In 2018, World Health Organization (WHO), working with the Democratic Republic of the Congo health authorities and other health partners, set up a programme to monitor the health of Ebola survivors and support them in their recovery. Dr Raymond Pallawo, a WHO epidemiologist and the programme’s coordinator explains why it is critical to support those who have recovered from the highly infectious viral disease and the ongoing efforts to understand and forestall a possible resurgence of the virus among survivors.

What challenges do Ebola survivors face?

From the country’s past seven Ebola outbreaks, we have recorded 1269 people who have recovered from the disease. But they face difficulties that include stigma, job losses or difficulty finding a job. Some have been denied treatment at health centres when their status is known. They also face medical problems. An assessment carried out in July 2022 among survivors found that some suffered persistent mental health issues, eye or joint problems.

To increase our understanding of these challenges, we have suggested to the Ministry of Health, in collaboration with UNICEF and associations of Ebola survivors, to carry out a further survey among those who have recovered from the disease. The survey, which is to start soon, will also include the opinions of the survivors about the programme to assist them.

What kind of assistance do the survivors receive?

The follow-up programme is essentially a public health programme. It provides medical care for the first 18 months after being discharged from treatment and monitors the possible persistence of the virus in bodily fluids. This entails checking for signs suggesting a relapse mitigating the risk of resurgence through early detection and care.

In practical terms, they receive monthly medical and psychological examination. If we detect signs indicating a possible relapse, further investigations are carried out and medical care is provided.

Cases of relapse have been managed and the risk of resurgence averted. Some people who recovered from Ebola have suffered meningitis and encephalitis (brain inflammation) but have not infected others. The staff in the Ebola survivors’ clinics have been trained to care for them and to observe infection prevention and control measures and protocols. As such someone who has recovered from Ebola and is suspected of relapsing is monitored in such a way that they do not pass on the virus to others.

Additionally, a person who has recovered from Ebola and suffers from another disease such as malaria or psychological distress is cared for at our clinics with all the costs covered. Pregnant women who have been cured of Ebola are also monitored during prenatal consultations up to delivery. Most of these women have delivered safely and their children are doing very well. At delivery, we take samples from the mother and the baby. So far, we have not seen any mother-to-child transmission of the virus.

What challenges does the monitoring programme face?

There is no follow-up of Ebola survivors beyond 18 months which is problematic because we have realized that the virus can resurface among survivors even years later. Often these are people with meningeal symptoms who test positive for Ebola in blood or cerebrospinal fluid even though they had previously recovered from Ebola. This can happen months or years later. This is why we want to deepen research to understand this issue as well as the factors for relapse and how to anticipate them to reduce the risks through adequate public health actions.

What is being done to detect the virus and curb potential Ebola resurgence?

First of all it is important to stop the stigma towards people who have recovered from Ebola. The proportion of survivors in whom the virus persists is negligible and not all cases with persistence of the virus cause a resurgence. For example, of the 1269 survivors monitored, only two continue to test positive for the virus.

Therefore, monitoring those who have recovered from the virus helps us detect the warning signs of a relapse and to take the right measures. Thanks to clinical monitoring and promoting safe sex such as abstinence or the use of condoms we have not observed any sexual transmission.

Surveillance systems and compliance with infection prevention and control measures should be reinforced. Since 2020, we have trained surveillance officers at all levels—provincial, health zones, health areas—and more than 18 000 community health workers. We have also set up rapid response teams in North Kivu, South Kivu and Ituri provinces.