Ebola returns to Sierra Leone

Tuesday, 26 January, 2016

The World Health Organization has confirmed a new case of Ebola virus disease in Sierra Leone, a 22 year old female student at Magburaka town in Tonkolili district who died on 12 January 2016 (Gulland 2016; WHO 2016). The case was reported just a day after WHO declared the end of transmission of the virus in west Africa. Human-to-human transmission directly linked to the 2014 Ebola virus disease (EVD) outbreak in West Africa was declared to have ended in Sierra Leone on 7 November 2015.

This is the 11th “flare up” of the disease—that is, a case not epidemiologically linked to the original outbreak and most likely caused by virus remaining in survivors after recovery. The virus can persist in immune privileged sites such as the eye, central nervous system and male reproductive system. Fortunately, the number of viral particles in these sites are low and escape outside the host is only via natural means in semen. This makes post-survival transmission a rare event. Male to female sexual transmission of EVD has been reported once only (Harries et al 2016). However, in some individuals EV can re-emerge and transmit as demonstrated in a case cluster in late 2015 in Liberia. This also appears to be very uncommon.

Advice on management of Ebola survivors within the health care system for routine procedures or when ill has just been issued in the UK (Harries et al 2016).

THS assisted the WHO Philippine office to develop an Ebola training course for countries that were preparing for Ebola arrival. This is available online at http://www.tropicalhealthsolutions.com/Ebolapreparedness. The course and its impact is described by Carlos et al (2015).

Carlos C, Capistrano R, Tobora CF, delos Reyes MR, Lupisan S, Corpuz A, Aumentado C, Lee Suy L, Hall J, Donald J, Counahan M, Curless MS, Rhymer W, Gavin M, Lynch C, Black MA, Anduyon AD, Buttner P, Speare R. Hospital preparedness for Ebola virus disease: A training course in the Philippines. Western Pacific Surveillance and Response Journal 2015;6(1):33-43. http://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/293/441
Gulland A. WHO confirms new case of Ebola in Sierra Leone BMJ 2016;352:i298. http://www.bmj.com.elibrary.jcu.edu.au/content/352/bmj.i298
Harries J, Jacobs M, Davies SC. Ebola survivors: not out of the woods yet: CMO’s advice on managing the risk of viral persistence and relapse. BMJ 2016;352:i178. http://www.bmj.com/content/352/bmj.i178
WHO. Ebola virus disease in Sierra Leone. http://www.afro.who.int/en/sierra-leone/who-country-office-sierra-leone....

Image: Presence of Ebola virus in tissues during acute EVD and recovery. Virus has been detected in semen of 26% of male survivors at 9 months.

Posted by Rick Speare