Authors: Alex Hyde, Future Science Group
Early results from a recent study carried out in Guinea suggest that Ebola survivors could be at an increased risk of death in the first year after hospital discharge compared with the general Guinean population. The increased risk is most significant in those who spent longer in hospital.
The observational study of 1130 people, published in The Lancet Infectious Diseases, reports the death of 55 Ebola survivors versus 11 of the general population. A follow-up report states that 37 of the 59 deaths were attributed to renal failure based purely on the description of symptoms made by family members.
The lack of documentation and autopsies to make it challenging to rule out other causes of death and the authors of the study call for an investigation into whether renal failure is a common long-term effect of the disease.
Mory Keita (WHO field coordinator, Beni, Democratic Republic of Congo) explained that: “Renal failure is a biologically plausible cause of death in survivors of Ebola virus disease. Previously, the virus has been detected in urine samples during the acute phase of the disease demonstrating that it can infect the kidney.”
Guinean survivors of the 2013–16 Ebola outbreak in West Africa were followed by the study from December 8 2015 to September 30 2016 recording 59 subsequent deaths in this time period. Where possible, survivor’s medical records were reviewed and family members interviewed following any deaths.
The average mortality rate was calculated at 5.2%, however, the study reports that mortality rates are higher for those survivors who spent at least 12 days in hospital at 7% compared with 3% for those who were hospitalised for fewer than 3 days. The authors speculate this may be a result of those who were hospitalised for longer having prolonged, acute forms of the disease.
The authors postulate that better access to healthcare can explain the disparity between mortality rates of survivors in the capital (2%) compared with those living in other regions. The distribution of deaths over time and the possibility that 60% of deaths may be attributed to renal failure has led the authors to believe that most deaths are linked to long-term effects of Ebola.
Study author Dr Ibrahima Socé Fall (WHO, Geneva, Switzerland) commented on the importance of the results and the implications they have for the future: “Our findings highlights the need to strengthen Ebola survivor programmes, particularly as the number of people surviving the infection are increasing.”
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Source: Keita M, Diallo B, Mesfin S et al. Subsequent mortality in survivors of Ebola virus disease in Guinea: a nationwide retrospective cohort study. Lancet Infect. Dis. doi:10.1016/S1473-3099(19)30313-5 (2019); www.eurekalert.org/emb_releases/2019-09/tl-pss090319.php