Ebola survivors in Guinea face a more than five times greater risk for mortality after hospital discharge than the general population, according to findings from a retrospective cohort study published in The Lancet Infectious Diseases. Most deaths among survivors were tentatively attributed to renal failure, and the risk for death was higher in survivors who had longer stays in Ebola treatment units, researchers reported.
“Ebola survivors are more vulnerable than previously thought, and therefore should be offered improved care, with a focus on available resources in the first few months and ideally up to a year after recovery,” WHO epidemiologist Lorenzo Subissi, PhD, told Infectious Disease News.
The 2013-2016 West African Ebola epidemic resulted in 28,646 cases and 11,323 recorded deaths, giving West Africa the largest cohort of survivors of Ebola virus disease at more than 17,000 people, Subissi and colleagues noted. However, little information is currently available about deaths that have occurred in patients discharged from Ebola treatment units.
Subissi and colleagues sought to address this gap in mortality data by developing and implementing a community monitoring program called Surveillance Active en ceinture using WHO guidelines. They attempted to contact and follow up all Ebola survivors in Guinea who were discharged from Ebola treatment units from December 2015 through September 2016, recording deaths that had occurred up until the endpoint. They conducted verbal autopsies with the closest family members of the deceased and reviewed medical records shared by those family members.
Ebola survivors in Guinea face a five times greater risk for mortality than the general population.
Source: CDC/Rebecca Hall, MPH
Finally, the researchers calculated the age-standardized mortality ratio compared with the general Guinean population and assessed risk factors for mortality using survival analysis and a Cox proportional hazards regression model, they explained.
A total of 1,270 survivors of Ebola virus disease were discharged from Ebola treatment units in Guinea. Of these, the researchers collected information for 1,130 (89%). They found that survivors of the disease had a more than five times increased risk of mortality up to Dec. 31, 2015 (age-standardized mortality ratio = 5.2; 95% CI, 4-6.8), a mean of 1 year of follow-up after discharge. From Jan. 1, 2016, to Sept. 30, 2016, mortality did not differ between survivors and the general population (age-standardized mortality ratio = 0.6; 95% CI, 0.2-1.4).
A total of 59 deaths were reported — 37 attributed to renal failure, mostly based on reported anuria, according to the researchers. Stays in Ebola treatment units that were equal to or longer than the median stay were associated with an increased risk for late death compared with shorter stays (adjusted HR = 2.62; 95% CI, 1.43-4.79).
“Many deaths were tentatively attributed to kidney failure,” Subissi said. “Though we want to emphasize that this information was only based on interviews with family members of survivors reporting that they stopped producing urine, this seems biologically plausible.”
Subissi said further studies should be conducted to confirm this association. In addition to body fluids, renal function could be monitored by survivor programs, he said.
In a related editorial, Hugues Fausther-Bovendo, PhD, and Gary Kobinger, PhD, researchers at the Infectious Disease Research Center at Laval University in Quebec, noted that previous research has detailed the long-term sequelae of Ebola survivors. They called increased mortality in survivors of Ebola virus disease “a new reality,” but one that can be mitigated.
“The high case fatality associated with Ebola virus infection, together with the long-term sequelae and late mortality associated with the infection, highlight the importance of preventive and early therapeutic clinical interventions against severe acute infections,” they wrote.
They said such measures should include early treatment of patients, immunization of at-risk individuals and education and social intervention within affected communities. – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.