The announcement that Scottish nurse Pauline Cafferkey is critically ill with late complications of Ebola virus disease has surprised medical experts. Although it is recognised that the virus can linger in parts of the body after a patient has recovered, it has never before been known to trigger potentially lethal disease more than six months after the initial illness.
It is a salutary reminder that we are only just learning about the potential long-term effects of Ebola virus disease and the management of secondary complications. Indeed as news broke of Ms Cafferkey’s deterioration, which in itself does not pose a renewed risk to public health, researchers announced that the virus persisted in semen for at least nine months after acute infection, much longer than previously estimated.
A type of haemorrhagic fever, Ebola virus first emerged in 1976 in what is now the Democratic Republic of Congo. There have been several major outbreaks since then with the most severe registering fatality rates in the region of 90 per cent. With a natural reservoir in rainforests, most likely involving fruitbats, Ebola infects humans when they handle the blood and other bodily fluids of infected animals. The disease then spreads by human to human transmission, when blood and other secretions from an infected person enter the next victim’s broken skin or mucous membranes.
Since the latest outbreak first commenced in March 2014, the virus has infected more than 28,000 people and caused in excess of 11,000 deaths. Some 500 of more than 800 health workers infected have died. It has devastated health systems in Guinea, Liberia and Sierra Leone.
With no proven effective treatment to prevent or manage secondary recurrence of Ebola virus, the World Health Organisation must offer survivors comprehensive support to minimise the risk of re-emergence. Survivors, their partners and families should receive appropriate counselling and follow up testing. All 8,000 male survivors in West Africa should be provided with information and support to enable them to apply correct hygiene measures and practise safe sex.