 2013-2016 West African epidemic but had unknowingly harbored the Ebola virus in his body, eventually transmitting it to somebody in his community, although the first known case of this current outbreak was a female nurse who had died on 28 January 2021.[72] The outbreak was declared over on 19 June 2021.[73]
Oct–Dec 2021 DRC EBOV 11 9 82%/18% On 8 October 2021, the Ministry of Public Health for the Democratic Republic of the Congo reported a new laboratory confirmed case of Ebola virus disease, ten more related cases were later confirmed.[74] On 16 December the outbreak was declared over.[75]

Research

African continent-Comparison of predictions for zoonotic niche of Ebola virus

Researchers from the National Institute of Neurological Disorders and Stroke (NINDS) and Liberian research partners are doing a 5-year follow-up study of 1500 Ebola survivors in Liberia. Survivors will be evaluated every 6 months; as of October 2017, two follow-ups have been performed. Researchers will track relapses and viral persistence, characterize sequelae in various bodily systems, and do clinical studies on pharmacologic interventions and vaccines.[76]

PREVAIL III (Partnership for Research on Ebola Vaccines in Liberia III), a study of survivors and their contacts, a collaboration between NIAID and Liberia, was planned in late 2014.[77]

Early results described abdominal, chest, neurologic, musculoskeletal, and ocular[78] challenges faced by survivors.[17]

PREVAIL IV examined if a medication, GS-5734, could help men with persistent Ebola virus RNA in semen to eliminate it,[79] and thereby reduce the potential risk for sexual transmission.

PREVAIL VII examined if survivors of Ebola virus disease had evidence of Ebola virus RNA in aqueous humor and outcomes of cataract surgery relative to the local population.[80]

See also

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