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Old 02-25-2016, 10:38 PM   #1
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Default Post Ebola Syndrome

In light of what's happening with the nurse, Pauline McCafferkey, these 2 studies, which help to explain what happens to survivors of Ebola, are definitely timely and informative.

h/t CIDRAP

Studies on Ebola survivors show range of complications

Quote:
Two new studies demonstrate some of the long-term problems faced by people who recover from Ebola virus infections, including high rates of neurologic problems and a potential for virus survival in semen for 18 months.

Data from one study, on more than 1,000 survivors in Liberia, were released by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, on Feb 23 at a conference in Boston. It also noted fairly high rates of complications in close contacts of the survivors.

The other study, published yesterday in Emerging Infectious Diseases (EID), involved a much smaller group of recovered Ebola patients in Sierra Leone.

NIAID researchers presented findings of the PREVAIL III study at the Conference on Retroviruses and Opportunistic Infections, according to an NIAID news release. The study included 1,049 survivors of Ebola virus disease (EVD) and 1,034 of their close contacts. The mean age of survivors was 30, and that of contacts was 26.

The scientists found that 68% of EVD survivors said they had neurologic problems, 60% reported eye difficulties, and 53% experienced musculoskeletal problems.

Close contacts also reported neurologic and musculoskeletal problems, but less commonly: 48% and 28%, respectively. Close contacts, however, reported vision problems at about the same rate: 59%. This group was potentially exposed to the virus but did not become infected.

The investigators also noted that 38% of 79 male survivors had Ebola detected in their semen at least once, and a third of the 69 who were tested more than once had intermittent findings (negative results then positive, or vice versa). One recovered EVD patient had Ebola virus detected in his semen after 18 months.

Previous studies have noted Ebola virus up to 9 months after infection, according to the US Centers for Disease Control and Prevention.

Without stating an exact percentage, the NIAID said that most survivors reported being sexually active. Only 4% of 126 close contacts who had sex with an EVD survivor reported regular condom use. This raises concerns about sexual transmission of the virus, but so far no such cases have been detected in the study cohort, the agency said.

The PREVAIL III trial is expected to enroll up to 1,500 EVD survivors and up to 6,000 close contacts, with participants monitored for up to 5 years and study visits every 6 months.

The EID study, meanwhile, found musculoskeletal problems and headaches the most common manifestations in EVD survivors. It involved 44 patients who were treated at a UK military hospital in Freetown, Sierra Leone.

The patients ranged in age from 8 to 70 years, with a median age of 25. Of the 44 patients, 31 (70%) reported musculoskeletal complications, 21 (48%) experienced headaches, and 6 (14%) had eye problems.

The next most common complications were coughing in 5 survivors and chest pain, abdominal pain, and itching, each reported in 4 survivors.

The researchers also noted that survivors who reported headaches had had evidence of higher Ebola viral loads on admission than did those who didn't report a headache (P < 0.03). No clinical factors that the team analyzed corresponded to a higher incidence of musculoskeletal or eye problems.

One of the patients, a 25-year-old man, died 1 month after recovering from EVD. He developed deteriorating respiratory symptoms and fluid buildup around one lung about 3 weeks after being discharged.

The authors conclude, "We can expect some survivors to have long-term clinical needs. The epidemic is waning but the effects of the disease it caused will remain."
Sources:

National Institute of Allergy and Infectious Diseases (NIAID): Study of Ebola Survivors Opens in Liberia

CDC Emerging Infectious Diseases; EID Journal (ahead of print)
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Last edited by Catbird; 02-25-2016 at 10:45 PM. Reason: typo
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Old 02-25-2016, 11:04 PM   #2
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These are remarkable findings - especially the complications in close contacts who, seemingly, were not infected. That certainly bears urgency in terms of follow up... WHY???

This chapter in the Ebola story is far from over.
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Old 02-26-2016, 12:38 AM   #3
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I agree. These studies raise a lot of issues that have probably not ever been closely examined before. The size and scope of this epidemic, and the participation of so many different health organizations (once the epidemic was finally recognized for the disaster that it was), has created a unique opportunity for all kinds of research. Previous studies have been on a smaller scale and probably not followed up so closely as these, and others, will be.

Further info about the NIAID study indicates that it will be a large, long-term project. Buried in the description of the study is the definition of "close contact" for purposes of this study (see bolded section). I'm confused about several aspects of the close contact portion of the study. Apparently, close contacts will be used as the control group (see bolded portion at the end). I'm no scientist and perhaps I don't understand the nuances of designing a study like this one. But, it seems to me that the control group should be a random sample of the local, non-infected population to establish a baseline prevalence of medical conditions such as diabetes, high blood pressure, joint issues, etc. Then study the effects of Ebola survivors and their apparently non-infected close contacts and compare the incident rates. Or am I way off base?

The first article that I posted says that close contacts were "...potentially exposed to the virus but did not become infected." But it doesn't specify how non-infection is demonstrated. Hopefully by blood work which shows a lack of antibodies? Or testing during the epidemic that showed them to be infection-free? I also wonder if the behavior of the close contacts will be studied as well, along with socioeconomic factors. One room shack with no running water or 4 room house with indoor plumbing? Did all, some, or none of them have hands-on contact with an infected person? Or once the household member showed signs of being ill, did they practice any kind of isolation, and if so, what did that entail - keeping the patient in a different room (if possible), not sharing food or water, not handling clothes or bed linens? I also wonder if poor nutrition may play a role in the rate of complications seen in close contacts. During the epidemic, there was definitely a lack of food in both rural and urban areas. Some of it was due to a lack of transportation of basic foods in the rural areas, and for quite a while the quarantined urban areas had nothing going in or coming out. So, many of the close contacts who stayed home, especially children without an adult presence, may have experienced anywhere from weeks to months of poor nutrition, which may be impacting their current medical status.

I also think it's important to know how many close contacts each infected person had at the time. If they had had 5, and only 1 got infected, that says one thing. But if they had 5 close contacts and 4 of them became ill, that says something else. I think the age of the close contacts also plays a role. An adult might have understood that they shouldn't sleep next to someone who was ill. But trying to keep a 4 year-old from trying to get a hug from Mommy is a different ballgame. But if these variables are taken into account, and if the infection rate of close contacts is 1 out of 5, then the transmission rate is less than we thought. But, if that's the case, how did the outbreaks spread so quickly and explode into a full-blown epidemic? If it isn't easily transmitted to close contacts, then how was it so easily transmitted to contacts who weren't close? OTOH, if the infection rate of close contacts was 4 of 5, then I wonder how many survivors have "up to 5" (see below) close contacts who didn't get infected.

Lots and lots and lots of questions which I hope will be eventually addressed. It may be that the results of research like this will be a game-changer for what we know about Ebola. And hopefully, this information will help us to stay ahead of the learning curve when the next major outbreak happens.





Study of Ebola Survivors Opens in Liberia
Research to Examine Long-Term Health Effects of Ebola Virus Disease


Quote:
The Liberia-U.S. clinical research partnership known as PREVAIL has launched a study of people in Liberia who have survived Ebola virus disease (EVD) within the past two years. The study investigators hope to better understand the long-term health consequences of EVD, determine if survivors develop immunity that will protect them from future Ebola infection, and assess whether previously EVD-infected individuals can transmit infection to close contacts and sexual partners. The study, sponsored by the Ministry of Health of Liberia and the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, will take place at various sites in Liberia and is expected to enroll approximately 7,500 people, including 1,500 people of any age who survived EVD and 6,000 of their close contacts.

...Study participants will undergo a medical history and physical and vision examination and have blood samples collected so researchers can identify and track any health issues, monitor organ and ocular function and record Ebola antibody levels. Some participants may also be asked to provide samples of bodily fluids, such as sweat, tears, and for adults, semen or cervical secretions. Participants will be asked if they would like to identify up to five close contacts (household members at the time of Ebola diagnosis and sexual partners after recovery from Ebola virus disease). Close contacts who agree to participate in the study will undergo a physical examination, have blood samples taken, and asked to complete a questionnaire detailing their contact with the Ebola survivor, such as touching, sleeping in the same bed and sexual intercourse. Staff from the NIH’s National Eye Institute have helped establish a new eye clinic at John F. Kennedy Medical Hospital, where ophthalmologists from NEI and Johns Hopkins will be evaluating study participants and their identified close contacts for visual problems.

Treatment will be provided by Liberian ophthalmologists partnering in the study.
“There have been reports of inflammatory eye disease and vision loss among Ebola survivors,” said NEI Clinical Director Frederick Ferris, M.D. “Our goal is to determine the incidence and extent of Ebola-related eye disease among survivors, risk factors contributing to its development, and optimal treatment strategies.”

The research team will follow the Ebola survivors and their close contacts for up to five years with study visits occurring every six months. At each follow-up visit, participants will undergo a physical examination and additional blood draws, to allow study physicians to monitor and characterize any changes in Ebola antibody levels and to detect the presence of select medical conditions. This information will help scientists determine the evolution of Ebola antibodies and will provide insight on whether survivors can still transmit the virus and if so, whether these people get sick with Ebola virus disease.

Using data collected at these site visits, the researchers will calculate the incidence, prevalence and risk factors for various health issues experienced by survivors, such as vision problems; immune system changes; mental disorders; joint pain; diabetes; hypertension; and pregnancy complications. Close contacts will be used as a control group to assess whether the risks of these conditions are the same or different from those who have not had Ebola virus disease.
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Old 02-26-2016, 12:58 AM   #4
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I'm going to follow up on this tomorrow - need to do more reading on what they're planning but yeah... there is a ton of material suitable for research based theses, fellowship work... tons of epidemiological, nursing, medical care studies...

Yeah, there really needs to be a truly random control group distinct from those who had Ebola or qualified as close contacts. When you consider the wide range of other infectious nasties hanging around these communities, you not only have to determine: a) the presence & rate of 'complications' in both Ebola survivors & purportedly non-infected close contacts but need a baseline level for 'headaches', 'eye problems' & other mentioned symptoms, then try to retroactively rule out other causes... a very difficult proposition. Not usually too many smoking guns still lingering & if everyone is dodging the charging rhino that's Ebola, they may miss the infected cat scratches - so to speak.

Can hardly wait to look at the existing studies tomorrow. After a good night's sleep.
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Old 02-26-2016, 02:19 AM   #5
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I don't understand. Is the nurse still ebolic or are these just side effects?
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Old 02-26-2016, 02:32 AM   #6
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In all the articles I've read, the medical authorities are rather vague on that issue. So far anyways. However, the way she was transported and the fact that she wasn't cared for at the local hospital leads me to believe that she's being treated as if she were infectious.

But that's just a guess.
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Old 02-26-2016, 05:42 AM   #7
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To sum it all up : even if you survive Ebola, you're still screwed.
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