Ebola Virus Infection Associated with Transmission from Survivors.

Saskia Den Boon,Anita Shah,Hugh H Green,Esther L Hamblion,Moumie Barry,Barbara J Marston,Christopher Dye,Margaret Lamunu,Tolbert G Nyenswah,Kara Durski,Alex Gasasira,Sakoba Keita,Oliver Morgan,Mamadou H Djingarey,Schabbethai S Senesie,Ian Crozier,Amara Jambai,Nuha O Mahmoud,Devin Perkins

doi:10.3201/eid2502.181011

Abstract

Ebola virus (EBOV) can persist in immunologically protected body sites in survivors of Ebola virus disease, creating the potential to initiate new chains of transmission. From the outbreak in West Africa during 2014–2016, we identified 13 possible events of viral persistence–derived transmission of EBOV (VPDTe) and applied predefined criteria to classify transmission events based on the strength of evidence for VPDTe and source and route of transmission. For 8 events, a recipient case was identified; possible source cases were identified for 5 of these 8. For 5 events, a recipient case or chain of transmission could not be confidently determined. Five events met our criteria for sexual transmission (male-to-female). One VPDTe event led to at least 4 generations of cases; transmission was limited after the other events. VPDTe has increased the importance of Ebola survivor services and sustained surveillance and response capacity in regions with previously widespread transmission.

Highlights

Ebola virus (EBOV) can persist in immunologically protected body sites in survivors of Ebola virus disease, creating the potential to initiate new chains of transmission
We describe a series of EBOV transmission events with evidence of transmission related to viral persistence in Ebola virus disease (EVD) survivors
On March 29, 2016, World Health Organization (WHO) declared the end of the Public Health Emergency of International Concern regarding the EVD outbreak in West Africa [25]

Summary

Introduction

Ebola virus (EBOV) can persist in immunologically protected body sites in survivors of Ebola virus disease, creating the potential to initiate new chains of transmission. Before the West Africa EVD outbreak, 1 case of Marburg disease [14] and 1 possible case of EVD [15] attributed to sexual transmission had been reported. From the EVD outbreak in West Africa, several incidents of possible sexual transmission of EBOV from EVD survivors have been described in detail [10,16,17,18,19], as have viral persistence–derived transmission of EBOV (VPDTe) events for which the mode of transmission was unknown [12,20,21,22]. Our findings are relevant for response planning, especially related to surveillance

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Conclusion