Systematic Review of the Literature on Viral Persistence & Sexual Transmission from Recovered Ebola Survivors
OBJECTIVE:
The
main aim of this article is to present a comprehensive, systematic review on evidence of sexual transmission from Ebola
survivors and persistence of Ebola virus in body fluids of relevance to sexual
transmission, and additionally to review condom
effectiveness against sexual transmission of Ebola.
DESIGN:
We
performed a systematic review of
viral persistence in body fluids of relevance to sexual transmission of Ebola
survivors and evidence of sexual transmission of Ebola, and carried out a targeted review of condom effectiveness.
RESULTS:
We
identified nine published original articles presenting results on persistence
of Ebola virus in relevant body fluids, or reporting suspect sexual
transmission from Ebola survivors. We also included unpublished reports from
the current 2014/2015 Ebola epidemic in West Africa. We found no articles
reporting on condom effectiveness, but have included a targeted review on general condom efficacy and effectiveness.
CONCLUSIONS:
We
conclude that the risk of sexual transmission from people who have recovered
from Ebola cannot be ruled out. We found the longest duration of persistent
Ebola RNA in a relevant body fluid from a survivor, to be reported from a man
in Sierra Leone who had reverse transcriptase PCR (RT-PCR) positive semen
284 days after symptom onset. In line with current WHO recommendations. We
recommend that men are offered the possibility to test their semen regularly
for presence of Ebola RNA from3 months post-symptom onset. Safe sex practices
including sexual abstinence, or else condom use, are recommended by WHO until
semen has tested negative twice, or in absence of testing for at least 6 months
post-symptom onset. Based on evidence reviewed, we conclude that male and
female latex condoms offer some protection against EBOV compared to no condom
use. Survivors should be offered access to care and prevention, in order to
provide them with possibilities to mitigate any risks that may occur, and
efforts should be linked to destigmatising activities.
Below: Depiction of the duration of measured persistence of Ebola virus and Ebola virus RNA in semen
- 1World Health Organization (WHO), Geneva, Switzerland Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
- 2World Health Organization (WHO), Geneva, Switzerland.
- BMJ Open. 2016 Jan 7;6(1):e008859. doi: 10.1136/bmjopen-2015-008859.
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