Findings of Ebola in semen nine months after illness add to unknowns about outbreak control

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Findings published this week tell of the persistence and consequence of Ebola virus in recovered patients, raising questions of new challenges to ending the largest recorded outbreak of the disease. At the same time, the critical condition of a nurse discharged from treatment for the virus last January reinforces concerns about the threat and scope of lasting complications from the disease.

Both come at a time when a report from the U.S. Centers for Disease Prevention and Control, summarizing responses so far to the Ebola outbreak that began nearly two years ago in West Africa, concludes the world remains unprepared to respond appropriately and effectively to emerging health threats.

A preliminary report on a study published in The New England Journal of Medicine Wednesday found evidence of the virus in the semen of all of nine men from whom samples were available two to three months after their illness began, in samples from 26 of 40 men four to six months after their illnesses, and samples from 11 of 43 men whose semen was tested seven to nine months after the onset of their illnesses. Results on a sample collected from a man 10 months after the onset of his illness were inconclusive. While noting that the findings leave questions about both the duration and scope of risks associated with different sexual acts after recovery from Ebola, the authors also note the findings point to a need for programs providing semen testing and preventive counseling, including on condom use and safe disposal.

The article on those findings was accompanied by another, on evidence of sexual transmission of the virus from a man who had become infected with Ebola six months earlier to a woman who fell ill in mid-March. The authors of that article conclude that the virus in the man’s semen remained infectious more than five months after the virus was cleared from his blood. The authors also note that Ebola has been found in breast milk 15 days after the onset of illness, in vaginal fluid 33 days after onset, and in patients’ eyes up to 98 days after onset.

Last week physician Ian Crozier, a physician who was infected with Ebola while caring for patients in Sierra Leone in 2014, told a conference of infectious disease researchers and clinicians of the medical issues he has experienced since, including virus remaining in an eye, seizures, and memory as well as hearing deficits. Nurse Paula Cafferkey, who was infected with Ebola last December was admitted to a hospital this week with what doctors have characterized as rare complications resulting from the virus, and is now in critical condition.

The Ebola outbreak has left about 16,000 survivors of the virus across Liberia, Sierra Leone and Guinea. Roughly half of them are male, as the article on Ebola Persistence in Semen notes. The World Health Organization declared Liberia “Ebola free” for a second time last month, while sporadic outbreaks have prevented Sierra Leone and Guinea from attaining that status. An article released by CDC earlier this week, and scheduled to be published in the November edition of the agency’s Emerging Infectious Diseases Journal, recounts how “For months the Ebola epidemic spread faster than the international community, including the CDC, responded.” The article, which describes failures in surveillance, communication, monitoring and infection control in countries where health systems lacked necessary skills, staffing and technology, notes the potential for ongoing Ebola outbreaks continues in the affected areas while the global community still lacks a system to respond in a timely fashion to the next epidemic.

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