title: Multidisciplinary assessment of post-Ebola sequelae in Guinea (Postebogui): an observational cohort study.
abstract: The high number of survivors from the 2013-16 west African outbreak of Ebola virus disease (EVD) has raised several new issues: long-term clinical complications, psychosocial consequences, risks of EVD reactivation, and secondary transmission due to viral persistence in body fluids. We aimed to assess long-term clinical, psychosocial, and viral outcomes in EVD survivors in Guinea.
  
  
  
  In this multidisciplinary observational cohort study, we recruited patients aged 1 year or more in four sites in Guinea (Donka National Hospital, Conakry; Macenta Prefectoral Hospital, Macenta; N'zérékoré Regional Hospital, N'zérékoré; and Forécariah Prefectoral Hospital, Forécariah) following discharge from any Ebola treatment centre in Guinea. Eligible patients had had laboratory-confirmed EVD and had then been declared clear of the virus in the blood. All consenting patients were included, with no exclusion criteria. Trained clinicians assessed patients at enrolment to the cohort, recording clinical symptoms and signs of depression. We did routine blood examinations and examined viral persistence in body fluids using RT-PCR. We did psychological evaluations using questionnaires developed for different age groups. Follow-up is planned to 2 years, and here we present findings at enrolment.
  
  
  
  Between March 23, 2015, and July 11, 2016, we recruited 802 patients, of whom 360 (45%) were male, 442 (55%) were female; 158 (20%) were younger than 18 years. The median age was 28·4 years (range 1·0-79·9, IQR 19·4-39·8). The median delay after discharge was 350 days (IQR 223-491). The most frequent symptoms were general symptoms (324 [40%] patients), musculoskeletal pain (303 [38%]), headache (278 [35%]), depression (124 [17%] of 713 responses), abdominal pain (178 [22%]), and ocular disorders (142 [18%]). More adults than children had at least one clinical symptom (505 [78%] vs 101 [64%], p<0·0003), ocular complications (124 [19%] vs 18 [11%], p=0·0200), or musculoskeletal symptoms (274 [43%] vs 29 [18%], p<0·0001). A positive RT-PCR in semen was found in ten (5%) of 188 men, at a maximum of 548 days after disease onset. 204 (26%) of 793 patients reported stigmatisation. Ocular complications were more frequent at enrolment than at discharge (142 [18%] vs 61 [8%] patients).
  
  
  
  Post-EVD symptoms can remain long after recovery and long-term viral persistence in semen is confirmed. The results justify calls for regular check-ups of survivors at least 18 months after recovery.
  
  
  
  INSERM/Reacting, the French Ebola Task Force, and Institut de Recherche pour le Développement.
authors.affiliation: IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etard
authors.affiliation: Donka National Hospital, Conakry, Guinea.
authors.forename: Mamadou Saliou
authors.initials: MS
authors.lastname: Sow
authors.affiliation: IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France; Episcience, London, UK.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Leroy
authors.affiliation: IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France; Conakry University, Department of Public Health, Conakry, Guinea.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Touré
authors.affiliation: IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Taverne
authors.affiliation: IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France.
authors.forename: Alpha Kabinet
authors.initials: AK
authors.lastname: Keita
authors.affiliation: IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Msellati
authors.affiliation: Donka National Hospital, Conakry, Guinea.
authors.forename: N'Fally
authors.initials: N
authors.lastname: Magassouba
authors.affiliation: Pasteur Institute/Unit of Biology of Emerging Viral Infections, International Center for Infectiology Research, INSERM, CNRS, Lyon I University, Ecole Normale Supérieure de Lyon, Lyon, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Baize
authors.affiliation: Laboratoire P4 Inserm-Jean Mérieux, US003 Inserm, Lyon, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Raoul
authors.affiliation: IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Izard
authors.affiliation: IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France.
authors.forename: Cécé
authors.initials: C
authors.lastname: Kpamou
authors.affiliation: IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France.
authors.forename: Laura
authors.initials: L
authors.lastname: March
authors.affiliation: Macenta Prefectoral Hospital, Macenta, Guinea.
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Savane
authors.affiliation: Donka National Hospital, Conakry, Guinea.
authors.forename: Moumié
authors.initials: M
authors.lastname: Barry
authors.affiliation: IRD UMI 233-INSERM U1175-Montpellier University, Montpellier, France. Electronic address: eric.delaporte@ird.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control*; D029043:Ebolavirus / Q000302:isolation & purification; D005128:Eye Diseases / Q000209:etiology; D005260:Female; D016701:Guinea / Q000453:epidemiology; D006261:Headache / Q000209:etiology; D019142:Hemorrhagic Fever, Ebola / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies; D012307:Risk Factors; D017741:Survivors; D019562:Viral Load