Ebola RNA Persistence in Semen of Ebola Virus Disease Survivors — Final Report

Abstract

BACKGROUND Ebola virus has been detected in the semen of men after their recovery from Ebola virus disease (EVD). We report the presence of Ebola virus RNA in semen in a cohort of survivors of EVD in Sierra Leone. METHODS We enrolled a convenience sample of 220 adult male survivors of EVD in Sierra Leone, at various times after discharge from an Ebola treatment unit (ETU), in two phases (100 participants were in phase 1, and 120 in phase 2). Semen specimens obtained at baseline were tested by means of a quantitative reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay with the use of the target sequences of NP and VP40 (in phase 1) or NP and GP (in phase 2). This study did not evaluate directly the risk of sexual transmission of EVD. RESULTS Of 210 participants who provided an initial semen specimen for analysis, 57 (27%) had positive results on quantitative RT-PCR. Ebola virus RNA was detected in the semen of all 7 men with a specimen obtained within 3 months after ETU discharge, in 26 of 42 (62%) with a specimen obtained at 4 to 6 months, in 15 of 60 (25%) with a specimen obtained at 7 to 9 months, in 4 of 26 (15%) with a specimen obtained at 10 to 12 months, in 4 of 38 (11%) with a specimen obtained at 13 to 15 months, in 1 of 25 (4%) with a specimen obtained at 16 to 18 months, and in no men with a specimen obtained at 19 months or later. Among the 46 participants with a positive result in phase 1, the median baseline cycle-threshold values (higher values indicate lower RNA values) for the NP and VP40 targets were lower within 3 months after ETU discharge (32.4 and 31.3, respectively; in 7 men) than at 4 to 6 months (34.3 and 33.1; in 25), at 7 to 9 months (37.4 and 36.6; in 13), and at 10 to 12 months (37.7 and 36.9; in 1). In phase 2, a total of 11 participants had positive results for NP and GP targets (samples obtained at 4.1 to 15.7 months after ETU discharge); cycle-threshold values ranged from 32.7 to 38.0 for NP and from 31.1 to 37.7 for GP. CONCLUSIONS These data showed the long-term presence of Ebola virus RNA in semen and declining persistence with increasing time after ETU discharge. (Funded by the World Health Organization and others.)

Post-exposure treatments for Ebola and Marburg virus infections

“…In rare cases, encephalitis has also been noted [30][31][32][33] . Filoviruses have also been detected by PCR and/or virus isolation in the breast milk 34,35 and semen [36][37][38][39] of survivors. The persistence of filoviruses in semen is particularly concerning, with detection in one individual occurring 565 days after discharge from an EBOV treatment centre in Liberia 38 .…”

Neurological Complications of Ebola Virus Infection

“…The face shield makes its difficult to do a fundoscopic evaluation. Sensory examination cannot be performed symptoms, although at decreasing rates over time (with all survivors who were tested at 2-3 months after onset having EBOV RNA-positive semen, 65% of survivors positive at 4-6 months after onset, and 26% positive at 7-9 months after onset) [42]. These findings are of further interest given the potential for sexual transmission of EVD, as in the previously mentioned March 2015 case in Liberia [15].…”

Essentials of filoviral load quantification

“…Variability in lethality might also relate to factors such as time from disease onset to presentation for care, quality of care available, patient demographics, or variant of infecting virus. 14,[22][23][24] Accurate viral load measurement is also important in interpreting Ebola virus persistence in and transmission risk from immuneprivileged body compartments and fl uids, 25 including the male gonads or semen, [25][26][27][28] eyes, 29 CNS, 30 breast milk, 31 and the intrauterine space in pregnant women. 32 Additionally, Ebola virus has occasionally been found in sweat and urine, 33 and in atypical or asymptomatic cases.…”