Ebola Virus Follow-up

  • Author: John W King, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Apr 20, 2010
 

Further Inpatient Care

  • Survivors can produce infectious virions for prolonged periods. Therefore, strict barrier isolation in a private room away from traffic patterns must be maintained throughout the illness.
  • Patient's urine, stool, sputum, and blood, along with any objects that have come in contact with the patient or the patient's body fluids (such as laboratory equipment), should be disinfected with a 0.5% sodium hypochlorite solution.
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Further Outpatient Care

  • Patients who survive continue to shed virus for weeks to months. Because Ebola virus has been isolated from seminal fluid 61 days after the onset of clinical disease, patients should abstain from sexual intercourse for 3 months.
  • Recovery often requires months. Weight gain and return of strength are slow.
  • The incubation period is 2-21 days. Individuals who were exposed to infected patients should be watched closely for signs of early Ebola disease.
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Deterrence/Prevention

  • Work continues on a vaccine for Ebola virus infection in primates. Sullivan et al from the Vaccine Research Center at the US National Institutes of Health and the Special Pathogens Branch at the US Centers for Disease Control and Prevention have reported on the combination of naked DNA vaccine capable of encoding Ebola proteins followed by a booster vaccination with a recombinant adenoviral vector expressing Ebola GP(Z).[14]
    • In this study, cynomolgus macaques were injected with 3 doses of the DNA vaccine, 1 dose every 4 weeks. Twelve weeks later, the macaques were vaccinated with the recombinant adenoviral vector. After another 12 weeks, unvaccinated macaques and vaccinated macaques were injected with a lethal dose of Ebola virus. All unvaccinated macaques died, while none of the vaccinated macaques died.
    • This work indicates that primates can be vaccinated against Ebola and can develop both a cell-mediated response (thought to be a result of the DNA vaccine) and a humoral antibody response (thought to result from the recombinant adenoviral vaccine).
  • Other attempts at designing vaccines that work in primates used vaccine strategies that were successful in mice and guinea pigs. Geisbert and colleagues at the US Army Medical Research Institute of Infectious Diseases in Fort Detrick, Md, studied a series of vaccines that included RNA replicon particles from an attenuated strain of Venezuelan equine encephalitis virus that expressed Ebola virus glycoprotein and nucleoprotein, a recombinant vaccina virus that expressed Ebola glycoprotein, liposomes containing lipid A and inactivated Ebola virus, and a concentrated, inactivated whole-virion Ebola preparation.[15] Although these vaccines protected rodents against an Ebola challenge, the vaccines did not protect Cynomolgus macaques (M fascicularis) or rhesus macaques (Macaca mulatta) against exposure to Ebola.
  • Ebola is transmissible person to person by direct contact with an infected patient's blood or other body fluids. Airborne transmission of the Reston strain occurred among primates, and, although most cases in humans occur following direct contact with a patient or their blood or body fluids, transmission of Ebola via the airborne route cannot be dismissed.
  • Infection control inside and outside of medical facilities relies on barrier protection using double gloves, fluid-impermeable gowns, face shields with eye protection, and coverings for legs and shoes.
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Complications

  • Ocular complications have been reported in 3 of 20 survivors (15%) of the 1995 Ebola outbreak in the DRC. Patients reported ocular pain, photophobia, increased lacrimation, and decreased visual acuity. All had documented uveitis, and all improved with topical application of 1% atropine and steroids.
  • Survivors have developed the following late manifestations:
    • Myalgias
    • Asymmetric and migratory arthralgias
    • Headache
    • Fatigue
    • Bulimia
    • Amenorrhea
    • Hearing loss
    • Tinnitus
    • Unilateral orchitis
    • Suppurative parotitis
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Prognosis

  • The overall prognosis of Ebola is poor. However, patients who survive for 2 weeks often make a slow recovery.
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Patient Education

  • Because the source of Ebola is unknown, education and prevention of primary cases is problematic.
  • Education of communities at risk, especially health care workers, can greatly reduce the number of secondary person-to-person transmissions.
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Contributor Information and Disclosures
Author

John W King, MD  Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi

Disclosure: emedicine $50.00 author of chapter

Coauthor(s)

Rushdah Malik, MD  Fellow, Department of Infectious Diseases, Louisiana State University Health Science Center

Rushdah Malik, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Martin J Wood, MD †  Former Consulting Staff, Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, UK

Martin J Wood, MD † is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, American Society for Microbiology, Infectious Diseases Society of America, International Society for Infectious Diseases, and Royal College of Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Thomas M Kerkering, MD  Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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Ebola virus. Courtesy of the US Centers for Disease Control and Prevention.
Table 1. History of Ebola Virus Sudan Outbreaksa
YearLocationReported Cases, No.Deaths, No. (%)
1976Sudan284151 (53)
1976Englandb10 (0)
1979Sudan3422 (65)
2000-2001Uganda425224 (53)
2004Sudan1717 (41)
Total761414 (54.4)
Table 2. History of Ebola Virus Zaire Outbreaksa
YearLocationReported Cases, No.Deaths, No. (%)
1976Zaire318280 (88)
1977Zaire11 (100)
1994Gabon5231 (60)
1995DRC315250 (81)
Jan 1996 to Apr 1996Gabon3721 (57)
Jul 1996 to Jan 1997Gabon6045 (74)
1996South Africa (acquired in Gabon)11 (100)
Oct 2001 to Mar 2002Gabon6553 (82)
Oct 2001 to Mar 2002DRC5944 (75)
Dec 2002 to Apr 2003DRC143128 (89)
Nov 2003 to Dec 2004DRC3529 (83)
2007DRC264187 (71)
Total1,3501,070 (79.3)
Table 3. History of Ebola Virus Côte-d’Ivoire Outbreaks (No Deaths Reported)a
YearLocationReported Cases, No.
1994Côte-d’Ivoire1
1995Liberia1
Total2
Table 4. History of Ebola Virus Reston Outbreaks (No Deaths Reported)a
YearLocationProven bCases Reported, No.
1989Virginia, Texas, Pennsylvania0
1990Virginia and Texas4
1989 -1990Philippines3
1992Italy0
1990Alice, Tex0
1996Philippines0
Nov 2008Philippinesc6
Total13
Table 5. History of Ebola Virus Bundibugyo Outbreaka
YearLocationReported Cases, No.Deaths, No. (%)
Dec 2007 to Jan 2008Uganda14937 (25)
Total14937 (25)
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