Ebola Virus Infection Associated with Transmission from Survivors

Saskia Den Boon, Barbara J Marston, Tolbert G Nyenswah, Amara Jambai, Moumie Barry, Sakoba Keita, Kara Durski, Schabbethai S Senesie, Devin Perkins, Anita Shah, Hugh H Green, Esther L Hamblion, Margaret Lamunu, Alex Gasasira, Nuha O Mahmoud, Mamadou H Djingarey, Oliver Morgan, Ian Crozier, Christopher Dye, Saskia Den Boon, Barbara J Marston, Tolbert G Nyenswah, Amara Jambai, Moumie Barry, Sakoba Keita, Kara Durski, Schabbethai S Senesie, Devin Perkins, Anita Shah, Hugh H Green, Esther L Hamblion, Margaret Lamunu, Alex Gasasira, Nuha O Mahmoud, Mamadou H Djingarey, Oliver Morgan, Ian Crozier, Christopher Dye

Abstract

Ebola virus (EBOV) can persist in immunologically protected body sites in survivors of Ebola virus disease, creating the potential to initiate new chains of transmission. From the outbreak in West Africa during 2014-2016, we identified 13 possible events of viral persistence-derived transmission of EBOV (VPDTe) and applied predefined criteria to classify transmission events based on the strength of evidence for VPDTe and source and route of transmission. For 8 events, a recipient case was identified; possible source cases were identified for 5 of these 8. For 5 events, a recipient case or chain of transmission could not be confidently determined. Five events met our criteria for sexual transmission (male-to-female). One VPDTe event led to at least 4 generations of cases; transmission was limited after the other events. VPDTe has increased the importance of Ebola survivor services and sustained surveillance and response capacity in regions with previously widespread transmission.

Keywords: Ebola virus disease; Guinea; Liberia; Sierra Leone; West Africa; response; sexual transmission; surveillance; survivors; viral persistence; viruses.

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