title: Long-term sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study.
abstract: BACKGROUND
  The limited data available for long-term Ebola virus disease health outcomes suggest that sequelae persist for longer than 1 year after infection. The magnitude of the present outbreak in west Africa necessitates a more complete understanding of the health effects and future medical needs of these patients.
  
  
  METHODS
  We invited adult survivors of the 2007 Bundibugyo Ebola virus outbreak in Uganda and their contacts to take part in an observational study roughly 29 months after the outbreak. We collected information about health status, functional limitations, and demographics. We collected blood samples for clinical chemistry, haematology, and filovirus antibodies using ELISA. Analyses were restricted to probable and confirmed survivors and their seronegative contacts.
  
  
  RESULTS
  We recruited 70 survivors of the 2007 Bundibugyo Ebola virus and 223 contacts. We did analyses for 49 probable and confirmed survivors and 157 seronegative contacts. Survivors of the Bundibugyo Ebola virus were at significantly increased risk of ocular deficits (retro-orbital pain [RR 4·3, 95% CI 1·9-9·6; p<0·0001], blurred vision [1·9, 1·1-3·2; p=0·018]), hearing loss (2·3, 1·2-4·5; p=0·010), difficulty swallowing (2·1, 1·1-3·9; p=0·017), difficulty sleeping (1·9, 1·3-2·8; p=0·001), arthralgias (2·0, 1·1-3·6; p=0·020), and various constitutional symptoms controlling for age and sex. Chronic health problems (prevalence ratio [PR] 2·1, 95% CI 1·2-3·6; p=0·008) and limitations due to memory loss or confusion (PR 5·8, 1·5-22·4; p=0·010) were also reported more frequently by survivors of Bundibugyo Ebola virus.
  
  
  CONCLUSIONS
  Long-term sequelae persist for more than 2 years after Ebola virus disease. Definition of health consequences related to Ebola virus disease could improve patient care for survivors and contribute to understanding of disease pathogenesis.
  
  
  BACKGROUND
  Chemical Biological Technologies Directorate, Defense Threat Reduction Agency.
authors.affiliation: Walter Reed Army Institute of Research, Silver Spring, MD, USA; Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick, MD, USA. Electronic address: dclark@aceso-sepsis.org.
authors.forename: Danielle V
authors.initials: DV
authors.lastname: Clark
authors.affiliation: Makerere University Walter Reed Project, Kampala, Uganda.
authors.forename: Hannah
authors.initials: H
authors.lastname: Kibuuka
authors.affiliation: Makerere University Walter Reed Project, Kampala, Uganda.
authors.forename: Monica
authors.initials: M
authors.lastname: Millard
authors.affiliation: Makerere University Walter Reed Project, Kampala, Uganda.
authors.forename: Salim
authors.initials: S
authors.lastname: Wakabi
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Luswa
authors.initials: L
authors.lastname: Lukwago
authors.affiliation: Makerere University Walter Reed Project, Kampala, Uganda.
authors.forename: Alison
authors.initials: A
authors.lastname: Taylor
authors.affiliation: US Military HIV Research Program, Bethesda, MD, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Eller
authors.affiliation: US Military HIV Research Program, Bethesda, MD, USA.
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Eller
authors.affiliation: Walter Reed Army Institute of Research, Silver Spring, MD, USA; US Military HIV Research Program, Bethesda, MD, USA.
authors.forename: Nelson L
authors.initials: NL
authors.lastname: Michael
authors.affiliation: Virology Division, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, USA; Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, MD, USA.
authors.forename: Anna N
authors.initials: AN
authors.lastname: Honko
authors.affiliation: Virology Division, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, USA; Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, MD, USA.
authors.forename: Gene G
authors.initials: GG
authors.lastname: Olinger
authors.affiliation: Diagnostic Systems Division, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, USA.
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Schoepp
authors.affiliation: Medical Division, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hepburn
authors.affiliation: Virology Division, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD, USA; Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, MD, USA.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Hensley
authors.affiliation: US Military HIV Research Program, Bethesda, MD, USA.
authors.forename: Merlin L
authors.initials: ML
authors.lastname: Robb
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004196:Disease Outbreaks; D029043:Ebolavirus; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017741:Survivors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult