Ebola can persist in semen of some survivors for at least nine months

First known case of sexually transmitted EVD reported Survivors need comprehensive support to minimize risk of re-emergence of virus, says WHO
The threat of another outbreak of the Ebola Virus Disease (EVD) in Nigeria persists with the report, yesterday, of the first known sexually transmitted case.

Also, the World Health Organisation (WHO), yesterday, confirmed that the virus could persist in semen of some survivors for at least nine months.

To address the threat, the WHO, yesterday, in a statement and in a preliminary report published in New England Journal of Medicine, recommended that survivors need comprehensive support to minimize the risk of re-emergence of the virus.

The report is titled “Ebola RNA persistence in semen of Ebola virus disease survivors.”
The United Nation’s (UN) apex health body said survivors, their partners and families, should receive support, appropriate and continuing counselling, and follow up testing. “All survivors should be provided information and support to enable them to apply correct hygiene measures and practise safe sex,” the WHO noted.

Researchers reported on October 14, 2015, issue of the New England Journal of Medicine that a Liberian woman contracted Ebola in March by having sex with a survivor of the viral disease. Using studies of both people’s viral genomes and of the people’s contacts with any other possible sources of the virus, the researchers conclude that the woman’s disease represents the first known case of sexual transmission of Ebola.

People ordinarily catch the often-deadly virus through direct contact with blood or other body fluids.

In this case, the two people had unprotected sex six months after the man got Ebola, and 155 days after his second blood test showed him to be clear of the virus.

The genomes of the Ebola virus from the man’s semen and woman’s blood were not only practically identical but also different from all other Western African Ebola viruses that had been sequenced.

Also appearing in the journal is a preliminary report that genetic material from Ebola viruses can persist in semen nine months after infection.

Both findings suggest that Ebola remains in certain parts of the body long after the blood is clear of the virus.

However, in an opinion piece that accompanies the two research reports, Armand Sprecher of Doctors Without Borders in Brussels noted that more than 17,000 people survived the West African Ebola outbreak. “If sexual transmission from survivors were an important means of disease propagation, we would have seen a number of cases by now,” he writes.

According to the WHO, a growing volume of data from careful clinical observation and testing of people who have recovered from acute Ebola virus disease indicates that the Ebola virus can persist at various sites in the body for many months in some people. Such sites include the inside of the eye, semen, amniotic fluid, the placenta, breast milk and the central nervous system.

A preliminary study on Ebola virus persistence in the semen of male survivors in Sierra Leone, has found that some men still produce semen that test positive on real time – polymerase chain reaction (RT-PCR), a test used to detect Ebola virus genetic material (RNA) – for nine months or longer.

These results, reported on 14 October 2015 in the online version of the New England Medical Journal, are from “baseline” samples provided by 93 men participating in the study being jointly conducted by the Sierra Leone Ministry of Health and Sanitation, the WHO and the United States Centers for Disease Control and Prevention (CDC).

According to the WHO statement, “All of the men who were tested in the first three months after their illness began 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 (11/46; 24 percent) of those tested between seven to nine months after their illness began also tested positive.

“The study is following this group of men, retesting at intervals to understand how long virus persists in semen, and will explore which factors may be associated with persistence of virus. After each test, the men are provided with their test results along with counselling, advice about appropriate hygiene and practising safe sex, and condoms.

“Based on current results, the presence of virus in semen decreases in the months after recovery from Ebola virus disease. However, one participant was still positive 9.5 months after his illness began. It is still not known how long the virus can persist in semen but this study will yield more information about how long it takes for men to clear Ebola virus from semen.