Ebola survivors: not out of the woods yet

The recent outbreak of Ebola virus disease in west Africa was unprecedented in scale, with over 28 600 cases and 11 300 deaths.1 Survivors may have a range of continuing health problems, including viral persistence and disease recrudescence. If they present with illness, or for certain interventional procedures, they could put others at risk of infection. Clinicians therefore need to know what action to take, and here we lay out the current evidence and expert advice for England.

Studies of survivors from previous smaller outbreaks, corroborated recently, suggest that post-infection sequelae are not uncommon.2 3 4 5 Fatigue, arthralgia, and ocular complications (including uveitis) are particular problems. The pathogenesis of post-disease complications, and in particular the presence and role of viral persistence, is unknown.

It now seems that earlier prevalence studies underestimated the duration of viral persistence in several immune privileged body sites, such as the testes,6 eye, and central nervous system. A recent small observational study showed persisting Ebola virus genome in the semen of 26% of male survivors up to nine months after disease onset, much longer than the 91 days previously recognised.7 In one case, Ebola virus was detected in aqueous humour …