eMedicine Specialties > Infectious Diseases > Viral Infections

Ebola Virus: Follow-up

Author: John W King, MD, Professor of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center; Director, Viral Therapeutics Clinics for Hepatitis; Consulting Staff, Department of Infectious Diseases, Overton Brook Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Apr 2, 2008

Follow-up

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.

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.

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).10   
    • 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.11 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.

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

Prognosis

  • Prognosis is poor. Patients surviving for 2 weeks often make a slow recovery.

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.
 


More on Ebola Virus

Overview: Ebola Virus
Differential Diagnoses & Workup: Ebola Virus
Treatment & Medication: Ebola Virus
Follow-up: Ebola Virus
Multimedia: Ebola Virus
References
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References

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Further Reading

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Keywords

Ebola virus, viral hemorrhagic fever syndrome, Arenaviridae, Bunyaviridae, Flaviviridae, Filoviridae, EBO-Z, Marburg virus, Ebola infection, Ebola virus Zaire, Ebola virus Sudan, EBO-S, African-derived Ebola virus, Ebola virus Côte-d'Ivoire, EBO-C, Ebola virus Reston, EBO-R

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Contributor Information and Disclosures

Author

John W King, MD, Professor of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center; Director, Viral Therapeutics Clinics for Hepatitis; Consulting Staff, Department of Infectious Diseases, Overton Brook 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

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M Kerkering, MD, Professor of Medicine and Microbiology, Department of Internal Medicine, Division of Infectious Disease, Brody School of Medicine at East Carolina University
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.

CME Editor

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.

 
 
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