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Sequelae of Ebola Virus Disease in Surviving Patients in Guinea: Postebogui Cohort
Jean-François Etard1; Mamadou Saliou Sow2; Sandrine Leroy1; Philippe Msellati1; Abdoulaye I. Toure3; Bernard Taverne4; Ibrahima Savane5; Moumié Barry6; Eric Delaporte7; for the Postebogui study group
1Institut de Recherche Pour le Développement, Montpellier, France;2Donka National Hosp, Conakry, Guinea;3Institut de Recherche Pour le Développement UMI 233, INSERM U1176, Montpellier, France;4Institut de Recherche Pour le Développement UMI 233, INSERM U1175, Montpellier, France;5Macenta Prectoral Hosp, Macenta, Guinea;6CHU de Conakry, Conakry, Guinea;7UMI 233-IRD/U1175-INSERM/Montpellier Univ, Montpellier, France
On 29 December 2015, Guinea was declared free of Ebola virus disease (EVD) and 1268 patients were discharged from the Ebola treatment centers (ETC). In March 2015, survivors were started to be enrolled in a follow-up study in Conakry and Macenta to describe clinical, biological, virological, immunological, and psychosocial evolution. Recruitment is still on-going and we report here the main manifestations at inclusion in the cohort.
Clinical examination, psychological (CES-D scale) and social assessment, standard biological exams and Ebola virus RNA search in body fluids (semen...) were performed in adults and children at inclusion then every 3 months.
As of 15 December 2015, 375 survivors were included. Mean age was 28.8 years (range: 1-67.4), 169 (45%) were male, 76 (20%) were children. The median delay between ETC discharge and Postebogui inclusion was 223 days (1-557 days). During the acute phase, mean viral load CT was of 33 (range: 16-36, n=53); 16 (4%) patients received favipiravir, and 37 (10%) plamaspheresis.
At inclusion, 1081 clinical events were registered in 296 (79%) surviving patients, more often in adults than children (82% vs. 64% resp.). Main signs were: general signs (39% - fatigue, fever, anorexia), neurological signs (32% - headache), rheumatologic signs (46% - join pain), ocular signs (16% - conjunctivitis, irdocyclitis, vision deficiency), infectious diseases (22%) pelvic-abdominal pain (21%), anemia (13% - Table).
Detailed ophthalmologic examination in 21 patients suffering from ocular signs showed 11 uveitis, including with bilateral corneal opacities, active chorioretinis or pigmented scars, and panuveitis.
From the 98 semen screened for Ebola virus RNA (68 men), 10 samples (8 men) were positive up to 9 months after onset of EVD with a decreasing trend in both proportion of positive samples and viral RNA load.
Among 131 patients discharged from Conakry ETC since 5 months on average, 20% presented a breakdown score justifying psychologic/psychiatric care. Two third of the 194 first included patients in Postebogui had more than one diseased person in their household (HH) with a mean number of 5.6 EVD person/HH, and a mean number of 2.5 death/HH.
Sequelae were from general, ocular, rheumatologic origins and major psychic pain, highlighting the heavy human and economic burden related to EVD. Moreover, the long-term viral persistence in semen raises the need of specific measures (screening/safe sex) in order to avoid secondary cases.