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Multidisciplinary assessment of post-Ebola sequelae in Guinea (Postebogui): an observational cohort study

2017; Elsevier BV; Volume: 17; Issue: 5 Linguagem: Inglês

10.1016/s1473-3099(16)30516-3

1474-4457

Jean-François Étard, Mamadou Sow, Sandrine Leroy, Abdoulaye Touré, Bernard Taverne, Alpha Kabinet Keïta, Philippe Msellati, N’Fally Magassouba, Sylvain Baize, Hervé Raoul, Suzanne Izard, Cécé Kpamou, Laura March, Ibrahima Savane, Moumié Barry, Éric Delaporte, Ahidjo Ayouba, Sylvain Baize, Kaba Bangoura, A BARRY, Moumié Barry, Mamoudou Cissé, Mohammed Cissé, Éric Delaporte, Jean‐François Delfraissy, Christelle Delmas, Alice Desclaux, Saliou Bella Diallo, Mamadou Safiatou Diallo, Mariama Sadjo Diallo, Jean-François Étard, Cécile Etienne, Ousmane Faye, Ibrahima Fofana, Bruno Granouillac, Esther Hereth Hébert, Suzanne Izard, Djenaba Kassé, Alpha Kabinet Keïta, Alpha Kabinet Keïta, Lamine Koivogui, Cécé Kpamou, Christine Lacarabaratz, Sandrine Leroy, Laura March, Yves Lévy, N’Fally Magassouba, Laura March, Vincent Mendiboure, Philippe Msellati, Harissatou Niane, Martine Peeters, Yves‐Marie Pers, Hervé Raoul, Sidi Lamine Sacko, Ibrahima Savané, Mamadou Sow, Bernard Taverne, Abdoulaye Touré, Fodé Amara Traore, Falaye Traoré, Yamoussa Youla, Yazdan Yazdanpanah,

Viral Infections and Vectors

The high number of survivors from the 2013-16 west African outbreak of Ebola virus disease (EVD) has raised several new issues: long-term clinical complications, psychosocial consequences, risks of EVD reactivation, and secondary transmission due to viral persistence in body fluids. We aimed to assess long-term clinical, psychosocial, and viral outcomes in EVD survivors in Guinea.In this multidisciplinary observational cohort study, we recruited patients aged 1 year or more in four sites in Guinea (Donka National Hospital, Conakry; Macenta Prefectoral Hospital, Macenta; N'zérékoré Regional Hospital, N'zérékoré; and Forécariah Prefectoral Hospital, Forécariah) following discharge from any Ebola treatment centre in Guinea. Eligible patients had had laboratory-confirmed EVD and had then been declared clear of the virus in the blood. All consenting patients were included, with no exclusion criteria. Trained clinicians assessed patients at enrolment to the cohort, recording clinical symptoms and signs of depression. We did routine blood examinations and examined viral persistence in body fluids using RT-PCR. We did psychological evaluations using questionnaires developed for different age groups. Follow-up is planned to 2 years, and here we present findings at enrolment.Between March 23, 2015, and July 11, 2016, we recruited 802 patients, of whom 360 (45%) were male, 442 (55%) were female; 158 (20%) were younger than 18 years. The median age was 28·4 years (range 1·0-79·9, IQR 19·4-39·8). The median delay after discharge was 350 days (IQR 223-491). The most frequent symptoms were general symptoms (324 [40%] patients), musculoskeletal pain (303 [38%]), headache (278 [35%]), depression (124 [17%] of 713 responses), abdominal pain (178 [22%]), and ocular disorders (142 [18%]). More adults than children had at least one clinical symptom (505 [78%] vs 101 [64%], p<0·0003), ocular complications (124 [19%] vs 18 [11%], p=0·0200), or musculoskeletal symptoms (274 [43%] vs 29 [18%], p<0·0001). A positive RT-PCR in semen was found in ten (5%) of 188 men, at a maximum of 548 days after disease onset. 204 (26%) of 793 patients reported stigmatisation. Ocular complications were more frequent at enrolment than at discharge (142 [18%] vs 61 [8%] patients).Post-EVD symptoms can remain long after recovery and long-term viral persistence in semen is confirmed. The results justify calls for regular check-ups of survivors at least 18 months after recovery.INSERM/Reacting, the French Ebola Task Force, and Institut de Recherche pour le Développement.