A New Twist in the Ebola Epidemic Saga

A New Twist in the Ebola Epidemic Saga

By E. Stanley Ukeni

It is rather unfortunate that just as West Africans are about to breathe a collective sigh of relieve regarding the abatement of the Ebola Virus Disease pandemic, disturbing information emerged, from the United States’ Center for Disease Control, that a previously infected US citizen who was subsequently declared free of Ebola have been found to still have traces of the virus in his system.

A case report from attending doctors at Emory University Hospital in Atlanta, USA confirms that an American doctor, Ian Crozier, who had contacted the Ebola Virus Disease in 2014 while working at a hospital in Sierra Leone, and was subsequently evacuated to Emory University Hospital where he was successfully treated for Ebola infection.

We have learnt that, upon his recovery from the symptoms of the infection, Dr. Ian Crozier’s blood was thoroughly screened for the presence of the Ebola virus in his body, before he was declared free of the pathogen, and subsequently discharged from hospital in October of last year.

The case report indicates that about two months after his initial discharge from hospital, Dr. Ian Crozier returned to the same hospital where he was previously treated for Ebola infection. This time, he was complaining of eye problems. He was referred to Emory Eye Center for further evaluation and treatment.

In the process of medical forensic investigation of his symptoms, the ophthalmologists at Emory University School of Medicine—who were treating him, stuck a needle in his eyes and retrieved some fluids for medical biopsy. The tests of the ocular fluids taken from Dr. Ian Crozier’s eyes indicated a positive presence of the Ebola Virus in his ocular fluids—long after the virus had been cleared from his blood. In essence, Dr. Crozier’s biopsy showed that the Ebola Virus is still actively present in his eyes, even though the pathogen is no longer present in his blood.

In light of this current discovery and disclosure by the medical team at Emory University Hospital, West African epidemiologists need to revisit the certification process for declaring an Ebola infected individual free of the disease.

 While we must all guard against irrational panic, our health providers and emergency medical responders need to equally ensure that the broader citizenry of ECOWAS States are not unduly put at risk by a flawed declaration that Ebola survivors are medically sound to reintegrate into society. I have a sense that new panic amongst policy makers in various ECOWAS countries is probably quietly brewing over this new revelation.

In other to alley this fear, infrastructure and procedures need to be quickly deployed to further screen all Ebola disease survivors—with particular emphasis on the eyes. This is necessary so as to ensure that these already traumatized people are not, in essence, unwitting vectors in the transmission of this deadly disease.

It is important that ophthalmologists across West Africa need to be promptly equipped with effective and inexpensive methods for screening the eyes of Ebola survivors. The equipment needed for effective ocular screening should be quickly deployed to medical facilities across the West African sub-region.

The governments of all Ebola affected counties should strongly consider creating a dedicated database of names and medical information of all Ebola survivors, and the whereabouts of these individuals effectively monitored by their relevant government institutions. The database should be managed by the WHO to ensure its integrity. Information on these survivors should be made available to nations should information to enhance their disease surveillance procedures. All those who receive ocular screening can effectively be removed from the list, so as to avoid needless profiling of persons at border posts.

Ophthalmologists and other medical responders must also remember to continue to follow Ebola Safety Protocols when treating Ebola survivors. This caution goes particularly to eye doctors. You can find information on safety protocols at the following link; http://www.cdc.gov/vhf/ebola/healthcare-us/hospitals/infection-control.html

In conclusion, Dr. Russell Van Gelder, of the American Academy of Ophthalmology, said; “This remarkable case now demonstrates that the virus can remain viable in ocular fluids long after the patient has recovered from the systemic infection.”

He continues, “If the Ebola epidemic continues, ophthalmologists throughout the world will be seeing patients with post-Ebola Uveitis (inflammation), and will need to recognize and treat this condition.”

Dr. Van Gelder concluded that, “However, I want to emphasis that as far as we know, the Ebola virus in not transmitted by casual contact. The current study does not suggest that infection can be transmitted through contact with tears of patients who have recovered from their initial infection.”

 I still maintain that, even with Dr. Russell Van Gelder caution, it’s better to be prepared for the worse than be caught off guard.

Authored by E. Stanley Ukeni, ©2015. All Rights Reserved.

Photograph courtesy of the US CDC