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The British nurse, Pauline Cafferkey, who had previously recovered from Ebola after working in West Africa has been admitted to hospital for a third time.
All our previous output on this subject can be seen here. The SMC also produced a Q&A on viral persistence with respect to Ebola, which is available here.
Dr Ben Neuman, Lecturer in Virology, University of Reading, said:
“This is really lousy news for Pauline Cafferkey and her family, who have been through this too many times already. I only hope that this is a false alarm, but the fact that she is heading back to the Royal Free Hospital in London shows that the health authorities are not taking any chances.
“If this is a complication caused by her previously having Ebola, as happened before, it means that the virus is still in a bodily compartment where antibodies can’t get to it in enough numbers to be effective. The virus is probably infecting cells that are somehow escaping surveillance from T cells – the immune system’s ‘hunter-killer’ cells, which guard against viruses.”
Dr Nathalie MacDermott, Clinical Research Fellow, Imperial College London, said:
“Ebola virus is known to cause ongoing problems in many survivors of the disease both in West Africa and in Europe and the USA. The type of problems it can cause are varied and differs between survivors, but can include inflammation in the eye, pain in the joints, prolonged fatigue and as has been described in one case, meningitis. The length of time these problems can continue for can be lengthy and may continue for many months and even more than a year following survival. It is still being determined how long survivors can suffer problems for, but as the length of time since the beginning of the epidemic in West Africa progresses we are discovering that problems may persist for longer than anticipated. While in most survivors the problems seem to improve and become less frequent with time, there are cases of reactivation of the virus in the eyes and nervous systems of survivors many months following survival from the disease.
“In Pauline Cafferkey’s situation we previously saw an unusual presentation of reactivation of the virus in the form of meningitis and at a much later stage than reactivations had previously been seen. This was an unprecedented situation. We don’t know what her current situation is and it would be wrong to speculate that it is related to a reactivation of Ebola virus. It is difficult to know what the likelihood of further relapses are given the previous unprecedented nature of her situation. While it would seem that further relapses become less likely the longer time progresses, the situation remains uncertain and this must be concerning for her and her family.
“As we learn more about Ebola virus disease and the post-Ebola problems it may cause, we gain further understanding of the nature of the virus’ persistence in bodily fluids and different organ systems of the body. This remains an area which requires further study by the scientific community to better understand the situation survivors face in the future and is a key area under investigation in West Africa at the present time.”
Dr Derek Gatherer, Lecturer in the Division of Biomedical and Life Sciences, Lancaster University, said:
“It is very sad to hear that Ms Cafferkey has once again been admitted to hospital. It is now becoming clear that Ebola is a far more complex disease than we previously imagined. The very large number of cases in West Africa since the end of 2013 have displayed a wide range of rare but extremely unpleasant consequences for those who survive their first battle with the disease. The meningitis that Ms Cafferkey suffered from at the end of last year is one of the most serious complications of all, as it can be life-threatening. She was unlucky enough to be one of only a handful of patients in whom it has been seen. The other main rare serious complication is inflammation of the eyes (conjunctivitis and/or uveitis) which can lead to blindness, especially if supportive treatments are unavailable. The major post-recovery complications are joint aches, headaches and general tiredness which can last for months. Up to half of Ebola survivors will have some or several of this milder range of symptoms. Although not life-threatening, these can be problematic, especially in societies like west Africa where a large number of people make their living from agricultural labour.”
Declared interests
Dr Ben Neuman: No conflicts of interest.
Dr Nathalie MacDermott: “I am a paediatrician. I am also undertaking a PhD in Ebola virus disease at Imperial College London funded by the Wellcome Trust.”
Dr Derek Gatherer: Derek Gatherer is internally funded by Lancaster University to cover costs related to participation in the WHO/NIBSC Ebola diagnostics optimization project.