title: Early clinical sequelae of Ebola virus disease in Sierra Leone: a cross-sectional study.
abstract: BACKGROUND
  Limited data are available on the prevalence and predictors of clinical sequelae in survivors of Ebola virus disease (EVD). The EVD Survivor Clinic in Port Loko, Sierra Leone, has provided clinical care for 603 of 661 survivors living in the district. We did a cross-sectional study to describe the prevalence, nature, and predictors of three key EVD sequelae (ocular, auditory, and articular) in this cohort of EVD survivors.
  
  
  METHODS
  We reviewed available clinical and laboratory records of consecutive patients assessed in the clinic between March 7, 2015, and April 24, 2015. We used univariate and multiple logistic regression to examine clinical and laboratory features of acute EVD with the following outcomes in convalescence: new ocular symptoms, uveitis, auditory symptoms, and arthralgias.
  
  
  RESULTS
  Among 277 survivors (59% female), median age was 29 years (IQR 20-36) and median time from discharge from an EVD treatment facility to first survivor clinic visit was 121 days (82-151). Clinical sequelae were common, including arthralgias (n=210, 76%), new ocular symptoms (n=167, 60%), uveitis (n=50, 18%), and auditory symptoms (n=67, 24%). Higher Ebola viral load at acute EVD presentation (as shown by lower cycle thresholds on real-time RT-PCR testing) was independently associated with uveitis (adjusted odds ratio [aOR] 3·33, 95% CI 1·87-5·91, for every five-point decrease in cycle threshold) and with new ocular symptoms or ocular diagnoses (aOR 3·04, 95% CI 1·87-4·94).
  
  
  CONCLUSIONS
  Clinical sequelae during early EVD convalescence are common and sometimes sight threatening. These findings underscore the need for early clinical follow-up of survivors of EVD and urgent provision of ocular care as part of health systems strengthening in EVD-affected west African countries.
  
  
  BACKGROUND
  Canadian Institutes of Health Research.
authors.affiliation: National Eye Health Program, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; Christian Blind Mission, Baptist Eye Hospital Lunsar and Lowell and Ruth Gess UMC Eye Hospital, Kissy, Freetown, Sierra Leone.
authors.forename: John G
authors.initials: JG
authors.lastname: Mattia
authors.affiliation: National Eye Health Program, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Vandy
authors.affiliation: Partners in Health, Port Loko, Sierra Leone.
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Chang
authors.affiliation: Partners in Health, Port Loko, Sierra Leone.
authors.forename: Devin E
authors.initials: DE
authors.lastname: Platt
authors.affiliation: Partners in Health, Port Loko, Sierra Leone.
authors.forename: Kerry
authors.initials: K
authors.lastname: Dierberg
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Bausch
authors.affiliation: Public Health England Port Loko Laboratory, Port Loko, Sierra Leone.
authors.forename: Tim
authors.initials: T
authors.lastname: Brooks
authors.affiliation: Partners in Health, Port Loko, Sierra Leone.
authors.forename: Sampha
authors.initials: S
authors.lastname: Conteh
authors.affiliation: World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Infectious Diseases Institute, Mulago Hospital Complex, Kampala, Uganda.
authors.forename: Ian
authors.initials: I
authors.lastname: Crozier
authors.affiliation: World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fowler
authors.affiliation: National Eye Health Program, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; Christian Blind Mission, Baptist Eye Hospital Lunsar and Lowell and Ruth Gess UMC Eye Hospital, Kissy, Freetown, Sierra Leone.
authors.forename: Amadu P
authors.initials: AP
authors.lastname: Kamara
authors.affiliation: Partners in Health, Port Loko, Sierra Leone.
authors.forename: Cindy
authors.initials: C
authors.lastname: Kang
authors.affiliation: GOAL Global, Port Loko, Sierra Leone.
authors.forename: Srividya
authors.initials: S
authors.lastname: Mahadevan
authors.affiliation: National Eye Health Program, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; Christian Blind Mission, Baptist Eye Hospital Lunsar and Lowell and Ruth Gess UMC Eye Hospital, Kissy, Freetown, Sierra Leone.
authors.forename: Yealie
authors.initials: Y
authors.lastname: Mansaray
authors.affiliation: Partners in Health, Port Loko, Sierra Leone.
authors.forename: Lauren
authors.initials: L
authors.lastname: Marcell
authors.affiliation: GOAL Global, Port Loko, Sierra Leone.
authors.forename: Gillian
authors.initials: G
authors.lastname: McKay
authors.affiliation: World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: O'Dempsey
authors.affiliation: International Medical Corps, Port Loko, Sierra Leone.
authors.forename: Victoria
authors.initials: V
authors.lastname: Parris
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Pinto
authors.affiliation: International Medical Corps, Port Loko, Sierra Leone.
authors.forename: Audrey
authors.initials: A
authors.lastname: Rangel
authors.affiliation: GOAL Global, Port Loko, Sierra Leone.
authors.forename: Alex P
authors.initials: AP
authors.lastname: Salam
authors.affiliation: Department of Ophthalmology, Emory University School of Medicine, Atlanta, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Shantha
authors.affiliation: International Medical Corps, Port Loko, Sierra Leone.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Wolfman
authors.affiliation: Department of Ophthalmology, Emory University School of Medicine, Atlanta, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Yeh
authors.affiliation: World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Department of Medicine, University of Toronto, Toronto, Canada; Dignitas International, Toronto, Canada.
authors.forename: Adrienne K
authors.initials: AK
authors.lastname: Chan
authors.affiliation: World Health Organization, Sierra Leone Ebola Response Team, Freetown, Sierra Leone; Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: sharmistha.mishra@utoronto.ca.
authors.forename: Sharmistha
authors.initials: S
authors.lastname: Mishra
mesh_terms: D000293:Adolescent; D000328:Adult; D018771:Arthralgia / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005128:Eye Diseases / Q000209:etiology*; D005260:Female; D034381:Hearing Loss / Q000209:etiology*; D019142:Hemorrhagic Fever, Ebola / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D012807:Sierra Leone / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult