Interim Guidance: Clinical care for survivors of Ebola virus disease
The outbreak of Ebola virus disease (EVD) that began in 2013 in West Africa had by December 2015, resulted in over 28,000 cases. Although estimates of the number of people affected during the outbreak vary, up to 10,000 EVD survivors may require convalescent care. A number of both short- and long-term medical problems have been reported in EVD survivors, including mental health issues for both survivors and other family and community members (1-19). In addition, increasing recognition that Ebola virus may persist in selected body compartments of EVD survivors, most notably in the semen of males, brings awareness of the possibility of reintroduction of the virus in areas where transmission has previously been eliminated.
EVD survivors need comprehensive support for the medical and psychosocial challenges they face and also to minimize the risk of continued Ebola virus transmission, especially from sexual transmission. This document provides guidance on providing the necessary care and services for clinical care and virus testing, and should be used to guide the planning and delivery of ongoing health services to people who have recovered from EVD.
The primary audience for this guidance includes health care professionals providing primary care to people who have recovered from EVD. This guidance may also be used by family or community members providing support and care to EVD survivors, as well as planners of health care services and policy makers.
Guidance development methods
This guidance was developed by the World Health Organization, Geneva, with inputs and feedback requested from stakeholders including Ministries of Health in Guinea, Liberia, and Sierra Leone; members of the UN Global Ebola Response Coalition; WHO country offices; research and non-governmental health organizations with recognized expertise and interest in the care of EVD survivors (Médecins-SansFrontières;
Centers for Disease Control and Prevention (CDC), Atlanta (United States of America); US National Institutes of Health, Bethesda (United States of America); Partners in Health, Boston (United States of America); GOAL, Dublin (Ireland)) and other stakeholders.
Due to the severe limitations of the existing scientific evidence base on clinical care for EVD survivors and the urgent need for guidance on this topic, the recommendations in this document have been developed from consensus expert opinion amongst the stakeholders consulted. Although this severely limits the scientific robustness of the guidance, the document still remains a representation of best available practice and will be reviewed as new evidence comes to light.
The unprecedented scale of the West African EVD outbreak that began in 2013 has resulted in many more survivors and thus opportunities to vastly enhance clinical observations and understanding of the many health challenges they face. New findings also come from clinical observations made on the 27 patients with EVD seen in high-resource settings in Europe and North America, where available medical technology often permits more detailed and comprehensive investigation. New presentations and complications of EVD are discovered on almost a weekly basis and new findings continue to be anticipated as capacity to care for EVD survivors in West Africa continues to grow.
WHO will continue to follow the research developments in the area of EVD and health outcomes for survivors, particularly those related to areas where new recommendations or a change in this guidance may be warranted.