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Of the 10 people treated for Ebola in the U.S., eight survived and all had some symptoms in the weeks and months after they recovered, CDC researchers said.
Their experience might help illuminate the challenges being faced in West Africa, where more than 17,000 people have survived the international Ebola outbreak, according to Lauren Epstein, MD, and colleagues at the agency's Atlanta headquarters.
Reports from the region, where most of the cases have occurred during the continuing outbreak, suggest survivors might face joint pain, hearing loss, eye disease, and fatigue, Epstein and colleagues reported in the New England Journal of Medicine.
But little is known definitively about the clinical consequences of Ebola, they noted.
To try to understand the issue, and illuminate the challenges faced in West Africa, they turned to the people successfully treated in the U.S., asking them to respond to a detailed questionnaire about the experience.
Of the 10 people treated in the U.S., only two died -- Thomas Eric Duncan, the first person to be diagnosed with Ebola on U.S. soil, and Martin Salia, MD, a Sierra Leone surgeon who was a U.S. resident. Two nurses who treated Duncan came down with Ebola, while the remaining six patients were U.S. physicians and missionaries who had been working in West Africa to battle the outbreak.
The eight had a range of symptoms after recovery, Epstein said, some of which were severe enough to require re-admission to hospital. Most improved or went away over time, but only one survivor said all symptoms had completely resolved.
Six of the eight said they were able to return to normal daily activities within 8 weeks of discharge.
Nonetheless, Epstein and colleagues argued, the findings suggest that survivors might need psychological and subspecialty assessments (such as rheumatologic, musculoskeletal, or neurologic evaluation) as well as their primary care.
Some signs and symptoms started during the acute care hospital stay, some at discharge, and some later during the recovery period, Epstein and colleagues noted. The median recovery period -- defined as the interval between hospital discharge and the survey, conducted in March -- was 5 months, they reported.
During that time, all survivors reported at least one symptom, Epstein and colleagues found.
The most frequently reported symptoms were:
- Lethargy or fatigue, reported by six people as being present at discharge and lasting for several weeks. One participant said the lethargy was still present when the survey was taken.
- Arthralgia, also reported by six people as being present at discharge and lasting for weeks. The joint pain was still present for one person when the survey was taken. Sites included knees, shoulder, lower back, and heel.
- Alopecia, also suffered by six people and reported as starting between 4 and 16 weeks after discharge.
As well, five participants had ocular symptoms, including pain, discomfort, or blurriness, and four had an ophthalmologic evaluation. Two survivors had treatment for unilateral uveitis.
Six people reported psychological or cognitive symptoms, including short-term memory loss, insomnia, and depression or anxiety, and fewer than half said those symptoms had resolved by the time of the survey.
Three reported paresthesia or dysesthesia soon after discharge, one of whom was treated for peripheral neuropathy; two said the symptoms had resolved by the time of the survey.
Two patients were admitted to hospital briefly for a non-Ebola febrile illness, they found.
The investigators cautioned they did not review medical records or assess whether the reported symptoms were directly caused by Ebola.
Also on Wednesday, the World Health Organization reported that no new cases of Ebola had been reported in West Africa since Nov. 22. The nation of Guinea could be declared free of active Ebola on Dec. 28 if no new cases develop; Liberia’s corresponding target date is Jan. 14. The third country involved in the outbreak, Sierra Leone, was declared Ebola-free in early November.
The study was supported by the CDC.
New England Journal of MedicineSource Reference: Epstein L, et al "Post-ebola signs and symptoms in U.S. survivors" N Engl J Med 373;25: 2484-2486.