Survivors of Ebola virus disease (EVD) in Liberia had a higher prevalence of certain health issues — including uveitis (eye redness and pain), abdominal, chest, neurologic, and musculoskeletal abnormalities upon physical exam — when compared to a control group of household and community members who did not have a history of EVD, according to findings from an ongoing study published in the New England Journal of Medicine. However, even participants in the control group experienced a relatively high burden of health issues overall.
The study began in 2015 and is following participants for five years. PREVAIL initiated the study of Ebola survivors (called PREVAIL 3) in Liberia to determine the long-term consequences of EVD by comparing health outcomes in survivors (966 people) and a control group of uninfected household and community contacts (2,350 people). Participants in the study completed a baseline clinic visit in 2015 and are being reevaluated every six months for five years. The newly published report compares health outcomes in survivors and contacts during their first year of study participation.
Both survivors and controls self-reported a range of symptoms. However, survivors reported certain symptoms at significantly higher rates than controls, and in both groups, adults reported more symptoms than children and adolescents. Survivors reported higher rates of: urinary frequency (14.7 percent vs. 3.4 percent), headache (47.6 percent vs. 35.6 percent), fatigue (18.4 percent vs. 6.3 percent), muscle pain (23.1 percent vs. 10.1 percent), memory loss (29.2 percent vs. 4.8 percent), and joint pain (47.5 percent vs. 17.5 percent).
Evaluations by healthcare professionals showed significantly more survivors than controls had abnormal findings on abdominal (10.4 percent vs. 6.4 percent), chest (4.2 percent vs. 2 percent), and neurologic (4.5 percent vs. 1.5 percent) examinations. With regards to abnormal musculoskeletal findings on examination, only muscle tenderness was observed significantly more frequently in survivors than controls (4.5 percent vs. 0.9 percent, respectively). Other musculoskeletal findings, such as joint swelling and decreased range of motion were not observed at a significantly higher frequency in survivors compared with controls. The prevalence of health issues declined in both groups over the one-year follow-up period.
The investigators observed that health issues identified with physical evaluations were much less frequent than self-reported symptoms. They note that the self-reported symptoms were like those seen in people with post-infection syndromes. However, they say more research is needed to understand the origin, development, and progression of these self-reported symptoms. Study neurologists are currently following a subset of survivors and close contacts to better understand and characterize post-infection neurologic issues.
