Ebola Virus Disease Complications as Experienced by Survivors in Sierra Leone

As of February 2016, >28 000 cases of Ebola virus disease (EVD) have been reported from the epidemic affecting West Africa since December 2013 [1]. The burden of disease was highest in Sierra Leone with >14 000 reported cases. Although many have died, with a case fatality ratio of approximately 50%, thousands have survived the disease [1]. The first report from the Sudan EVD outbreak in 1976 described a “slow and painful” recovery in survivors [2]. Few cohorts have characterized clinical complications [3–14], and only 2 controlled studies have been published [5, 13]. Arthralgia, weakness, hair loss, anorexia, weight loss, abdominal pain, hearing loss and tinnitus, neuropathy, increased susceptibility to infections, and cardiac problems have been reported. Ocular complications, most often uveitis and conjunctivitis, have also been described in small case series [3–5, 7–9, 11, 14–17]. Whether delayed complications are due to persistent viral replication in immune-protected body sites, immune complex deposition, persistence of virus antigen, molecular mimicry, or another mechanism remains unknown. A better understanding of the long-term physical and psychological complications of EVD is needed to address and prevent long-term sequelae. Here we describe complications among survivors attending an EVD survivor clinic in Freetown, Sierra Leone.