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Clinical sequelae among individuals with pauci-symptomatic or asymptomatic Ebola virus infection and unrecognised Ebola virus disease in Liberia: a longitudinal cohort study.
Kelly, J Daniel; Van Ryn, Collin; Badio, Moses; Fayiah, Tamba; Johnson, Kumblytee; Gayedyu-Dennis, Dehkontee; Weiser, Sheri D; Porco, Travis C; Martin, Jeffery N; Sneller, Michael C; Rutherford, George W; Reilly, Cavan; Fallah, Mosoka P; Moses, J Soka.
  • Kelly JD; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Institute for Global Health Sciences, University of California, San Francisco, CA, USA; F I Proctor Foundation, University of California, San Francisco, CA, USA; Partnership for Research on Vaccines and I
  • Van Ryn C; Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA.
  • Badio M; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia.
  • Fayiah T; Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia.
  • Johnson K; Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia.
  • Gayedyu-Dennis D; Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia.
  • Weiser SD; Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, CA, USA.
  • Porco TC; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; F I Proctor Foundation, University of California, San Francisco, CA, USA.
  • Martin JN; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
  • Sneller MC; Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
  • Rutherford GW; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
  • Reilly C; Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia; Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA.
  • Fallah MP; Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia; A M Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia.
  • Moses JS; Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia.
Lancet Infect Dis ; 22(8): 1163-1171, 2022 08.
Article in English | MEDLINE | ID: covidwho-1972392
ABSTRACT

BACKGROUND:

Whether or not individuals with pauci-symptomatic or asymptomatic Ebola virus infection and unrecognised Ebola virus disease develop clinical sequelae is unknown. We assessed current symptoms and physical examination findings among individuals with pauci-symptomatic or asymptomatic infection and unrecognised Ebola virus disease compared with Ebola virus disease survivors and uninfected contacts.

METHODS:

Between June 17, 2015, and June 30, 2017, we studied a cohort of Ebola virus disease survivors and their contacts in Liberia. Surveys, current symptoms and physical examination findings, and serology were used to characterise disease status of reported Ebola virus disease, unrecognised Ebola virus disease, pauci-symptomatic or asymptomatic Ebola virus infection, or no infection. We pre-specified findings known to be differentially prevalent among Ebola virus disease survivors versus their contacts (urinary frequency, headache, fatigue, muscle pain, memory loss, joint pain, neurological findings, chest findings, muscle findings, joint findings, abdominal findings, and uveitis). We estimated the prevalence and incidence of selected clinical findings by disease status.

FINDINGS:

Our analytical cohort included 991 reported Ebola virus disease survivors and 2688 close contacts. The median time from acute Ebola virus disease onset to baseline was 317 days (IQR 271-366). Of 222 seropositive contacts, 115 had pauci-symptomatic or asymptomatic Ebola virus infection and 107 had unrecognised Ebola virus disease. At baseline, prevalent findings of joint pain, memory loss, muscle pain, and fatigue were lowest among those with pauci-symptomatic or asymptomatic infection or no infection, higher among contacts with unrecognised Ebola virus disease, and highest in reported survivors of Ebola virus disease. Joint pain was the most prevalent finding, and was reported in 434 (18%) of 2466 individuals with no infection, 14 (12%) of 115 with pauci-symptomatic or asymptomatic infection, 31 (29%) of 107 with unrecognised Ebola virus disease, and 476 (48%) of 991 with reported Ebola virus disease. In adjusted analyses, this pattern remained for joint pain and memory loss. Survivors had an increased odds of joint pain compared with unrecognised Ebola virus disease contacts (adjusted odds ratio [OR] 2·13, 95% CI 1·34-3·39); unrecognised Ebola virus disease contacts had an increased odds of joint pain compared with those with pauci-symptomatic or asymptomatic infection and uninfected contacts (adjusted OR 1·89, 95% CI 1·21-2·97). The adjusted odds of memory loss was more than four-times higher among survivors than among unrecognised Ebola virus disease contacts (adjusted OR 4·47, 95% CI 2·41-8·30) and two-times higher among unrecognised Ebola virus disease contacts than in those with pauci-symptomatic or asymptomatic infection and uninfected contacts (adjusted OR 2·05, 95% CI 1·10-3·84). By 12 months, prevalent findings had decreased in the three infected groups.

INTERPRETATION:

Our findings provide evidence of post-Ebola virus disease clinical sequelae among contacts with unrecognised Ebola virus disease but not in people with pauci-symptomatic or asymptomatic Ebola virus infection.

FUNDING:

National Cancer Institute and National Institute of Allergy and Infectious Diseases of the National Institutes of Health.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Hemorrhagic Fever, Ebola / Ebolavirus Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Country/Region as subject: Africa Language: English Journal: Lancet Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hemorrhagic Fever, Ebola / Ebolavirus Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Country/Region as subject: Africa Language: English Journal: Lancet Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article