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Ebola survivors five times more likely to die in year following recovery than general population
Survivors of Ebola are five times more likely to die in the year following recovery from the disease than the general population, research has found.
In a study set to have implications for those managing the current Ebola epidemic raging in the Democratic Republic of Congo, researchers followed up patients discharged from Ebola treatment centres in Guinea during the 2014 to 2016 outbreak.
The study, published in the Lancet Infectious Diseases journal, found that of the 1,130 Ebola survivors followed for a year after being discharged from treatment centres 55 died, compared to 11 that would be expected in the general population.
The majority of patients – 37 – died from kidney problems although researchers stressed that this finding was still tentative.
In the majority of cases there were no proper records to determine exact causes of death and the researchers relied on interviews with family members.
Judith Glynn, professor of epidemiology at the London School of Hygiene and Tropical Medicine and one of the study’s authors, said that kidney failure as a cause of death was mainly determined by families reporting that loved ones stopped producing urine.
“We know that Ebola can infect the kidney. If you get acute kidney problems it can give rise to acute renal failure later so this as a cause of death is possible. I would emphasise that the evidence is quite weak for most cases. For most people the cause of death was based on interviews with family members,” she said.
A range of health problems has been reported in Ebola survivors including headache, memory loss, severe tiredness and joint and muscle pain. The virus is also known to persist in body fluid, particularly semen, for up to a year and, in one case, two years.
But this is the first time that researchers have shown that death rates are higher among those who have been successfully treated for the disease.
The study also showed that death rates were higher for those who stayed longer in Ebola treatment units – probably because they had more acute forms of the disease.
And mortality was lower among those living in the capital of Guinea, Conakry, than for those in rural areas. The authors suggest better access to health care in urban regions is a reason for the disparity.
The study has implications for those responsible for the after-care of the 900 survivors of the current Ebola outbreak in DRC. Since the outbreak was declared last August there have been more than 3,000 cases of the disease, including more than 2,000 deaths.
Some 16 Ebola survivors have died since being discharged from treatment units and researchers are currently investigating the causes of death. Survivors are offered six months medical follow up and 12 months psycho-social support.
Dr Mory Keita, one of the authors of the Lancet study and currently World Health Organization field coordinator in the Ebola-affected region of North Kivu in DRC, said that it was still unclear why the 16 patients had died but researchers will look at renal failure as one cause.
But he added that for the first time in an Ebola epidemic effective treatments are now available. A recent trial of four experimental treatments found that if administered early enough two of the treatments are 90 per cent effective, meaning the disease is no longer incurable.
“We now have treatments in the DRC which we didn’t have during the West African outbreak. This could change the situation for survivors as those in West Africa did not get the same treatments. But the fact is we have already had 16 deaths so this is something we still need to monitor,” he said.
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