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WHO: Study Shows Ebola Virus Fragments May Be Detectable In Semen For > 9 Months

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Credit WHO


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A NEJM study has come off of embargo this afternoon that looks at a topic we’ve discussed previously – the persistence of RT-PCR detectable Ebola virus in the semen of convalescent men.  Last May, in MMWR & WHO On Risks Of Sexual Transmission Of Ebola we looked at a suspected case of sexual transmission last March  from a male patient who had been believed `recovered’ for well over six months.

Several months prior to that,  Flublogia’s very own Dr. Ian Mackay, along with Dr. Katherine Arden, penned a piece for The Lancet  (see Mackay & Arden On Ebola In Semen Of Convalescent Men) discussing the risks of Ebola transmission via semen even months after apparent recovery from the disease.  


With the recent relapse of Scottish nurse Pauline Cafferkey, some 9 months after her release from isolation, there are a growing number of questions on how long the virus can remain viable in a post convalescent patient.  The virus, or virus fragments, have been detected in convalescent Ebola patients residing in various places, including inside of the eye, in amniotic fluid, the placenta, breast milk and the central nervous system (cite).

Today’s report in the NEJM looks specifically for the RT-PCR detectable Ebola virus fragments in semen, and finds evidence of the virus’s persistence of 9 months or more.  


It should be stressed, however, that right now we don’t know to what extent detectability by highly sensitive PCR testing equates to infectivity.  Until more is known, the WHO continues to urge caution and offers the following Interim advice on the sexual transmission of the Ebola virus disease.


First, a link to the NEJM study (funded by the WHO), then a statement from the World Health Organization.


Ebola RNA Persistence in Semen of Ebola Virus Disease Survivors — Preliminary Report

Gibrilla F. Deen, M.D., Barbara Knust, D.V.M., Nathalie Broutet, M.D., Ph.D., Foday R. Sesay, M.D., Pierre Formenty, D.V.M., Christine Ross, M.D., Anna E. Thorson, M.D., Ph.D., Thomas A. Massaquoi, M.D., Jaclyn E. Marrinan, M.Sc., Elizabeth Ervin, M.P.H., Amara Jambai, M.D., Suzanna L.R. McDonald, Ph.D., Kyle Bernstein, Ph.D., Alie H. Wurie, M.D., Marion S. Dumbuya, R.N., Neetu Abad, Ph.D., Baimba Idriss, M.D., Teodora Wi, Ph.D., Sarah D. Bennett, M.D., Tina Davies, M.S., Faiqa K. Ebrahim, M.D., Elissa Meites, M.D., Dhamari Naidoo, Ph.D., Samuel Smith, M.D., Anshu Banerjee, Ph.D., Bobbie Rae Erickson, M.P.H., Aaron Brault, Ph.D., Kara N. Durski, M.P.H., Jorn Winter, Ph.D., Tara Sealy, M.P.H., Stuart T. Nichol, Ph.D., Margaret Lamunu, M.D., Ute Ströher, Ph.D., Oliver Morgan, Ph.D., and Foday Sahr, M.D.

October 14, 2015DOI: 10.1056/NEJMoa1511410




Preliminary study finds that Ebola virus fragments can persist in the semen of some survivors for at least nine months


Preliminary results of a study into persistence of Ebola virus in body fluids show that some men still produce semen samples that test positive for Ebola virus nine months after onset of symptoms.

The report, published today in the New England Journal of Medicine, provides the first results of a long-term study being jointly conducted by the Sierra Leone Ministry of Health and Sanitation, Sierra Leone Ministry of Defence, the World Health Organization and the U.S. Centers for Disease Control and Prevention.

“Sierra Leone is committed to getting to zero cases and to taking care of our survivors, and part of that effort includes understanding how survivors may be affected after their initial recovery,” said Amara Jambai, M.D., M.Sc., Deputy Chief Medical Officer for the Sierra Leone Ministry of Health and Sanitation. “Survivors are to be commended for contributing to the studies that help us understand how long the virus may persist in semen.”

The first phase of this study has focused on testing for Ebola virus in semen because of past research showing persistence in that body fluid.  Better understanding of viral persistence in semen is important for supporting survivors to recover and to move forward with their lives.

“These results come at a critically important time, reminding us that while Ebola case numbers continue to plummet,

Ebola survivors and their families continue to struggle with the effects of the disease. This study provides further evidence that survivors need continued, substantial support for the next 6 to 12 months to meet these challenges and to ensure their partners are not exposed to potential virus,” said Bruce Aylward, WHO Director-General’s Special Representative on the Ebola Response.

Ninety three men over the age of 18 from Freetown, Sierra Leone, provided a semen sample that was tested to detect the presence of Ebola virus genetic material. The men enrolled in the study between two and 10 months after their illness began. For men who were tested in the first three months after their illness began, all were positive (9/9; 100 percent). More than half of men (26/40; 65 percent) who were tested between four to six months after their illness began were positive, while one quarter (11/43; 26 percent) of those tested between seven to nine months after their illness began also tested positive. The men were given their test results along with counseling and condoms.

“EVD survivors who volunteered for this study are doing something good for themselves and their families and are continuing to contribute to the fight against Ebola and our knowledge about this disease,” said Yusuf Kabba, National President of the Sierra Leone Association of Ebola Survivors.

Why some study participants had cleared the fragments of Ebola virus from semen earlier than others remains unclear. The U.S. Centers for Disease Control and Prevention in Atlanta is conducting further tests of the samples to determine if the virus is live and potentially infectious.

“Ebola survivors face an increasing number of recognized health complications,” said CDC Director Tom Frieden, M.D., M.P.H. “This study provides important new information about the persistence of Ebola virus in semen and helps us make recommendations to survivors and their loved ones to help them stay healthy.”

Until more is known, the more than 8000 male Ebola survivors across the three countries need appropriate education, counseling and regular testing so they know whether Ebola virus persists in their semen; and the measures they should take to prevent potential exposure of  their partners to the virus. Until a male Ebola survivor’s semen has twice tested negative, he should abstain from all types of sex or use condoms when engaging in sexual activity. Hands should be washed after any physical contact with semen. For more information: Interim advice on the sexual transmission of the Ebola virus disease

In the current West African outbreak, continued vigilance to identify, provide care for, contain and stop new cases, are key strategies on the road to achieving zero cases.

What’s hard to understand about camels carrying MERS-CoV and rarely infecting humans…?


What is the hard part to understanding that camels harbour the same Middle East respiratory syndrome coronavirus (MERS-CoV) that infects humans, but only does so rarely? Not a different strain or species – variants of the same virus.

It may be that this is not a simple 1 + 1 = 2 kind of equation and sometimes that can be a tough camel to ride. 

There is a need to understand a few things where camels are concerned. For example…

  1. Camels definitely get infected by MERS-CoV – they can get mildly ill or not. Infection effectively results in a camel “common cold” illness
  2. When a camel in a herd is infected, that doesn’t mean that every camel in that herd is infected
  3. When a camel is infected it may not be very ill, or show no sign of illness at all
  4. MERS is a respiratory disease – while there is no evidence for exactly how humans acquire MERS-CoV, it has been considered, by medical experts in the Kingdom of Saudi Arabia, to be most likely acquired via droplets or other modes of transport of virus contaminated material and the upper or lower respiratory tract epithelium (lining). Ingestion is not considered to be a likely route of infection to date. This may be why those who drink fresh camel milk do not all get infected by MERS-CoV. But frothy bowls of milk have lots of popping bubbles that could create droplets that can be inhaled. And MERS-CoV can survive in milk and in the cold and on surfaces (which can be contacted and then self-inoculated via eye rubbing, nose picking etc). But the distinction between ingestion and inhalation can be confusing.
  5. Most human MERS cases have not reported camel contact. Most cases have acquired their infection in association with a small or uncontrolled hospital outbreak of disease
  6. In the 185 cases of MERS-CoV infection acquired in South Korea – none were infected by or had any, camel contact. Those cases were due to human-to-human infections. Camel contact is a sporadic cause of infection despite most camels in the Arabian Peninsula showings signs of past infection
  7. Because camel contact is rare does not mean it never
    occurs – just that it is rare. A single camel-to-human

    infection may trigger dozens or more human cases if the hospital which that first case attends does not have effective infection prevention and control procedures. We have seen this again and again and again since 2012

  8. Those in close contact with camels, who are otherwise healthy, may have been infected but not developed more than a cold or flu-like illness (who does anything about those – or remembers when they had them?). 
  9. We do not yet know whether those who are in frequent close contact with camels and who have underlying disease, may also have some cross-protective immunity due to infection by a closely or perhaps even distantly related camel virus that does not cause lethal infections, as MERS-CoV does, in those with a comorbidity 
  10. MERS-CoV may move around Africa and the Arabian Peninsula via infected camel imports and exports but no surveys of camels in Africa for MERS-CoV, or other coronavirus ancestors, have been reported to date


  11. No MERS-CoV PCR-based diagnostic surveys of respiratory disease cases – mild, moderate or severe – have been conducted in countries harbouring camels known to have been infected by MERS-CoV (or an antigenically similar virus) in the past. Ethiopia the Sudan and Somalia are such countries
  12. Camels do not need to be culled to prevent infection – they just need to be approached with more awareness and appropriate care to reduce the risk of infection and disease. Plenty of animals that we co-exist with carry viruses that can infect us and seriously harm us – we don’t seek out and kill them all to stop getting infected, we need to address the activities by which we humans get infected.
© 2013-2015 Ian M. Mackay. PhD.
This content was originally published at

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