Abstract
Ebola virus disease (EVD) and emerging infectious disease threats continue to threaten life, prosperity and global health security. To properly counteract EVD, an improved understanding of the long-term impact of recent EVD outbreaks in West Africa and the Democratic Republic of Congo are needed. In the wake of recent outbreaks, numerous health sequelae were identified in EVD survivors. These findings include joint pains, headaches, myalgias, and uveitis, a vision-threatening inflammatory condition of the eye. Retrospective and more recent prospective studies of EVD survivors from West Africa have demonstrated that uveitis may occur in 13–34% of patients with an increase in prevalence from baseline to 12-month follow-up. The clinical spectrum of disease ranges from mild, anterior uveitis to severe, sight-threatening panuveitis. Untreated inflammation may ultimately lead to secondary complications of cataract and posterior synechiae, with resultant vision impairment. The identification of Ebola virus persistence in immune privileged organs, such as the eye, with subsequent tissue inflammation and edema may lead to vision loss. Non-human primate models of EVD have demonstrated tissue localization to the eye including macrophage reservoirs within the vitreous matter. Moreover, in vitro models of Ebola virus have shown permissiveness in retinal pigment epithelial cells, potentially contributing to viral persistence. Broad perspectives from epidemiologic studies of the outbreak, animal modeling, and immunologic studies of EVD survivors have demonstrated the spectrum of the eye disease, tissue specificity of Ebola virus infection, and antigen-specific immunologic response. Further studies in these areas will elucidate the mechanisms of this highly prevalent disease with the potential for improved therapeutics for Ebola virus in immune-privileged sites.
Highlights
Ebola virus disease (EVD) was first discovered in the Democratic Republic of Congo (DRC) in 1976 [1]
The magnitude of the West African EVD outbreak from 2013 to 2016, primarily within the highest transmission countries of Sierra Leone, Liberia and Guinea, eclipsed all prior outbreaks combined by over 10-fold with over 28,600 cases and 11,300 deaths [3]. While this outbreak was unprecedented in scope and magnitude, with 12 countries affected and threatening health security globally, lessons learned from the West African EVD outbreak were translated to more recent EVD outbreaks in DRC
While the West African EVD outbreak and recent DRC outbreaks have provided significant improvements related to our understanding of the prevalence of uveitis and sequelae, as well as their key implications for the vision health of survivors, the mechanisms of ocular disease are the subject of ongoing investigation
Summary
Ebola virus disease (EVD) was first discovered in the Democratic Republic of Congo (DRC) in 1976 [1]. The magnitude of the West African EVD outbreak from 2013 to 2016, primarily within the highest transmission countries of Sierra Leone, Liberia and Guinea, eclipsed all prior outbreaks combined by over 10-fold with over 28,600 cases and 11,300 deaths [3]. In the wake of the West African EVD outbreak and recent DRC outbreak, the international community has recognized that thousands of survivors are at risk of post EVD sequelae. These system health sequelae include uveitis, arthritis/arthralgias, psychosocial stressors and mental health disorders, as well as viral persistence in immune privileged organs (e.g., eye, reproductive organs, and central nervous system). Following acute EVD, survivors may experience a number of sequelae, which has been termed the post-Ebola virus disease syndrome (PEVDS), which can include arthralgia, myalgia, hearing loss and tinnitus, cognitive impairment, and ocular disease [7]
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