Wednesday, August 31, 2016

Lancet Global Health: Traces Of Ebola Can Remain In Semen For Longer Than 1 Year


The persistence of the Ebola virus, detected in some organs and bodily fluids (i.e. semen, breast milk, etc.), among some survivors even months after their recovery (see ECDC On Ebola Persistence & Rapid Risk Assessment) has been an ongoing and evolving story.
Last May, in Virus Evolution: Rapid Sequencing Reveals Rare Ebola Transmission Via Breast milk And Semen, we looked at a study that used genetic sequencing to identify the lineage of  Ebola infections during the tail end of the outbreak in Sierra Leone, and which indicated sexual or breast milk transmission was likely in a handful of cases.

And a little over a year ago, in MMWR & WHO On Risks Of Sexual Transmission Of Ebola we looked at a suspected case of sexual transmission in March of 2015 from a male patient who had been believed `recovered’ for well over six months. 

At first, just a very few Ebola survivors were believed able to carry the virus for up to 3 months post recovery, but over time that number has expanded to six months . . and then nine. 

The persistence of symptoms (see EID Journal Post-Ebola Syndrome, Sierra Leone), and Scottish Nurse Pauline Cafferkey's high profile relapse 9 months after her initial recovery,  has led the WHO to issue guidance, and the following assessment:
Today, there are over 10 000 survivors of Ebola virus disease. A number of medical problems have been reported in survivors, including mental health issues. Ebola virus may persist in some body fluids, including semen. Ebola survivors need comprehensive support for the medical and psychosocial challenges they face and also to minimize the risk of continued Ebola virus transmission. 

Today the Lancet Global Health has published a new study that pushes the time envelope for carriage of the Ebola virus out even further, with one man showing detectable viral RNA in his semen 565 days post recovery, and multiple patients still showing viral RNA in their semen a year after they were discharged from the hospital. 

The presence of viral RNA doesn't necessarily mean these men can still pass on the virus to others, but it can't be discounted either. 

First the link and Abstract to the Lancet report, then a link to a CDC statement on these findings.

Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors: an analysis of Ebola virus RNA results and behavioural data

Moses J Soka, Mary J Choi, April Baller, Stephen White, Emerson Rogers, Lawrence J Purpura, Nuha Mahmoud, Christine Wasunna, Moses Massaquoi, Neetu Abad, Jomah Kollie, Straker Dweh, Philip K Bemah, Athalia Christie, Victor Ladele, Oneychachi C Subah, Satish Pillai, Margaret Mugisha, Jonathan Kpaka, Stephen Kowalewski, Emilio German, Mark Stenger, Stuart Nichol, Ute Ströher, Kristin E Vanderende, Shauna Mettee Zarecki, Hugh Henry W Green, Jeffrey A Bailey, Pierre Rollin, Barbara Marston, Tolbert G Nyenswah, Alex Gasasira, Barbara Knust, Desmond Williams


Ebola virus has been detected in semen of Ebola virus disease survivors after recovery. Liberia's Men's Health Screening Program (MHSP) offers Ebola virus disease survivors semen testing for Ebola virus. We present preliminary results and behavioural outcomes from the first national semen testing programme for Ebola virus.


The MHSP operates out of three locations in Liberia: Redemption Hospital in Montserrado County, Phebe Hospital in Bong County, and Tellewoyan Hospital in Lofa County. Men aged 15 years and older who had an Ebola treatment unit discharge certificate are eligible for inclusion. Participants' semen samples were tested for Ebola virus RNA by real-time RT-PCR and participants received counselling on safe sexual practices. Participants graduated after receiving two consecutive negative semen tests. Counsellors collected information on sociodemographics and sexual behaviours using questionnaires administered at enrolment, follow up, and graduation visits. Because the programme is ongoing, data analysis was restricted to data obtained from July 7, 2015, to May 6, 2016.


As of May 6, 2016, 466 Ebola virus disease survivors had enrolled in the programme; real-time RT-PCR results were available from 429 participants. 38 participants (9%) produced at least one semen specimen that tested positive for Ebola virus RNA. Of these, 24 (63%) provided semen specimens that tested positive 12 months or longer after Ebola virus disease recovery. The longest interval between discharge from an Ebola treatment unit and collection of a positive semen sample was 565 days. Among participants who enrolled and provided specimens more than 90 days since their Ebola treatment unit discharge, men older than 40 years were more likely to have a semen sample test positive than were men aged 40 years or younger (p=0·0004). 84 (74%) of 113 participants who reported not using a condom at enrolment reported using condoms at their first follow-up visit (p< 0·0001). 176 (46%) of 385 participants who reported being sexually active at enrolment reported abstinence at their follow-up visit (p< 0·0001).


Duration of detection of Ebola virus RNA by real-time RT-PCR varies by individual and might be associated with age. By combining behavioural counselling and laboratory testing, the Men's Health Screening Program helps male Ebola virus disease survivors understand their individual risk and take appropriate measures to protect their sexual partners.

And this from the CDC:

Traces of Ebola Virus Linger Longer than Expected in Semen

Older men more likely to have a positive semen test

Press Release

Embargoed until 6:30 p.m. EST: Tuesday, August 30, 2016
Contact: Media Relations
(404) 639-3286

Initial data from a Liberian public health program show about 9 percent (38) of 429 male Ebola survivors had fragments of Ebola virus in their semen. Of those, 63 percent had semen samples that tested positive for Ebola fragments a year after recovering from disease and, in one man’s case, at least 565 days after he recovered from illness. Men older than 40 were more likely than younger men to have a semen sample test positive.

Published in the August 30 issue of Lancet Global Health, the report provides preliminary results from Liberia’s Men’s Health Screening Program (MHSP), the first national semen testing program for Ebola virus. It is the largest analysis to date to look at Ebola virus persistence in male survivors. The tests detect Ebola virus genetic material but cannot tell if live virus is present and capable of spreading disease.

In addition to semen testing, the MHSP provides counseling and education about safe sex practices. The report shows that this program led to a marked increase in men reporting condom use or abstinence. Nearly 75 percent of study participants who reported having sex without condoms during enrollment later reported using condoms during sexual activity.

(Continue . . . )

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