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Survivors

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 Ebola

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).[1][9]

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

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.

References

[1] Qureshi AI, Chughtai M, Loua TO, Pe Kolie J, Camara HF, Ishfaq MF, N’Dour CT, Beavogui K. Study of Ebola Virus Disease Survivors in Guinea. Clin Infect Dis. 2015 Oct 1;61(7):1035-42.

[2] Nanyonga M, Saidu J, Ramsay A, Shindo N, Bausch DG. Sequelae of Ebola Virus Disease, Kenema District, Sierra Leone. Clin Infect Dis. 2016 Jan 1;62(1):125-6.

[3] Epstein L, Wong KK, Kallen AJ, Uyeki TM. Post EVD signs and symptoms in U.S. survivors. N Engl J Med. 2015;373:2484-6.

[4] Mohammed A, Sheikh TL, Gidado S, Poggensee G, Nguku P, Olayinka A, Ohuabunwo C, Waziri N, Shuaib F, Adeyemi J, Uzoma O, Ahmed A, Doherty F, Nyanti SB, Nzuki CK, Nasidi A, Oyemakinde A, Oguntimehin O, Abdus-Salam IA, Obiako RO. An evaluation of psychological distress and social support of survivors and contacts of Ebola virus disease infection and their relatives in Lagos, Nigeria: a cross sectional study–2014. BMC Public Health. 2015 Aug 27;15:824.

[5] Clark DV, Kibuuka H, Millard M, Wakabi S, Lukwago L, Taylor A, Eller MA, Eller LA, Michael NL, Honko AN, Olinger GG Jr, Schoepp RJ, Hepburn MJ, Hensley LE, Robb ML. Long-term sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study. Lancet Infect Dis. 2015 Aug;15(8):905-12.

[6] Kibadi K, Mupapa K, Kuvula K, Massamba M, Ndaberey D, Muyembe-Tamfum JJ, Bwaka MA, De Roo A, Colebunders R. Late ophthalmologic manifestations in survivors of the 1995 Ebola virus epidemic in Kikwit, Democratic Republic of the Congo. J Infect Dis. 1999 Feb;179 Suppl 1:S13-4.

[7] Bwaka MA, Bonnet MJ, Calain P, Colebunders R, De Roo A, Guimard Y, Katwiki KR, Kibadi K, Kipasa MA, Kuvula KJ, Mapanda BB, Massamba M, Mupapa KD, Muyembe-Tamfum JJ, Ndaberey E, Peters CJ, Rollin PE, Van den Enden E, Van den Enden E. Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients. J Infect Dis. 1999 Feb;179 Suppl 1:S1-7.

[8] Chancellor JR, Padmanabhan SP, Greenough TC, Sacra R, Ellison RT, Madoff LC, Droms RJ, Hinkle DM,  Asdourian GK, Finberg RW, Stroher U, Uyeki TM, Cerón OM. Uveitis and systemic inflammatory markers in convalescent phase of Ebola virus disease. Emerg Infect Dis. 2016 Feb [date cited]. http://dx.doi.org/10.3201/eid2202.151416

[9] Mahadevan S, Mansaray Y, Marcell L, McKay G, O’Dempsey T, Parris V, Pinto R, Rangel A, Salam AP, Shantha J, Wolfman V, Yeh S, Chan AK, Mishra S. Early clinical sequelae of Ebola virus disease in Sierra Leone: a cross-sectional study. Lancet Infect Dis. 2015 Dec 22. pii: S1473-3099(15)00489-2. doi: 10.1016/S1473-3099(15)00489-2. [Epub ahead of print]

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