Abstract
There is an increasing frequency of reports regarding the persistence of the Ebola virus (EBOV) in Ebola virus disease (EVD) survivors. During the 2014–2016 West African EVD epidemic, sporadic transmission events resulted in the initiation of new chains of human-to-human transmission. Multiple reports strongly suggest that these re-emergences were linked to persistent EBOV infections and included sexual transmission from EVD survivors. Asymptomatic infection and long-term viral persistence in EVD survivors could result in incidental introductions of the Ebola virus in new geographic regions and raise important national and local public health concerns. Alarmingly, although the persistence of filoviruses and their potential for sexual transmission have been documented since the emergence of such viruses in 1967, there is limited knowledge regarding the events that result in filovirus transmission to, and persistence within, the male reproductive tract. Asymptomatic infection and long-term viral persistence in male EVD survivors could lead to incidental transfer of EBOV to new geographic regions, thereby generating widespread outbreaks that constitute a significant threat to national and global public health. Here, we review filovirus testicular persistence and discuss the current state of knowledge regarding the rates of persistence in male survivors, and mechanisms underlying reproductive tract localization and sexual transmission.
Highlights
Remdesivir is currently being examined as a potential preventative of EBOV testicular persistence in a phase 2 clinical trial consisting of Ebola virus disease (EVD) survivors [123,124]
The studies performed to date suggest that up to 10% of male EVD survivors will have persistent testicular infections that extend beyond the nine-month abstinence window recommended by the WHO [29,62]
EBOV transmission was largely controlled towards the end of the West African epidemic, sporadic transmission events continued to occur
Summary
The family Filoviridae (order Mononegavirales) includes three genera of single-stranded, negative-sense RNA viruses that are enveloped, filamentous, and non-segmented [1,2]. Species within the genus Ebolavirus include: Bundibugyo ebolavirus (BDBV), Zaire ebolavirus (EBOV), Reston ebolavirus (RESTV), Sudan ebolavirus (SUDV), Taï Forest ebolavirus (TAFV), and the recently discovered Bombali ebolavirus (BOMV) [5]. The mean case fatality rates of EBOV, SUDV, and BDBV in human outbreaks have. While persistence had been noted in cases studies in previous outbreaks of EVD and MVD, the scale of the West African epidemic led to targeted surveillance of survivors in numbers suitable for statistical analysis [25,26,27,28]. The unprecedented scale of the West African EVD epidemic and the risk that persistent filovirus infections could result in the transmission of EBOV to new geographic regions constitutes a significant threat to global public health
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