Comprehensive health responses and lessons from HIV can guide efforts to confront sexual transmission of Ebola

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Persistence of virus calls for on the ground research, services, and new diagnostic, surveillance capacities

Before the most recent Ebola crisis, scientists knew that the virus had been detected in genital fluids, but the reality that a virus spread through contact with sick and deceased infected people can also be sexually transmitted by recovered survivors was not confirmed until the waning days of the West Africa outbreak, a recent article in Clinical Infectious Diseases notes.

The ramifications of that reality, as well as findings that the virus remains in reservoirs of spinal and ocular fluids, and can re-emerge, has changed the definition, the timing and the demands of controlling an outbreak, and of responding to the needs left in its wake, the article, by William Fischer and David Wohl of the University of North Carolina at Chapel Hill says.

The persistence of the virus already has been highlighted in renewed, if contained outbreaks of disease in all three of the most affected countries after they were declared “Ebola free.” In the process, the point from which a 42-day countdown to “Ebola free” status should start has changed from after the last sick person leaves treatment to when the last sick person no longer is shedding transmissible virus. “At present,” the authors note,”we do not know when that happens.”

Answering that question and addressing the demands it raises, the article, Confronting Ebola as a Sexually Transmitted Infection, argues, must drive comprehensive attention to the welfare of survivors as health systems affected by the crisis of the last two years. And in that, the authors note, efforts can derive lessons from HIV research directed at eradicating viral reservoirs, as well as from policies and interventions aiming to prevent HIV transmission.

Dr. Fischer, who traveled to Gueckedou, the remote southeastern forest region of Guinea that was the epicenter of the outbreak with a team from Médecins Sans Frontières in May 2014, has earlier compared the challenges posed by Ebola to those posed over the last three and a half decades by HIV in regions lacking in health resources, both in the unknowns surrounding that epidemic, and the consequences of not responding to evidence of the virus’ spread quickly and effectively. Now, he and Dr. Wohl note, the new challenges posed by the persistence of the virus and its potential to recur also offer opportunities, to better understand the threats posed by Ebola, offer appropriate care to survivors, and establish lasting control over the next outbreak.

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