“We have never had such a large number of survivors,” said Dr. Anders Nordstrom, the World Health Organization representative for Sierra Leone. He spoke from the country’s capital, Freetown, on Friday in a telephone news briefing about a conference on survivors that was held there this week. “The countries affected by Ebola also have a long road to recovery,” he added.
The largest previous outbreak, in Uganda in 2000 and 2001, had 425 cases. There have been about 28,000 cases in the current epidemic centered in Guinea, Liberia and Sierra Leone.
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About half the survivors seem to have chronic joint pain that is often severe enough to prevent them from working, said Dr. Daniel Bausch, a senior consultant for the W.H.O. and an infectious-diseases specialist at Tulane University. People who were the sickest, and therefore probably the most heavily infected, seem more likely to develop the pains, which often last for many months after the infection has cleared. The exact cause of the pain is not known, so all doctors can do is treat the symptoms.
Many people who recover from the infection also have persistent headaches, extreme fatigue and difficulty concentrating.
About a quarter of the survivors have eye problems, and some have lost vision or gone completely blind, Dr. Bausch said. Ebola sometimes invades the inside of the eye and lurks there for months, even in someone who has recovered from the acute illness and whose blood is free of the virus. The result is an inflammation, uveitis, that can threaten sight. People with this condition are not infectious, because the virus is contained inside the eyeball.
There is no proven therapy to rid the eye of the virus, so doctors can treat only the inflammation and other symptoms, hoping to preserve sight while the patient’s immune system gradually revs up and wipes out the virus.
“If we can get to them early on, we can reverse the inflammatory problems, and that can potentially be vision-saving,” Dr. Bausch said.
Sometimes, he said, the viral attack on the eye causes the rapid formation of a cataract, a clouding of the lens that results in blindness. Surgery to remove the cataract can restore sight if the rest of the eye is healthy. But that surgery could expose doctors and nurses to the virus. “In no country has one of those cataracts been removed,” Dr. Bausch said.
Doctors from Emory University in Atlanta and aid groups have been working with ministries of health in West Africa to set up eye clinics, he said, as well as vans with mobile clinics to take ophthalmologists and the needed equipment to remote areas.
Another major worry has been the ability of the Ebola virus to persist in semen for months after a man has recovered from the illness, posing a risk of sexual transmission. Studies are underway to try to determine just how long the virus really lasts.
“We have data that the virus can persist for a considerable time, but we have very little evidence of sexual transmission occurring,” Dr. Bausch said. In a few cases, he said, researchers were “relatively convinced” that such transmission had taken place. But he added, “For whatever reason, it doesn’t seem to be a frequent occurrence.”
A big concern to researchers is the fate of blood samples taken from Ebola patients. Many scientists want access to them for studies of the disease and possible treatments. Dr. Bausch said there were probably tens of thousands of samples in freezers in labs in the United States, Canada and Europe.
“It’s very fragmented,” he said, adding that researchers hoped a more organized storage system could be developed.
International groups recognize that the samples belong to the patients and their countries, Dr. Bausch said, and their governments will decide how they should be handled.
“It’s a process that will not be fast,” he said.Source; NYTIMES
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