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Ebola Persistence In Recovered Cases Including HCWs

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Media reports citing Ebola persistence after recovered HCW is readmitted in Scotland.

Edited by niman

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Health Fri Oct 9, 2015 7:14am EDT

Ebola's persistence in survivors fuels concerns over future risks


A growing awareness of how the Ebola virus can hide in parts of the body such as eyes, breasts and testicles long after leaving the bloodstream raises questions about whether the disease can ever be beaten.

Virologists said Friday's case of a Scottish nurse, Pauline Cafferkey, who had recovered from Ebola but is now suffering complications adds to signs that the virus is a long-term health risk and can lead to a "post-Ebola syndrome".

"Over the past few years there has been mounting evidence of mental and physical health problems in Ebola survivors that can last for years after the virus is cleared from the bloodstream," said Ben Neuman, an Ebola expert and lecturer in virology at Britain's University of Reading.

"The newly discovered twist on this post-Ebola syndrome is that in some cases the health problems - often including damage to the eyes and joints - are caused by live Ebola virus growing in fluids in some of the less accessible compartments of the body."

Ebola, one of the deadliest viruses known in humans, infected 28,000 people and killed more than 11,300 of them in an unprecedented outbreak in West Africa which was declared in March 2014 and is only now coming under control.

Partly because of the vast numbers involved in the epidemic, which centered on Guinea, Sierra Leone and Liberia, infectious disease experts say we are learning more every day about Ebola from cases such as Cafferkey's and thousands more survivors.

Ebola experts said in August that around half of Ebola survivors in West Africa were already reporting suffering from chronic problems, including serious joint pain and eye inflammation that can lead to blindness.



"Due to the sheer scale of this outbreak compared to previous ones we are going to see aspects of Ebola virus infection that we have not observed before," said Julian Hiscox, a professor of infection and global health at Britain's Liverpool University.

He was concerned that Ebola's persistence in survivors, who have no obvious symptoms of Ebola infection and so are often living and working normally and not kept in isolation as a symptomatic patient would be, means they are "a potential reservoir of the virus".

"It's why men who have had Ebola and recovered are advised to abstain or wear condoms," he noted.

The World Health Organization's advice is that all male survivors should be tested three months after the onset of symptoms and then monthly until they know they have no risk of passing on the virus through their semen.

John Edmunds, an expert at the London School of Hygiene and Tropical Medicine, said that while the risk of transmission from survivors harboring the virus in their eye fluids and other organs "appears to be very low", it still warrants attention.

"With so many survivors in West Africa now, there is a risk that further outbreaks can be triggered, which is why authorities have to remain very vigilant," he said.

Cafferkey, a 39-year-old nurse, was back in hospital in London on Friday with doctors saying she would be treated in isolation as a precautionary measure.

The hospital said in statement it had "identified a small number of close contacts ... that we will be following up as a precaution", but added: "The risk to the general public remains low."

Cafferkey was the first person to be diagnosed with Ebola on British soil and was originally discharged in January after seemingly making a full recovery.

Neuman said the likelihood of survivors spreading Ebola depends on how much of the virus is present in the blood.

In Cafferkey's case, he said, "if her body was able to control the virus once, the chances are she can do it twice."


(Reporting by Kate Kelland; editing by Giles Elgood)


Edited by niman

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Ebola Nurse Pauline Cafferkey Back in Hospital After 'Complication'


 Ebola Nurse Airlifted to Secure Hospital Unit After 'Complication' 0:34

LONDON — A British nurse who contracted Ebola was flown back to a secure hospital unit Friday after suffering "an unusual late complication of her illness," health officials said.

Pauline Cafferkey was discharged from London's specialist Royal Free Hospital in January after contracting the virus while working with a charity in Sierra Leone.

Image: Pauline Cafferkey Ebola patient discharged
Scottish healthcare worker Pauline Cafferkey at the Royal Free Hospital in London on January 24.LISA FERGUSON / SCOTLAND ON SUND / EPA

Cafferkey, who is from South Lanarkshire, Scotland, was flown by military aircraft under the supervision of experts back to the specialist unit in the early hours of Friday, Public Health England said in a statement.

A spokesman for Scotland's NHS Greater Glasgow and Clyde health authority confirmed to NBC News on Friday that Ebola had been detected in Cafferkey, but becausethe nurse had suffered the virus before this was "not a new infection."

Cafferkey was discharged from hospital more than nine months ago. But she was admitted to Glasgow's Queen Elizabeth University Hospital again Tuesday after reporting feeling unwell, NHSGGC said in statement.

She was treated in the infectious diseases unit before being flown to the Royal Free Hospital, which houses the U.K.'s only high-level isolation unit, in the early hours of Friday morning following the unspecified "complication."


 What's Out There to Treat Ebola? 0:42

Dr Emilia Crighton, director of public health at NHSGGC, said the risk to the public was "very low," but she added that officials had identified a number of people with whom Cafferkey may have come into contact and would be "following up as a precaution."

The news came just two days after the World Health Organization announcedthat the three West African countries at the heart of the epidemic had their first Ebola-free week since March 2014.

More than 11,000 people died and some 28,000 have been infected across Guinea, Liberia and Sierra Leone in the worst known outbreak of the disease.

Eleven patients were treated in the United States, mainly medical missionaries and medical volunteers. Two people died from the disease in the U.S.

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Pauline Cafferkey, Nurse With Ebola Complications, Is 'Critically Ill'

A nurse who's back in the hospital 10 months after recovering from Ebola is now "critically ill" in a hospital in Scotland, and 25 people who'd been in close contact with her have been vaccinated against the virus.

"We are sad to announce that Pauline Cafferkey's condition has deteriorated and she is now critically ill. Pauline is being treated for Ebola in the high level isolation unit at the Royal Free Hospital," the hospital said in a statement.

Cafferkey got infected last year while helping fight the Ebola epidemic in West Africa. She was taken back to the hospital last week.

An undated Cafferkey family handout photo of Scottish nurse Pauline Cafferkey, who has been unofficially named as the healthcare worker who is being treated in London's Royal Free Hospital for Ebola. HO / EPA

It's not precisely clear if the Ebola virus has returned to cause a repeat infection. If it has, it would be the first documented case.

"We know that Ebola can linger for many months after visible symptoms have cleared. We also know from outbreaks in the past that survivors can show a variety of symptoms, and the debilitating effect of these can last for a very long time, but this is frankly staggering, " said Jonathan Ball, a virology professor at University of Nottingham.

"I am not aware from the scientific literature of a case where Ebola has been associated with what we can only assume as life-threatening complications after someone has initially recovered, and certainly not so many months after."

The hospital said last week that some genetic material from Ebola had been found in Cafferkey's body, but it wasn't clear if it was infectious. They said Cafferkey was not a threat to the public, but identified 58 people who had been in close contact with her recently.

"Forty of the 58 close contacts were confirmed as having had direct contact with Pauline's bodily fluids and were offered the vaccine," the local branch of Britain's National Health Service said in a statement.

It said 25 of them have been vaccinated.

World Health Organization officials said in August they were finding many survivors had serious long-term effects, from aching joints to blindness. It can remain in semen for months, as well as in the eye.

The highly deadly virus has infected more than 28,000 people in the worst epidemic ever seen, and killed more than 11,000 of them.



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