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 We also included unpublished reports from the current 2014/2015 Ebola epidemic in West Africa.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 

Full article at:   http://goo.gl/NrQLQA

By:  Thorson A1, Formenty P2, Lofthouse C2, Broutet N2.

• 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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Quantifying Poverty as a Driver of Ebola Transmission

BACKGROUND:

Poverty has been implicated as a challenge in the control of the current Ebola outbreak in West Africa. Although disparities between affected countries have been appreciated, disparities within West African countries have not been investigated as drivers of Ebola transmission. To quantify the role that poverty plays in the transmission of Ebola, we analyzed heterogeneity of Ebola incidence and transmission factors among over 300 communities, categorized by socioeconomic status (SES), within Montserrado County, Liberia.

METHODOLOGY/PRINCIPAL FINDINGS:

We evaluated 4,437 Ebola cases reported between February 28, 2014 and December 1, 2014 for Montserrado County to determine SES-stratified temporal trends and drivers of Ebola transmission. A dataset including dates of symptom onset, hospitalization, and death, and specified community of residence was used to stratify cases into high, middle and low SES. Additionally, information about 9,129 contacts was provided for a subset of 1,585 traced individuals. To evaluate transmission within and across socioeconomic subpopulations, as well as over the trajectory of the outbreak, we analyzed these data with a time-dependent stochastic model. Cases in the most impoverished communities reported three more contacts on average than cases in high SES communities (p<0.001). Our transmission model shows that infected individuals from middle and low SES communities were associated with 1.5 (95% CI: 1.4-1.6) and 3.5 (95% CI: 3.1-3.9) times as many secondary cases as those from high SES communities, respectively. Furthermore, most of the spread of Ebola across Montserrado County originated from areas of lower SES.

CONCLUSIONS/SIGNIFICANCE:

Individuals from areas of poverty were associated with high rates of transmission and spread of Ebola to other regions. Thus, Ebola could most effectively be prevented or contained if disease interventions were targeted to areas of extreme poverty and funding was dedicated to development projects that meet basic needs.

Below:  Key factors of Ebola transmission based on socioeconomic status (SES) of probable and confirmed cases

Full article at:   http://goo.gl/myN1Ll

By:  Fallah MP1,2,3,4, Skrip LA4, Gertler S4, Yamin D4,5, Galvani AP3,4.

• 1Community-Based Initiative, Ministry of Health, Monrovia, Liberia.
• 2National Institute of Allergy and Infectious Diseases, PREVAIL-III Study, Monrovia, Liberia.
• 3A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia.
• 4Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America.
• 5Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel.
• PLoS Negl Trop Dis. 2015 Dec 31;9(12):e0004260. doi: 10.1371/journal.pntd.0004260. eCollection 2015. 

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Impact of the Ebola Epidemic on General and HIV Care in Macenta, Forest Guinea, 2014

The current Ebola epidemic massively affected the Macenta district in Forest Guinea. We aimed at investigating its impact on general and HIV care at the only HIV care facility in the district.

Routinely collected data on use of general hospital services and HIV care were linked to Ebola surveillance data published by the Guinea Ministry of Health. In addition, we compared retention among HIV-infected patients enrolled into care in the first semesters of 2013 and 2014.

Throughout 2014, service offer was continuous and unaltered at the facility. 

• During the main epidemic period (August-December 2014), compared with the same period of 2013, 
• there were important reductions in attendance at the primary care outpatient clinic (-40%), 
• in HIV tests done (-46%), 
• in new diagnoses of tuberculosis (-53%) 
• and in patients enrolled into HIV care (-47%). 
• There was a smaller reduction in attendance at the HIV follow-up clinic (-11%). 

Kaplan-Meier estimates of retention were similar among the patients enrolled into care in 2014 and 2013. In a multivariable Cox regression analysis, the year of enrolment was not associated with attrition (hazard ratio 1.02; 95% confidence interval: 0.72-1.43).

The Ebola epidemic resulted in an important decrease in utilization of the facility despite unaltered service offer. Effects on care of HIV-positive patients enrolled prior to the epidemic were limited. HIV care in such circumstances is challenging, but not impossible.

Via:  http://ht.ly/Spp5R 

By: Leuenberger D1, Hebelamou J, Strahm S, De Rekeneire N, Balestre E, Wandeler G, Dabis F; IeDEA West Africa study group.

• 1aCentre Médical de Macenta, Mission Philafricaine, Conakry, Guinea bINSERM U897 - Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux cUniversité de Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France dDepartment of Infectious Diseases, University Hospital Bern eInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland fDepartment of Infectious Diseases, University of Dakar, Senegal.

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Rapid Assessment of Ebola-Related Implications for Reproductive, Maternal, Newborn and Child Health Service Delivery and Utilization in Guinea

Below:  Median number of outpatient visits in hospitals

Introduction: Since March 2014, Guinea has been in the midst of the largest, longest, and deadliest outbreak of Ebola Virus Disease ever recorded. Due to sub-optimal health conditions prior to the outbreak, Guinean women and children may have been especially vulnerable to worsening health care conditions. A rapid assessment was conducted to better understand how the delivery and utilization of routine RMNCH services may have been affected by the extraordinary strain placed on the health system and its client population by the Ebola outbreak in Guinea.

Methods: Data were collected January-February 2015 in a convenience sample of public and private facilities in areas of the country that were Ebola active, calm and inactive. Monthly data on a number of RMNCH services were collected by facility record abstraction for the period from October 1, 2013 through December 31, 2014. Structured interviews were also held with facility directors and RMNCH service providers.

Results: Data on RMNCH services from forty five public facilities were obtained. A statistically significant decline of 31% was seen in outpatient visits between October-December 2013 (before the Ebola outbreak) and October-December 2014 (the advanced stage of the Ebola outbreak). Service declines appeared to be greater in hospitals compared to health centers. Child health services were more affected by the Ebola epidemic than other assessed health areas. For example, the number of children under five seen for diarrhea and Acute Respiratory Infection (ARI) showed a large decrease over the one-year period in both hospitals (60% for diarrhea and 58% for ARI) and health centers (25% and 23%, respectively). Results also suggest that the negative effects on service availability (such as reduced hours, closures, and service suspensions) are likely to be regional and/or facility-specific. Providers reported a number of improved infection control behaviors as a result of the Ebola outbreak, including more frequent hand-washing and the use of disinfectants. Nevertheless, 30% of interviewed staff had not received any training on Ebola infection control.  

Discussion: Although there may be differences in RMNCH service delivery and availability in selected versus non-selected facilities, a large number of indicators were assessed in order to provide needed information on the effects of the Ebola crisis on routine RMNCH service delivery and uptake in Guinea. This information is an important and timely contribution to ongoing efforts to understand and respond to the adverse effects of the Ebola crisis on essential RMNCH services in Guinea.

Via: http://ht.ly/RUnI7

By: Janine Barden-O'Fallon,* Mamadou Alimou Barry,* Paul Brodish, and Jack Hazerjian

MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill,