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Schindell BG, Titanji BK, Rimoin AW, Shaw SY, Kangbai JB, Kindrachuk J. Clinical health outcomes of Ebola virus disease survivors eight years post recovery: a cross-sectional study in Sierra Leone. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.29.24312780. [PMID: 39252914 PMCID: PMC11383457 DOI: 10.1101/2024.08.29.24312780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Background The West African Ebola virus disease (EVD) epidemic that occurred between 2013-2016 resulted in >28,000 confirmed cases and >11,000 fatalities. Thousands of survivors necessitate an understanding of the long-term health effects and future medical needs of these patients. Methods A cross-sectional study of 595 EVD survivors from Sierra Leone and 403 close contacts (n=998). An in-person survey conducted between November 2021 and March 2022 included demographics, clinical health symptomology assessment of each organ system and a reproductive health assessment including sexual dysfunction question sets. The frequency of each disorder was examined and the association of each disorder with EVD survival was assessed. Results Of 12 number of symptom types, five were reported by >50% of EVD survivors (Ocular, Neurological, Constitutional, Genitourinary, Dermatological), and all but one were reported by >40% of EVD survivors. Symptom types associated with EVD survival included ENT symptoms (AOR: 8.75, 95% CI: 5.63 - 13.60, p < 0.001), ocular symptoms (AOR: 7.18, 95% CI: 5.02 - 10.25, p < 0.001), dermatological symptoms (AOR: 4.16, 95% CI: 3.06 - 5.65, p < 0.001) and cardiovascular symptoms (AOR: 2.96, 95% CI: 2.12 - 4.13, p < 0.001). Conclusion The West Africa EVD epidemic resulted in a high prevalence of persistent health issues among disease survivors. Continued support for survivor services in West Africa is crucial, and future outbreak response planning should include dedicated funding to ensure adequate care for survivors, both during the acute phase of infection and throughout the post recovery period.
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Affiliation(s)
- Brayden G Schindell
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Boghuma K Titanji
- Division of Infectious Disease, Emory University, Atlanta, United States of America
| | - Anne W Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles
| | - Souradet Y Shaw
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jia B Kangbai
- Department of Public Health, Njala University, Sierra Leone
| | - Jason Kindrachuk
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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2
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Mandizadza OO, Phebeni RT, Ji C. Prevalence of somatic symptoms among Ebola Virus Disease (EVD) survivors in Africa: a systematic review and meta-analysis. BMC Public Health 2024; 24:1511. [PMID: 38840082 PMCID: PMC11155043 DOI: 10.1186/s12889-024-19013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Many Ebola virus disease (EVD) survivors have reported somatic and neuropsychological symptoms after discharge from the Ebola Treatment Unit (ETU). Since the 2014-2016 Ebola epidemic in West Africa, various studies have investigated and identified these symptoms. Evidence on somatic symptoms is widely available in the literature, however, there is no concise overview of the prevalence across different time intervals. METHODS This meta-analysis was conducted following the (PRISMA) guidelines. A database search was conducted to identify original studies that reported the prevalence of symptoms. The primary outcome measure was the prevalence rate of several somatic symptoms. Results were pooled, and prevalence rates were assessed over time, to elucidate any particular trends. RESULTS We included 23 studies (5,714 participants). The pooled prevalence was: arthralgia 50% (95% CI: 41%-59%); headache 44% (95% CI: 36%-52%); myalgia 32% (95% CI: 26%-38%); abdominal pain 27% (95% CI: 15%-39%); fatigue 25% (95% CI: 19%-31%); numbness of feet 16% (95% CI: 14%-18%); numbness of hands 12% (95% CI: 10%-14%) and hearing loss 9% (95% CI: 5%-12%). Prevalence across different time intervals revealed significant patterns. All the symptoms persisted for more than 2 years after discharge except for abdominal pain. CONCLUSION The pooled prevalence rates of somatic symptoms are notably high. Arthralgia and headache are the most prevalent of the symptoms, with hearing loss and numbness in hands and feet being the least. We found that arthralgia, myalgia, and abdominal pain decreased over time. However, headache, fatigue, numbness of hands and feet, and hearing loss increased over time.
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Affiliation(s)
| | | | - Conghua Ji
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China.
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3
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Ngathaweesuk Y, Hendrikse J, Groot-Mijnes JDFD, de Boer JH, Hettinga YM. Causes of infectious pediatric uveitis: A review. Surv Ophthalmol 2024; 69:483-494. [PMID: 38182040 DOI: 10.1016/j.survophthal.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
Infectious pediatric uveitis is a rare disease that can cause severe ocular damage if not detected rapidly and treated properly. Additionally, early identification of an infection can protect the child from life-threatening systemic infection. Infectious uveitis can be congenital or acquired and may manifest as a primary ocular infection or as a reactivation. Nevertheless, publications on infectious paediatric uveitis are usually limited to a small number of patients or a case report. So far, most studies on uveitis in children have focused primarily on noninfectious uveitis, and a systematic study on infectious uveitis is lacking. In this review, we summarize the literature on infectious uveitis in pediatric populations and report on the epidemiology, pathophysiology, clinical signs, diagnostic tests, and treatment. We will describe the different possible pathogens causing uveitis in childhood by microbiological group (i.e. parasites, viruses, bacteria, and fungi). We aim to contribute to early diagnosis and management of infectious pediatric uveitis, which in turn might improve not only visual outcome, but also the general health outcome.
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Affiliation(s)
- Yaninsiri Ngathaweesuk
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Jytte Hendrikse
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Jolanda Dorothea Francisca de Groot-Mijnes
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joke Helena de Boer
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands
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4
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Curran EH, Devine MD, Hartley CD, Huang Y, Conrady CD, Debiec MR, Justin GA, Thomas J, Yeh S. Ophthalmic implications of biological threat agents according to the chemical, biological, radiological, nuclear, and explosives framework. Front Med (Lausanne) 2024; 10:1349571. [PMID: 38293299 PMCID: PMC10824978 DOI: 10.3389/fmed.2023.1349571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
As technology continues to evolve, the possibility for a wide range of dangers to people, organizations, and countries escalate globally. The United States federal government classifies types of threats with the capability of inflicting mass casualties and societal disruption as Chemical, Biological, Radiological, Nuclear, and Energetics/Explosives (CBRNE). Such incidents encompass accidental and intentional events ranging from weapons of mass destruction and bioterrorism to fires or spills involving hazardous or radiologic material. All of these have the capacity to inflict death or severe physical, neurological, and/or sensorial disabilities if injuries are not diagnosed and treated in a timely manner. Ophthalmic injury can provide important insight into understanding and treating patients impacted by CBRNE agents; however, improper ophthalmic management can result in suboptimal patient outcomes. This review specifically addresses the biological agents the Center for Disease Control and Prevention (CDC) deems to have the greatest capacity for bioterrorism. CBRNE biological agents, encompassing pathogens and organic toxins, are further subdivided into categories A, B, and C according to their national security threat level. In our compendium of these biological agents, we address their respective CDC category, systemic and ophthalmic manifestations, route of transmission and personal protective equipment considerations as well as pertinent vaccination and treatment guidelines.
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Affiliation(s)
- Emma H. Curran
- Creighton University School of Medicine, Omaha, NE, United States
| | - Max D. Devine
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Caleb D. Hartley
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ye Huang
- Department of Ophthalmology, University of Illinois-Chicago, Chicago, IL, United States
| | - Christopher D. Conrady
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Microbiology and Pathology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Matthew R. Debiec
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Grant A. Justin
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Joanne Thomas
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, United States
- National Strategic Research Institute, University of Nebraska Medical Center, Omaha, NE, United States
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5
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Dobbs KR, Lobb A, Dent AE. Ebola virus disease in children: epidemiology, pathogenesis, management, and prevention. Pediatr Res 2024; 95:488-495. [PMID: 37903937 DOI: 10.1038/s41390-023-02873-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 11/01/2023]
Abstract
Ebola disease is a severe disease with extremely high case-fatality rates ranging from 28-100%. Observations made during the 2013-2016 West African epidemic improved our understanding of the clinical course of Ebola disease and accelerated the study of therapeutic and preventative strategies. The epidemic also highlighted the unique challenges associated with providing optimal care for children during Ebola disease outbreaks. In this review, we outline current understanding of Ebola disease epidemiology, pathogenesis, management, and prevention, highlighting data pertinent to the care of children. IMPACT: In this review, we summarize recent advancements in our understanding of Ebola disease epidemiology, clinical presentation, and therapeutic and preventative strategies. We highlight recent data pertinent to the care of children and pregnant women and identify research gaps for this important emerging viral infection in children.
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Affiliation(s)
- Katherine R Dobbs
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
| | - Alyssa Lobb
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Arlene E Dent
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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6
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Ahmad F, Deshmukh N, Webel A, Johnson S, Suleiman A, Mohan RR, Fraunfelder F, Singh PK. Viral infections and pathogenesis of glaucoma: a comprehensive review. Clin Microbiol Rev 2023; 36:e0005723. [PMID: 37966199 PMCID: PMC10870729 DOI: 10.1128/cmr.00057-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide, caused by the gradual degeneration of retinal ganglion cells and their axons. While glaucoma is primarily considered a genetic and age-related disease, some inflammatory conditions, such as uveitis and viral-induced anterior segment inflammation, cause secondary or uveitic glaucoma. Viruses are predominant ocular pathogens and can impose both acute and chronic pathological insults to the human eye. Many viruses, including herpes simplex virus, varicella-zoster virus, cytomegalovirus, rubella virus, dengue virus, chikungunya virus, Ebola virus, and, more recently, Zika virus (ZIKV) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), have been associated with sequela of either primary or secondary glaucoma. Epidemiological and clinical studies suggest the association between these viruses and subsequent glaucoma development. Despite this, the ocular manifestation and sequela of viral infections are not well understood. In fact, the association of viruses with glaucoma is considered relatively uncommon in part due to underreporting and/or lack of long-term follow-up studies. In recent years, literature on the pathological spectrum of emerging viral infections, such as ZIKV and SARS-CoV-2, has strengthened this proposition and renewed research activity in this area. Clinical studies from endemic regions as well as laboratory and preclinical investigations demonstrate a strong link between an infectious trigger and development of glaucomatous pathology. In this article, we review the current understanding of the field with a particular focus on viruses and their association with the pathogenesis of glaucoma.
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Affiliation(s)
- Faraz Ahmad
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Nikhil Deshmukh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Aaron Webel
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandra Johnson
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Ayman Suleiman
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Rajiv R. Mohan
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Departments of Veterinary Medicine & Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Frederick Fraunfelder
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Pawan Kumar Singh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
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7
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Matson MJ, Bushmaker T, Scott DP, Rosenke R, Saturday G, Chertow DS, Munster VJ. Ebola Virus Tropism in Ex Vivo Cynomolgus Macaque Ocular Tissues. J Infect Dis 2023; 228:S626-S630. [PMID: 37386692 PMCID: PMC10651198 DOI: 10.1093/infdis/jiad239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/01/2023] Open
Abstract
Ocular complications of Ebola virus disease are well-documented and long-term sequelae in survivors are common and lead to considerable morbidity. However, little is currently known regarding EBOV's tropism and replication kinetics within the eye. To date, limited studies have utilized in vitro infections of ocular cell lines and analyses of archived pathology samples to investigate these issues. Here, we employed ex vivo cultures of cynomolgus macaque eyes to determine the tropism of EBOV in 7 different ocular tissues: cornea, anterior sclera with bulbar conjunctiva, ciliary body, iris, lens, neural retina, and retina pigment epithelium. We report that, except for neural retina, all tissues supported EBOV replication. Retina pigment epithelium produced the fastest growth and highest viral RNA loads, although the differences were not statistically significant. Immunohistochemical staining confirmed and further characterized infection. This study demonstrates that EBOV has a broad tropism within the eye.
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Affiliation(s)
- M Jeremiah Matson
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Trent Bushmaker
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - Dana P Scott
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MontanaUSA
| | - Rebecca Rosenke
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MontanaUSA
| | - Greg Saturday
- Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MontanaUSA
| | - Daniel S Chertow
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Vincent J Munster
- Laboratory of Virology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
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8
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Rishi E, Thomas J, Fashina T, Kim L, Yeh S. Emerging Pathogenic Viral Infections of the Eye. Annu Rev Vis Sci 2023; 9:71-89. [PMID: 37018917 DOI: 10.1146/annurev-vision-100820-010504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Global health security threats and the public health impact resulting from emerging infectious diseases including the ongoing COVID-19 pandemic and recent Ebola virus disease outbreaks continuously emphasize the need for a comprehensive approach to preparedness, management of disease outbreaks, and health sequelae associated with emergent pathogens. A spectrum of associated ophthalmic manifestations, along with the potential persistence of emerging viral pathogens in ocular tissues, highlight the importance of an ophthalmic approach to contributing to efforts in the response to public health emergencies from disease outbreaks. This article summarizes the ophthalmic and systemic findings, epidemiology, and therapeutics for emerging viral pathogens identified by the World Health Organization as high-priority pathogens with epidemic potential.
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Affiliation(s)
- Ekta Rishi
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA; , ,
| | | | - Tolulope Fashina
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA; , ,
| | - Lucas Kim
- Mercer University School of Medicine, Augusta, Georgia, USA;
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA; , ,
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
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9
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Mudalegundi S, Ross RD, Larbelee J, Amegashie F, Dolo RF, Prakalapakorn GS, Ray V, Gargu C, Sosu Y, Sackor J, Cooper PZ, Wallace A, Nyain R, Burkholder B, Van Ryn C, Davis B, Fallah MP, Reilly C, Bishop RJ, Eghrari AO. Long-Term Decrease in Intraocular Pressure in Survivors of Ebola Virus Disease in the Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL) III Study. OPHTHALMOLOGY SCIENCE 2023; 3:100238. [PMID: 36582215 PMCID: PMC9792389 DOI: 10.1016/j.xops.2022.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Objective Survivors of Ebola virus disease (EVD) experience decreased intraocular pressure (IOP) relative to unaffected close contacts during the first year of convalescence. Whether this effect persists over time and its relationship to intraocular pathology are unclear. We sought to determine whether IOP remained lower in survivors of EVD over 4 years of follow-up and to identify associated risk factors. Design Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL) III is a 5-year, longitudinal cohort study of survivors of EVD and their close contacts and is a collaboration between the Liberian Ministry of Health and the United States National Institutes of Health. Participants Participants who enrolled in PREVAIL III at John F. Kennedy Medical Center in Liberia, West Africa from June 2015 to March 2016 who underwent comprehensive ophthalmic evaluation annually for 5 consecutive visits. Methods Intraocular pressure was measured at each visit by a handheld rebound tonometer using sterile tips. Comparisons are made between antibody-positive survivors and antibody-negative close contacts. Main Outcome Measures Intraocular pressure, measured in mmHg, at each study visit. Results Of 565 antibody-positive survivors and 644 antibody-negative close contacts enrolled in the study at baseline, the majority of participants returned annually, with 383 (67.8%) and 407 (63.2%) participants, respectively, presenting for the final study visit at a median of 60 months after symptom onset. A sustained, relative decrease in IOP was observed in survivors relative to close contacts, with mean difference of -0.72 mmHg (95% confidence interval [CI] -1.18 to -0.27) at the final study visit. This difference remained constant throughout the study period (P = 0.4 for interaction over time). Among survivors, physical examination findings of vitreous cell and OCT findings of vitreous opacities both demonstrated a significant association with decreased IOP at baseline (P < 0.05 for both). After adjusting for such factors, the difference throughout the follow-up (-0.93 mmHg, 95% CI, -1.23 to -0.63) remained significant. Conclusions Survivors of EVD experienced a sustained decrease in IOP relative to close contacts over a 5-year period after EVD. The results highlight the importance of considering long-term sequelae of emerging infectious diseases within a population. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
| | | | | | - Fred Amegashie
- Liberia Noncommunicable Disease Alliance, Monrovia, Liberia
| | | | | | - Vincent Ray
- Department of Ophthalmology, California Pacific Medical Center, San Francisco
| | - Catherine Gargu
- Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | - Yassah Sosu
- Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | - Jennie Sackor
- Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | - Precious Z. Cooper
- Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | - Augustine Wallace
- Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | - Ruth Nyain
- Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | | | - Collin Van Ryn
- Division of Biostatistics, University of Minnesota, Minneapolis
| | - Bionca Davis
- Division of Biostatistics, University of Minnesota, Minneapolis
| | | | - Cavan Reilly
- Division of Biostatistics, University of Minnesota, Minneapolis
| | - Rachel J. Bishop
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
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10
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Gao J, Guo Z, Li W, Zhang X, Zhang XE, Cui Z. Ebola virus disrupts the inner blood-retinal barrier by induction of vascular endothelial growth factor in pericytes. PLoS Pathog 2023; 19:e1011077. [PMID: 36652443 PMCID: PMC9847965 DOI: 10.1371/journal.ppat.1011077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
Ebola virus (EBOV) causes severe hemorrhagic fever in humans with high mortality. In Ebola virus disease (EVD) survivors, EBOV persistence in the eyes may break through the inner blood-retinal barrier (iBRB), leading to ocular complications and EVD recurrence. However, the mechanism by which EBOV affects the iBRB remains unclear. Here, we used the in vitro iBRB model to simulate EBOV in retinal tissue and found that Ebola virus-like particles (EBO-VLPs) could disrupt the iBRB. Cytokine screening revealed that EBO-VLPs stimulate pericytes to secrete vascular endothelial growth factor (VEGF) to cause iBRB breakdown. VEGF downregulates claudin-1 to disrupt the iBRB. Ebola glycoprotein is crucial for VEGF stimulation and iBRB breakdown. Furthermore, EBO-VLPs caused iBRB breakdown by stimulating VEGF in rats. This study provides a mechanistic insight into that EBOV disrupts the iBRB, which will assist in developing new strategies to treat EBOV persistence in EVD survivors.
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Affiliation(s)
- Jiawang Gao
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Zhengyuan Guo
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Wei Li
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, China
| | - Xiaowei Zhang
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, China
| | - Xian-En Zhang
- Faculty of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zongqiang Cui
- State Key Laboratory of Virology, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, China
- University of Chinese Academy of Sciences, Beijing, China
- * E-mail:
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11
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Huang Y, Mustapha J, Harrison-Williams L, Fashina T, Randleman C, Ifantides C, Shantha JG, Yeh S. Global Ophthalmic Health Initiatives in Ebola and Emerging Infectious Disease Outbreaks: Implications for Vision Health Systems, Program Implementation, and Disease Surveillance. Int Ophthalmol Clin 2023; 63:79-89. [PMID: 36598835 PMCID: PMC9819215 DOI: 10.1097/iio.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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12
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Worwa G, Cooper TK, Yeh S, Shantha JG, Hischak AMW, Klim SE, Byrum R, Kurtz JR, Anthony SM, Aiosa NM, Ragland D, Lee JH, Claire MS, Davis C, Ahmed R, Holbrook MR, Kuhn JH, Saphire EO, Crozier I. Persistent intraocular Ebola virus RNA is associated with severe uveitis in a convalescent rhesus monkey. Commun Biol 2022; 5:1204. [PMID: 36352100 PMCID: PMC9644391 DOI: 10.1038/s42003-022-04158-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
Despite increasing evidence that uveitis is common and consequential in survivors of Ebola virus disease (EVD), the host-pathogen determinants of the clinical phenotype are undefined, including the pathogenetic role of persistent viral antigen, ocular tissue-specific immune responses, and histopathologic characterization. Absent sampling of human intraocular fluids and tissues, these questions might be investigated in animal models of disease; however, challenges intrinsic to the nonhuman primate model and the animal biosafety level 4 setting have historically limited inquiry. In a rhesus monkey survivor of experimental Ebola virus (EBOV) infection, we observed and documented the clinical, virologic, immunologic, and histopathologic features of severe uveitis. Here we show the clinical natural history, resultant ocular pathology, intraocular antigen-specific antibody detection, and persistent intraocular EBOV RNA detected long after clinical resolution. The association of persistent EBOV RNA as a potential driver of severe immunopathology has pathophysiologic implications for understanding, preventing, and mitigating vision-threatening uveitis in EVD survivors.
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Affiliation(s)
- Gabriella Worwa
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA.
| | - Timothy K Cooper
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Steven Yeh
- Emory Eye Center, Emory University, Atlanta, GA, 30322, USA
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, 68105, USA
| | | | - Amanda M W Hischak
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Sarah E Klim
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Russell Byrum
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Jonathan R Kurtz
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Scott M Anthony
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Nina M Aiosa
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Danny Ragland
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Ji Hyun Lee
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Marisa St Claire
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Carl Davis
- Emory Vaccine Center, Emory University, Atlanta, GA, 30322, USA
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University, Atlanta, GA, 30322, USA
| | - Michael R Holbrook
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Erica Ollmann Saphire
- Center for Infectious Disease and Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, 92065, USA
| | - Ian Crozier
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA.
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA.
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13
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Taha MJJ, Abuawwad MT, Alrubasy WA, Sameer SK, Alsafi T, Al-Bustanji Y, Abu-Ismail L, Nashwan AJ. Ocular manifestations of recent viral pandemics: A literature review. Front Med (Lausanne) 2022; 9:1011335. [PMID: 36213628 PMCID: PMC9537761 DOI: 10.3389/fmed.2022.1011335] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/30/2022] [Indexed: 12/02/2022] Open
Abstract
Viral pandemics often take the world by storm, urging the medical community to prioritize the most evident systemic manifestations, often causing ocular manifestations to go unnoticed. This literature review highlights the ocular complications of the Monkeypox, SARS-CoV-2, MERS, Ebola, H1N1, and Zika viruses as the most recent viral pandemics. Research into the effects of these pandemics began immediately. Moreover, it also discusses the ocular complications of the vaccines and treatments that were used in the scope of the viral pandemics. Additionally, this review discusses the role of the eye as an important route of viral transmission, and thereafter, the International recommendations to reduce the incidence of viral transmission were mentioned. Lastly, this paper wants to lay out a platform for researchers who want to learn more about how viruses show up in the eye.
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Affiliation(s)
- Mohammad J. J. Taha
- Department of Clinical Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammad T. Abuawwad
- Department of Clinical Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Warda A. Alrubasy
- Department of Clinical Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shams Khalid Sameer
- Department of Clinical Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Taleb Alsafi
- Department of Optometry, Western University College of Optometry, Pomona, CA, United States
| | - Yaqeen Al-Bustanji
- Department of Clinical Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Luai Abu-Ismail
- Department of Ophthalmology, Islamic Hospital, Amman, Jordan
| | - Abdulqadir J. Nashwan
- Department of Nursing Education and Research, Hamad Medical Corporation, Doha, Qatar
- *Correspondence: Abdulqadir J. Nashwan
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14
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Atinga RA, Alhassan NMI, Ayawine A. Recovered but Constrained: Narratives of Ghanaian COVID-19 Survivors Experiences and Coping Pathways of Stigma, Discrimination, Social Exclusion and Their Sequels. Int J Health Policy Manag 2022; 11:1801-1813. [PMID: 34634884 PMCID: PMC9808237 DOI: 10.34172/ijhpm.2021.81] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Research about the coronavirus disease 2019 (COVID-19), its epidemiology and socio-economic impact on populations worldwide has gained attention. However, there is dearth of empirical knowledge in low- and middle-income settings about the pandemic's impact on survivors, particularly the tension of their everyday life arising from the experiences and consequences of stigma, discrimination and social exclusion, and how they cope with these behavioral adversities. METHODS Realist qualitative approach drawing data from people clinically diagnosed positive of COVID-19, admitted into therapy in a designated treatment facility, and subsequently recovered and discharged for or without follow-up domiciliary care. In-depth interviews were conducted by maintaining a code book for identifying and documenting thematic categories in a progression leading to thematic saturation with 45 participants. Data were transcribed and coded deductively for broad themes at the start before systematically nesting emerging themes into the broad ones with the aid of NVivo 12 software. RESULTS Everyday lived experiences of the participants were disrupted with acts of indirect stigmatization (against relatives and family members), direct stigmatization (labeling, prejudices and stereotyping), barriers to realizing full social life and discriminatory behaviors across socio-ecological structures (workplace, community, family, and social institutions). These behavioral adversities were associated with self-reported poor health, anxiety and psychological disorders, and frustrations among others. Consequently, supplicatory prayers, societal and organizational withdrawal, aggressive behaviors, supportive counseling, and self-assertive behaviors were adopted to cope and modify the adverse behaviors driven by misinformation and fearful perceptions of the COVID-19 and its contagious proportions. CONCLUSION In the face of the analysis, social campaigns and dissemination of toolkits that can trigger behavior change and responsible behaviors toward COVID-19 survivors are proposed to be implemented by health stakeholders, policy and decision makers in partnership with social influencers, the media, and telecoms.
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Affiliation(s)
- Roger A. Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | | | - Alice Ayawine
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Sunyani, Ghana
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15
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Kelly JD, Van Ryn C, Badio M, Fayiah T, Johnson K, Gayedyu-Dennis D, Weiser SD, Porco TC, Martin JN, Sneller MC, Rutherford GW, Reilly C, Fallah MP, Moses JS. Clinical sequelae among individuals with pauci-symptomatic or asymptomatic Ebola virus infection and unrecognised Ebola virus disease in Liberia: a longitudinal cohort study. THE LANCET. INFECTIOUS DISEASES 2022; 22:1163-1171. [PMID: 35588755 PMCID: PMC9329265 DOI: 10.1016/s1473-3099(22)00127-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/30/2021] [Accepted: 01/31/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Whether or not individuals with pauci-symptomatic or asymptomatic Ebola virus infection and unrecognised Ebola virus disease develop clinical sequelae is unknown. We assessed current symptoms and physical examination findings among individuals with pauci-symptomatic or asymptomatic infection and unrecognised Ebola virus disease compared with Ebola virus disease survivors and uninfected contacts. METHODS Between June 17, 2015, and June 30, 2017, we studied a cohort of Ebola virus disease survivors and their contacts in Liberia. Surveys, current symptoms and physical examination findings, and serology were used to characterise disease status of reported Ebola virus disease, unrecognised Ebola virus disease, pauci-symptomatic or asymptomatic Ebola virus infection, or no infection. We pre-specified findings known to be differentially prevalent among Ebola virus disease survivors versus their contacts (urinary frequency, headache, fatigue, muscle pain, memory loss, joint pain, neurological findings, chest findings, muscle findings, joint findings, abdominal findings, and uveitis). We estimated the prevalence and incidence of selected clinical findings by disease status. FINDINGS Our analytical cohort included 991 reported Ebola virus disease survivors and 2688 close contacts. The median time from acute Ebola virus disease onset to baseline was 317 days (IQR 271-366). Of 222 seropositive contacts, 115 had pauci-symptomatic or asymptomatic Ebola virus infection and 107 had unrecognised Ebola virus disease. At baseline, prevalent findings of joint pain, memory loss, muscle pain, and fatigue were lowest among those with pauci-symptomatic or asymptomatic infection or no infection, higher among contacts with unrecognised Ebola virus disease, and highest in reported survivors of Ebola virus disease. Joint pain was the most prevalent finding, and was reported in 434 (18%) of 2466 individuals with no infection, 14 (12%) of 115 with pauci-symptomatic or asymptomatic infection, 31 (29%) of 107 with unrecognised Ebola virus disease, and 476 (48%) of 991 with reported Ebola virus disease. In adjusted analyses, this pattern remained for joint pain and memory loss. Survivors had an increased odds of joint pain compared with unrecognised Ebola virus disease contacts (adjusted odds ratio [OR] 2·13, 95% CI 1·34-3·39); unrecognised Ebola virus disease contacts had an increased odds of joint pain compared with those with pauci-symptomatic or asymptomatic infection and uninfected contacts (adjusted OR 1·89, 95% CI 1·21-2·97). The adjusted odds of memory loss was more than four-times higher among survivors than among unrecognised Ebola virus disease contacts (adjusted OR 4·47, 95% CI 2·41-8·30) and two-times higher among unrecognised Ebola virus disease contacts than in those with pauci-symptomatic or asymptomatic infection and uninfected contacts (adjusted OR 2·05, 95% CI 1·10-3·84). By 12 months, prevalent findings had decreased in the three infected groups. INTERPRETATION Our findings provide evidence of post-Ebola virus disease clinical sequelae among contacts with unrecognised Ebola virus disease but not in people with pauci-symptomatic or asymptomatic Ebola virus infection. FUNDING National Cancer Institute and National Institute of Allergy and Infectious Diseases of the National Institutes of Health.
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Affiliation(s)
- J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Institute for Global Health Sciences, University of California, San Francisco, CA, USA; F I Proctor Foundation, University of California, San Francisco, CA, USA; Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia.
| | - Collin Van Ryn
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Moses Badio
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Tamba Fayiah
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Kumblytee Johnson
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Dehkontee Gayedyu-Dennis
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Sheri D Weiser
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, CA, USA
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; F I Proctor Foundation, University of California, San Francisco, CA, USA
| | - Jeffery N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Michael C Sneller
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - George W Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Cavan Reilly
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia; Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Mosoka P Fallah
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia; A M Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - J Soka Moses
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
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16
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Ficenec SC, Grant DS, Sumah I, Alhasan F, Yillah MS, Brima J, Konuwa E, Gbakie MA, Kamara FK, Bond NG, Engel EJ, Shaffer JG, Fischer WA, Wohl DA, Emmett SD, Schieffelin JS. The prevalence of Post-Ebola Syndrome hearing loss, Sierra Leone. BMC Infect Dis 2022; 22:624. [PMID: 35850699 PMCID: PMC9290210 DOI: 10.1186/s12879-022-07604-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, hearing loss is the second leading cause of disability, affecting approximately 18.7% of the world's population. However, the burden of hearing loss is unequally distributed, with the majority of affected individuals located in Asia or Sub-Saharan Africa. Following the 2014 West African Ebola Outbreak, disease survivors began to describe hearing loss as part of the constellation of symptoms known as Post-Ebola Syndrome. The goal of this study was to more fully characterize hearing loss among Ebola Virus Disease (EVD) survivors. METHODOLOGY AND PRINCIPAL FINDINGS EVD survivors and their household contacts were recruited (n = 1,12) from Eastern Sierra Leone. Each individual completed a symptom questionnaire, physical exam, and a two-step audiometry process measuring both air and bone conduction thresholds. In comparison to contacts, EVD survivors were more likely to have complaints or abnormal findings affecting every organ system. A significantly greater percentage of EVD survivors were found to have hearing loss in comparison to contacts (23% vs. 9%, p < 0.001). Additionally, survivors were more likely to have bilateral hearing loss of a mixed etiology. Logistic regression revealed that the presence of any symptoms of middle or inner ear (p < 0.001), eye (p = 0.005), psychiatric (p = 0.019), and nervous system (p = 0.037) increased the odds of developing hearing loss. CONCLUSIONS AND SIGNIFICANCE This study is the first to use an objective and standardized measurement to report hearing loss among EVD survivors in a clinically meaningful manner. In this study it was found that greater than 1/5th of EVD survivors develop hearing loss. The association between hearing impairment and symptoms affecting the eye and nervous system may indicate a similar mechanism of pathogenesis, which should be investigated further. Due to the quality of life and socioeconomic detriments associated with untreated hearing loss, a greater emphasis must be placed on understanding and mitigating hearing loss following survival to aid in economic recovery following infectious disease epidemics.
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Affiliation(s)
- Samuel C Ficenec
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Donald S Grant
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Ibrahim Sumah
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Foday Alhasan
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Mohamed S Yillah
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Jenneh Brima
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Edwin Konuwa
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Michael A Gbakie
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Fatima K Kamara
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Nell G Bond
- Department of Immunology and Microbiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emily J Engel
- Department of Pediatrics, Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jeffrey G Shaffer
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - William A Fischer
- Department of Internal Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - David A Wohl
- Department of Internal Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Susan D Emmett
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - John S Schieffelin
- Department of Pediatrics, Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, LA, USA
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17
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Shantha JG, Canady D, Hartley C, Cassedy A, Miller C, Angeles-Han ST, Harrison-Williams LC, Vandy MJ, Weil N, Bastien G, Yeh S. Ophthalmic sequelae and psychosocial impact in pediatric ebola survivors. EClinicalMedicine 2022; 49:101483. [PMID: 35747182 PMCID: PMC9167858 DOI: 10.1016/j.eclinm.2022.101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
Background Ebola virus disease (EVD) outbreaks in West Africa (2013-2016) and the Democratic Republic of Congo (2018-2020) have resulted in thousands of EVD survivors who remain at-risk for survivor sequelae. While EVD survivorship has been broadly reported in adult populations, pediatric EVD survivors are under-represented. In this cross-sectional study, we investigated the prevalence of eye disease, health-related quality-of-life, vision-related quality-of-life, and the burden of mental illness among pediatric EVD survivors in Sierra Leone. Methods Twenty-three pediatric EVD survivors and 58 EVD close contacts were enrolled. Participants underwent a comprehensive ophthalmic examination and completed the following surveys: Pediatric Quality of Life Inventory Version 4.0, Effect of Youngsters Eyesight on Quality-of-Life, and the Revised Child Anxiety and Depression Scale. Findings A higher prevalence of uveitis was observed in EVD survivor eyes (10·8%) cohort compared to close contacts eyes (1·7%, p=0·03). Overall, 47·8% of EVD survivor eyes and 31·9% of close contact eyes presented with an eye disease at the time of our study (p=0·25). Individuals diagnosed with an ocular complication had poorer vision-related quality-of-life (p=0·02). Interpretation Both health related quality-of-life and vision-related quality-of-life were poor among EVD survivors and close contacts. The high prevalence of eye disease associated with reduced vision health, suggests that cross-disciplinary approaches are needed to address the unmet needs of EVD survivors. Funding National Institutes of Health R01 EY029594, K23 EY030158; National Eye Institute; Research to Prevent Blindness (Emory Eye Center); Marcus Foundation Combating Childhood Illness; Emory Global Health Institute; Stanley M. Truhlsen Family Foundation.
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Affiliation(s)
- Jessica G. Shantha
- University of California San Francisco, F.I. Proctor Foundation, San Francisco, CA, United States
| | | | - Caleb Hartley
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, United States
| | - Chris Miller
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheila T. Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, United States
| | | | - Matthew J. Vandy
- Ministry of Health and Sanitation Sierra Leone, Freetown, Sierra Leone
| | - Natalie Weil
- Children's Hospital New Orleans, New Orleans, LA, United States
| | | | - Steven Yeh
- Truhlsen Eye Institute, Department of Ophthalmology, University of Nebraska Medical Center, Omaha, NE, United States
- Child Health Research Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
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18
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Choutka J, Jansari V, Hornig M, Iwasaki A. Unexplained post-acute infection syndromes. Nat Med 2022; 28:911-923. [PMID: 35585196 DOI: 10.1038/s41591-022-01810-6] [Citation(s) in RCA: 241] [Impact Index Per Article: 120.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/01/2022] [Indexed: 02/06/2023]
Abstract
SARS-CoV-2 is not unique in its ability to cause post-acute sequelae; certain acute infections have long been associated with an unexplained chronic disability in a minority of patients. These post-acute infection syndromes (PAISs) represent a substantial healthcare burden, but there is a lack of understanding of the underlying mechanisms, representing a significant blind spot in the field of medicine. The relatively similar symptom profiles of individual PAISs, irrespective of the infectious agent, as well as the overlap of clinical features with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), suggest the potential involvement of a common etiopathogenesis. In this Review, we summarize what is known about unexplained PAISs, provide context for post-acute sequelae of SARS-CoV-2 infection (PASC), and delineate the need for basic biomedical research into the underlying mechanisms behind this group of enigmatic chronic illnesses.
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Affiliation(s)
- Jan Choutka
- Department of Chemistry of Natural Compounds, University of Chemistry and Technology, Prague, Czech Republic.
| | - Viraj Jansari
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Mady Hornig
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA. .,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA. .,Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT, USA. .,Howard Hughes Medical Institute, Chevy Chase, MD, USA.
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19
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Coughlan L, Kremer EJ, Shayakhmetov DM. Adenovirus-based vaccines-a platform for pandemic preparedness against emerging viral pathogens. Mol Ther 2022; 30:1822-1849. [PMID: 35092844 PMCID: PMC8801892 DOI: 10.1016/j.ymthe.2022.01.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/24/2022] Open
Abstract
Zoonotic viruses continually pose a pandemic threat. Infection of humans with viruses for which we typically have little or no prior immunity can result in epidemics with high morbidity and mortality. These epidemics can have public health and economic impact and can exacerbate civil unrest or political instability. Changes in human behavior in the past few decades-increased global travel, farming intensification, the exotic animal trade, and the impact of global warming on animal migratory patterns, habitats, and ecosystems-contribute to the increased frequency of cross-species transmission events. Investing in the pre-clinical advancement of vaccine candidates against diverse emerging viral threats is crucial for pandemic preparedness. Replication-defective adenoviral (Ad) vectors have demonstrated their utility as an outbreak-responsive vaccine platform during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Ad vectors are easy to engineer; are amenable to rapid, inexpensive manufacturing; are relatively safe and immunogenic in humans; and, importantly, do not require specialized cold-chain storage, making them an ideal platform for equitable global distribution or stockpiling. In this review, we discuss the progress in applying Ad-based vaccines against emerging viruses and summarize their global safety profile, as reflected by their widespread geographic use during the SARS-CoV-2 pandemic.
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Affiliation(s)
- Lynda Coughlan
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Center for Vaccine Development and Global Health (CVD), University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Eric J Kremer
- Institut de Génétique Moléculaire de Montpellier, Université de Montpellier, CNRS 5535, Montpellier, France.
| | - Dmitry M Shayakhmetov
- Lowance Center for Human Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA; Emory Vaccine Center, Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; Discovery and Developmental Therapeutics Program, Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA.
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20
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Shivpuri A, Turtsevich I, Solebo AL, Compeyrot-Lacassagne S. Pediatric uveitis: Role of the pediatrician. Front Pediatr 2022; 10:874711. [PMID: 35979409 PMCID: PMC9376387 DOI: 10.3389/fped.2022.874711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
The challenges of childhood uveitis lie in the varied spectrum of its clinical presentation, the often asymptomatic nature of disease, and the evolving nature of the phenotype alongside normal physiological development. These issues can lead to delayed diagnosis which can cause significant morbidity and severe visual impairment. The most common ocular complications include cataracts, band keratopathy, glaucoma, and macular oedema, and the various associated systemic disorders can also result in extra-ophthalmic morbidity. Pediatricians have an important role to play. Their awareness of the various presentations and etiologies of uveitis in children afford the opportunity of prompt diagnosis before complications arise. Juvenile Idiopathic Arthritis (JIA) is one of the most common associated disorders seen in childhood uveitis, but there is a need to recognize other causes. In this review, different causes of uveitis are explored, including infections, autoimmune and autoinflammatory disease. As treatment is often informed by etiology, pediatricians can ensure early ophthalmological referral for children with inflammatory disease at risk of uveitis and can support management decisions for children with uveitis and possible underling multi-system inflammatory disease, thus reducing the risk of the development of irreversible sequelae.
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Affiliation(s)
- Abhay Shivpuri
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Inga Turtsevich
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ameenat Lola Solebo
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Centre, Great Ormond Street Hospital for Children, London, United Kingdom.,University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sandrine Compeyrot-Lacassagne
- Rheumatology Department, Great Ormond Street Hospital for Children, London, United Kingdom.,Biomedical Research Centre, Great Ormond Street Hospital for Children, London, United Kingdom
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21
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Diallo MSK, Toure A, Sow MS, Kpamou C, Keita AK, Taverne B, Peeters M, Msellati P, Barry TA, Etard JF, Ecochard R, Delaporte E. Understanding Long-term Evolution and Predictors of Sequelae of Ebola Virus Disease Survivors in Guinea: A 48-Month Prospective, Longitudinal Cohort Study (PostEboGui). Clin Infect Dis 2021; 73:2166-2174. [PMID: 33621316 PMCID: PMC8677527 DOI: 10.1093/cid/ciab168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Longitudinal analyses are needed to better understand long-term Ebola virus disease (EVD) sequelae. We aimed to estimate the prevalence, incidence, and duration of sequelae and to identify risk factors associated with symptom occurrence among EVD survivors in Guinea. Methods We followed 802 EVD survivors over 48 months and recorded clinical symptoms with their start/end dates. Prevalence, incidence, and duration of sequelae were calculated. Risk factors associated with symptom occurrence were assessed using an extended Cox model for recurrent events. Results Overall, the prevalence and incidence of all symptoms decreased significantly over time, but sequelae remained present 48 months after Ebola treatment center discharge with a prevalence of 30.68% (95% confidence interval [CI] 21.40–39.96) for abdominal, 30.55% (95% CI 20.68–40.41) for neurologic, 5.80% (95% CI 1.96–9.65) for musculoskeletal, and 4.24% (95% CI 2.26–6.23) for ocular sequelae. Half of all patients (50.70%; 95% CI 47.26–54.14) complained of general symptoms 2 years’ postdischarge and 25.35% (95% CI 23.63–27.07) 4 years’ post-discharge. Hemorrhage (hazard ratio [HR], 2.70; P = .007), neurologic (HR 2.63; P = .021), and general symptoms (HR 0.34; P = .003) in the EVD acute phase were significantly associated with the further occurrence of ocular sequelae, whereas hemorrhage (HR 1.91; P = .046) and abdominal (HR 2.21; P = .033) symptoms were significantly associated with musculoskeletal sequelae. Conclusions Our findings provide new insight into the long-term clinical complications of EVD and their significant association with symptoms in the acute phase, thus reinforcing the importance of regular, long-term follow-up for EVD survivors.
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Affiliation(s)
- Mamadou Saliou Kalifa Diallo
- IRD/INSERM/Montpellier University, Montpellier, France
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Abdoulaye Toure
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
- Institut National de Santé Publique, Conakry, Guinea
| | | | - Cécé Kpamou
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Alpha Kabinet Keita
- IRD/INSERM/Montpellier University, Montpellier, France
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | | | | | | | - Thierno Alimou Barry
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | | | - René Ecochard
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
- CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
| | - Eric Delaporte
- IRD/INSERM/Montpellier University, Montpellier, France
- Correspondence: E. Delaporte, IRD UMI233-INSERM U1175, Montpellier University, Délégation Régionale Occitanie, 911 avenue Agropolis, BP 64501, Montpellier Montpellier, France ()
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Fakhri S, Mohammadi Pour P, Piri S, Farzaei MH, Echeverría J. Modulating Neurological Complications of Emerging Infectious Diseases: Mechanistic Approaches to Candidate Phytochemicals. Front Pharmacol 2021; 12:742146. [PMID: 34764869 PMCID: PMC8576094 DOI: 10.3389/fphar.2021.742146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
Growing studies are revealing the critical manifestations of influenza, dengue virus (DENV) infection, Zika virus (ZIKV) disease, and Ebola virus disease (EVD) as emerging infectious diseases. However, their corresponding mechanisms of major complications headed for neuronal dysfunction are not entirely understood. From the mechanistic point of view, inflammatory/oxidative mediators are activated during emerging infectious diseases towards less cell migration, neurogenesis impairment, and neuronal death. Accordingly, the virus life cycle and associated enzymes, as well as host receptors, cytokine storm, and multiple signaling mediators, are the leading players of emerging infectious diseases. Consequently, chemokines, interleukins, interferons, carbohydrate molecules, toll-like receptors (TLRs), and tyrosine kinases are leading orchestrates of peripheral and central complications which are in near interconnections. Some of the resulting neuronal manifestations have attracted much attention, including inflammatory polyneuropathy, encephalopathy, meningitis, myelitis, stroke, Guillain-Barré syndrome (GBS), radiculomyelitis, meningoencephalitis, memory loss, headaches, cranial nerve abnormalities, tremor, and seizure. The complex pathophysiological mechanism behind the aforementioned complications urges the need for finding multi-target agents with higher efficacy and lower side effects. In recent decades, the natural kingdom has been highlighted as promising neuroprotective natural products in modulating several dysregulated signaling pathways/mediators. The present study provides neuronal manifestations of some emerging infectious diseases and underlying pathophysiological mechanisms. Besides, a mechanistic-based strategy is developed to introduce candidate natural products as promising multi-target agents in combating major dysregulated pathways towards neuroprotection in influenza, DENV infection, ZIKV disease, and EVD.
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Affiliation(s)
- Sajad Fakhri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pardis Mohammadi Pour
- Department of Pharmacognosy, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sana Piri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javier Echeverría
- Departamento de Ciencias del Ambiente, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
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Pawęska JT, Jansen van Vuren P, Storm N, Markotter W, Kemp A. Vector Competence of Eucampsipoda africana (Diptera: Nycteribiidae) for Marburg Virus Transmission in Rousettus aegyptiacus (Chiroptera: Pteropodidae). Viruses 2021; 13:2226. [PMID: 34835032 PMCID: PMC8624361 DOI: 10.3390/v13112226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/04/2022] Open
Abstract
This study aimed to determine the vector competence of bat-associated nycteribiid flies (Eucamsipoda africana) for Marburg virus (MARV) in the Egyptian Rousette Bat (ERB), Rousettus aegyptiacus. In flies fed on subcutaneously infected ERBs and tested from 3 to 43 days post infection (dpi), MARV was detected only in those that took blood during the peak of viremia, 5-7 dpi. Seroconversion did not occur in control bats in contact with MARV-infected bats infested with bat flies up to 43 days post exposure. In flies inoculated intra-coelomically with MARV and tested on days 0-29 post inoculation, only those assayed on day 0 and day 7 after inoculation were positive by q-RT-PCR, but the virus concentration was consistent with that of the inoculum. Bats remained MARV-seronegative up to 38 days after infestation and exposure to inoculated flies. The first filial generation pupae and flies collected at different times during the experiments were all negative by q-RT-PCR. Of 1693 nycteribiid flies collected from a wild ERB colony in Mahune Cave, South Africa where the enzootic transmission of MARV occurs, only one (0.06%) tested positive for the presence of MARV RNA. Our findings seem to demonstrate that bat flies do not play a significant role in the transmission and enzootic maintenance of MARV. However, ERBs eat nycteribiid flies; thus, the mechanical transmission of the virus through the exposure of damaged mucous membranes and/or skin to flies engorged with contaminated blood cannot be ruled out.
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Affiliation(s)
- Janusz T. Pawęska
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham 2131, South Africa; (P.J.v.V.); (N.S.); (A.K.)
- Centre for Viral Zoonoses, Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa;
- School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2050, South Africa
| | - Petrus Jansen van Vuren
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham 2131, South Africa; (P.J.v.V.); (N.S.); (A.K.)
- Australian Centre for Disease Preparedness, CSIRO Health & Biosecurity, Geelong, VIC 3220, Australia
| | - Nadia Storm
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham 2131, South Africa; (P.J.v.V.); (N.S.); (A.K.)
- Department of Microbiology, School of Medicine, Boston University, Boston, MA 02118, USA
| | - Wanda Markotter
- Centre for Viral Zoonoses, Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa;
| | - Alan Kemp
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Sandringham 2131, South Africa; (P.J.v.V.); (N.S.); (A.K.)
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Amuzu C, James PB, Bah AJ, Bayoh AVS, Singer SR. Post-Ebola sequelae among Ebola child survivors in Sierra Leone. BMC Pediatr 2021; 21:482. [PMID: 34717580 PMCID: PMC8556876 DOI: 10.1186/s12887-021-02957-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are limited data regarding the long-term health effects of child survivors of the 2013-2016 West African Ebola virus disease (EVD) outbreak. Here, we assess post-Ebola sequelae among EVD child survivors by comparing the self-reported symptoms between EVD child survivors and their close household contacts over one year after the end of the outbreak. Methods EVD child survivors(n=159) and their close contacts(n=303) were enrolled in Western and Eastern Sierra Leone. Demographics and self-reported symptoms data were collected using an interviewer-administered questionnaire. We compared a list of self-reported symptoms between EVD child survivors and their close household contacts using backward stepwise logistic regression. Results EVD child survivors were more likely to be orphans compared to their close contacts. Musculoskeletal, ocular, auditory and neurological symptoms were more prevalent among Ebola child survivors than their close contacts (p<0.001). Joint pain and headache were the most common self-reported symptoms in EVD child survivors and their close contacts. Joint pain (AOR=2.633; 95 % CI:1.31-5.28, p=0.006), eye pain (AOR=4.56;95 %CI: 2.16-9.64, p<0.001), hearing loss (AOR=3.85; 95 %CI: 1.15-12.87, p=0.029), memory impairment (AOR=7.76;0.95 %CI: 1.34-45.01 p=0.022), mood changes (AOR=5.07; 95 %CI: 2.35-10.94, p<0.001) were more common among survivors than their contacts. Conclusions Our data suggest that EVD child survivors have higher odds than their close contacts of suffering from musculoskeletal, ophthalmic, auditory and neurological impairment more than a year after the end of the EVD outbreak. Routine screening, treatment and monitoring of these symptoms is required to prevent long-term disability among EVD child survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02957-w.
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Affiliation(s)
- Claudette Amuzu
- Braun School of Public Health, Hadassah/Hebrew University, Jerusalem, Israel
| | - Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia. .,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Queen Margaret University Edinburgh, Musselburgh, Scotland, UK
| | | | - Shepherd Roee Singer
- Braun School of Public Health, Hadassah/Hebrew University, Jerusalem, Israel.,Israel Ministry of Health, Jerusalem, Israel
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25
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Bond NG, Grant DS, Himmelfarb ST, Engel EJ, Al-Hasan F, Gbakie M, Kamara F, Kanneh L, Mustapha I, Okoli A, Fischer W, Wohl D, Garry RF, Samuels R, Shaffer JG, Schieffelin JS. Post-Ebola Syndrome Presents With Multiple Overlapping Symptom Clusters: Evidence From an Ongoing Cohort Study in Eastern Sierra Leone. Clin Infect Dis 2021; 73:1046-1054. [PMID: 33822010 PMCID: PMC8442780 DOI: 10.1093/cid/ciab267] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Following the 2013-2016 West African Ebola outbreak, distinct, persistent health complaints were recognized in Ebola virus disease (EVD) survivors. Here we provide an in-depth characterization of post-Ebola syndrome >2.5 years after resolution of disease. Additionally, we report subphenotypes of post-Ebola syndrome with overlapping symptom clusters in survivors from Eastern Sierra Leone. METHODS Participants in Eastern Sierra Leone were identified by the Sierra Leone Association of Ebola survivors. Survivors and their contacts were administered a questionnaire assessing self-reported symptoms and a physical examination. Comparisons between survivors and contacts were conducted using conditional logistic regression. Symptom groupings were identified using hierarchical clustering approaches. Simplified presentation of incredibly complex evaluations (SPICE), correlation analysis, logistic regression, and principal component analysis (PCA) were performed to explore the relationships between symptom clusters. RESULTS Three hundred seventy-five EVD survivors and 1040 contacts were enrolled into the study. At enrollment, EVD survivors reported significantly more symptoms than their contacts in all categories (P < .001). Symptom clusters representing distinct organ systems were identified. Correlation and logistic regression analysis identified relationships between symptom clusters, including stronger relationships between clusters including musculoskeletal symptoms (r = 0.63, P < .001; and P < .001 for correlation and logistic regression, respectively). SPICE and PCA further highlighted subphenotypes with or without musculoskeletal symptoms. CONCLUSIONS This study presents an in-depth characterization of post-Ebola syndrome in Sierra Leonean survivors >2.5 years after disease. The interrelationship between symptom clusters indicates that post-Ebola syndrome is a heterogeneous disease. The distinct musculoskeletal and non-musculoskeletal phenotypes identified likely require targeted therapies to optimize long-term treatment for EVD survivors.
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Affiliation(s)
- Nell G Bond
- Tulane University, New Orleans, Louisiana, USA
| | | | | | | | | | | | | | | | | | | | - William Fischer
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Wohl
- University of North Carolina, Chapel Hill, North Carolina, USA
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Shantha JG, Crozier I, Kraft CS, Grant DG, Goba A, Hayek BR, Hartley C, Barnes KG, Uyeki TM, Schieffelin J, Garry RF, Bausch DG, Farmer PE, Mattia JG, Vandy MJ, Yeh S. Implementation of the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) study: Lessons learned for vision health systems strengthening in Sierra Leone. PLoS One 2021; 16:e0252905. [PMID: 34242218 PMCID: PMC8270115 DOI: 10.1371/journal.pone.0252905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Following the West African Ebola virus disease (EVD) outbreak of 2013-2016 and more recent EVD outbreaks in the Democratic Republic of Congo, thousands of EVD survivors are at-risk for sequelae including uveitis, which can lead to unremitting inflammation and vision loss from cataract. Because of the known risk of Ebola virus persistence in ocular fluid and the need to provide vision-restorative, safe cataract surgery, the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study was implemented in Sierra Leone. During implementation of this multi-national study, challenges included regulatory approvals, mobilization, community engagement, infection prevention and control, and collaboration between multiple disciplines. In this report, we address the multifacted approach to address these challenges and the impact of implementation science research to address an urgent clinical subspecialty need in an outbreak setting. METHODOLOGY/PRINCIPAL FINDINGS Given the patient care need to develop a protocol to evaluate ocular fluid for Ebola virus RNA persistence prior to cataract surgery, as well as protocols to provide reassurance to ophthalmologists caring for EVD survivors with cataracts, the EVICT study was designed and implemented through the work of the Ministry of Health, Sierra Leone National Eye Programme, and international partnerships. The EVICT study showed that all 50 patients who underwent ocular fluid sampling at 19 and 34 months, respectively, tested negative for Ebola virus RNA. Thirty-four patients underwent successful cataract surgery with visual acuity improvement. Here we describe the methodology for study implementation, challenges encountered, and key issues that impacted EVD vision care in the immediate aftermath of the EVD outbreak. Key aspects of the EVICT study included defining the pertinent questions and clinical need, partnership alignment with key stakeholders, community engagement with EVD survivor associations, in-country and international regulatory approvals, study site design for infection prevention and control, and thorough plans for EVD survivor follow-up care and monitoring. Challenges encountered included patient mobilization owing to transportation routes and distance of patients in rural districts. Strong in-country partnerships and multiple international organizations overcame these challenges so that lessons learned could be applied for future EVD outbreaks in West and Central Africa including EVD outbreaks that are ongoing in Guinea and Democratic Republic of Congo. CONCLUSIONS/SIGNIFICANCE The EVICT Study showed that cataract surgery with a protocol-driven approach was safe and vision-restorative for EVD survivors, which provided guidance for EVD ophthalmic surgical care. Ophthalmologic care remains a key aspect of the public health response for EVD outbreaks but requires a meticulous, yet partnered approach with international and local in-country partners. Future efforts may build on this framework for clinical care and to improve our understanding of ophthalmic sequelae, develop treatment paradigms for EVD survivors, and strengthen vision health systems in resource-limited settings.
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Affiliation(s)
- Jessica G. Shantha
- Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Ian Crozier
- National Institute for Allergy and Infectious Disease, Bethesda, Maryland, United States of America
| | - Colleen S. Kraft
- Department of Pathology and Laboratory Medicine, Emory University Serious Communicable Disease Unit, Atlanta, Georgia, United States of America
| | - Donald G. Grant
- Kenema Government Hospital Lassa Hemorrhagic Fever Laboratory, Kenema, Sierra Leone
| | - Augustine Goba
- Kenema Government Hospital Lassa Hemorrhagic Fever Laboratory, Kenema, Sierra Leone
| | - Brent R. Hayek
- Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Caleb Hartley
- Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Kayla G. Barnes
- Department of Organismic and Evolutionary Biology, Harvard University, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Timothy M. Uyeki
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John Schieffelin
- Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Robert F. Garry
- Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Daniel G. Bausch
- United Kingdom Public Health Rapid Support Team (UK-PHRST), London School of Tropical Medicine and Hygiene, Public Health England, London, United Kingdom
| | - Paul E. Farmer
- Partners in Health, Boston, Massachusetts, United States of America
| | - John G. Mattia
- Lowell and Ruth Gess Eye Hospital, Freetown, Sierra Leone
| | - Matthew J. Vandy
- Ministry of Health and Sanitation, National Eye Programme, Freetown, Sierra Leone
| | - Steven Yeh
- Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
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Tozay S, Fischer WA, Wohl DA, Kilpatrick K, Zou F, Reeves E, Pewu K, DeMarco J, Loftis AJ, King K, Grant D, Schieffelin J, Gorvego G, Johnson H, Conneh T, Williams G, Nelson JAE, Hoover D, McMillian D, Merenbloom C, Hawks D, Dube K, Brown J. Long-term Complications of Ebola Virus Disease: Prevalence and Predictors of Major Symptoms and the Role of Inflammation. Clin Infect Dis 2021; 71:1749-1755. [PMID: 31693114 DOI: 10.1093/cid/ciz1062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/29/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cohort studies have reported a high prevalence of musculoskeletal, neurologic, auditory, and visual complications among Ebola virus disease (EVD) survivors. However, little is known about the host- and disease-related predictors of these symptoms and their etiological mechanisms. METHODS The presence and patterns of 8 cardinal symptoms that are most commonly reported following EVD survival were assessed in the 326 EVD survivors who participated in the ongoing longitudinal Liberian EVD Survivor Study. At quarterly study visits, symptoms that developed since acute EVD were recorded and blood was collected for biomarkers of inflammation and immune activation. RESULTS At baseline (mean 408 days from acute EVD), 75.5% of survivors reported at least 1 new cardinal symptom since surviving EVD, which in 85.8% was rated as highly interfering with life. Two or more incident symptoms were reported by 61.0% of survivors, with pairings of joint pain, headache, or fatigue the most frequent. Women were significantly more likely than men to report headache, while older age was significantly associated with musculoskeletal and visual symptoms. In analyses adjusted for multiple comparisons, no statistically significant association was found between any symptom and 26 markers of inflammation and immune activation. Symptom frequency remained largely unchanged during study follow-up. CONCLUSIONS Post-EVD complications occur in a majority of survivors and remain present more than 4 years after acute infection. An association between markers of inflammation and immune activation and individual symptoms was not found, suggesting an alternative etiology for persistent post-EVD symptomatology.
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Affiliation(s)
- Sam Tozay
- Eternal Love Winning Africa Hospital, Paynesville, Liberia
| | - William A Fischer
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.,Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David A Wohl
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kayla Kilpatrick
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Fei Zou
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Edwina Reeves
- Eternal Love Winning Africa Hospital, Paynesville, Liberia
| | - Korto Pewu
- Eternal Love Winning Africa Hospital, Paynesville, Liberia
| | - Jean DeMarco
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amy James Loftis
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katie King
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Donald Grant
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - John Schieffelin
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Tonia Conneh
- Eternal Love Winning Africa Hospital, Paynesville, Liberia
| | | | - Julie A E Nelson
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Hoover
- ICON Government and Public Health Solutions (formerly Clinical RM), Leopardstown, Dublin, Ireland
| | - Darrius McMillian
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Carson Merenbloom
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Darrell Hawks
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karine Dube
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jerry Brown
- Eternal Love Winning Africa Hospital, Paynesville, Liberia
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Venkatesh A, Patel R, Goyal S, Rajaratnam T, Sharma A, Hossain P. Ocular manifestations of emerging viral diseases. Eye (Lond) 2021; 35:1117-1139. [PMID: 33514902 PMCID: PMC7844788 DOI: 10.1038/s41433-020-01376-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
Emerging infectious diseases (EIDs) are an increasing threat to public health on a global scale. In recent times, the most prominent outbreaks have constituted RNA viruses, spreading via droplets (COVID-19 and Influenza A H1N1), directly between humans (Ebola and Marburg), via arthropod vectors (Dengue, Zika, West Nile, Chikungunya, Crimean Congo) and zoonotically (Lassa fever, Nipah, Rift Valley fever, Hantaviruses). However, specific approved antiviral therapies and vaccine availability are scarce, and public health measures remain critical. Patients can present with a spectrum of ocular manifestations. Emerging infectious diseases should therefore be considered in the differential diagnosis of ocular inflammatory conditions in patients inhabiting or returning from endemic territories, and more general vigilance is advisable in the context of a global pandemic. Eye specialists are in a position to facilitate swift diagnosis, improve clinical outcomes, and contribute to wider public health efforts during outbreaks. This article reviews those emerging viral diseases associated with reports of ocular manifestations and summarizes details pertinent to practicing eye specialists.
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Affiliation(s)
- Ashwin Venkatesh
- grid.5335.00000000121885934School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ravi Patel
- grid.439257.e0000 0000 8726 5837Moorfields Eye Hospital, London, UK
| | - Simran Goyal
- grid.5335.00000000121885934School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Timothy Rajaratnam
- grid.5335.00000000121885934School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anant Sharma
- grid.439257.e0000 0000 8726 5837Moorfields Eye Hospital, London, UK
| | - Parwez Hossain
- grid.430506.4Eye Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK ,grid.5491.90000 0004 1936 9297Clinical Experimental Sciences, Faculty of Medicine, Univeristy of Southampton, Southampton, UK
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LaVergne SM, Sakabe S, Kanneh L, Momoh M, Al-Hassan F, Yilah M, Goba A, Sandi JD, Gbakie M, Cubitt B, Boisen M, Mayeux JM, Smira A, Shore K, Bica I, Pollard KM, Carlos de la Torre J, Branco LM, Garry RF, Grant DS, Schieffelin JS, Oldstone MBA, Sullivan BM. Ebola-Specific CD8+ and CD4+ T-Cell Responses in Sierra Leonean Ebola Virus Survivors With or Without Post-Ebola Sequelae. J Infect Dis 2021; 222:1488-1497. [PMID: 32436943 DOI: 10.1093/infdis/jiaa268] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Ebola virus (EBOV) disease has killed thousands of West and Central Africans over the past several decades. Many who survive the acute disease later experience post-Ebola syndrome, a constellation of symptoms whose causative pathogenesis is unclear. METHODS We investigated EBOV-specific CD8+ and CD4+ T-cell responses in 37 Sierra Leonean EBOV disease survivors with (n = 19) or without (n = 18) sequelae of arthralgia and ocular symptoms. Peripheral blood mononuclear cells were infected with recombinant vesicular stomatitis virus encoding EBOV antigens. We also studied the presence of EBOV-specific immunoglobulin G, antinuclear antibodies, anti-cyclic citrullinated peptide antibodies, rheumatoid factor, complement levels, and cytokine levels in these 2 groups. RESULTS Survivors with sequelae had a significantly higher EBOV-specific CD8+ and CD4+ T-cell response. No differences in EBOV-specific immunoglobulin G, antinuclear antibody, or anti-cyclic citrullinated peptide antibody levels were found. Survivors with sequelae showed significantly higher rheumatoid factor levels. CONCLUSION EBOV-specific CD8+ and CD4+ T-cell responses were significantly higher in Ebola survivors with post-Ebola syndrome. These findings suggest that pathogenesis may occur as an immune-mediated disease via virus-specific T-cell immune response or that persistent antigen exposure leads to increased and sustained T-cell responses.
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Affiliation(s)
- Stephanie M LaVergne
- Viral-Immunobiology Laboratory, Department of Immunology and Microbiology, Scripps Research, La Jolla, California, USA.,Division of Infectious Diseases, University of California, San Diego, La Jolla, California, USA
| | - Saori Sakabe
- Viral-Immunobiology Laboratory, Department of Immunology and Microbiology, Scripps Research, La Jolla, California, USA
| | - Lansana Kanneh
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mambu Momoh
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone.,Eastern Polytechnic Institute, Kenema, Sierra Leone
| | - Foday Al-Hassan
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mohamed Yilah
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Augustine Goba
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - John Demby Sandi
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Michael Gbakie
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Beatrice Cubitt
- Viral-Immunobiology Laboratory, Department of Immunology and Microbiology, Scripps Research, La Jolla, California, USA
| | | | - Jessica M Mayeux
- Department of Molecular Medicine, Scripps Research, La Jolla, California, USA
| | - Ashley Smira
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Kayla Shore
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Iris Bica
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - K Michael Pollard
- Department of Molecular Medicine, Scripps Research, La Jolla, California, USA
| | - Juan Carlos de la Torre
- Viral-Immunobiology Laboratory, Department of Immunology and Microbiology, Scripps Research, La Jolla, California, USA
| | | | - Robert F Garry
- Department of Immunology and Microbiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Donald S Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone.,College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - John S Schieffelin
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Michael B A Oldstone
- Viral-Immunobiology Laboratory, Department of Immunology and Microbiology, Scripps Research, La Jolla, California, USA
| | - Brian M Sullivan
- Viral-Immunobiology Laboratory, Department of Immunology and Microbiology, Scripps Research, La Jolla, California, USA
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Medina‐Rivera M, Centeno‐Tablante E, Finkelstein JL, Rayco‐Solon P, Peña‐Rosas JP, Garcia‐Casal MN, Rogers L, Ridwan P, Martinez SS, Andrade J, Layden AJ, Chang J, Zambrano MP, Ghezzi‐Kopel K, Mehta S. Presence of Ebola virus in breast milk and risk of mother-to-child transmission: synthesis of evidence. Ann N Y Acad Sci 2021; 1488:33-43. [PMID: 33113592 PMCID: PMC8048832 DOI: 10.1111/nyas.14519] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/16/2020] [Accepted: 10/08/2020] [Indexed: 12/28/2022]
Abstract
To help inform global guidelines on infant feeding, this systematic review synthesizes evidence related to the presence of the Ebola virus (EBOV) in breast milk and its potential risk of viral transmission to the infant when breastfeeding. We relied on a comprehensive search strategy to identify studies including women with suspected, probable, or confirmed EBOV infection, intending to breastfeed or give breast milk to an infant. Our search identified 10,454 records, and after deduplication and screening, we assessed 148 full texts. We included eight studies reporting on 10 breastfeeding mothers and their children (one mother with twins), who provided breast milk samples for assessment. EBOV was detected via RT-PCR or viral culture in seven out of ten breast milk samples. Four out of the five-breastfed infants with EBOV-positive breast milk were found positive for EBOV infection, and all of these EBOV-positive infants died. Since previous reports have detected EBOV in tears, saliva, sweat, and contaminated surfaces, with the current evidence, it is not possible to conclude with certainty that breast milk was the main route of EBOV transmission.
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Affiliation(s)
| | | | | | - Pura Rayco‐Solon
- Department of Maternal, Newborn, Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
| | | | | | - Lisa Rogers
- Department of Nutrition and Food SafetyWorld Health OrganizationGenevaSwitzerland
| | - Pratiwi Ridwan
- Division of Nutritional SciencesCornell UniversityIthacaNew York
| | - Sabrina Sales Martinez
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social WorkFlorida International UniversityMiamiFlorida
| | - Joyce Andrade
- Hospital de Niños Roberto Gilbert ElizaldeGuayaquilEcuador
| | | | - Juan Chang
- Hospital de Niños Roberto Gilbert ElizaldeGuayaquilEcuador
| | | | | | - Saurabh Mehta
- Division of Nutritional SciencesCornell UniversityIthacaNew York
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31
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Radosavljevic A, Agarwal M, Chee SP, Zierhut M. Epidemiology of Viral Induced Anterior Uveitis. Ocul Immunol Inflamm 2021; 30:297-309. [PMID: 33617392 DOI: 10.1080/09273948.2020.1853177] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Viral agents are the most common cause of infectious anterior uveitis worldwide. The purpose of this review is to analyze the frequency, gender and racial differences of viral anterior uveitis (VAU) in various populations.Methods: Systematized literature review of epidemiological reports of VAU cited in PubMed, EMBASE and the Cochrane Library database published until June 30th, 2020.Results: A total of 12 clinical studies on epidemiology of definite VAU and 36 clinical studies of presumed VAU were identified. Members of Herpesviridae family represent the most common causes of VAU. Other less frequently reported causes, such as rubella and endemic viruses (HTLV-1, Chikungunya, Dengue, Ebola, Zika virus) were also analyzed.Conclusion: HSV, VZV are prevalent worldwide. CMV is more frequent in Asia, and rubella in the West. However, due to globalization and air travel, HTLV-1, Chikungunya, Dengue and Ebola may become important causes of VAU across the world.
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Affiliation(s)
| | - Mamta Agarwal
- Uveitis & Cornea Services, Sankara Nethralaya, Chennai, India
| | - Soon Phaik Chee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Duke-NUS Medical School, Singapore
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tubingen, Tubingen, Germany
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32
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Choi MJ, Cossaboom CM, Whitesell AN, Dyal JW, Joyce A, Morgan RL, Campos-Outcalt D, Person M, Ervin E, Yu YC, Rollin PE, Harcourt BH, Atmar RL, Bell BP, Helfand R, Damon IK, Frey SE. Use of Ebola Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep 2021; 70:1-12. [PMID: 33417593 PMCID: PMC7802368 DOI: 10.15585/mmwr.rr7001a1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
This report summarizes the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of the rVSVΔG-ZEBOV-GP Ebola vaccine (Ervebo) in the United States. The vaccine contains rice-derived recombinant human serum albumin and live attenuated recombinant vesicular stomatitis virus (VSV) in which the gene encoding the glycoprotein of VSV was replaced with the gene encoding the glycoprotein of Ebola virus species Zaire ebolavirus. Persons with a history of severe allergic reaction (e.g., anaphylaxis) to rice protein should not receive Ervebo. This is the first and only vaccine currently licensed by the Food and Drug Administration for the prevention of Ebola virus disease (EVD). These guidelines will be updated based on availability of new data or as new vaccines are licensed to protect against EVD.ACIP recommends preexposure vaccination with Ervebo for adults aged ≥18 years in the U.S. population who are at highest risk for potential occupational exposure to Ebola virus species Zaire ebolavirus because they are responding to an outbreak of EVD, work as health care personnel at federally designated Ebola treatment centers in the United States, or work as laboratorians or other staff at biosafety level 4 facilities in the United States. Recommendations for use of Ervebo in additional populations at risk for exposure and other settings will be considered and discussed by ACIP in the future.
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33
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Eghrari AO, Bishop RJ, Ross RD, Davis B, Larbelee J, Amegashie F, Dolo RF, Prakalapakorn SG, Gaisie C, Gargu C, Sosu Y, Sackor J, Cooper PZ, Wallace A, Nyain R, Gray M, Kamara F, Burkholder B, Brady CJ, Ray V, Tawse KL, Yeung I, Neaton JD, Higgs ES, Lane HC, Reilly C, Sneller MC, Fallah MP. Characterization of Ebola Virus-Associated Eye Disease. JAMA Netw Open 2021; 4:e2032216. [PMID: 33399856 PMCID: PMC7786253 DOI: 10.1001/jamanetworkopen.2020.32216] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Survivors of Ebola virus disease (EVD) may experience ocular sequelae. Comparison with antibody-negative individuals from the local population is required to characterize the disease. OBJECTIVE To assess features of ophthalmic disease specific to EVD. DESIGN, SETTING, AND PARTICIPANTS This baseline cross-sectional analysis of survivors of EVD and their close contacts was conducted within PREVAIL III, a 5-year, longitudinal cohort study. Participants who enrolled at John F. Kennedy Medical Center in Liberia, West Africa from June 2015 to March 2016 were included in this analysis. Close contacts were defined as household members or sex partners of survivors of EVD. Data were analyzed from July 2016 to July 2020. EXPOSURES All participants, both survivors and close contacts, underwent testing of IgG antibody levels against Ebola virus surface glycoprotein. MAIN OUTCOMES AND MEASURES Ocular symptoms, anterior and posterior ophthalmologic examination findings, and optical coherence tomography images were compared between antibody-positive survivors and antibody-negative close contacts. RESULTS A total of 564 antibody-positive survivors (320 [56.7%] female; mean [SD] age, 30.3 [14.0] years) and 635 antibody-negative close contacts (347 [54.6%] female; mean [SD] age, 25.8 [15.5] years) were enrolled in this study. Survivors were more likely to demonstrate color vision deficit (28.9% vs 19.0%, odds ratio [OR], 1.6; 95% CI, 1.2-2.1) and lower intraocular pressure (12.4 vs 13.5 mm Hg; mean difference, -1.2 mm Hg; 95% CI, -1.6 to -0.8 mm Hg) compared with close contacts. Dilated fundus examination revealed a higher percentage of vitreous cells (7.8% vs 0.5%; OR, 16.6; 95% CI, 5.0-55.2) and macular scars (4.6% vs 1.6%; OR, 2.8; 95% CI, 1.4-5.5) in survivors than in close contacts. Uveitis was present in 26.4% of survivors and 12.1% of close contacts (OR, 2.4; 95% CI, 1.8-3.2). Among all participants with uveitis, survivors were more likely than close contacts to have intermediate uveitis (34.2% vs 6.5% of all cases; OR, 7.8; 95% CI, 3.1-19.7) and had thicker mean central subfield thickness on optical coherence tomography (222 vs 212 μm; mean difference, 14.4 μm; 95% CI, 1.9-26.9 μm). CONCLUSIONS AND RELEVANCE In this cross-sectional study, survivors of EVD had a distinct spectrum of ocular and neuro-ophthalmologic findings compared with close contacts that potentially require medical and surgical treatment.
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Affiliation(s)
| | | | | | - Bionca Davis
- Division of Biostatistics, University of Minnesota, Minneapolis
| | | | | | | | | | | | - Catherine Gargu
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | - Yassah Sosu
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | - Jennie Sackor
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | | | - Augustine Wallace
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | - Ruth Nyain
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | - Maima Gray
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | - Famatta Kamara
- Partnership for Research on Ebola Virus in Liberia, Monrovia, Liberia
| | | | | | - Vincent Ray
- Department of Ophthalmology, California Pacific Medical Center, San Francisco
| | - Kirstin L. Tawse
- Department of Ophthalmology, Kaiser Permanente, Denver, Colorado
| | - Ian Yeung
- National Institutes of Health, Bethesda, Maryland
| | - James D. Neaton
- Division of Biostatistics, University of Minnesota, Minneapolis
| | | | | | - Cavan Reilly
- Division of Biostatistics, University of Minnesota, Minneapolis
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Tell JG, Coller BAG, Dubey SA, Jenal U, Lapps W, Wang L, Wolf J. Environmental Risk Assessment for rVSVΔG-ZEBOV-GP, a Genetically Modified Live Vaccine for Ebola Virus Disease. Vaccines (Basel) 2020; 8:vaccines8040779. [PMID: 33352786 PMCID: PMC7767225 DOI: 10.3390/vaccines8040779] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 01/04/2023] Open
Abstract
rVSVΔG-ZEBOV-GP is a live, attenuated, recombinant vesicular stomatitis virus (rVSV)-based vaccine for the prevention of Ebola virus disease caused by Zaire ebolavirus. As a replication-competent genetically modified organism, rVSVΔG-ZEBOV-GP underwent various environmental evaluations prior to approval, the most in-depth being the environmental risk assessment (ERA) required by the European Medicines Agency. This ERA, as well as the underlying methodology used to arrive at a sound conclusion about the environmental risks of rVSVΔG-ZEBOV-GP, are described in this review. Clinical data from vaccinated adults demonstrated only infrequent, low-level shedding and transient, low-level viremia, indicating a low person-to-person infection risk. Animal data suggest that it is highly unlikely that vaccinated individuals would infect animals with recombinant virus vaccine or that rVSVΔG-ZEBOV-GP would spread within animal populations. Preclinical studies in various hematophagous insect vectors showed that these species were unable to transmit rVSVΔG-ZEBOV-GP. Pathogenicity risk in humans and animals was found to be low, based on clinical and preclinical data. The overall risk for non-vaccinated individuals and the environment is thus negligible and can be minimized further through defined mitigation strategies. This ERA and the experience gained are relevant to developing other rVSV-based vaccines, including candidates under investigation for prevention of COVID-19.
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Affiliation(s)
- Joan G. Tell
- Merck & Co., Inc., Kenilworth, NJ 07033, USA; (B.-A.G.C.); (S.A.D.); (W.L.); (L.W.); (J.W.)
- Correspondence:
| | - Beth-Ann G. Coller
- Merck & Co., Inc., Kenilworth, NJ 07033, USA; (B.-A.G.C.); (S.A.D.); (W.L.); (L.W.); (J.W.)
| | - Sheri A. Dubey
- Merck & Co., Inc., Kenilworth, NJ 07033, USA; (B.-A.G.C.); (S.A.D.); (W.L.); (L.W.); (J.W.)
| | - Ursula Jenal
- Jenal & Partners Biosafety Consulting, 4310 Rheinfelden, Switzerland;
| | - William Lapps
- Merck & Co., Inc., Kenilworth, NJ 07033, USA; (B.-A.G.C.); (S.A.D.); (W.L.); (L.W.); (J.W.)
| | - Liman Wang
- Merck & Co., Inc., Kenilworth, NJ 07033, USA; (B.-A.G.C.); (S.A.D.); (W.L.); (L.W.); (J.W.)
| | - Jayanthi Wolf
- Merck & Co., Inc., Kenilworth, NJ 07033, USA; (B.-A.G.C.); (S.A.D.); (W.L.); (L.W.); (J.W.)
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Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study. Clin Microbiol Infect 2020; 27:89-95. [PMID: 32979574 PMCID: PMC7510771 DOI: 10.1016/j.cmi.2020.09.023] [Citation(s) in RCA: 407] [Impact Index Per Article: 101.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe the prevalence, nature and risk factors for the main clinical sequelae in coronavirus disease 2019 (COVID-19) survivors who have been discharged from the hospital for more than 3 months. METHODS This longitudinal study was based on a telephone follow-up survey of COVID-19 patients hospitalized and discharged from Renmin Hospital of Wuhan University, Wuhan, China before 1 March 2020. Demographic and clinical characteristics and self-reported clinical sequelae of the survivors were described and analysed. A cohort of volunteers who were free of COVID-19 and lived in the urban area of Wuhan during the outbreak were also selected as the comparison group. RESULTS Among 538 survivors (293, 54.5% female), the median (interquartile range) age was 52.0 (41.0-62.0) years, and the time from discharge from hospital to first follow-up was 97.0 (95.0-102.0) days. Clinical sequelae were common, including general symptoms (n = 267, 49.6%), respiratory symptoms (n = 210, 39%), cardiovascular-related symptoms (n = 70, 13%), psychosocial symptoms (n = 122, 22.7%) and alopecia (n = 154, 28.6%). We found that physical decline/fatigue (p < 0.01), postactivity polypnoea (p= 0.04) and alopecia (p < 0.01) were more common in female than in male subjects. Dyspnoea during hospitalization was associated with subsequent physical decline/fatigue, postactivity polypnoea and resting heart rate increases but not specifically with alopecia. A history of asthma during hospitalization was associated with subsequent postactivity polypnoea sequela. A history of pulse ≥90 bpm during hospitalization was associated with resting heart rate increase in convalescence. The duration of virus shedding after COVID-19 onset and hospital length of stay were longer in survivors with physical decline/fatigue or postactivity polypnoea than in those without. CONCLUSIONS Clinical sequelae during early COVID-19 convalescence were common; some of these sequelae might be related to gender, age and clinical characteristics during hospitalization.
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36
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Cooper TK, Logue J, Liu DX, Perry DL, Hart RJ, Hischak AMW, Bernbaum JG, Gerhardt DM, Rojas O, Bohannon JK, Hagen KR, Johnson RF, Crozier I, Jahrling PB, Hensley LE, Bennett RS. Filoviruses Infect Rhesus Macaque Synoviocytes in Vivo and Primary Human Synoviocytes in Vitro. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:1867-1880. [PMID: 32479821 PMCID: PMC7456742 DOI: 10.1016/j.ajpath.2020.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 11/18/2022]
Abstract
The most commonly reported symptom of post-Ebola virus disease syndrome in survivors is arthralgia, yet involvement of the joints in acute or convalescent Ebola virus infection is not well characterized in human patients or animal models. Through immunohistochemistry, we found that the lining synovial intima of the stifle (knee) is a target for acute infection by Ebola virus/Kikwit, Ebola virus/Makona-C05, and Marburg virus/Angola in the rhesus macaque model. Furthermore, histologic analysis, immunohistochemistry, RNAscope in situ hybridization, and transmission electron microscopy showed that synoviocytes of the stifle, shoulder, and hip are a target for mouse-adapted Ebola virus/Yambuku-Mayinga infection during acute disease in rhesus macaques. A time course of infection study with Ebola virus/Kikwit found that the large joint synovium became immunopositive beginning on postinfection day 6. In total, the synovium of 28 of 30 rhesus macaques with terminal filovirus disease had evidence of infection (64 of 96 joints examined). On the basis of immunofluorescence, infected cell types included CD68+ type A (macrophage-like) synoviocytes and CD44+ type B (fibroblast-like) synoviocytes. Cultured primary human fibroblast-like synoviocytes were permissive to infection with Ebola and Marburg viruses in vitro. Because synovial joints include immune privileged sites, these findings are significant for future investigations of filovirus pathogenesis and persistence as well as arthralgias in acute and convalescent filovirus disease.
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Affiliation(s)
- Timothy K Cooper
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland.
| | - James Logue
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - David X Liu
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Donna L Perry
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Randy J Hart
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Amanda M W Hischak
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - John G Bernbaum
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Dawn M Gerhardt
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Oscar Rojas
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - J Kyle Bohannon
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Katie R Hagen
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Reed F Johnson
- Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Ian Crozier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Peter B Jahrling
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Lisa E Hensley
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland.
| | - Richard S Bennett
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
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37
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Canady D, Weil NC, Miller C, Shantha JG, Bastien G, Yeh S. Ophthalmic and psychosocial sequelae in Ebola virus disease survivors: ongoing need for health systems strengthening across disciplines. Expert Rev Anti Infect Ther 2020; 19:117-119. [PMID: 32772594 DOI: 10.1080/14787210.2020.1808461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Natalie C Weil
- Department of Ophthalmology, Emory University School of Medicine , Atlanta, GA, USA
| | - Christopher Miller
- Department of Ophthalmology, Emory University School of Medicine , Atlanta, GA, USA
| | - Jessica G Shantha
- Morehouse School of Medicine , Atlanta, GA, USA.,Department of Ophthalmology, Emory University School of Medicine , Atlanta, GA, USA
| | | | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine , Atlanta, GA, USA.,Emory Global Health Institute, Emory University , Atlanta, GA, USA
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38
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Long-lasting severe immune dysfunction in Ebola virus disease survivors. Nat Commun 2020; 11:3730. [PMID: 32709840 PMCID: PMC7381622 DOI: 10.1038/s41467-020-17489-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 06/29/2020] [Indexed: 12/30/2022] Open
Abstract
Long-term follow up studies from Ebola virus disease (EVD) survivors (EBOV_S) are lacking. Here, we evaluate immune and gene expression profiles in 35 Guinean EBOV_S from the last West African outbreak, a median of 23 months (IQR [18–25]) after discharge from treatment center. Compared with healthy donors, EBOV_S exhibit increases of blood markers of inflammation, intestinal tissue damage, T cell and B cell activation and a depletion of circulating dendritic cells. All survivors have EBOV-specific IgG antibodies and robust and polyfunctional EBOV-specific memory T-cell responses. Deep sequencing of the genes expressed in blood reveals an enrichment in ‘inflammation’ and ‘antiviral’ pathways. Integrated analyses identify specific immune markers associated with the persistence of clinical symptoms. This study identifies a set of biological and genetic markers that could be used to define a signature of “chronic Ebola virus disease (CEVD)”. Patients who have recovered from Ebola virus can have ongoing health problems. Here, the authors show that 35 Guinean survivors of the last West African Ebola epidemic have a chronic disease with high inflammatory cytokine expression and other markers of immune activation as well as evidence of intestinal tissue damage nearly two years after their release from hospital.
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Kelly JD, Hoff NA, Spencer D, Musene K, Bramble MS, McIlwain D, Okitundu D, Porco TC, Rutherford GW, Glymour MM, Bjornson Z, Mukadi P, Okitolonda-Wemakoy E, Nolan GP, Muyembe-Tamfum JJ, Rimoin AW. Neurological, Cognitive, and Psychological Findings Among Survivors of Ebola Virus Disease From the 1995 Ebola Outbreak in Kikwit, Democratic Republic of Congo: A Cross-sectional Study. Clin Infect Dis 2020; 68:1388-1393. [PMID: 30107392 PMCID: PMC6452000 DOI: 10.1093/cid/ciy677] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/08/2018] [Indexed: 11/12/2022] Open
Abstract
Background Clinical sequelae of Ebola virus disease (EVD) have not been described more than 3 years postoutbreak. We examined survivors and close contacts from the 1995 Ebola outbreak in Kikwit, Democratic Republic of Congo (DRC), and determined prevalence of abnormal neurological, cognitive, and psychological findings and their association with EVD survivorship. Methods From August to September 2017, we conducted a cross-sectional study in Kikwit, DRC. Over 2 decades after the EVD outbreak, we recruited EVD survivors and close contacts from the outbreak to undergo physical examination and culturally adapted versions of the Folstein mini-mental status exam (MMSE) and Goldberg anxiety and depression scale (GADS). We estimated the strength of relationships between EVD survivorship and health outcomes using linear regression models by comparing survivors versus close contacts, adjusting for age, sex, educational level, marital status, and healthcare worker status. Results We enrolled 20 EVD survivors and 187 close contacts. Among the 20 EVD survivors, 4 (20%) reported at least 1 abnormal neurological symptom, and 3 (15%) had an abnormal neurological examination. Among the 187 close contacts, 14 (11%) reported at least 1 abnormal neurologic symptom, and 9 (5%) had an abnormal neurological examination. EVD survivors had lower mean MMSE and higher mean GADS scores as compared to close contacts (MMSE: adjusted coefficient: −1.85; 95% confidence interval [CI]: −3.63, −0.07; GADS: adjusted coefficient: 3.91; 95% CI: 1.76, 6.04). Conclusions EVD survivors can have lower cognitive scores and more symptoms of depression and anxiety than close contacts more than 2 decades after Ebola virus outbreaks.
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Affiliation(s)
- J Daniel Kelly
- School of Medicine, University of California, San Francisco
| | - Nicole A Hoff
- School of Public Health, University of California, Los Angeles
| | - D'Andre Spencer
- School of Public Health, University of California, Los Angeles
| | - Kamy Musene
- School of Public Health, University of California, Los Angeles
| | - Matthew S Bramble
- School of Public Health, University of California, Los Angeles.,Department of Genetic Medicine Research, Children's Research Institute, Children's National Medical Center, Washington, D.C
| | - David McIlwain
- Department of Microbiology and Immunology, Stanford University, California
| | - Daniel Okitundu
- Institut National de Recherche Biomédicale, Université de Kinshasa, Democratic Republic of Congo.,Faculté de Médecine, Université de Kinshasa, Democratic Republic of Congo
| | - Travis C Porco
- School of Medicine, University of California, San Francisco
| | | | | | - Zach Bjornson
- Department of Microbiology and Immunology, Stanford University, California
| | - Patrick Mukadi
- Institut National de Recherche Biomédicale, Université de Kinshasa, Democratic Republic of Congo.,Faculté de Médecine, Université de Kinshasa, Democratic Republic of Congo
| | | | - Garry P Nolan
- Department of Microbiology and Immunology, Stanford University, California
| | | | - Anne W Rimoin
- School of Public Health, University of California, Los Angeles
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Landry MD, Geddes L, Park Moseman A, Lefler JP, Raman SR, Wijchen JV. Early reflection on the global impact of COVID19, and implications for physiotherapy. Physiotherapy 2020; 107:A1-A3. [PMID: 32312528 PMCID: PMC7194933 DOI: 10.1016/j.physio.2020.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Michel D Landry
- Duke Global Health Institute (DGHI), Duke University, 184 Durham, USA; Western Norway University of Applied Sciences, Bergen, 186 Norway.
| | | | | | | | - Sudha R Raman
- Department of Population Health Sciences, Duke University, Durham, USA
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Landry MD, Geddes L, Park Moseman A, Lefler JP, Raman SR, Wijchen JV. Early reflection on the global impact of COVID19, and implications for physiotherapy. Physiotherapy 2020. [PMID: 32312528 DOI: 10.1016/j.physio.2020.03.003)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Affiliation(s)
- Michel D Landry
- Duke Global Health Institute (DGHI), Duke University, 184 Durham, USA; Western Norway University of Applied Sciences, Bergen, 186 Norway.
| | | | | | | | - Sudha R Raman
- Department of Population Health Sciences, Duke University, Durham, USA
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Secor A, Macauley R, Stan L, Kagone M, Sidikiba S, Sow S, Aronovich D, Litvin K, Davis N, Alva S, Sanderson J. Mental health among Ebola survivors in Liberia, Sierra Leone and Guinea: results from a cross-sectional study. BMJ Open 2020; 10:e035217. [PMID: 32461296 PMCID: PMC7259862 DOI: 10.1136/bmjopen-2019-035217] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To describe the prevalence and correlates of depression and anxiety among adult Ebola virus disease (EVD) survivors in Liberia, Sierra Leone and Guinea. DESIGN Cross-sectional. SETTING One-on-one surveys were conducted in EVD-affected communities in Liberia, Sierra Leone and Guinea in early 2018. PARTICIPANTS 1495 adult EVD survivors (726 male, 769 female). PRIMARY AND SECONDARY OUTCOME MEASURES Patient Health Questionnaire-9 (PHQ-9) depression scores and Generalised Anxiety Disorder-7 (GAD-7) scores. RESULTS Prevalence and severity of depression and anxiety varied across the three countries. Sierra Leone had the highest prevalence of depression, with 22.0% of participants meeting the criteria for a tentative diagnosis of depression, compared with 20.2% in Liberia and 13.0% in Guinea. Sierra Leone also showed the highest prevalence of anxiety, with 10.7% of participants meeting criteria for generalized anxiety disorder (GAD-7 score ≥10), compared with 9.9% in Liberia and 4.2% in Guinea. Between one-third and one-half of respondents reported little interest or pleasure in doing things in the previous 2 weeks (range: 47.0% in Liberia to 37.6% in Sierra Leone), and more than 1 in 10 respondents reported ideation of self-harm or suicide (range: 19.4% in Sierra Leone to 10.4% in Guinea). Higher depression and anxiety scores were statistically significantly associated with each other and with experiences of health facility-based stigma in all three countries. Other associations between mental health scores and respondent characteristics varied across countries. CONCLUSIONS Our results indicate that both depression and anxiety are common among EVD survivors in Liberia, Sierra Leone and Guinea, but that there is country-level heterogeneity in prevalence, severity and correlates of these conditions. All three countries should work to make mental health services available for survivors, and governments and organisations should consider the intersection between EVD-related stigma and mental health when designing programmes and training healthcare providers.
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Affiliation(s)
- Andrew Secor
- JSI Research and Training Institute Inc, Monrovia, Liberia
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Rose Macauley
- JSI Research and Training Institute Inc, Monrovia, Liberia
| | - Laurentiu Stan
- JSI Research and Training Institute Inc, Freetown, Sierra Leone
| | - Meba Kagone
- JSI Research and Training Institute Inc, Conakry, Guinea
| | | | - Sadou Sow
- JSI Research and Training Institute Inc, Conakry, Guinea
| | - Dana Aronovich
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Kate Litvin
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Nikki Davis
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Soumya Alva
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
| | - Jeff Sanderson
- JSI Research and Training Institute Inc, Arlington, Virginia, USA
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43
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McWilliams IL, Kielczewski JL, Ireland DDC, Sykes JS, Lewkowicz AP, Konduru K, Xu BC, Chan CC, Caspi RR, Manangeeswaran M, Verthelyi D. Pseudovirus rVSVΔG-ZEBOV-GP Infects Neurons in Retina and CNS, Causing Apoptosis and Neurodegeneration in Neonatal Mice. Cell Rep 2020; 26:1718-1726.e4. [PMID: 30759384 DOI: 10.1016/j.celrep.2019.01.069] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/15/2018] [Accepted: 01/17/2019] [Indexed: 02/07/2023] Open
Abstract
Zaire Ebola virus (ZEBOV) survivors experience visual and CNS sequelae that suggests the ZEBOV glycoprotein can mediate neurotropism. Replication-competent rVSVΔG-ZEBOV-GP vaccine candidate is generally well tolerated; however, its potential neurotropism requires careful study. Here, we show that a single inoculation of rVSVΔG-ZEBOV-GP virus in neonatal C57BL/6 mice results in transient viremia, neurological symptoms, high viral titers in eyes and brains, and death. rVSVΔG-ZEBOV-GP infects the inner layers of the retina, causing severe retinitis. In the cerebellum, rVSVΔG-ZEBOV-GP infects neurons in the granular and Purkinje layers, resulting in progressive foci of apoptosis and neurodegeneration. The susceptibility to infection is not due to impaired type I IFN responses, although MDA5-/-, IFNβ-/-, and IFNAR1-/- mice have accelerated mortality. However, boosting interferon levels by co-administering poly(I:C) reduces viral titers in CNS and improves survival. Although these data should not be directly extrapolated to humans, they challenge the hypothesis that VSV-based vaccines are non-neurotropic.
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Affiliation(s)
- Ian L McWilliams
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
| | | | - Derek D C Ireland
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Jacob S Sykes
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Aaron P Lewkowicz
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Krishnamurthy Konduru
- Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases, Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Biying C Xu
- Laboratory of Immunology, National Eye Institute, NIH, Bethesda, MD 20892, USA
| | - Chi-Chao Chan
- Laboratory of Immunology, National Eye Institute, NIH, Bethesda, MD 20892, USA
| | - Rachel R Caspi
- Laboratory of Immunology, National Eye Institute, NIH, Bethesda, MD 20892, USA
| | - Mohanraj Manangeeswaran
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Daniela Verthelyi
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA.
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Pathogenesis of Uveitis in Ebola Virus Disease Survivors: Evolving Understanding from Outbreaks to Animal Models. Microorganisms 2020; 8:microorganisms8040594. [PMID: 32325950 PMCID: PMC7232169 DOI: 10.3390/microorganisms8040594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/05/2020] [Accepted: 04/13/2020] [Indexed: 01/24/2023] Open
Abstract
Ebola virus disease (EVD) and emerging infectious disease threats continue to threaten life, prosperity and global health security. To properly counteract EVD, an improved understanding of the long-term impact of recent EVD outbreaks in West Africa and the Democratic Republic of Congo are needed. In the wake of recent outbreaks, numerous health sequelae were identified in EVD survivors. These findings include joint pains, headaches, myalgias, and uveitis, a vision-threatening inflammatory condition of the eye. Retrospective and more recent prospective studies of EVD survivors from West Africa have demonstrated that uveitis may occur in 13–34% of patients with an increase in prevalence from baseline to 12-month follow-up. The clinical spectrum of disease ranges from mild, anterior uveitis to severe, sight-threatening panuveitis. Untreated inflammation may ultimately lead to secondary complications of cataract and posterior synechiae, with resultant vision impairment. The identification of Ebola virus persistence in immune privileged organs, such as the eye, with subsequent tissue inflammation and edema may lead to vision loss. Non-human primate models of EVD have demonstrated tissue localization to the eye including macrophage reservoirs within the vitreous matter. Moreover, in vitro models of Ebola virus have shown permissiveness in retinal pigment epithelial cells, potentially contributing to viral persistence. Broad perspectives from epidemiologic studies of the outbreak, animal modeling, and immunologic studies of EVD survivors have demonstrated the spectrum of the eye disease, tissue specificity of Ebola virus infection, and antigen-specific immunologic response. Further studies in these areas will elucidate the mechanisms of this highly prevalent disease with the potential for improved therapeutics for Ebola virus in immune-privileged sites.
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Steptoe PJ, Momorie F, Fornah AD, Komba P, Emsley E, Scott JT, Williams SJ, Harding SP, Vandy MJ, Sahr F, Beare NAV, Semple MG. Evolving Longitudinal Retinal Observations in a Cohort of Survivors of Ebola Virus Disease. JAMA Ophthalmol 2020; 138:395-403. [PMID: 32134433 PMCID: PMC7146102 DOI: 10.1001/jamaophthalmol.2020.0173] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance The 2-year ophthalmic sequelae of Ebola virus disease (EVD) in survivors of the 2013 to 2016 epidemic is unknown and may have public health implications for future outbreaks. Objective To assess the potential for uveitis recurrence, the behavior of dark without pressure, and visual outcomes in a cohort of Sierra Leonean survivors of EVD 2 years following the 2013 to 2016 Ebola epidemic. Design, Setting, and Participants Prospective, 1-year observational cohort study performed between 2016 and 2017 at 34 Military Hospital, Freetown, Sierra Leone. Participants included survivors of EVD who reported ocular symptoms since Ebola treatment unit discharge and were participants of a previous case-control study. Participants were invited for ophthalmic reexamination and finger-prick blood sampling for immunoglobulin G (IgG) to Toxoplasma gondii and HIV. Exposures Ebola virus disease. Main Outcomes and Measures Primary outcome measure: comparative ultra-widefield retinal imaging. Secondary outcome measures: visual acuity and detection of IgG to T gondii and HIV. Results Of 57 survivors of EVD who underwent repeated ophthalmic evaluation, 37 were women (64.9%). Mean (SD) age was 31.9 (11.1) years. Median interval between first and last examination was 370 days (interquartile range [IQR], 365-397.5 days), and median time from discharge to last examination was 779 days (IQR, 732-821 days). Fifteen eyes of 10 survivors (17.5%) had retinal lesions secondary to EVD. No new EVD-associated retinal lesions were observed. Two survivors (3.5%) developed new posterior uveitis resembling toxoplasmosis chorioretinitis and 41 (73%) were seropositive for T gondii IgG. Areas of dark without pressure were observed either confined to the perimeter of Ebola retinal lesions (n = 7) and non-Ebola lesions (n = 2), involving extensive retinal areas adjacent to Ebola retinal lesions (n = 4) and non-Ebola lesions (n = 2) or in isolation (n = 6). Both expansion and regression of areas of dark without pressure were observed over the study period. Best eye-presenting visual acuity had mild or no visual impairment in 55 survivors (96.4%) 2 years following discharge. Conclusions and Relevance Vision was maintained in survivors of EVD 2 years following discharge. Evolving regions of dark without pressure may be associated with EVD retinal lesions and might suggest the presence of an ongoing intraretinal stimulus, which may be associated with infective etiology. Treatment strategies should account for the possibility of toxoplasmosis chorioretinitis recurrence within survivors of EVD.
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Affiliation(s)
- Paul J Steptoe
- Department of Women's and Children's Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England.,St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, England
| | - Fayiah Momorie
- Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, Scotland.,34 Military Hospital, Freetown, Sierra Leone
| | - Alimamy D Fornah
- Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, Scotland.,34 Military Hospital, Freetown, Sierra Leone
| | - Patrick Komba
- Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, Scotland.,34 Military Hospital, Freetown, Sierra Leone
| | - Elizabeth Emsley
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England
| | - Janet T Scott
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, England.,Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, Scotland
| | - Samantha J Williams
- Department of Women's and Children's Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England
| | - Simon P Harding
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.,Department of Eye and Vision Science, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England
| | | | - Foday Sahr
- Medical Research Council, University of Glasgow Centre for Virus Research, Glasgow, Scotland.,34 Military Hospital, Freetown, Sierra Leone
| | - Nicholas A V Beare
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England.,Department of Eye and Vision Science, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England
| | - Malcolm G Semple
- Department of Women's and Children's Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, England.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, England
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Ebola Virus Disease: Epidemiology, Clinical Features, Management, and Prevention. Infect Dis Clin North Am 2020; 33:953-976. [PMID: 31668200 DOI: 10.1016/j.idc.2019.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ebola virus disease (EVD) is a deadly zoonotic disease caused by the Ebola virus. There is no specific treatment approved for EVD. Supportive care and management of complications are mainstays of treatment. Effective outbreak control requires a multidisciplinary team effort applying case management, infection prevention and control practices, surveillance and contact tracing, a good laboratory service, safe and dignified burials, and social and community mobilization. This article highlights the epidemiology, clinical features, diagnosis, management, and prevention of EVD. The emerging diagnostic technologies, rapid viral characterization, geospatial mapping of EVD transmission, and new treatments and vaccines are discussed.
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Ficenec SC, Schieffelin JS, Emmett SD. A Review of Hearing Loss Associated with Zika, Ebola, and Lassa Fever. Am J Trop Med Hyg 2020; 101:484-490. [PMID: 31333155 PMCID: PMC6726950 DOI: 10.4269/ajtmh.18-0934] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The neglected tropical diseases Zika, Ebola, and Lassa fever (LF) have all been noted to cause some degree of hearing loss (HL). Hearing loss is a chronic disability that can lead to a variety of detrimental effects, including speech and language delays in children, decreased economic productivity in adults, and accelerated cognitive decline in older adults. The objective of this review is to summarize what is known regarding HL secondary to these viruses. Literature for this review was gathered using the PubMed database. Articles were excluded if there were no data of the respective viruses, postinfectious complications, or conditions related to survivorship. A total of 50 articles were included in this review. Fourteen articles discussing Zika virus and subsequent complications were included. Across these studies, 56 (21.2%) of 264 Zika-infected individuals were found to have HL. Twenty-one articles discussing Ebola virus and subsequent complications were included, with 190 (5.7%) of 3,350 Ebola survivors found to have HL. Fifteen additional articles discussing LF and subsequent complications were included. Of 926 individuals with LF, 79 (8.5%) were found to have HL. These results demonstrate a relationship between HL and infection. The true prevalence is likely underestimated, however, because of lack of standardization of reporting and measurement. Future studies of viral sequelae would benefit from including audiometric evaluation. This information is critical to understanding pathophysiology, preventing future cases of this disability, and improving quality of life after survival of infection.
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Affiliation(s)
| | | | - Susan D Emmett
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina.,Duke Global Health Institute, Durham, North Carolina.,Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina
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Jacob ST, Crozier I, Fischer WA, Hewlett A, Kraft CS, Vega MADL, Soka MJ, Wahl V, Griffiths A, Bollinger L, Kuhn JH. Ebola virus disease. Nat Rev Dis Primers 2020; 6:13. [PMID: 32080199 PMCID: PMC7223853 DOI: 10.1038/s41572-020-0147-3] [Citation(s) in RCA: 296] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 12/16/2022]
Abstract
Ebola virus disease (EVD) is a severe and frequently lethal disease caused by Ebola virus (EBOV). EVD outbreaks typically start from a single case of probable zoonotic transmission, followed by human-to-human transmission via direct contact or contact with infected bodily fluids or contaminated fomites. EVD has a high case-fatality rate; it is characterized by fever, gastrointestinal signs and multiple organ dysfunction syndrome. Diagnosis requires a combination of case definition and laboratory tests, typically real-time reverse transcription PCR to detect viral RNA or rapid diagnostic tests based on immunoassays to detect EBOV antigens. Recent advances in medical countermeasure research resulted in the recent approval of an EBOV-targeted vaccine by European and US regulatory agencies. The results of a randomized clinical trial of investigational therapeutics for EVD demonstrated survival benefits from two monoclonal antibody products targeting the EBOV membrane glycoprotein. New observations emerging from the unprecedented 2013-2016 Western African EVD outbreak (the largest in history) and the ongoing EVD outbreak in the Democratic Republic of the Congo have substantially improved the understanding of EVD and viral persistence in survivors of EVD, resulting in new strategies toward prevention of infection and optimization of clinical management, acute illness outcomes and attendance to the clinical care needs of patients.
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Affiliation(s)
- Shevin T Jacob
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Global Health Security Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Ian Crozier
- Integrated Research Facility at Fort Detrick, Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research supported by the National Cancer Institute, Frederick, MD, USA
| | - William A Fischer
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Chapel Hill, NC, USA
| | - Angela Hewlett
- Nebraska Biocontainment Unit, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Colleen S Kraft
- Microbiology Section, Emory Medical Laboratory, Emory University School of Medicine, Atlanta, GA, USA
| | - Marc-Antoine de La Vega
- Department of Microbiology, Immunology & Infectious Diseases, Université Laval, Quebec City, QC, Canada
| | - Moses J Soka
- Partnership for Ebola Virus Disease Research in Liberia, Monrovia Medical Units ELWA-2 Hospital, Monrovia, Liberia
| | - Victoria Wahl
- National Biodefense Analysis and Countermeasures Center, Fort Detrick, Frederick, MD, USA
| | - Anthony Griffiths
- Department of Microbiology and National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA, USA
| | - Laura Bollinger
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA.
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Masys AJ, Izurieta R, Reina Ortiz M. The Emerging Threat of Ebola. ADVANCED SCIENCES AND TECHNOLOGIES FOR SECURITY APPLICATIONS 2020. [PMCID: PMC7123219 DOI: 10.1007/978-3-030-23491-1_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ebola is one of the deadliest infectious disease of the modern era. Over 50% of those infected die. Prior to 1976, the disease was unknown. No one knows exactly where it came from, but it is postulated that a mutation in an animal virus allowed it to jump species and infect humans. In 1976 simultaneous outbreaks of Ebola occurred in what is now South Sudan and the Democratic Republic of the Congo (DRC). For 20 years, only sporadic cases were seen, but in 1995 a new outbreak occurred killing hundreds in the DRC. Since that time the frequency of these outbreaks has been increasing. It is uncertain why this is occurring, but many associate it with increasing human encroachment into forested areas bringing people and animals into more intimate contact and increased mobility of previously remote population. This chapter will navigate Ebola in the context of global health and security. There are multiple objectives of this chapter. First is to provide a basic understanding of Ebola disease processes and outbreak patterns. Second, is to explore the interplay between social determinants of health and Ebola. The role of technology in spreading Ebola outbreaks will be explained as will Ebola’s potential as a bioweapon. Readers will gain understanding of the link between environmental degradation and Ebola outbreaks. This chapter will be divided into five main sections. These are (1) a case study; (2) Ebola Disease process; (3) Social determinants of health and Ebola; (4) Ebola in the modern era, and (5) the link between Ebola and environmental degradation.
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Affiliation(s)
- Anthony J. Masys
- College of Public Health, University of South Florida, Tampa, FL USA
| | - Ricardo Izurieta
- College of Public Health, University of South Florida, Tampa, FL USA
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Ebola virus disease: An emerging and re-emerging viral threat. J Autoimmun 2019; 106:102375. [PMID: 31806422 DOI: 10.1016/j.jaut.2019.102375] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022]
Abstract
The genus Ebolavirus from the family Filoviridae is composed of five species including Sudan ebolavirus, Reston ebolavirus, Bundibugyo ebolavirus, Taï Forest ebolavirus, and Ebola virus (previously known as Zaire ebolavirus). These viruses have a large non-segmented, negative-strand RNA of approximately 19 kb that encodes for glycoproteins (i.e., GP, sGP, ssGP), nucleoproteins, virion proteins (i.e., VP 24, 30,40) and an RNA dependent RNA polymerase. These viruses have become a global health concern because of mortality, their rapid dissemination, new outbreaks in West-Africa, and the emergence of a new condition known as "Post-Ebola virus disease syndrome" that resembles inflammatory and autoimmune conditions such as rheumatoid arthritis, systemic lupus erythematosus and spondyloarthritis with uveitis. However, there are many gaps in the understanding of the mechanisms that may induce the development of such autoimmune-like syndromes. Some of these mechanisms may include a high formation of neutrophil extracellular traps, an uncontrolled "cytokine storm", and the possible formation of auto-antibodies. The likely appearance of autoimmune phenomena in Ebola survivors suppose a new challenge in the management and control of this disease and opens a new field of research in a special subgroup of patients. Herein, the molecular biology, pathogenesis, clinical manifestations, and treatment of Ebola virus disease are reviewed and some strategies for control of disease are discussed.
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