Essay on Ebola Virus and Its Long-Term Effects

Background information

In Guinea, Sierra Leone, and Liberia predominantly, the Ebola Virus Disease (EVD) had just about 17,000 survivors. Physical, psychiatric, and cognitive abnormalities were experienced by a majority of the people who survived. A third of the survivors are at the risk of experiencing permanent blindness owing to the inflammation of the middle layer of the eye; this condition is known as Uveitis (Clark et al., 2015). Longitudinally for one year, 2,053 people who remained uninfected after coming in close contact with an individual with EVD and 860 EVD survivors were prospectively followed by the National Institute of Allergy and Infectious Diseases (NIAID) in Liberia and the Liberian Ministry of Health in order to unravel EVD-specific sequelae (WHO, 2016). The survivors of EVD are encouraged to seek general medical care and particularly long-term eye medical care by the findings of this study. Additionally, prevention of EVD sexual transmission is also highlighted by the study and its guidance should be reevaluated.

Semen, stool, emesis, blood and other infected body fluids are directly responsible for the transmission of the Ebola virus (EBOV). Dissemination into blood by EBOV occurs after a 6-day incubation phase and virus exposure. Consequently, multiple organ failure and profound disability occur as a result after the body’s cells have been infected throughout. Persistence of EBOV in the central nervous system may cause meningoencephalitis and encephalopathy. Moreover, occurrence of ischemia of the spinal cord and focal brain is common. Significant impact is also felt by the genitourinary tract, skin, eyes, kidneys, liver, gastrointestinal tract, lungs and heart. Manifestation of EVD sequelae occurs over a long period just like other illnesses that result in multiple organ failure (Brolin Ribacke et al., 2016).

Hypothesis

The hypothesis of this study was that there are significant long-term effects after exposure to the Ebola virus (EBOV).

Methodology and results

The uninfected controls (2,053 people) and the EVD survivors (860 individuals) used in this study to investigate the prevalence and incidence of EBOV are the largest prospective observational cohort ever recorded. Serologic testing was used to confirm infection status while the national registry was used to identify the survivors of EVD. Individuals who had sexual partners with EVD and those who lived with an EVD patient at the diagnosis time where chosen as the uninfected control patients. Evaluations occurred at the time of entry and periodically after 6 months and a year for the controls and survivors. A hematologic assessment and chemical analysis of collected blood was done, performance of a medical history and physical examination was also conducted as well as completion of a comprehensive checklist of symptoms was carried out during these visits (Chertow, 2019).

Following a year of acute EVD condition, the survivors entered this research. The control individuals had significantly less symptoms to report than the survivors; to put this in context; a total of 48 broad arrays of symptoms were reported by the survivors upon entry in this study. For a difference between groups, more stringent statistical criteria were met by six symptoms. Urinary frequency, joint pain, muscle pain, fatigue, headache and memory loss were among the targeted symptoms. The control individuals recorded a 4.8% memory loss compared to the EVD survivors who found out to have a 29.2% memory loss upon study entry. After a year, this memory loss plummeted for both categories as control individuals recorded 0.1% and survivors reported 4.7%. The control individuals continued to have decreased chances of multiple symptoms compared to survivors despite both groups experiencing decreased prevalence of targeted symptoms after a year. Notably, abnormalities on examination of the abdomen, chest, joints, muscles and the neurology were expected for the survivors upon study entry. In comparison to control individuals, neurologic examination was expected to reveal new abnormalities developed by survivors during the first one year of evaluation. At baseline and at the yearly follow up, control individuals and survivors had similar outcomes of the laboratory and clinical evaluations (Chertow, 2019).

Significance of the study

This study is important since the long-term sequelae of EVD are better understood owing to the significant progress made by the findings of the longitudinal study thanks to the close-contact controls and EVD survivors. Survivors could experience functional neurocognitive impairment due to their increased odds of memory loss. Earlier published reports are consistent with this study that reports a high prevalence of uveitis. Survivors of EVD are encouraged to seek ophthalmologic care particularly those who have experienced acute EVD illnesses. Nonetheless, regardless of EVD status, improved access to ophthalmic care should be emphasized at baseline and at year one for control individuals and survivors in order to counteract vision loss.

Reason behind choosing this article

I chose this particular review article since I saw what was going on in West Africa during the 2013 to 2016 outbreak as far as Ebola virus disease is concerned. It was reported that following the EBOV outbreak in West Africa there was an approximate 40% mortality rate. Reduced mortality rates are associated with supportive care although no targeted therapies are available for EVD.

References

Clark, D. V., Kibuuka, H., Millard, M., Wakabi, S., Lukwago, L., Taylor, A., and Robb, M. L. (2015). Long-term sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study. The Lancet Infectious Diseases, 15, 905-912.

WHO. (2016). Clinical care for survivors of Ebola virus disease: Interim guidance (No. WHO/EVD/OHE/PED/16.1 Rev. 2). World Health Organization.

Brolin Ribacke, K. J., Saulnier, D. D., Eriksson, A., and Von Schreeb, J. (2016). Effects of the West Africa Ebola virus disease on health-care utilization–a systematic review. Frontiers in public health, 4, 222.

Chertow, D. S. (2019). Understanding long-term effects of Ebola virus disease. Nature medicine, 25, 714-715.