“Critically Ill” Nurse Highlights How We’re Still in the Dark on Ebola

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Ebola NurseAlthough the World Health Organization (WHO) has reported no new Ebola cases, that doesn’t mean the virus still can’t cause problems. Pauline Cafferkey, a London nurse who survived Ebola nine months ago, is now back in hospital in reportedly critical condition. Her case highlights the long-term struggles many Ebola survivors have to face, as well as how much there still is to understand about the disease.

Traces of Ebola have been known to linger in the body after the primary infection has passed. The traces tend to collect in locations where the immune system is slow to react, such as the eyes, and occasionally cause symptoms that are classified under “post-Ebola syndrome.” Survivors have reported experiencing joint and muscle pain, hearing and vision difficulties, fatigue, and in some cases an eye inflammation called uveitis that can lead to blindness.

Although some reports on Cafferkey’s hospitalization mention a resurgence of her Ebola virus, she has not actually contracted the disease once again. The virus appears to have infiltrated her spinal cord and is causing symptoms similar to meningitis. This is the only known case of such a severe complication, although a child in Liberia last year may have died from encephalopathy (swelling of the brain) brought on by Ebola traces. One current theory is that the severity of post-Ebola complications is related to how advanced the initial infection was, with larger pools of the virus being able to infiltrate more of the body. If true, this would explain why cases like Cafferkey’s are rare—those who experience such severe infections do not often survive.

The closest comparison that can be made is to observations made in the 1970s during treatment of the Junin virus, which is another hemorrhagic fever. Similar to Cafferkey, some Junin survivors who were treated with antibodies developed brain infections. However, these side effects came within weeks at most, not months.

Cafferkey’s case highlights how little is currently known about post-Ebola syndrome and how well the virus can persist in survivors. A recent WHO study, published yesterday in the New England Journal of Medicine, noted that Ebola can survive in semen for up to nine months in some survivors. The study mentioned a case where a woman contracted Ebola from having unprotected sex with such an individual.

The good news is that if such a thing can be said about the current situation, there is believed to be minimal risk of others having caught Ebola from Cafferkey, since she was initially released after surviving the disease. Ebola is only transmitted from the fluids of patients who are showing symptoms. So far, 58 people have been identified as having contact with Cafferkey since she started becoming symptomatic and they are being monitored as part of standard procedure. Those who had interacted with her fluids were also offered an experimental vaccine as a precaution.

The Ebola outbreak began in Guinea in 2014 and subsequently spread across the African continent. To date, over 28,000 people have contracted the virus since the outbreak began; approximately 11,200 have died.

Sources for Today’s Article:
Botelho, G., ” 9 months after discharge, relapsed UK Ebola patient ‘critically ill’,” CNN web site, last updated October 14, 2015; http://www.cnn.com/2015/10/14/europe/uk-ebola-nurse/index.html, last accessed October 15, 2015.
Melvin, D., “WHO: Ebola Virus Found in Male Survivors 9 Months after Symptoms.” CNN web site, last updated October 15, 2015; http://www.cnn.com/2015/10/15/health/who-ebola-report/, last accessed October 15, 2015.

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