A NEJM study has come off of embargo this afternoon that looks at a topic we’ve discussed previously – the persistence of RT-PCR detectable Ebola virus in the semen of convalescent men. Last May, in MMWR & WHO On Risks Of Sexual Transmission Of Ebola we looked at a suspected case of sexual transmission last March from a male patient who had been believed `recovered’ for well over six months.
Several months prior to that, Flublogia’s very own Dr. Ian Mackay, along with Dr. Katherine Arden, penned a piece for The Lancet (see Mackay & Arden On Ebola In Semen Of Convalescent Men) discussing the risks of Ebola transmission via semen even months after apparent recovery from the disease.
With the recent relapse of Scottish nurse Pauline Cafferkey, some 9 months after her release from isolation, there are a growing number of questions on how long the virus can remain viable in a post convalescent patient. The virus, or virus fragments, have been detected in convalescent Ebola patients residing in various places, including inside of the eye, in amniotic fluid, the placenta, breast milk and the central nervous system (cite).
Today’s report in the NEJM looks specifically for the RT-PCR detectable Ebola virus fragments in semen, and finds evidence of the virus’s persistence of 9 months or more.
It should be stressed, however, that right now we don’t know to what extent detectability by highly sensitive PCR testing equates to infectivity. Until more is known, the WHO continues to urge caution and offers the following Interim advice on the sexual transmission of the Ebola virus disease.
First, a link to the NEJM study (funded by the WHO), then a statement from the World Health Organization.
Gibrilla F. Deen, M.D., Barbara Knust, D.V.M., Nathalie Broutet, M.D., Ph.D., Foday R. Sesay, M.D., Pierre Formenty, D.V.M., Christine Ross, M.D., Anna E. Thorson, M.D., Ph.D., Thomas A. Massaquoi, M.D., Jaclyn E. Marrinan, M.Sc., Elizabeth Ervin, M.P.H., Amara Jambai, M.D., Suzanna L.R. McDonald, Ph.D., Kyle Bernstein, Ph.D., Alie H. Wurie, M.D., Marion S. Dumbuya, R.N., Neetu Abad, Ph.D., Baimba Idriss, M.D., Teodora Wi, Ph.D., Sarah D. Bennett, M.D., Tina Davies, M.S., Faiqa K. Ebrahim, M.D., Elissa Meites, M.D., Dhamari Naidoo, Ph.D., Samuel Smith, M.D., Anshu Banerjee, Ph.D., Bobbie Rae Erickson, M.P.H., Aaron Brault, Ph.D., Kara N. Durski, M.P.H., Jorn Winter, Ph.D., Tara Sealy, M.P.H., Stuart T. Nichol, Ph.D., Margaret Lamunu, M.D., Ute Ströher, Ph.D., Oliver Morgan, Ph.D., and Foday Sahr, M.D.
October 14, 2015DOI: 10.1056/NEJMoa1511410
Preliminary results of a study into persistence of Ebola virus in body fluids show that some men still produce semen samples that test positive for Ebola virus nine months after onset of symptoms.
The report, published today in the New England Journal of Medicine, provides the first results of a long-term study being jointly conducted by the Sierra Leone Ministry of Health and Sanitation, Sierra Leone Ministry of Defence, the World Health Organization and the U.S. Centers for Disease Control and Prevention.
“Sierra Leone is committed to getting to zero cases and to taking care of our survivors, and part of that effort includes understanding how survivors may be affected after their initial recovery,” said Amara Jambai, M.D., M.Sc., Deputy Chief Medical Officer for the Sierra Leone Ministry of Health and Sanitation. “Survivors are to be commended for contributing to the studies that help us understand how long the virus may persist in semen.”
The first phase of this study has focused on testing for Ebola virus in semen because of past research showing persistence in that body fluid. Better understanding of viral persistence in semen is important for supporting survivors to recover and to move forward with their lives.
“These results come at a critically important time, reminding us that while Ebola case numbers continue to plummet,
Ebola survivors and their families continue to struggle with the effects of the disease. This study provides further evidence that survivors need continued, substantial support for the next 6 to 12 months to meet these challenges and to ensure their partners are not exposed to potential virus,” said Bruce Aylward, WHO Director-General’s Special Representative on the Ebola Response.
Ninety three men over the age of 18 from Freetown, Sierra Leone, provided a semen sample that was tested to detect the presence of Ebola virus genetic material. The men enrolled in the study between two and 10 months after their illness began. For men who were tested in the first three months after their illness began, all were positive (9/9; 100 percent). More than half of men (26/40; 65 percent) who were tested between four to six months after their illness began were positive, while one quarter (11/43; 26 percent) of those tested between seven to nine months after their illness began also tested positive. The men were given their test results along with counseling and condoms.
“EVD survivors who volunteered for this study are doing something good for themselves and their families and are continuing to contribute to the fight against Ebola and our knowledge about this disease,” said Yusuf Kabba, National President of the Sierra Leone Association of Ebola Survivors.
Why some study participants had cleared the fragments of Ebola virus from semen earlier than others remains unclear. The U.S. Centers for Disease Control and Prevention in Atlanta is conducting further tests of the samples to determine if the virus is live and potentially infectious.
“Ebola survivors face an increasing number of recognized health complications,” said CDC Director Tom Frieden, M.D., M.P.H. “This study provides important new information about the persistence of Ebola virus in semen and helps us make recommendations to survivors and their loved ones to help them stay healthy."
Until more is known, the more than 8000 male Ebola survivors across the three countries need appropriate education, counseling and regular testing so they know whether Ebola virus persists in their semen; and the measures they should take to prevent potential exposure of their partners to the virus. Until a male Ebola survivor’s semen has twice tested negative, he should abstain from all types of sex or use condoms when engaging in sexual activity. Hands should be washed after any physical contact with semen. For more information: Interim advice on the sexual transmission of the Ebola virus disease
In the current West African outbreak, continued vigilance to identify, provide care for, contain and stop new cases, are key strategies on the road to achieving zero cases.