Credit CDC PHIL
Pauline Cafferkey, the 39 year-old British aid worker who fell ill with the Ebola virus in Glasgow shortly after her return from Sierra Leone late last December, after weeks of treatment was finally declared `free of the virus’ and released from the hospital on January 24th.
Overnight, it has been revealed that Ms. Cafferkey has suffered some sort of relapse linked to her original infection, and has been placed back into isolation at the Royal Free Hospital in London more than 8 months after her release.
Details are still emerging, but based on some news reports, she may still be harboring some detectable levels of the Ebola virus. First, this statement from the Royal Free Hospital.
9 October 2015
We can confirm that Pauline Cafferkey was transferred from the Queen Elizabeth University Hospital in Glasgow to the Royal Free Hospital in the early hours of this morning due to an unusual late complication of her previous infection by the Ebola virus. She will now be treated in isolation in the hospital’s high level isolation unit under nationally agreed guidelines.
The Ebola virus can only be transmitted by direct contact with the blood or bodily fluids of an infected person while they are symptomatic so the risk to the general public remains low and the NHS has well established and practised infection control procedures in place.
The Scottish Government has issued the following statement as well.
Chief Medical Officer comments.
Scotland’s Chief Medical Officer Catherine Calderwood said:
“We are aware that Pauline Cafferkey has been transferred from the Queen Elizabeth University Hospital to the Royal Free Hospital in London as a result of becoming unwell from an unusual late complication of her illness. We have been working closely with NHS Greater Glasgow & Clyde and Health Protection Scotland to ensure Pauline has received all appropriate treatment and care throughout her stay at the QEUH and onward transfer to the Royal Free Hospital.
“Pauline is now being cared for in the best place possible, with specialists who have the most experience of looking after patients who have previously recovered from the ebola virus. This is not a new case of ebola and is a complication of her previous illness. The risk to the public remains extremely low and all appropriate infection control measures are in place.
The BBC is running real-time updates, and has recently posted the following quotes:
Update: Ebola nurse back in hospital
Posted at 10:53
Medical experts said the virus can sometimes persist in some survivors.
The Ebola virus can occasionally persist for some months in certain tissues within survivors. The risk of transmission from these individuals appears to be very low.
Pro John Edmunds London School of Hygiene and Tropical Medicine
We know that Ebola virus can shelter in the body in what are called immune privileged sites such as the eye, central nervous system and testes.
Prof Julian Hiscox Professor of Infection and Global Health, University of Liverpool
Persistent Ebola virus infections have rarely been reported previously. The majority of patients are considered non-infectious once symptoms and viremia (virus in the blood) disappear. However, eye infections have been detected 9 weeks after clearance of viremia and virus is detectable in seminal fluid at least 14 weeks after the onset of symptoms in some patients.
Prof David Evans Professor of Virology, University of St. Andrews
We’ve looked at some of these `persistent’ Ebola infections in the past, usually involving seminal fluid (see Referral: Mackay On Lesser Ebola Transmission Risks), discoveries that prompted the the following report by the MMWR & WHO On The Risks Of Sexual Transmission Of Ebola.
Somewhat presciently, in August of this year, Dr. Ian Mackay wrote about the lingering after effects of Ebola infection on his VDU blog, and discussed the possibility of seeing `chronic Ebola virus disease’ in some `recovered’ patients.
There are at least 13,000 people in Guinea, Liberia and Sierra Leone who have survived an encounter with the Makona variant of Zaire ebolavirus (EBOV) since December 2013.1
But that’s not where the story, or the suffering, ends for these people.
Following the resolution of acute Ebola virus disease (EVD), there is the spectre of a lengthy period of subsequent symptoms, sometimes called ‘post-Ebola syndrome’ (I’d prefer post-Ebola virus disease syndrome or PEVDS), which is similar to that found among survivors from past outbreaks.2,3
In West Africa up to 50% of EVD survivors report these and other symptoms as well as fatigue, pressure in the eyes, uveitis (eye inflammation), blindness, hair loss, myalgias, swelling, menstrual irregularities, rashes and shooting pains.6-11 Eye problems have been reported in around a quarter of survivors.11 Anorexia was reported by 98% of survivors in a study of 105 participants with joint pain (87%) and back pain (46%) also common.12 This study also reported difficulty in short-term memory (27%), headaches (22%), sleep difficulties (19%), insomnia (13%), dizziness (11%), abdominal pain (32%), constipation (14%), decreased exercise tolerance (77%), decreased libido (23%), and sexual dysfunction (20%).12 There are also issues of stigmatisation, psychosomatic illness and a broader psychological impact among survivors, including depression and post-traumatic stress.9,12
We’ll revisit this story when more details become available.