#Neurological Manifestations in Adult #Survivors of #Ebola Virus Disease

 

Key Points

    ° Question: 

        - What neurological symptoms are present in adult survivors of Ebola virus disease (EVD) and how long are they present after infection?

    ° Findings:  

        - In this cohort study conducted in Liberia including 148 EVD survivors and 81 control individuals, survivors had a wide range of neurological symptoms during acute EVD (including headaches, altered mental status, and meningitis symptoms) and numerous neurological sequelae in convalescence (including headaches, memory loss, and neurological examination abnormalities). Seven years later, most survivors’ symptoms and findings had improved, but many still had neurological symptoms, most notably memory loss.

    ° Meaning:  

        - The findings indicate that many neurological symptoms, including those that can affect quality of life and socioeconomic burden, were associated with EVD, warranting close neurological follow-up of EVD survivors.

Abstract

Importance  

    Ebola virus disease (EVD) causes multiorgan damage and is highly fatal. EVD’s neurological impact among survivors remains poorly characterized due to limited neurological assessment capabilities in the remote regions where most outbreaks occur.

Objective  

    To characterize neurological sequelae in EVD survivors over more than 7 years’ longitudinal follow-up.

Design, Setting, and Participants  

    Under the Ebola Natural History Study (PREVAIL III; PIII), the Neurology Study of PIII was a prospective longitudinal cohort study in Liberia of adult Ebola survivors and control individuals conducted from September 2015 to March 2023 at the Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL) site at John F. Kennedy Medical Center in Monrovia, Liberia. Data were analyzed from April 2023 to September 2025.

Exposures  

    Neurological evaluations were performed by trained neurologists biannually. Questionnaire and neurological examination data were collected on case report forms.

Main Outcomes and Measures  

    Neurological symptom prevalence and neurological examination scores were compared to those of control individuals. Tests for differences between survivors and control individuals were conducted using generalized linear mixed-effects models controlling for age and sex. Overdispersed Poisson models were used to test for computed neurological examination score differences. Neurological examination scores were developed for this study, representing the cumulative abnormalities on neurological examinations, denoted on standardized case report forms, with the general neurological examination score representing all examination abnormalities and the central nervous system score representing the central nervous system–specific abnormalities on examination.

Results  

    Analysis after serologic testing included 148 Ebola antibody-positive survivors (mean [SD] age, 34.8 [10.5] years; 74 [50%] female) and 81 antibody-negative contacts (mean [SD] age, 35.8 [12.6] years; 41 [51%] female). During acute infection, survivors reported headaches, altered mental status, and strokelike symptoms or meningoencephalitis (rarely). Survivors had significant neurological sequelae involving the entire neuraxis: cognitive dysfunction (83 [56.1%]), persistent headaches (98 [66.2%]), sleep abnormalities (40 [27.0%]), depression (73 [49.3%]), sexual dysfunction (48 [32.4%]), tremor (18 [20.3%]), fatigue (71 [51.1%]), cranial nerve abnormalities (60 [40.5%]), and sensory abnormalities (45 [30.4%]). Over 7 years’ follow-up, most survivors demonstrated improvement in neurological status. The final visit included 115 survivors (77.7%) and 61 close contacts (75.3%). Persistent symptoms at final evaluation in survivors compared to contacts were memory loss (66 [57.4%] vs 16 [26.2%], respectively; P < .001), irritability (42 [36.5%] vs 9 [14.8%], respectively; P = .006), and trouble concentrating (34 [29.6%] vs 6 [9.8%], respectively; P = .002).

Conclusions and Relevance  

    The findings indicate that Ebola virus infection is associated with neurological complications in survivors, with increased health care burden and socioeconomic consequences. These neurological issues generally improved with time, but some persisted long-term. Close neurological follow-up of EVD survivors may be warranted.

Source: 

Link: https://jamanetwork.com/journals/jamaneurology/fullarticle/2850237#251071811

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#Lassa fever #symptomatology, viral dynamics, and host immune response (PREPARE): a prospective, observational cohort study in #Liberia

 

Summary

Background

Lassa virus (LASV) is a persistent threat to public health in west Africa and beyond. LASV is endemic in west Africa and each year it is responsible for an estimated 2·7 million infections, 23 700 hospitalisations, and 5000 deaths. With over 32 reported cases of Lassa fever imported into non-endemic countries—one-third of which were fatal—the importance of enhanced detection and management of Lassa fever extends beyond west Africa.

Methods

The prevalence, pathogenesis, and persistence (PREPARE) study was a prospective cohort study among patients admitted to two hospitals in a hyperendemic area of Liberia. Any patients aged 5 years or older with a febrile illness were eligible to enrol and be tested for Lassa fever. The study aimed to measure the prevalence of LASV infection and assess the signs and symptoms, LASV viral replication kinetics, and LASV-specific IgM and IgG responses longitudinally among adults and children with laboratory-confirmed Lassa fever.

Findings

From July 10, 2018, to Aug 12, 2024, a total of 435 participants were enrolled, including 362 admitted with a febrile illness and 73 who were directly admitted with clinical suspicion for Lassa fever. Lassa fever was diagnosed by plasma LASV RT-PCR in 41 (11%) of 362 febrile participants and 47 (64%) of 73 participants directly admitted with suspected Lassa fever, resulting in a total of 88 cases of confirmed Lassa fever. At entry, anorexia (71 [81%] of 88 vs 178 [51%] of 347), severe fatigue or weakness (63 [72%] vs 178 [51%]), and nausea or vomiting (39 [44%] vs 95 [27%]) were more likely to be reported by participants with Lassa fever than by participants who tested LASV RNA negative. Among the participants with Lassa fever, 11 (13%) of 88 died after admission. Mental status changes, seizures, acute kidney failure, hyperkalaemia, and metabolic acidosis were more frequent in patients with Lassa fever who died than in patients who survived. Median cycle threshold values at study entry for glycoprotein complex gene (GPC) or polymerase gene (L) were lower in those who died (GPC cycle threshold 22·4 [IQR 20·0–27·9]; L cycle threshold 21·7 [19·0–27·7]) than in those who survived (GPC cycle threshold 31·5 [28·0–33·9]; L cycle threshold 32·3 [28·0–33·9]). Among the 70 participants with Lassa fever who consented to longitudinal follow-up through their hospitalisation, seven died and these participants tended to have lower cycle threshold values and lower IgM and IgG LASV responses compared with survivors.

Interpretation

In a region of Liberia where it is endemic, Lassa fever is a prevalent cause of morbidity and mortality. Several symptoms were more likely in those with Lassa fever but overlap with those caused by other common infectious diseases. Compared with survivors, those who died during hospitalisation for Lassa fever tended to have evidence of organ dysfunction along with higher viral loads at study entry and during follow-up and lower antibody levels during their illness, suggesting a muted humoral immune response might be a factor in the development of severe Lassa fever.

Funding

US National Institute of Allergy and Infectious Diseases and National Institutes of Health.

Source: 

Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(25)00725-X/abstract?rss=yes

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#Liberia - High pathogenicity avian #influenza #H5N1 viruses (poultry) (Inf. with) - Immediate notification

 

A poultry farm in Totota, right behind the Lutheran football field in Bong County.

Source: WOAH, https://wahis.woah.org/#/in-review/6432

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