In 2018, the World Health Organization (WHO), in collaboration with the health authorities of the Democratic Republic of the Congo and other health partners, established a program to monitor the health of Ebola survivors and support them in their recovery.
Dr. Raymond Pallawo, WHO epidemiologist and program coordinator, explains why it is critical to support those who have recovered from the highly infectious viral disease and ongoing efforts to understand and prevent a potential resurgence of the virus among survivors.
What challenges do Ebola survivors face?
Of the last seven Ebola outbreaks in the country, we have recorded 1,269 people who have recovered from the disease.
But they face difficulties including stigma, job loss, or difficulty finding work.
Some have been denied treatment in health centers when their status is known.
They also face medical problems.
An assessment conducted in July 2022 among the survivors found that some suffered from persistent mental health, eye or joint problems.
To increase our understanding of these challenges, we suggest that the Ministry of Health, in collaboration with UNICEF and associations of Ebola survivors, conduct an additional survey among those who have recovered from the disease.
The survey, which will begin soon, will also include survivors’ thoughts on the program to help them.
What kind of assistance do survivors receive?
The monitoring program is essentially a public health program.
Provides medical care during the first 18 months after discharge from treatment and monitors the possible persistence of the virus in body fluids.
This involves looking for signs that suggest a relapse while mitigating the risk of recurrence through early detection and care.
In practical terms, they receive a monthly medical and psychological examination.
If we detect signs that indicate a possible relapse, further investigations are carried out and medical attention is provided.
Cases of relapse have been managed and the risk of resurgence has been avoided.
Some people who recovered from Ebola developed meningitis and encephalitis (swelling of the brain) but did not infect others.
Staff at Ebola survivor clinics have been trained to care for survivors and observe infection prevention and control measures and protocols.
As such, someone who has recovered from Ebola and is suspected of having relapsed is monitored in such a way that they do not transmit the virus to others.
In addition, in our clinics, a person who has recovered from Ebola and suffers from another disease such as malaria or mental illness is treated with all covered expenses.
Pregnant women who have been cured of Ebola are also monitored during antenatal consultations until delivery.
Most of these women have given birth without problems and their children are doing very well.
At the time of delivery, we take samples from the mother and the baby.
So far, we have not seen any mother-to-child transmission of the virus.
What challenges does the monitoring program face?
There is no follow-up of Ebola survivors beyond 18 months, which is problematic because we have realized that the virus can resurface among survivors even years later.
These are often people with meningeal symptoms who test positive for Ebola in blood or cerebrospinal fluid even though they have previously recovered from Ebola.
This can happen months or years later.
This is why we want to deepen the research to understand this topic, as well as the factors of relapse and how to anticipate them in order to reduce the risks through appropriate public health actions.
What is being done to detect the virus and stop the possible resurgence of Ebola?
First of all, it is important to break down the stigma towards people who have recovered from Ebola.
The proportion of survivors in whom the virus persists is negligible, and not all cases with persistent virus result in a resurgence.
For example, of the 1,269 survivors monitored, only two continue to test positive for the virus.
Therefore, monitoring those who have recovered from the virus helps us spot the warning signs of a relapse and take appropriate action.
Thanks to clinical monitoring and the promotion of safe sex such as abstinence or the use of condoms, we have not observed any sexual transmission.
Surveillance systems and compliance with infection prevention and control measures must be strengthened.
Since 2020, we have trained surveillance agents at all levels—provincial, health zones, health areas—and more than 18,000 community health workers.
We have also established rapid response teams in North Kivu, South Kivu and Ituri provinces.