John G Mattia1, Mathew J Vandy2, Joyce C Chang3, Devin E Platt3, Kerry Dierberg3, Daniel G Bausch4, Tim Brooks5, Sampha Conteh3, Ian Crozier6, Robert A Fowler7, Amadu P Kamara1, Cindy Kang3, Srividya Mahadevan8, Yealie Mansaray1, Lauren Marcell3, Gillian McKay8, Tim O'Dempsey9, Victoria Parris10, Ruxandra Pinto11, Audrey Rangel10, Alex P Salam8, Jessica Shantha12, Vanessa Wolfman10, Steven Yeh12, Adrienne K Chan13, Sharmistha Mishra14. 1. National Eye Health Program, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; Christian Blind Mission, Baptist Eye Hospital Lunsar and Lowell and Ruth Gess UMC Eye Hospital, Kissy, Freetown, Sierra Leone. 2. National Eye Health Program, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone. 3. Partners in Health, Port Loko, Sierra Leone. 4. World Health Organization, Geneva, Switzerland. 5. Public Health England Port Loko Laboratory, Port Loko, Sierra Leone. 6. World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Infectious Diseases Institute, Mulago Hospital Complex, Kampala, Uganda. 7. World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Department of Medicine, University of Toronto, Toronto, Canada. 8. GOAL Global, Port Loko, Sierra Leone. 9. World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Liverpool School of Tropical Medicine, Liverpool, UK. 10. International Medical Corps, Port Loko, Sierra Leone. 11. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada. 12. Department of Ophthalmology, Emory University School of Medicine, Atlanta, USA. 13. World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Department of Medicine, University of Toronto, Toronto, Canada; Dignitas International, Toronto, Canada. 14. World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: sharmistha.mishra@utoronto.ca.
Abstract
BACKGROUND: Limited data are available on the prevalence and predictors of clinical sequelae in survivors of Ebola virus disease (EVD). The EVD Survivor Clinic in Port Loko, Sierra Leone, has provided clinical care for 603 of 661 survivors living in the district. We did a cross-sectional study to describe the prevalence, nature, and predictors of three key EVD sequelae (ocular, auditory, and articular) in this cohort of EVD survivors. METHODS: We reviewed available clinical and laboratory records of consecutive patients assessed in the clinic between March 7, 2015, and April 24, 2015. We used univariate and multiple logistic regression to examine clinical and laboratory features of acute EVD with the following outcomes in convalescence: new ocular symptoms, uveitis, auditory symptoms, and arthralgias. FINDINGS: Among 277 survivors (59% female), median age was 29 years (IQR 20-36) and median time from discharge from an EVD treatment facility to first survivor clinic visit was 121 days (82-151). Clinical sequelae were common, including arthralgias (n=210, 76%), new ocular symptoms (n=167, 60%), uveitis (n=50, 18%), and auditory symptoms (n=67, 24%). Higher Ebola viral load at acute EVD presentation (as shown by lower cycle thresholds on real-time RT-PCR testing) was independently associated with uveitis (adjusted odds ratio [aOR] 3·33, 95% CI 1·87-5·91, for every five-point decrease in cycle threshold) and with new ocular symptoms or ocular diagnoses (aOR 3·04, 95% CI 1·87-4·94). INTERPRETATION: Clinical sequelae during early EVD convalescence are common and sometimes sight threatening. These findings underscore the need for early clinical follow-up of survivors of EVD and urgent provision of ocular care as part of health systems strengthening in EVD-affected west African countries. FUNDING: Canadian Institutes of Health Research.
BACKGROUND: Limited data are available on the prevalence and predictors of clinical sequelae in survivors of Ebola virus disease (EVD). The EVD Survivor Clinic in Port Loko, Sierra Leone, has provided clinical care for 603 of 661 survivors living in the district. We did a cross-sectional study to describe the prevalence, nature, and predictors of three key EVD sequelae (ocular, auditory, and articular) in this cohort of EVD survivors. METHODS: We reviewed available clinical and laboratory records of consecutive patients assessed in the clinic between March 7, 2015, and April 24, 2015. We used univariate and multiple logistic regression to examine clinical and laboratory features of acute EVD with the following outcomes in convalescence: new ocular symptoms, uveitis, auditory symptoms, and arthralgias. FINDINGS: Among 277 survivors (59% female), median age was 29 years (IQR 20-36) and median time from discharge from an EVD treatment facility to first survivor clinic visit was 121 days (82-151). Clinical sequelae were common, including arthralgias (n=210, 76%), new ocular symptoms (n=167, 60%), uveitis (n=50, 18%), and auditory symptoms (n=67, 24%). Higher Ebola viral load at acute EVD presentation (as shown by lower cycle thresholds on real-time RT-PCR testing) was independently associated with uveitis (adjusted odds ratio [aOR] 3·33, 95% CI 1·87-5·91, for every five-point decrease in cycle threshold) and with new ocular symptoms or ocular diagnoses (aOR 3·04, 95% CI 1·87-4·94). INTERPRETATION: Clinical sequelae during early EVD convalescence are common and sometimes sight threatening. These findings underscore the need for early clinical follow-up of survivors of EVD and urgent provision of ocular care as part of health systems strengthening in EVD-affected west African countries. FUNDING: Canadian Institutes of Health Research.
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