The End of an Ebola Outbreak Brings New Problems to Survivors

Healio recently published interviews with members of UCLA’s DRC Health Training and Research Program conducted by Infectious Disease News.

Only a few months ago, WHO had announced the end of an Ebola outbreak that was almost as large as the West African epidemic.

At about the same time, just as the country saw the end to the eastern Democratic Republic’s (DRC) outbreak, one hundred new cases broke out on the opposite side of the country.

Never Ending

Aside from concern about the new outbreak, research shows that survivors of Ebola must confront the mental and physical effects of the illness over the long term.

Dr. Majid Sadigh, a global health director, said that survivors of Ebola are forever affected, both mentally and physically, after they leave the Ebola treatment units (ETUs).

The survivors face the prospect of a shorter life span, kidney and eye problems, and the obvious stigma of the disease. Being an Ebola survivor often results in loss of their employment and problems not only for themselves but also for their families.

Increased Risk For Mortality

Dr. Anne Rimoin, a director for the DRC Training Program, discussed the many consequences of the Ebola infection and the decrease in life expectancy.

One study published in 2019 in The Lancet involved data from 1,130 Ebola patients after their discharge from Guinea’s ETUs. It found that in the period leading up to December 31, 2019, Ebola survivors had almost a fivefold risk of increased mortality in comparison to the general public.

The researchers were alarmed to find that out of fifty-nine reported deaths among Ebola survivors, thirty-seven were from renal failure. This prompted researchers to recommend further investigations of Ebola survivors in connection with renal failure.

Emphasis on Early Intervention

Researchers at Quebec’s Laval University emphasized the importance of early interventions to mitigate acute infections.

About Ocular Disorders

One of the Ebola survivors’ more common health effects are ocular disorders, especially those resulting from uveitis, according to Dr. Rimoin.

Uveitis is a form of inflammation in the eye affecting the middle layer of tissue in the eye wall. The WHO estimates that twenty percent of Ebola survivors from West Africa had some type of eye disease.

In 2017, researchers studied the bulk of 28,652 cases and 11,325 deaths attributed to the epidemic. The large volume of cases enabled the researchers to characterize the Ebola syndrome with specific attention to the retinal lesions that occurred among Sierra Leone survivors.

The PREVAIL III Study

The PREVAIL III study enrolled almost 1,000 survivors in Liberia together with their 2,300 Ebola negative close contacts.

The researchers studied the long-term outlook for Ebola survivors. They found that survivors had a 14.7% increase in urinary frequency compared to 3.4% of the controls. A significant increase over negatively affected contacts also applied to headaches, fatigue, muscle pain, memory loss, and joint pain.

In addition, Ebola survivors experienced abdominal, neurological, chest, and musculoskeletal discomfort or pain as well as uveitis.

During a one-year follow-up, most conditions improved with the exception of uveitis. The results are a strong indication of the need to incorporate eye care in the Ebola survivor program.

Other Areas of Transmission

 The Ebola virus may also remain in the central nervous system and other sites that are hidden from the survivors’ immune systems. This means that Ebola can still be transmitted after the person has recovered.

One of the areas of post-Ebola transmission is the testes, indicating the possibility of sexual transmission. It is for this reason that the WHO strongly advocates abstinence or at a minimum, practicing safe sex.

Weighing the Risk and Dispelling the Myth

According to the experts, the average person considers the uncertainties that Ebola survivors represent and how that affects their own lives. This, of course, complicates the recovery and the survivor’s return to a normal life.

There seems to be no question that the fear of verbal abuse by the public intimidates the survivor. It leads to self-quarantine and results in long-term isolation. This is true especially in the initial period of returning home.

But the primary reason for the stigmatism is the public’s fear of transmission of the virus by a survivor through daily interaction.

Social worker health workers and counselors strive to overcome this barrier by having elders in the community accompany the survivors back home. Educating the villagers and attending to their fears helps considerably.

About Community Centers

Anaïs Legand, a technical officer at the WHO Emergencies Program, stated that since 2018 the program has been in operation in the DRC. It began after the outbreak in Equateur Province and is now in operation in Eastern DRC. It is an adaptation of West African programs and research.

But the frequent violence, including armed attacks against Ebola centers, were a hindrance to vaccination efforts and treatment. These attacks occurred in eastern DRC and continued until the end of the Ebola outbreak in that area.

Each of the clinics includes a psychologist, physician, laboratory technicians, hygienist, nurse, psychosocial assistants, and an Ebola representative who helps to get other survivors involved in the program.

Survivors may apply for examinations, personal care, and psychological evaluation. Counseling on practicing safe sex as well as sample analysis is also available. One area, Butembo, now has an ophthalmologic clinic.

However, Anais Legand said that survivors must still go through the stressful process of returning to their community. They should prepare for a loss of employment, being rejected by their community, and other complications associated with Ebola.

Rose Duesterwald

Rose Duesterwald

Rose became acquainted with Patient Worthy after her husband was diagnosed with Acute Myeloid Leukemia four years ago. He was treated with a methylating agent While he was being treated with a hypomethylating agent, Rose researched investigational drugs being developed to treat relapsed/refractory AML.

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