Clinical Sequelae and Urogenital Viral Dynamics in Survivors of Ebola Virus Disease



 DESCRIPTION (provided by applicant): Ebola virus disease has emerged as a public health threat of international concern. The objective of this K23 Mentored Patient-Oriented Career Development Award Application is to facilitate the development of essential skills that will allow the principal investigator to become an independent and productive physician-scientist and to address the two primary concerns of Ebola survivors: a) the potential for sexual transmission of the Ebola virus and b) the presence of ongoing clinical sequelae of Ebola virus infection. The Ebola epidemic currently devastating West Africa has evolved into an unprecedented humanitarian crisis. In the forty years since the discovery of the Ebola virus we have been able to learn very little due to the high mortality rates associated with this virus, the low number of survivors, and the austere settings of most outbreaks which limit the ability to do research in the field. The scale of current outbreak and the infrastructure that the principal investigator and his mentor, Dr. Wohl, have put in place will allow them to be able to directly address the concerns listed above by Ebola virus disease (EVD) survivors. The continued shedding of live virus despite recovery from EVD has a number of public health implications including the potential for perpetuation of the epidemic through on going viral transmission. The WHO and CDC recommend abstinence for 7 weeks and 3 months respectively based on data from only 10 subjects. AIM I of this proposal includes a cross sectional study of the presence of Ebola virus by PCR and culture in the semen and vaginal fluid from at least 200 Ebola disease survivors across the spectrum of time from recovery (0-3months, 3-6months, 6-9months, and 9-12months). We will then longitudinally follow the group of survivors most recently discharged from an ETU (0-3 months) to determine the duration of live viral shedding. The proposed studies will thus provide a thorough characterization of viral dynamics in urogenital compartments on which sound public health policies and recommendations can be based. AIM II includes a clinical and psychosocial assessment of survivors in both the cross-sectional and longitudinal aspects of the study. This, along with collection of blood for evaluation of serologic markers of immune activation and inflammation will provide important insight into the clinical sequelae of Ebola virus disease and explore potential associations between ongoing virus replication, systemic inflammation, and Post-Ebola symptoms. Ultimately this study will ensure that the world is prepared for the next epidemic through improved understanding of virus shedding in semen and vaginal fluid, heightened awareness of the clinical complications of Ebola virus disease and the development of the principal investigator as a clinical researcher so that he can not only respond but learn and lead at the same time as a physician and a scientist.