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Persistent virus in people recovering from Ebola virus disease

A growing volume of data from careful clinical observation andtesting of people who have recovered from acute Ebola virus disease indicatesthat the Ebola virus can persist at various sites in the body for many monthsin some people. Such sites include the inside of the eye, semen, amnioticfluid, the placenta, breast milk and the central nervous system.

 

A preliminary study on Ebola virus persistence in the semen ofmale survivors in Sierra Leone, has found that some men still produce sementhat test positive on real time – polymerase chain reaction (RT-PCR), a testused to detect Ebola virus genetic material (RNA) - for nine months or longer.


These results, reported on 14 October 2015 in the online versionof the New England Medical Journal, are from "baseline" samplesprovided by 93 men participating in the study being jointly conducted by theSierra Leone Ministry of Health and Sanitation, the World Health Organizationand the U.S. Centers for Disease Control and Prevention.

 

All of the men who were tested in the first three months aftertheir illness began were positive (9/9; 100 percent). More than half of men(26/40; 65 percent) who were tested between four to six months after theirillness began were positive, while one quarter (11/46; 24 percent) of thosetested between seven to nine months after their illness began also testedpositive.


The study is following this group of men, retesting at intervalsto understand how long virus persists in semen, and will explore which factorsmay be associated with persistence of virus. After each test, the men areprovided with their test results along with counselling, advice aboutappropriate hygiene and practising safe sex, and condoms.


Based on current results, the presence of virus in semen decreasesin the months after recovery from Ebola virus disease. However, one participantwas still positive 9.5 months after his illness began. It is still not knownhow long the virus can persist in semen but this study will yield moreinformation about how long it takes for men to clear Ebola virus from semen.


While it is now clear that virus persists longer in semen thanpreviously thought, the risk of people being infected with Ebola by those whohave survived the disease is probably low. Although sexual transmission bysurvivors with persistent virus is a possibility, it appears to be rare. Inareas of Sierra Leone – Kailahun and Kenema - that had very large outbreaks andhave high numbers of survivors, there have been no new cases of Ebola for 300days.


WHO currently recommends that male Ebola survivors should beoffered semen testing at 3 months after onset of disease, and then, for thosewho test positive, every month thereafter until their semen tests negative forvirus twice by RT-PCR, with an interval of one week between tests.


Until such time as their semen has twice tested negative forEbola, survivors should abstain from sex or use condoms, practise good hand andpersonal hygiene by immediately and thoroughly washing with soap and waterafter any physical contact with semen, including after masturbation. Duringthis period used condoms should be handled safely, and safely disposed of, soas to prevent contact with seminal fluids.


Survivors and their families should have access to the supportthey need to re-establish their livelihoods and to obtain care for theirresidual medical needs (such as joint pain and eye problems. Understanding andresponding to community concerns is essential.


The study will be widened to examine viral persistence in otherbody fluids, in both women and men, post-Ebola. This will also be led by theSierra Leone Government, supported by WHO, US CDC and Chinese CDC.


                                                              Source: http://www.who.int/csr/disease/ebola/virus-persistence/en/


Tag: breast milk and the central nervous systemthe placentaamniotic fluidsemensuch sites include the inside of the eyegrowing volume of data from careful clinical observation and testing of people who have recovered from acute ebola virus disease indicates that the ebola virus can persist at various sites in the body for many months in some people

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